Health and Social Care (Community Health and Standards) Bill

Public Bill Committee, 12 June 2003.

Standing Committee E

Clause 42 - Standards set by Assembly

Chris Grayling (Conservative, Epsom and Ewell)

I beg to move amendment No. 476, in

clause 42, page 14, line 31, leave out 'may' and insert 'must'.

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to discuss the following amendments: No. 477, in

clause 42, page 14, line 33, leave out from 'may' to end of line 34 and insert

'amend the standards whenever it considers it appropriate. The National Assembly must publish amended statements'.

No. 478, in

clause 42, page 14, line 35, leave out from 'must' to end of line and insert 'publish proposals for consultation'.

Chris Grayling (Conservative, Epsom and Ewell)

I have taken it upon my shoulders to move the amendment, particularly as I want to discuss amendment No. 470.

Peter Atkinson (Conservative, Hexham)

Order. Amendment No. 470 has not been selected.

Steve Pound (Labour, Ealing North)

I invite the Under-Secretary to consider the benefits and advantages of the amendment. A fairly minor amendment in many ways, it seeks to progress matters slightly and to underline the significance of clause 42. I am happy to address any issues later.

Chris Grayling (Conservative, Epsom and Ewell)

Having moved the hon. Gentleman's amendments, I will pick up his point from a different perspective. We on these Benches are anxious about separate standards for England and Wales. Amendment No. 476 inserts ''must'' as opposed to ''may'', thus compounding the problem. Rather than giving the Assembly discretion over whether Wales has standards separate from those in England, the amendment will place a requirement on the Assembly. That is wrong for two reasons. First, if one believes in devolution and local responsibility, one must allow the local decision-making body—in this case the Assembly—the freedom to decide whether it wants to opt into standards established for the entire United Kingdom, or for England and Wales, or to propose its own set of standards to meet the needs of its own country.

The second reason for our profound anxiety is that having two different sets of standards moves us away from a national health service, which is a development that we should not welcome. That will create issues in cross-border areas and unwanted discrepancies between England and Wales. I am in favour of local accountability, but the natural correlation to setting up two sets of standards—we will discuss that later in

the debate—is two different inspection regimes, and the result of that would be a lesser amount of good care for patients, duplication of resources and bureaucracy and a waste of public money.

If we bring an iron curtain down along the border between England and Wales, not only will that have an adverse effect on patients in cross-border areas, but we will lose the opportunities for sharing best practice across the border, for clinical treatment flows from one side of the border to the other, and for Wales to learn from experience in England. The end result will be a genuinely local health service. If the Government's policy is to have a Welsh health service and an English health service and to move away from the principle of a national health service, let them say so loud and clear.

Whitehall Ministers may want to get the Welsh health service off their hands. That is understandable, because the Welsh health service is not functioning well and is not responding to the aspirations of central Government.

Some of the statistics are absurd. In Wales there are 71,000 more people waiting more than six months for out-patient treatment than there are in England. There are 46 million more people in England than in Wales, so it is quite an achievement to perform as badly as that.

People in border areas are being disadvantaged by the discrepancies in the standards and frameworks on both sides of the border. A Welsh patient was told by his nearest hospital, which is in Shropshire, that he had to wait six months longer for his hip operation than English patients in the same situation, because he was Welsh. A gentleman from north Wales who had been waiting more than 16 months for vital heart surgery in a Liverpool hospital was informed by the hospital of a Government initiative under which all patients waiting more than five months would have the choice of undergoing surgery elsewhere. He was told that as he lived in Wales he would not be involved in the scheme because Welsh authorities had declined to take part.

Is it fair or appropriate to have an increasingly divergent health care system, with different standards, principles and priorities in border areas, where people may be looking to a local tertiary centre or local hospital for treatment? If we continue to go down the road of having separate systems in both countries, some people in border areas will not have the same access to health care as those who live a mile up the road. It is happening today and it will continue to happen as sure as night follows day.

Proper strategic decisions on a particular population area or a rural community are not being made. Communities that do not divide because there is a border between England and Wales are being treated differently by the health service. Decisions are being made on the basis of the villages that people live in.

It would be madness if the principle of standards meant that the two Administrations—the Secretary of State in Whitehall and the National Assembly for Wales—were telling clinicians to do one thing and not another. That would inevitably distort the services

available and the treatment that could be received by patients who live in border areas.

Last week, I briefly mentioned that it is perfectly conceivable—I have just illustrated that it happens—that a doctor in a clinic will have to treat his 10 o'clock and his quarter-past 10 appointments differently, even though both patients may have the same condition, because of the differences in the standards framework and the requirements placed on that doctor by the Welsh Assembly. It makes no sense. Ministers must be extremely careful about this matter.

Steve Pound (Labour, Ealing North)

I am reluctant to interrupt the hon. Gentleman in mid-flow because he seems to be constructing an exegesis that is comparable to the Schleswig-Holstein question. I appreciate that he has wider points to make; however, the purpose of the amendment is to compel the Welsh Assembly to take those factors into consideration and to drive up standards. How can he possibly have a problem with that? It would deal with the very issue of disparity in service provision about which he so eloquently speaks.

Chris Grayling (Conservative, Epsom and Ewell)

What the hon. Gentleman is saying in his amendment, and I do not doubt his honourable intentions, is that inserting the word ''must'' removes discretion from the Welsh Assembly to apply common sense.

Let us suppose that in its wisdom—it would be in its wisdom—the Welsh Assembly decides that it is not in the interests of the Welsh people to have two different sets of standards. Let us suppose that it decides not to pay the money that will be required to the team that will produce a set of standards or the money that will be required to communicate those standards to medical practitioners across Wales, in border areas and in hospitals from Liverpool to Bristol. Let us suppose that it will decide not to pay the money required to set up an inspectorate to inspect those standards.

In its wisdom, the Assembly might judge it better to spend that money on patient care. The effect of the hon. Gentleman's amendment would be to say that it could not take that decision, which must be wrong.

Steve Pound (Labour, Ealing North)

Under the circumstances, why does the hon. Gentleman not simply suggest the deletion of subsection (1)?

Chris Grayling (Conservative, Epsom and Ewell)

I would be delighted to see clause 42 disappear. I would argue against clause 42 in its entirety, because it is not in the interests of the people in Wales, or those in England who live close to Wales, to have separate standards. That would be a hindrance to them and a waste of public money. In the same way, I shall argue this morning that it is not in the interests of those people to have two separate, parallel inspection processes.

My concern about the amendment is that the word ''must'' creates an obligation. Clause 42(1) would then state:

''The Assembly must prepare and publish statements of standards in relation to the provision of health care by and for Welsh NHS bodies.''

That would remove from the Assembly the discretion to stick with the national standards that the Government have set out from Whitehall. It might choose to do otherwise. I think that it would be wrong to do so, but under this clause it would not have the ability to do so, and that would be a mistake.

It would be a particular mistake for cross-border areas. At least six trusts truly serve cross-border communities, including the North East Wales NHS trust and the Gwent Healthcare NHS trust. There are also the strategic health authorities on the English side of the border: Cheshire and Merseyside; Shropshire and Staffordshire; Coventry, Warwickshire, Herefordshire and Worcestershire; and Avon, Gloucestershire and Wiltshire. Each of those oversees services for significant numbers of patients from Wales. To ask each of those organisations to handle two different sets of standards would add yet more of a bureaucratic burden both to the managers running those trusts and, more particularly, to the clinicians who must deal with them. I see no benefit in doing that.

The only condition that I am aware of that came out of the debate on the Health (Wales) Bill that could be argued to be peculiar to Wales relates to those who worked in the limestone and slate industries. In a telling intervention last week, my hon. Friend the Member for Westbury (Dr. Murrison) asked the Minister how Welsh diabetes differs from English diabetes. The Minister must realise that after his Government have put the effort into creating a national service framework for diabetes, it would be nonsense if the Welsh tore that up and came up with something different just for them.

We must remember that although Wales has a proud tradition, it is also a geographical area with a population that is not much larger than Surrey and Sussex. Is it really sensible and a prudent use of public funds to have a set of standards devised for that number of people that differs from the standards that apply to their compatriots? That would cause confusion, complication and difficulties to practitioners who straddle both countries.

Therefore, the requirement under the amendment to follow that road would be short-sighted and would compound a problem that exists more broadly in clause 42, which in my view has no place in the proper provision of good health care for the future of England and Wales.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I oppose the amendment. Although it may make some sense to insert ''must'' instead of ''may'' in clause 42, clauses 41 and 42 are both worded in exactly the same way. Clause 41(1) states:

''The Secretary of State may prepare and publish statements''.

Clause 42(1) says:

''The Assembly may prepare and publish statements''.

There is an argument that the word ''may'' should have been replaced by the word ''must''. However, if that is to happen, it should be replaced in both clauses rather than in the clause relating to the Assembly and not in the clause relating to the Secretary of State. I

have some sympathy for the application of common standards wherever possible. However, that will not be achieved by removing clause 42 in its entirety, because we would then need to reword clause 41. If we are to have common standards, it is surely not right for those standards to be imposed on Wales by the Secretary of State in Westminster without consultation.

Chris Grayling (Conservative, Epsom and Ewell)

I absolutely agree with the hon. Gentleman. I hope that if we stand against clause 42, it will secure the Under-Secretary's agreement to go away and rewrite both those clauses before Report. In that way we could have what the hon. Member for Cardiff, Central (Mr. Jones) and I both wish to achieve, which is a proper set of national standards with a bit of flexibility to deal with specific local issues such as those that we have discussed in relation to the slate industry.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I am glad that the hon. Gentleman has reminded me about the use of the word ''national'', because it has been applied so far to mean England and Wales. One can argue that England and Wales are two separate nations; what cannot be argued is that the combination of England and Wales is a nation. The British state is possibly a nation, in which case we need to be arguing about common standards to be applied in Northern Ireland, Scotland, Wales and England rather than to this greater England that just happens to comprise Wales as well. That is the way that the word ''nation'' has been used in the debate so far.

It concerns me that we may have a wide range of standards, which would be deleterious to effective and efficient health care. I can think of circumstances in which some standards might diverge, but surely we should ensure that, as far as possible, common standards apply. The Bill does not do that in the best way. I do not support the amendments being proposed for the reasons that I have stated, and I do not support the deletion of clause 42, because it would make little sense, given the way in which the rest of the Bill is worded.

Gary Streeter (Conservative, South West Devon)

I am listening carefully to the hon. Gentleman's point about common standards. We heard earlier that health care outcomes in Wales seem to have fallen short of those achieved in England. I am simply requesting information: does he have an explanation for that?

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I do not wish to be tempted too far down the road of explaining different health outcomes. What was referred to was the different waiting times, which are not quite the same thing as health outcomes. In comparing different parts of the country, it is not valid to compare health outcomes across all of England with those across all of Wales. It is more appropriate to compare health outcomes across Wales with those in the north-east of England, because the morbidity and mortality rates are more similar for those two areas. If one does that, the results also raise several questions. However, I do not think that it would be appropriate to debate them in the context of these amendments.

Don Touhig (Labour/Co-operative, Islwyn)

I take this opportunity, Mr. Atkinson, to welcome you to the Chair on my first speaking appearance in the Committee. I look forward to your guidance taking us through these important Welsh clauses this morning.

I also thank colleagues on both sides for their forbearance and understanding of my limited attendance in Committee. Earlier this year, I was on three Standing Committees on three separate Bills at once, which was a bit difficult at times. Perhaps that is an answer to those who say that we have not got enough to do in the Wales Office. I will not take that point any further in case there are further announcements this afternoon. It might amuse the Committee to know that the Lincolnshire Echo arrived in my office yesterday afternoon addressed to the Arab Republic of Egypt at Gwydyr house. I do not know if that is an indication of any changes in the Wales Office.

This is a substantial and important Bill for Wales. About 50 of the Bill's clauses apply wholly or partly to Wales. The Bill will continue the joint programme that the Government are pursuing with their colleagues in the Welsh Assembly further to raise health and social care standards in Wales. For Wales, the main effects of the Bill are the inspection, monitoring and enforcement of standards of health and social care providers. At earlier sittings, my right hon. and hon. Friends outlined proposals for the Commission for Healthcare, Audit and Inspection, the new body that will assess performance and enforce standards across a range of health care providers in England and Wales.

In addition, the Bill provides for the Welsh Assembly to undertake reviews and to investigate health care provision across a series of NHS bodies in Wales. CHAI will have a wide national remit. I take the point that was made by my hon. Friend the Member for Cardiff, Central (Mr. Jones)—by ''national'' the Bill is referring to England and Wales. However, the Assembly needs the opportunity and ability to monitor and to focus closely on addressing the health priorities that it set for the people of Wales.

The Healthcare Inspection Unit for Wales will undertake the reviews and inspections. It will adopt techniques that have been used successfully to review the social services in Wales and will provide a robust case for the improvement of clinical governance tailored to particular Welsh needs.

The Bill establishes the Commission for Social Care Inspection in England, and it places the responsibility for conducting such inspections in Wales on the Welsh Assembly. Consequently, it provides the same powers to the Assembly as are provided to the Secretary of State in England. Another significant change is that the Assembly will be given similar powers to those of the Secretary of State to prescribe a range of foods that are made available under the welfare food scheme. Those powers will allow the Assembly to broaden the nutritional basis of the scheme with particular regard to Welsh matters.

The Bill also recognises several other differences in the application and operation of the health service in Wales, which it would not be prudent of me to discuss at length at this stage. However, so that people may understand where I come from, and where the Government come from, I should say that I do not subscribe to tweaking every piece of legislation that comes through this place so that each has a ''made in Wales'' stamp on it. However, I do subscribe to a ''better for Wales'' stamp, whereby a piece of legislation can be improved by doing things slightly differently, as is proposed in this part of the Bill.

The amendments tabled in the name of my hon. Friend the Member for Ealing, North (Mr. Pound) take away the Assembly's discretion in preparing and publishing statements, standards and consultation documents. Under those amendments, it would be an absolute requirement for the Assembly to prepare and publish statements, standards and consultation documents.

The principle of the devolution settlement was the ability of the Assembly to conduct its business in an unrestricted way within the confines of the Government of Wales Act 1998, which was Parliament's intention when it handed over those powers and responsibilities to the Assembly. To impose an absolute requirement to prepare and publish statements, standards and consultation documents will run contrary to the fundamental principle that this place guaranteed when it passed that Act. It is for the Assembly to determine what action it should take on the provision of the health service in Wales, which is its remit through the process of secondary legislation that the Act conferred on the Assembly.

In setting standards, the Assembly consults those persons whom it considers appropriate and takes account of the standards set by bodies in England and Wales; for example, it refers to guidance provided by the National Institute for Clinical Excellence, the royal colleges and so forth. Moreover, amended powers conferred on the Assembly under the National Health Service Act 1977, to give direction to NHS trusts, special health authorities and local health boards, do not place an obligation on the Assembly, but rather permit it to issue such directions as it sees fit.

The hon. Member for Epsom and Ewell (Chris Grayling) made some important points in his useful contribution, as he did when he served on the Standing Committee on the Health (Wales) Bill. He researches well, but—this may surprise him—I disagree with several points that he made this morning. He was concerned about the question of standards, mainly the difference in standards that might apply in Wales and in England.

Standards set in Wales will be as high as those in England. They will be determined by the Assembly, but are likely to include the national clinical standards, the national service frameworks, the NICE guidelines and so on. Moreover, targets and other standards developed and issued by the Assembly will be taken into account in assessments. National standards, such

as the national service frameworks, underpin many of the standards determined by the Assembly. A clinical standards board for Wales will be set up to act as a mechanism to co-ordinate and monitor Welsh clinical standards.

Chris Grayling (Conservative, Epsom and Ewell)

Will the Under-Secretary confirm that, under the Bill, the Assembly has the right to ignore NICE?

Don Touhig (Labour/Co-operative, Islwyn)

The Assembly will listen to points made by NICE. It was made clear last year, in discussion of the NHS Reform and Health Care Professions Bill, that NICE applies across England and Wales.

Chris Grayling (Conservative, Epsom and Ewell)

If the Welsh Assembly has the right to establish its own standards, does it have the legal right to decide that it will no longer listen to NICE? I accept that it might not choose to do so.

Don Touhig (Labour/Co-operative, Islwyn)

That is not my understanding. We made it clear in discussions on the NHS Reform and Health Care Professions Bill last year that NICE applies across England and Wales.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

Will the Under-Secretary give way?

Don Touhig (Labour/Co-operative, Islwyn)

Will my hon. Friend permit me to make this one point? I will give way in a moment.

Our problem in this discussion is the use of the word ''standards''. In my context, those are clinical standards, whereby a doctor treating a patient in England will have the same standards as a doctor treating a patient in Wales. We are confused by talk of ''standards'' when sometimes we mean ''targets''. Those are political with a big ''P'', in that the Government or the Assembly will set a target—an objective for delivery of the health service in Wales—and with a small ''p'', in that some NHS trusts will have a particular objective, target or mission statement which they want to see realised. That point must be clarified.

We use the word ''standards'' when all sorts of other things, such as targets, clinical standards and so on, are meant. There is a difference. The standards I refer to are those of delivery and the quality of health care. Targets are different—they are set by politicians, systems, Government Departments and agencies and others in order to achieve objectives.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

Before the publication of the Bill, was consideration given in the Welsh Assembly and in the Government to a form of wording which involved the co-ordination of standards so that, as far as possible, common standards could be met? If not, could it now be considered during the Bill's progress in this House and in another place?

Don Touhig (Labour/Co-operative, Islwyn)

Yes, of course there were discussions on the issue of standards at ministerial and official levels between the Department of Health and the Assembly. We shall try to ensure that the national standards that I mentioned are broadly similar across England and Wales in respect of CHAI. Those discussions are ongoing, and we shall, as I have said, seek to ensure that the standards in Wales are as high as those in England. That will involve much co-operation and collaboration between HIUW, CHAI and the various Departments.

The hon. Member for Epsom and Ewell was also concerned about duplication. In previous sittings he has made several points about where he considers there may be waste, in that CHAI and HIUW would be in competition and that inspections would be duplicated. There will be no such duplication. CHAI's role in Wales is important, but it is restricted to undertaking—I apologise to my hon. Friend the Member for Cardiff, Central—national reviews in England and Wales of the particular health care provided by the English and Welsh NHS trusts, and so on.

The review of cross-border issues and special health authorities will be carried out by CHAI. Under section 41 of the Government of Wales Act, the Assembly, through HIUW, may enter into arrangements with CHAI, whereby CHAI may undertake investigations into serious service failures or malpractice on behalf of the health inspectorate in Wales and, if appropriate, accredit HIUW's inspection methodology.

The health care inspectorate in Wales will undertake reviews and investigations of Welsh NHS bodies using the joint review of the social service model that involves the participation of the Audit Commission. We have used that successfully in Wales. It will also assess the management arrangements that are in place to deliver NHS services, and the quality of NHS services across all the agencies and service providers. It might be helpful if I wrote to colleagues at the end of the sitting to give them a breakdown of how we see CHAI operating and how we see the health inspectorate unit in Wales operating, and to explain how their objectives are quite different.

Chris Grayling (Conservative, Epsom and Ewell)

The Under-Secretary has described the defining line between the two organisations. However, the point that I am seeking to make is that two organisations with two secretariats and so forth will inevitably create additional costs. Why is it necessary to have two organisations? Why will one inspectorate—CHAI—not be able to do the job properly for the people of England and Wales?

Peter Atkinson (Conservative, Hexham)

Order. We are already straying away from the territory of clause 42 into that of clause 66. We will come to those matters later.

Don Touhig (Labour/Co-operative, Islwyn)

I take the point, Mr. Atkinson. I will reserve some of my comments until we reach that part of the debate.

The hon. Member for Epsom and Ewell mentioned some of the problems that we have had with delivering the health service in Wales. There are differences in the rates of treatment, particularly for orthopaedics in Wales. That is being addressed through further funding and reforms. To make a partisan point, I must say to the hon. Gentleman that 18 years of under-investment in the health service has left its mark in Wales. Certainly, we have serious difficulties in delivering health care in Wales.

Demographically, 17 per cent. of the population in Wales is aged over 65, compared with 15 per cent. in England. There are also regional differences within Wales. Only 14 per cent. of the population are over 65 in the constituency of my hon. Friend the Member for Cardiff, Central (Mr. Jones), compared with 25 per

cent. in Conwy in north Wales. We are seeking to address those differences with this legislation.

I am sure that we will have further debates on standards and so on when we move to clause 66, so I shall conclude at this point. As I said, I am not clear who moved these amendments, although they were tabled by my hon. Friend the Member for Ealing, North. I am told that, in a vote last week, he answered in Welsh. Some people say that Welsh is the language of heaven, but it is certainly not the language of this place. If my hon. Friend has the interests of Wales at heart, I invite him to withdraw the amendment so that we can make some progress.

Peter Atkinson (Conservative, Hexham)

Order. The amendment was moved by the hon. Member for Epsom and Ewell, although he did not appear to be in favour of it.

Chris Grayling (Conservative, Epsom and Ewell)

You will therefore not be surprised to hear, Mr. Atkinson, that I beg to ask leave to withdraw the amendments.

Amendment, by leave, withdrawn.

Clause 42 ordered to stand part of the Bill.

Clause 66 - Reviews and investigations relating to Wales

Chris Grayling (Conservative, Epsom and Ewell)

I beg to move amendment No. 533, in

clause 66, page 24 line 41, after 'conducting', insert

', where appropriate in conjunction with the CHAI,'.

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to discuss the following:

Amendment No. 588, in

clause 66, page 25, line 17, at end insert—

'(f) the impact of its decisions upon the provision of healthcare in English border areas.'.

Amendment No. 589, in

clause 66, page 25, line 19, at end insert

', or in the case of NHS Trusts which provide services to both English and Welsh patients, to statements published under sections 41 and 42.'.

Amendment No. 590, in

clause 66, page 25, line 23, leave out paragraph (b).

Amendment No. 591, in

clause 66, page 25, line 25, at end insert—

'(3A) For the purposes of subsection (1) the Assembly may request CHAI to provide it with a report on the provision of healthcare by an English NHS body to a Welsh NHS body.'.

Amendment No. 534, in

clause 67, page 25 line 29, leave out 'Secretary of State' and insert 'CHAI'.

Amendment No. 592, in

clause 67, page 25, line 29, leave out 'conducting' and insert 'receiving'.

Amendment No. 593, in

clause 68, page 26, line 9, leave out 'or for'.

Chris Grayling (Conservative, Epsom and Ewell)

These amendments are designed to tidy up some of the issues that we see arising from the provisions in the Bill. We do not wish to depart from the view that we have expressed on this side that it is absurd to have two inspection systems. Despite the

Under-Secretary's reassuring words, I am not persuaded. It will be a waste of public money. It is entirely logical to have a single inspection system and I regret the fact that, given the Government's majority, this part of the Bill is likely to be approved.

The amendments are designed to tidy up the structures that the Bill would put in place. They are also designed to remove part of the anomaly that gives Welsh inspectors powers in England, without providing for a reciprocal arrangement. The Assembly cannot—and must not—have the power to amble over the border and inspect an English hospital at will. That would impose a huge additional managerial burden on that hospital. We all know that a review of any kind—whether a hospital review by CHAI, an Ofsted review or the inspection of a local government organisation—takes up a huge amount of the management's time.

I recall a local authority chief executive saying that the inspection that she had just been through had taken up about 90 per cent. of her time for three months. Therefore, the arrival of an inspectorate to assess the performance of a hospital will inevitably take the hospital's chief executive away from his or her job to a significant degree and for a significant time.

The amendments are designed to ensure that that does not happen twice and that the Welsh inspectorate does not have clear authority to walk across the border and inspect an English hospital. They are also designed to ensure that the Welsh inspectorate does not hold powers over English NHS institutions that their English counterparts do not hold in Wales. I am sure that you agree, Mr. Atkinson, that it would be nonsense if the Welsh inspectorate were profoundly concerned about the service being provided at a hospital over the border in England and was able to inspect that hospital in detail and report to the Secretary of State. That would be particularly true if CHAI did not have a similar ability to represent effectively the interests of patients in English border areas by carrying out inspections across the border and by making recommendations about the quality of health care in Wales for English patients.

Such reciprocity does not appear to be in the Bill. Amendment No. 533, therefore, adds a duty to co-operate, where appropriate, with CHAI, and is a tone-setter for the amendments that follow.

Amendment No. 588 relates to page 25, line 17, at the end of the list of the various issues that the Assembly must take into account in exercising its functions under subsection (1). Essentially, subsection (2) outlines those matters that should be taken into account when the Assembly sets out the areas that it wants to review and sets the parameters for the Welsh inspectorate. Most of those are sensible in the context of any inspectorate, for example:

''the quality and effectiveness of the health care''

and

''the availability of, and access to, the health care''.

However, there is no duty in the Bill to understand the impact on the provision of health care in England of the decisions that are being taken. I shall give an example of how that might work. Hospital reconfiguration is a popular topic at present. Around the country, debates are taking place in the NHS and in local communities about the balance between acute hospitals and community hospitals, the future of individual community hospitals and the location of hospital services.

Let us suppose that there is one hospital 10 miles from the border with England and another 40 miles from the border. There is increased pressure, for example, to meet the requirements of the European 48-hour directive, and the trusts responsible for managing the hospitals may decide that the only way to continue to provide the full range of services at the two hospitals is to bring them together in a new hospital on a new site halfway between the two; or, indeed, on one of the existing sites. They may even decide that the hospital further away from the border was close enough to Wales to make provision for patients from some Welsh areas and, therefore, they would move services currently close to the English border further away from that border. That is perfectly conceivable.

Of course, that decision would not take into account the interests of English patients on the other side of the border who are used to using their local hospital. Under the terms of the Bill, Welsh NHS authorities have absolutely no duty of care to the patients they serve who live in England.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

As the Bill is currently worded, a foundation hospital on the English side of the border would have no duty of care to its Welsh patients, nor any obligation to take into account their interests.

Chris Grayling (Conservative, Epsom and Ewell)

We debated that issue earlier, and the Government have gone some way to addressing it in their subsequent amendments. When the final amended Bill is produced at the end of the Committee, the hon. Gentleman and I will examine it carefully to see whether the Government have gone far enough in ensuring that that duty of care exists across borders.

The purpose of amendment No. 588 is to place a duty on the NHS in Wales to be mindful of the fact that people in England use its services too. As such, I hope that the amendment will be considered non-controversial and that the Under-Secretary will accept it. It will not affect the quality of patient care in Wales; it simply requires the NHS authorities in Wales to remember that not all their patients are Welsh.

Amendment No. 590 relates to the carrying out of reviews and investigations. Clause 66(3)(b) gives the Assembly the power to conduct investigations into the provision of health care for a Welsh NHS body otherwise than by an NHS foundation trust. The key words are ''for a Welsh NHS body.'' Health care for a Welsh NHS body may well be provided across the border in England; that is one piece of our jigsaw puzzle of anxiety. We are concerned by the fact that Welsh authorities can carry out investigations across the border, while that situation does not exist in

reverse. The purpose of the amendment is to seek the Under-Secretary's views on the issue, and to urge him and his colleagues to consider how we can ensure that true reciprocity exists on both sides of the border—it is not apparent at the moment.

Amendment No. 591 proposes that the Assembly could request CHAI to provide it with a report on the provision of health care by an English NHS body to a Welsh NHS body. It is very much our hope that the Government and the Assembly will be willing to move in that direction. Rather than the Welsh having the ability to send their inspection teams over the border—a raiding party into English hospitals—they can phone CHAI and say ''We are not happy with the quality of care that Welsh patients are receiving at English hospital x. Please look at it for us.'' CHAI can then do the fieldwork and report to the Welsh Assembly as well as to the Secretary of State. The Assembly can use that report when holding dialogue with the English NHS to try to resolve the matter.

The Under-Secretary will see that one or two of our other amendments are designed to try to reinforce the point that it is not right to have two inspection teams floating around. Of course, it is right and proper that the Welsh NHS should be able to examine problems its patients encounter with English NHS trusts, but it is also right and proper that English NHS trusts and CHAI should have the same rights in reverse. That issue is not adequately dealt with in the Bill.

However, if there are to be two inspection teams, field work in hospitals in either England or Wales should be done by the local inspection team, which can then report back to the appropriate authority in the other country.

Amendments No. 534 and No. 592 deal with clause 67(1), which states that

''The Assembly must report to the Secretary of State where, after conducting a review or investigation under section 66, it is of the view that—''

and goes on to talk about the various failings in English NHS bodies. Amendment No. 534 would give back to CHAI the responsibility for reporting. CHAI is the organisation in England that has responsibility for highlighting to the Secretary of State English NHS trusts' performance shortcomings. We think that the report-back mechanism should fall to CHAI, which would compile a report for the Secretary of State. We do not want multiple reports about the performance of a hospital to land on the Secretary of State's desk.

For example, if an English hospital close to the Welsh border was underperforming and the Welsh Assembly was not happy with that hospital, it could ask CHAI to carry out an investigation. CHAI could then investigate and provide feedback. The Assembly would then wrap together a report that says, ''This is not working. These failings are having an adverse effect on the people of Wales'' and then detail those failings. The report would be packaged and passed back to CHAI, which would then provide the Secretary of State with a complete report on the hospital's performance. Surely that is the right way to do things, rather than to have two parallel reports; one from CHAI about the impact of the hospital's

underperformance on English patients and the other from the Welsh Assembly to the Secretary of State about the underperformance in respect of Welsh patients. Amendment No. 534 effectively would create a consistent channel for reporting an English NHS trust's performance back to the Secretary of State.

Amendment No. 592, arguably, is the most important. It would simply change the word ''conducting'' to ''receiving'' and would remove the Welsh Assembly's right to conduct investigations in England. The amendment would place on the Assembly a clear duty not to conduct any review itself by removing its ability to do so. Amendment No. 592, which would make CHAI the field work operator in carrying out the review, would be strengthened because clause 67 would simply refer to ''receiving'' a report. Again, the same principle applies. The Assembly should be able to commission CHAI to carry out the field work, but it should not be able to carry out that field work itself.

Amendment No. 593 concerns right of entry. Clause 68(1)(b)(i) would give a person who has been authorised by the Assembly the right to enter and inspect, at any reasonable time, any other premises used, or which are proposed to be used, for any purpose connected with

''the provision of health care by or for a Welsh NHS body''.

The problem with the words ''or for'' is that they will give the Welsh inspectors the right to access any facility on the English side of the border whenever they want. That seems to be wrong, because there is no corresponding right in the Bill for an English body. Neither CHAI—nor, indeed, the Secretary of State—has the right to demand access to a Welsh hospital in order to inspect the premises. There will be an inspection flow one way but not the other.

If Ministers are saying that it is right and appropriate that the parallel inspection systems have proper rights to review the services provided to their patients, regardless of where those services come from, surely that should be a two-way process. The point of the amendment—to delete the words ''or for''—would remove the right of a person authorised by the Assembly to access such a body in England. I am happy for the Under-Secretary to take away the amendment and use his drafting resources to rewrite it in a way that works better for him.

However, the principle seems unshakeable. Why can the Welsh Assembly access an NHS building in England, while CHAI—on behalf the English taxpayer and patients—cannot have the same access to a hospital in Wales in which services are provided to English patients?

This is a long set of amendments, but I hope that the Under-Secretary will be able to respond positively to some of them. I hope that he will accept that this is a real issue that must be addressed before the Bill reaches the statute books.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I have considerable sympathy with the arguments that the hon. Member for Epsom and Ewell has made in support of his amendments.

I feel isolated. I do not wish to be too modest but, as the only Welsh Back-Bencher on the Committee, I do not think that on my own I can adequately represent Welsh interests on so many Welsh clauses. Until they read the Bill, the majority of Welsh MPs were under the impression that there was to be a joint inspectorate, not separate inspections. That has also been my impression since the production of the second Wanless report. Hon. Members may recall that the report's major conclusion was that funding for the national health service would be increased out of general taxation. There would, therefore, be one funding system, unlike the variety of funding systems in most European countries.

The report recognised that relying on one funding system reduced the accountability to different paymasters that existed within European systems. It was suggested that to make up for that structural lack of accountability, it would be necessary to introduce a rigorous, independent system of audit and inspection. I was under the impression that that rigorous, independent system of audit and inspection would be common to every part of the United Kingdom. I was rather surprised that that is not what is in the Bill.

At some point, the Department of Health and the Wales Office have been convinced by an argument to set up different inspections. So far, little effort has been made to convince anyone else that different inspections are a good idea, and there has been little debate about the merits of that idea.

The Committee has limited time, and few members with direct experience of the Welsh system, to examine how these issues would affect Wales. I hope that there will be much more discussion of the idea in the House of Lords. However, if there are to be different inspections, the arguments for reciprocity have been well made. I hope that my hon. Friend the Under-Secretary will consider carefully, if not the exact wording of the proposed amendments, at least the arguments behind them.

Gary Streeter (Conservative, South West Devon)

Two issues arise from this group of amendments and our debate. The first is whether there should be a separate inspectorate for Welsh NHS bodies. The hon. Member for Cardiff, Central has just spoken to that, and has expressed his surprise. The second issue is whether the Welsh Assembly, and the inspection system that it sets up and relies upon, should have access to English health care providers to Welsh NHS bodies. On that second point, I am unclear as to whether that is the Government's intention.

It may be that, while locked in this room over the past three weeks, I momentarily lost concentration; an astonishing thought, but I may have fleetingly overlooked a Minister explaining precisely how the Bill is intended to operate in relation to inspections of cross-border bodies. However, I do not believe that to be true.

Clause 66 of the Bill makes it clear that the Welsh Assembly has the power to inspect English hospitals,

such as those in Liverpool or Chester, that provide health care to Welsh patients. Welsh patients are presumably part and parcel of the Welsh NHS body and general practice. Members must forgive me, but I am not entirely sure whether there are primary care trusts in Wales. If there are not, there will be equivalent organisations that could be described as Welsh NHS bodies for the purposes of clause 66(3)(b), clause 66(4) and clause 68(1)(b)(i), to which my hon. Friend the Member for Epsom and Ewell also referred.

Therefore, it seems that the Bill is drafted, whether intentionally or not, to give the Welsh Assembly the power to send inspectors into English hospitals. Such an inspection might occur as a result of a complaint made by a Welsh patient to a Welsh Assembly Member, who then would raise it in Cardiff, where other Members became excited and decided to send in the inspectors.

If I may say so, I was extremely impressed with the Under-Secretary's first outing in this Committee. He is obviously a Minister who seeks to give clarity. Therefore, I ask him to give the Committee maximum clarity on this issue. Was it the Government's intention to have a right to enter and inspect English hospitals? If that is the intention, I strongly agree with my hon. Friend the Member for Epsom and Ewell that that is a terrible waste of resources. It would also complicate and confuse English hospitals.

From constituency experience, we all know that when Ofsted decides to inspect a school, it is a nightmare for a month in advance as the school prepares. The inspection causes a very stressful week or two, and it takes the school the rest of the term to recover. The same applies to hospital inspections, regardless of whether hospitals gear up only for those weeks during which they know that certain departments will be inspected.

Inspections place a lot of focus on hospitals and cause much stress and distraction. It would horrify me if, for example, CHAI inspected a hospital in Liverpool in April and an inspectorate from the Welsh Assembly did the same thing three months later. Therefore, the points made by my hon. Friend the Member for Epsom and Ewell about the need for inspection in Wales to draw on existing inspection by CHAI were very well made. I hope that the Under-Secretary will be able to give the Committee clarity and focus on those points. If he cannot, the Bill must be amended.

I want to make another point about the list of paragraphs in clause 66(2). There are dangers, as every lawyer knows, in setting out a specific list of the functions, powers and focus to which a body is to have regard. I was interested to read in clause 66(2)(d) that the Welsh Assembly should have particular regard to

''the need to safeguard and promote the rights and welfare of children''.

Who could disagree with that?

The Under-Secretary mentioned that there is an unusually high level of retired people in Wales; 17 per cent., I think he said, as opposed to 15 per cent. in England. Therefore, why on earth have the rights and

welfare of children—which, of course, we all support—been singled out for attention in clause 66, while the rights and welfare of elderly and retired people have not?

Although the rights and welfare of elderly people flow through the entire subsection, when specifics are expressly mentioned, it is in the nature of we human beings to use them as a particular focus, resulting in other elements being left out and not receiving the same priority or attention. I would have thought that it rather important that if the Bill were to contain lists, they should refer not only to children, but to elderly and retired people.

I hope that the Under-Secretary—he has indicated that he is a reasonable man who listens and seeks clarity—can answer those questions. If he cannot, perhaps he will seek advice on the provisions and return to the Committee with greater clarity.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I support these amendments, which raise important issues about the way in which the Assembly will discharge its functions under the Bill. Reasoned points have been made by the hon. Member for Cardiff, Central about how that might better be arranged and how the resources of the new Commission for Healthcare Audit and Inspection could be used on some form of agency basis by the Assembly to enable it to discharge its responsibilities. I am sure that the Bill provides for such an agency arrangement. However, the Minister should give us some assurances that that possibility was explored during the discussions that led to the framing of the Bill, and that that arrangement is intended for the future operation of inspection in Wales. That would overcome our concern about the possibility of English NHS bodies being inspected by both HIUW and the Commission for Healthcare Audit and Inspection.

The point about reciprocity is entirely fair, and I hope that the Minister, when responding to this group of amendments, can give us some assurance on that. It is important that in establishing the new architecture for inspection and regulation of health care we do not inadvertently create the possibility of further inspections, rather than reduce the number of inspections enjoyed by English NHS bodies. Clearly, a simple mechanism could be used to allow the commission to act on behalf of the Assembly in discharging its functions. That would tidy up the provisions in a way that would meet all the concerns raised so far in the debate.

Don Touhig (Labour/Co-operative, Islwyn)

Clauses 66 and the clauses that follow give the Assembly powers to undertake reviews and investigations into the provision of health care by Welsh NHS bodies. They complete the review and investigation jigsaw by placing on the Assembly the duties and powers in respect of providing services to patients who are resident in Wales that are exercised by CHAI in respect of patients who are resident in England. By placing those responsibilities and powers on the Assembly, we are providing an important support for the Assembly's drive to improve the health and well-being of people in Wales by ensuring that the health priorities they set are specific to Wales and are addressed and monitored locally.

I will take each of the amendments moved by the hon. Member for Epsom and Ewell in turn. The Government do not believe that amendment No. 533 is necessary. The Assembly and CHAI are under a duty to co-operate where appropriate under clause 132 for the effective and efficient discharge of their inspection functions. That could include co-ordination of reviews of health care, so that where it was considered appropriate, CHAI could review health care provided by an English NHS body for a Welsh NHS body. Furthermore, section 41 of the Government of Wales Act 1998, to which I referred in the previous debate, would allow CHAI and the Assembly to enter into arrangements whereby CHAI could exercise the inspection functions for the Assembly. That explains and overcomes some of the concerns that colleagues have about duplication, and one inspection being carried out by CHAI one week and another by HIUW the next.

Gary Streeter (Conservative, South West Devon)

Does the Bill give inspectors charged by the Welsh Assembly permission to enter English hospitals to carry out inspections?

Don Touhig (Labour/Co-operative, Islwyn)

Yes, that would be possible if a hospital trust had been commissioned by a provider in Wales to carry out health care or treatments for Welsh patients.

There is confusion about the roles of CHAI and HIUW compared with community health councils in Wales and patient forums in England. As hon. Members know, it has been made clear in previous legislation, most recently the Health (Wales) Act 2003, that a patient concerned about treatment from a provider, including a health service trust in England, can go to a community health council. In that Act, as the hon. Member for Epsom and Ewell will remember, we strengthened the power of those bodies and gave them advocacy roles on behalf of patients to conduct such investigations. A| reciprocal arrangement exists in England whereby patient forums can conduct the same sort of inquiries and inspections if there is a complaint from an English person who has been treated in a Welsh hospital about the standard or quality of care. However, we are not discussing that as far as CHAI and HIUW are concerned.

Chris Grayling (Conservative, Epsom and Ewell)

I am always surprised that the Minister manages to keep a straight face when he talks about community health councils, since he voted to scrap them in England but keep them in Wales. He just gave a clear answer to my hon. Friend the Member for South-West Devon (Mr. Streeter). Can he confirm that an English inspector will not have a statutory right to enter a Welsh hospital, yet a Welsh inspector will have a statutory right to enter an English hospital?

Don Touhig (Labour/Co-operative, Islwyn)

CHAI would have the ability to inspect a Welsh trust if the patient care was commissioned by a body in England for patients in Wales.

Chris Grayling (Conservative, Epsom and Ewell)

Where does it say that in the Bill?

Don Touhig (Labour/Co-operative, Islwyn)

I cannot answer that without further reading. However, the hon. Gentleman should accept that there are circumstances in which CHAI would inspect a Welsh health body if care had been

commissioned by an English health body. I will clarify exactly where that provision is in the Bill. English inspectors will have such a right under clause 53(5), I believe. Colleagues may want to digest that point and return to it.

The Government do not believe that amendment No. 534 is necessary because the Assembly should report to the Secretary of State any failings in the running of or provision of health care by an English NHS body where that has occurred. It is for the Secretary of State to consider what action should be taken in respect of English health care. Under clause 54, CHAI has a similar duty to report failings relating to the provision of English health care to the Secretary of State. The Secretary of State has responsibility for the provision of health services in England under section 2 of the National Health Service Act 1977 and has the power to issue direction to English NHS bodies.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I apologise if, in a moment of distraction, I misheard or did not hear the Under-Secretary state specifically how he envisages clause 53(5) applying to Welsh bodies. For the future construction and interpretation of the law in this respect, can he confirm that that clause is to be interpreted as including Welsh NHS bodies?

Don Touhig (Labour/Co-operative, Islwyn)

Yes, I can confirm that.

Chris Grayling (Conservative, Epsom and Ewell)

As the Under-Secretary knows, lawyers can be extremely meticulous in their interpretation of detail. Might it therefore be prudent to insert on Report a reference that simply says: ''which may include Welsh NHS bodies'' or something similar?

Don Touhig (Labour/Co-operative, Islwyn)

The hon. Gentleman makes a perfectly valid and proper point, and I have no doubt that my colleagues in the Department of Health will consider the report of this morning's proceedings and his comments. If it is felt appropriate to have further amendments, observations or clarity included on Report, I am sure that the opportunity will be taken to do that. However, I will make sure that his point is brought to the attention of my colleagues, particularly the Minister of State.

I am not quite clear what is meant by ''decisions'' in amendment No. 588. The Assembly will not have any control over English NHS bodies nor will it be able to award any form of star rating in respect of such bodies. Instead, under clause 67 the Assembly will be under a duty to report to the Secretary of State if it considers that there are significant failings in the provision of health care or the running of an English NHS body or any other body or person providing health care for an English NHS body. It will be entirely for the Secretary of State to determine what action should be taken in respect of English NHS bodies.

The Government do not support amendment No. 589. Even if the Welsh Assembly wishes to review health care provided for Welsh NHS bodies by English NHS bodies, it will not issue any form of rating to such bodies. It is for CHAI to assess whether an

English NHS body fulfils the standards set by the Secretary of State, and to award the performance ratings accordingly. In turn, it is for the Secretary of State to take any action he or she deems fit in respect of a failing NHS body, by virtue of the powers already vested in that office under health legislation.

Chris Grayling (Conservative, Epsom and Ewell)

Amendment No. 589 refers back to clauses 41 and 42, which establish the standards. Does the Under-Secretary accept that the purpose of the amendment is to ensure that the Welsh inspectorate, when assessing the performance of a Welsh NHS body, is duty-bound to be mindful that that body may also have to work to an English set of standards, because it is serving English patients, and that that may affect the way in which the body carries out its work?

Don Touhig (Labour/Co-operative, Islwyn)

That was implicit in my remarks in the debate in which we discussed the question of how to ensure that standards in England and Wales are comparable. It seems to be an obvious point, which would have to be taken into account in the circumstances that the hon. Gentleman describes. The Assembly will be required to advise the Secretary of State when, after conducting a review or investigation, it is of the view that there are significant failings in the running of an English NHS body, or the provision of care by such a body or by another body or person for an NHS trust.

Amendments Nos. 595, 591 and 592 are not necessary. By virtue of section 1 of the National Health Service Act 1977 where functions were transferred from the Secretary of State to the Welsh Assembly under the National Assembly for Wales (Transfer of Functions) Order 1999, the Assembly has the duty to continue the promotion in Wales of a comprehensive health service, designed to secure improvement in the physical and mental health of the people of Wales. Under commissioning arrangements, NHS bodies in Wales will commission health care from bodies across the border in England. Accordingly, the Assembly will need to ensure that such health care is properly provided to Welsh residents, given its duty to provide a comprehensive health service in Wales.

Amendment No. 591 is not necessary, as the Welsh Assembly is required under clause 132 to co-operate with CHAI, where appropriate, for the efficient and effective discharge of their respective inspection functions. As such, both inspectorates will need to ensure that their reviews are properly co-ordinated—a point rightly made by the hon. Member for South-West Devon.

Gary Streeter (Conservative, South West Devon)

Does the Under-Secretary accept that clause 132 is really concerned with the robustness and effectiveness of the inspection from the inspector's point of view? The clause does not take into account the hospital's point of view or the inconvenience, cost and waste of possible duplicated inspections. Perhaps that needs to be tidied up?

Don Touhig (Labour/Co-operative, Islwyn)

I thought that I had stated clearly that there must be co-ordination and that there should be no duplication. That would not be a sensible use of resources. If we are to drive up standards, we must

have proper assessment and inspection of the services provided. Nowhere is that more important than in the health service. Were the Assembly to wish to review the health care provided by an English or a Welsh NHS body, it would need to ensure that that did not impede CHAI's timetable for reviews in any way.

Amendment No. 593 causes me more concern. Its drafting is not clear. It would take away from the Assembly the power to enter the premises of English NHS bodies. The actual effect of the drafting of the amendment would mean that that the Assembly could not enter the premises of any person or body providing health care for Welsh NHS bodies. That would extend to health care providers situated in Wales, not just English NHS bodies. As far as the inspections are concerned, that would not be of any benefit.

Chris Grayling (Conservative, Epsom and Ewell)

I remind the Under-Secretary that I said that he might want to redraft the proposal, given that he has rather more substantial access to drafting resources than Opposition Members have. None the less, the point about the right of Welsh inspectors to access English premises at a moment of their choosing remains important.

Don Touhig (Labour/Co-operative, Islwyn)

I take note of the hon. Gentleman's point.

Gary Streeter (Conservative, South West Devon)

Is the Under-Secretary right on that point? Clause 68(1)(a) talks about the right of the Assembly to:

''enter and inspect any—

(a) premises owned or controlled by a Welsh NHS body;''

and goes on to include:

''(b) any other premises used''.

Therefore, although taking out ''or for '' in paragraph (b) might have some impact, it is overridden by the express provision in clause 68(1)(a) that the Assembly can enter any Welsh NHS body anyway.

Don Touhig (Labour/Co-operative, Islwyn)

I have looked into the matter. Far be it from me to challenge the parliamentary draftsmen, but that was the advice that I received about the consequence of the amendment.

The Assembly will wish to review and investigate health care provided by Welsh NHS bodies. That could be care provided by English NHS bodies or special health authorities or, indeed, care provided by other bodies or individuals in Wales. In all circumstances, the Assembly will need powers of entry into relevant premises whether they belong to Welsh or English NHS bodies or health care providers.

Several hon. Members made points during the debate, and I have answered most of the points made during the debate as far as I have been able.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

The Under-Secretary has answered many of the points relating to the amendments, but he has not advanced any argument for the benefit of having a separate inspection regime. Underlying the arguments for the amendments is an attempt to make the best of a bad job and the deficiencies of having two inspectorate regimes. I do not know what we should read into that, but so far the Under-Secretary has not argued for the perceived benefit of having separate inspection regimes.

Don Touhig (Labour/Co-operative, Islwyn)

I was not going to leave my hon. Friend the Member for Cardiff Central out of this debate by any means. He used to do the job that I now do—in fact, he had a greater degree of responsibility because he was formerly the health Minister for Wales. I know what a tremendous job he did: woe betide the chairman of any NHS trust who had not met the targets that he had set, because he would phone on a Monday morning to ask why. I will address the point that he makes.

In the early discussions that took place between my officials, officials from the Department of Health and the Assembly, and at ministerial level, we examined the possibility of CHAI carrying out all the inspectorate functions across England and Wales. As my hon. Friend pointed out in his contribution, that was what he believed would happen until the Bill was published. However, we had extensive discussions with colleagues and became convinced that there was merit in having a separate inspection unit in Wales to carry out the sort of inspection that I mentioned earlier. As I told the Committee, I will provide Members with a breakdown of how we see the separate functions of CHAI and HIUW applying and the benefits that we believe they will bring.

My hon. Friend knows me well enough to know that I do not subscribe to making changes in legislation simply for the sake of having a ''Made in Wales'' stamp on it. However, when I think we can improve the delivery of any service by tweaking it, and if that benefits the people of Wales, we should do it because we can do so through the Government of Wales Act, through which many of these responsibilities and functions are devolved. I will write to hon. Members to set out why we regard the measure as important and set out clearly how the two operations, CHAI and HIUW, will provide a valuable service that will monitor and inspect our health service.

The hon. Member for South-West Devon spoke about clarity and about the clarification of inspections. I have covered that point. Legislation has already been passed to provide for community health councils in Wales and patient forums in England to act as representatives and advocates for those who feel that they have not been properly treated by the health service. Their concerns will be investigated. The concerns of a Welsh patient who has been treated in England will be investigated. The same arrangements apply to patient forums in England in respect of English patients. The hon. Gentleman also asked about children, and I shall write to him when I have received greater clarity on that matter.

The hon. Member for Sutton and Cheam (Mr. Burstow) also asked about the functions of CHAI and HIUW. I give him the same response as I gave my hon. Friend the Member for Cardiff, Central, and as soon as he sees my letter he will understand why we have gone down that road: it is the best way of delivering the inspection of the health service in Wales. I urge the hon. Member for Epsom and Ewell to withdraw his amendments.

Chris Grayling (Conservative, Epsom and Ewell)

I am happy to withdraw the amendments—on two or three conditions that I hope the Under-Secretary will meet. He said that amendment No. 589 was not needed, although its purpose is to ensure that the inspection regime in Wales has a duty to be mindful that some of the people whom they inspect must deal with two different sets of standards. I accept his point that the National Assembly for Wales may wish to be extremely consistent with the standards that have been set down by the Department of Health; however, it may not—who knows? Politics is a funny business, and we are leaving control over national standards in Wales in the hands of the Assembly.

I therefore ask the Under-Secretary whether he would be willing, with his draftsmen, to reconsider the clause in order to ensure that they are happy that it contains such a duty and that the inspectorate will not be judging practitioners against standards that apply only to some of their patients. We must ensure that practitioners are not adversely judged because they operate to standards that are different from those in England. That is the first assurance that I seek from the Under-Secretary.

The second assurance that I seek relates to amendment No. 588. The Under-Secretary's quibble was with the word ''decisions''. He might dispute the drafting of the amendment. Perhaps it should contain a duty of availability and access to health care in English border areas, as is the case in Welsh border areas. My concern is that the inspectorate will be asked to carry out inspections and to make recommendations about the strategy and direction of Welsh NHS trusts without any reference to its task of catering for patients in England. Therefore I ask the Under-Secretary to consider whether inserting a stipulation to be mindful of availability and access to health care in English border areas should be included as one of the duties in this part of the Bill.

If the Under-Secretary gives me those assurances I shall withdraw the amendments. Although it may not happen, it is clear that the Bill gives the two inspectorates in England and Wales the right to inspect the same institution in the same year, but at different times. I trust and hope that that will not happen. I accept that clause 132 provides for a duty of co-operation between the two inspectorates, but I cannot see anything to prevent dual inspection. The Under-Secretary must understand the burden that two inspections would place on hospital management: it would be daft. We must bear in mind that we are framing legislation. We are not talking about ideals or what we expect to happen—we are talking about the law of the land. The law of the land will permit two inspectorates to inspect the same hospital within a short time. That is wrong, and Ministers would do well to consider that carefully before the Bill is placed on the statute book.

I am not certain, Mr. Atkinson, whether you intend to allow a clause stand part debate; I suspect that you may judge that such a debate has taken place. Therefore, in anticipation of such a ruling, let me say that we firmly do not believe that a single patient will

benefit as a result of having two separate inspectorates—it will not enhance patient care one iota. What will HIUW do for patients in Wales that CHAI will not? If HIUW has a hidden mystery ingredient that will make a huge difference to the people of Wales, can we please have it in England? Otherwise, we will end up with a scenario similar to the absurd CHC situation, whereby one set of Ministers told the House that it was time for CHCs to pass on, only for them to be replaced a few weeks later by another set of Ministers who said that CHCs are the way of the future. Indeed, as I pointed out, the Under-Secretary voted for both of those options.

To be frank, the Under-Secretary did not truly answer the questions asked by the hon. Member for Cardiff, Central. What will the creation of a second inspectorate bring to the people of Wales that CHAI serving both England and Wales could not? What is the mystery ingredient? What is it about a second inspectorate that will improve patient care in such a way that a single inspectorate cannot? Does the Under-Secretary agree that if we do not have a second inspectorate, money that might pay for a few extra hip replacements or the like for patients in Wales will undoubtedly be saved? Are we not doing those patients a disservice, rather than a service, in creating a second inspectorate?

I hope that the Under-Secretary will respond briefly to my points, after which I will be happy to withdraw the amendments. However, I give him notice that we will support neither clause 66 nor clause 67—they are wrong.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I assume that we will not have a clause stand part debate, but in answer to the questions that I asked the Under-Secretary, he has agreed to write to us to explain the advantages of having two inspectorates. Therefore as it currently stands, I have no idea what the advantages are that outweigh the obvious disadvantages of having two inspectorates. I harbour a dark suspicion that some will perceive one advantage to be the avoidance of a degree of accountability, which is the exact opposite of the point of establishing a strong inspectorate in the first place. However, I continue to see no advantage to a separate inspectorate for patients in Wales; indeed, the reason for that separate inspectorate has not been explained to me.

Wales must have as independent an inspection system as England. It is immensely difficult to ensure an efficient, effective health service, given the existence of this monopolistic provision and the fact that the taxpayer constitutes the sole funding stream. In Wales, the population base and the number of hospitals to be inspected are much smaller than in England, and I am fearful about the inspectorate achieving sufficient autonomy and independence from its political masters. I have concerns about the proposal in the Bill, and I do not support a separate inspectorate for Wales.

Don Touhig (Labour/Co-operative, Islwyn)

This has been a useful debate. I do not take the view that Bills cannot be improved by debates in Standing Committees. Standing Committees exist to scrutinise Government legislation properly and, where appropriate, to revise and amend that legislation.

I will take account of the points made by the hon. Member for Epsom and Ewell about amendments No. 589 and No. 588. I will read today's proceedings in Hansard, and if certain points require a further response, I will take those into account on Report. In the meantime, if I think that further clarification is required, I will write to hon. Members. The hon. Gentleman referred to the dual inspection roles of CHAI and HIUW. We can demonstrate the importance and value of the methods outlined in our proposals. I explained the benefits earlier, but as promised I will write to colleagues before Report to ensure that they have the fullest information in order to understand why we have chosen that route.

Perhaps my hon. Friend the Member for Cardiff, Central and I might have a word later. We are both former Whips as well as good comrades and good friends, so I might be able to remind him where we might have had an opportunity to discuss these matters elsewhere. However, he makes an important point; we must make it clear why we are going down our chosen route. He also has concerns about demonstrating the independence of HIUW. That is an important issue, and my right hon. Friend the Minister of State, Department of Health, has clarified the independence of CHAI in England.

It is important that the Committee has the fullest understanding of how we propose to demonstrate the independence HIUW in the same way as the Bill demonstrates the independence of CHAI in England. I have sent two letters about this issue to Ministers in the Welsh Assembly, copies of which I will release to hon. Members within the next day or so. They will then see in detail why we believe that HIUW will be sufficiently independent of politicians to carry out its proper functions.

I recognise that the hon. Member for Epsom and Ewell is perhaps prepared to withdraw his amendments. I will ensure that the Committee has all the information to which I have referred.

Chris Grayling (Conservative, Epsom and Ewell)

I am grateful to the Under-Secretary for the thoughtful way in which he has responded to my specific questions. None the less, we shall take a rather more robust view of the big picture issues. I beg leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendments made: No. 306, in

clause 66, page 25, line 4, leave out

'otherwise than by an NHS foundation trust'.

No. 445, in

clause 66, page 25, line 20, leave out

'subject to this Part, conduct'

and insert 'carry out'.

No. 307, in

clause 66, page 25, line 23, leave out

'other than an NHS foundation trust'.—[Mr. Hutton.]

Question put, That the clause, as amended, stand part of the Bill:—

The Committee divided: Ayes 14, Noes, 6.

Clause 67 - Reporting to Secretary of State

George Young (Conservative, North West Hampshire)

Clause 67 is consequential on clause 66, but it seems to go a little wider, particularly in subsection (1)(c). Can the Minister take us through why he needs that subsection? As I understand clause 66, which we have just discussed, the Welsh Assembly has a mandate where Welsh patients are treated in English hospitals. I have no difficulty with that. Under clause 66(3) that mandate is restricted to situations where health care is being provided for a Welsh NHS body, albeit by an English trust.

However, under clause 67(1)(c) it seems that the Assembly has much wider powers, because if it finds significant failings in an English body that is providing services not to Welsh patients but to an English primary care trust, it now has the right to report that to the Secretary of State. It is not immediately clear why clause 67(1)(c) goes so much wider than clause 66(3)(b). Can the Minister explain what appears to be a significant widening of the mandate of the Welsh Assembly in respect of English NHS bodies?

Don Touhig (Labour/Co-operative, Islwyn)

As I understand the intention behind subsection (1)(c), it will apply where a person from Wales has been treated at a hospital in England and there has been some form of deficiency in the health provision. There would be the opportunity to report that matter to the Secretary of State. There is a similar provision in relation to CHAI in reporting matters to the Secretary of State arising from English inspections. It seems perfectly proper to follow on from there.

George Young (Conservative, North West Hampshire)

In those circumstances, although the care would be provided by an English hospital, would it not be a Welsh NHS body that was paying for it?

Don Touhig (Labour/Co-operative, Islwyn)

Yes, it would be care commissioned by a Welsh NHS body.

George Young (Conservative, North West Hampshire)

In that case I do not understand why subsection (1)(c) refers to

''providing health care for an English NHS body''.

The Welsh Assembly has an interest where health care is being provided for a Welsh NHS body by an English trust, but paragraph (c) seems to go slightly wider.

Don Touhig (Labour/Co-operative, Islwyn)

This is a very interesting debate.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I will try to help the Minister. Will he consider the point that in this clause the Secretary of State is stipulated as the person to whom the Welsh inspectorate should report? Surely, given that CHAI is to discharge these responsibilities in England, it ought to be CHAI to which the Welsh inspectorate reports, so that CHAI can then discharge its responsibilities for NHS bodies in England providing care to English patients. That would seem to be consistent within this clause, and I hope that the Minister will be able to explain that. Is there a specific responsibility on CHAI to report to the Welsh Assembly if it finds similar problems in NHS hospitals in Wales?

Peter Atkinson (Conservative, Hexham)

We have addressed that point in amendment 534, which we dealt with earlier.

Don Touhig (Labour/Co-operative, Islwyn)

I did respond to that point.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

There has been some confusion about subsection (1)(c), which works with subsection (1)(b) to cover private or voluntary hospitals that provide health care. By definition, paragraph (b) applies only to an English NHS body. The point made by the right hon. Member for North-West Hampshire (Sir George Young) might apply equally to paragraphs (b) and (c). How would the Assembly know about problems if it did not have the free-standing ability to inspect those areas providing Welsh-commissioned services? If the Assembly were providing those services, presumably it would already have the power to take action without reporting to a third party.

Don Touhig (Labour/Co-operative, Islwyn)

Clause 67 states:

(1) ''The Assembly must report to the Secretary of State where, after conducting a review or investigation under section 66, it is of the view that

(a) there are significant failings in relation to the provision of health care by or for an English NHS body or cross-border SHA; or

(b) there are significant failings in the running of an English NHS body or cross-border SHA;

(c) there are significant failings in the running of any body, or the practice of any individual, providing health care for an English NHS body or cross-border SHA.''

There could be a series of arrangements, for example, the care provider for a Welsh body could be sub-delegated by an English body to be provided by an independent person or body. We want to ensure that if any deficiencies are discovered, there is a mechanism for bringing them to the attention of the appropriate person so that action can be taken; that person would be the Secretary of State in England. It would not be appropriate for the Assembly to take action, but if any of its inspections were to discover any failing, clause 67 provides that the matter should go to the Secretary of State for him to take note and, where appropriate, take action.

Chris Grayling (Conservative, Epsom and Ewell)

My right hon. Friend the Member for North-West Hampshire makes an interesting

point. Does the Under-Secretary accept that theoretically under the terms of this part of the Bill the inspectorate in Wales, as the body responsible for services that cross borders, could investigate the Coventry, Warwickshire, Herefordshire and Worcestershire strategic health authority and mount a further inspection or investigation into a hospital in Coventry, for example? Clause 67 creates an almost open-ended inspection flow outwards from Wales.

Don Touhig (Labour/Co-operative, Islwyn)

I thought that our earlier debate had covered the ability of CHAI and HIUW to inspect across borders when a provider in England commissions health provision into Wales and vice versa. The clause is clear on that issue. We want to ensure that any failure, discrepancy or difficulty is brought to the attention of the person with the appropriate power or responsibility to take action to correct such shortcomings. Health commissioners in Wales already come from English bodies. That is covered by the patient advocacy legislation.

In relation to the inspectorates, we should ensure that if there are any problems or difficulties, they are brought to the attention of the Secretary of State. This clause seeks to do that.

George Young (Conservative, North West Hampshire)

I am sorry to labour the point, but I should like to take the Under-Secretary through my dilemma. Clause 67 is consequential on clause 66 since clause 67(1) states:

''The Assembly must report to the Secretary of State where, after conducting a review or investigation under section 66,''

Clause 67 follows clause 66. In clause 66(3)(b), the Assembly's powers of inspection are restricted to circumstances in which health care is provided for a Welsh NHS body. It may be provided by an English hospital, but it is for a Welsh NHS body. That is the Assembly's mandate. However, under clause 67(1)(c), the Assembly's mandate does not just cover circumstances in which health care is provided for a Welsh NHS body, but also applies where services are provided by an English NHS hospital for an English NHS body. I do not understand why it says ''Welsh NHS body'' in clause 66(3)(b) but ''English NHS body'' in clause 67(1)(c).

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

Will the right hon. Gentleman give way?

George Young (Conservative, North West Hampshire)

If the hon. Gentleman can shed some light on this, he will succeed where the Under-Secretary has so far failed.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I think that I can. Clause 66 provides for the investigation of a person, independent hospital or English NHS hospital that provides services for Welsh and English patients. Let us say that the Welsh inspectors find a dodgy lab when carrying out such an inspection. Since that lab provides services for English patients, it would be reasonable for the Assembly responsibly to report the lab to the English authorities and to inform them that it may affect English patients. That would be appropriate risk management. A serendipitous finding during an inspection of a hospital providing services for the people of Wales that may impact on English patients will be reported to the English authorities.

George Young (Conservative, North West Hampshire)

I am grateful to the putative Minister for his response. In those circumstances, one does not need the words ''English NHS body'' because they also provide for a Welsh NHS body. I agree that if inspectors came across something that also affected English patients, they should respond. However, that is already covered under clause 66(3)(b). In the circumstances mentioned, health care is being provided for a Welsh NHS body. Clause 67(1)(c) goes far wider than that. Although the hon. Gentleman has made a valiant attempt, I still do not understand why it says ''English'' in clause 67(1)(c) and ''Welsh'' in clause 66(3)(b).

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

The Under-Secretary will probably correct me if I am wrong, but there may be a small independent unit or person who is providing services only for the Welsh because that person's only contract is over the border with a Welsh commissioner. It would be inappropriate for the inspectors to draw the English authorities' attention to that because it does not involve either an ''English NHS body'', as in clause 67(1)(b), or the provision of services for an English NHS body. The clause is competent, but whether it is overly fussy is a separate question.

George Young (Conservative, North West Hampshire)

During this interesting exchange, the Under-Secretary has had some in-flight refuelling. It may be that he can now shed light on the issues that we have both raised and bring this debate to a satisfactory conclusion.

Don Touhig (Labour/Co-operative, Islwyn)

I reiterate my earlier point that under this clause:

''The Assembly must report to the Secretary of State where, after conducting a review or investigation under section 66, it is of the view that—''

and that is followed by paragraphs (a), (b) and (c). We would all agree that if in any way it could be demonstrated that there was a failing in any health service provider, that should be investigated. This clause allows that to be done. Health care for a Welsh NHS body could encompass care provided by an independent body in England, such as an independent clinic. That could cover a host of organisations.

In view of the right hon. Gentleman's concerns, I will examine the matter further. Clarification is necessary so that everyone understands the objectives. I shall write to Members, if that is acceptable, to make the Government's intentions clear, but those intentions are along the lines that I have explained. However, I want to ensure that colleagues are given the details with full authority. If hon. Members are happy with that, I shall do that today.

Question put and agreed to.

Clause 67 ordered to stand part of the Bill.

Clause 68 - Right of Entry

Simon Burns (Conservative, West Chelmsford)

I am grateful to have the opportunity to discuss briefly clause 68,

which deals with the right of entry under the reviews for investigations. Clauses 69 to 71 inevitably flow from clause 68, which is the main clause. I am particularly pleased because the content of those clauses is also dealt with in clauses 62 to 65, but relates to a different body. Indeed, the argument will be repeated in clauses 95 and 98 for a third body. We were unable to debate how those clauses refer to CHAI under clauses 62 to 65 because of the guillotine at the end of the sitting on Tuesday.

I want the Under-Secretary to clarify several issues that flow from the powers that clause 68 proposes to grant. It is logical that if a piece of legislation allowed a review and investigation system, those who carry those out must have sufficient powers and abilities to satisfactorily conclude them. However, it seems that the powers of the right of entry under clause 68 are extremely wide ranging with few checks and balances, which means that the system could be abused. I do not suggest that there will be abuse. However, if one prepares legislation and confers powers of such a sweeping nature, one has a duty to consider that it is possible that an individual might abuse those powers. There should be sufficient safeguards against that.

Under clause 68, if it considers it necessary or expedient, the Welsh Assembly can authorise a person to:

''at any reasonable time, enter and inspect any—

(a) premises owned or controlled by a Welsh NHS body;

(b) any other premises used, or proposed to be used, for any purpose connected with—

(i) the provision of health care by or for a Welsh NHS body; or

(ii) the discharge of any of the functions of a Welsh NHS body.''

That is an all-embracing power. Will the Under-Secretary tell us his intentions so far as that is concerned? For example, what is meant by

''considers it necessary or expedient''?

Attempts are made in subsequent clauses to give greater information about that. I will not stray too far down that line, because I might be considered out of order. However, will the Under-Secretary expand on that in layman's language?

What is meant by ''at any reasonable time''? What might be a reasonable time to one person may not be a reasonable time to another. For example, in sensitive investigations, the police regard a reasonable time to be 5 o' clock or 6 o' clock in the morning. Will the Bill give that sort of power to authorised individuals? An explanation of ''any reasonable time'' would be helpful.

In clause 68(1)(b), the power to enter and inspect ''any other premises used'' seems straightforward. However, what is meant by:

''or proposed to be used''?

There should not be an opportunity for nit-picking arguments to arise over what would seem to a non-lawyer to be a nebulous definition. What are the checks against abuse? Are they in another part of the Bill? Is the Assembly the right body to have sole authorisation of a person to carry out rights of entry?

Would it not be an improvement, and a greater protection against abuse, if a court order were required following an Assembly decision to hold an investigation or review and it was necessary for a person to have right of entry to premises? In certain circumstances, such as in more serious and sensitive reviews and investigations, the requirement of a court order would provide an additional safeguard to ensure that there was no abuse.

Don Touhig (Labour/Co-operative, Islwyn)

Clauses 68 to 71 provide the Welsh Assembly with rights equivalent to those conferred on CHAI, and clauses 62 to 65 provide for the right to enter Welsh NHS body premises to inspect documents and records, to interview people and to require documents, information and explanations. If an inspectorate is to do its work properly, it must be able to have access to premises and appropriate records. The powers conferred under those clauses will allow the Welsh Assembly to undertake reviews and investigations into the provision of health care by Welsh NHS bodies. As I have said, the clauses complete the review and investigation of the Assembly's powers and ensure that the Assembly can carry out the duties we have placed upon it regarding the delivery of the health service.

The hon. Member for West Chelmsford (Mr. Burns) mentioned right of entry and queried the phrasing in clause 68(1):

''A person authorised to do so by the Assembly may, if the Assembly considers it necessary or expedient for the purposes of this Chapter, at any reasonable time enter and inspect . . . ''.

A ''reasonable time'' would not necessarily be in the middle of the night or the early hours of the morning. The hon. Gentleman mentioned how the police would operate. Clearly, the police would deal with matters of a suspected criminal nature. We consider that a ''reasonable time'' would be an appropriate time—such as working hours—to allow the Assembly to access records so that it could carry out a proper and thorough investigation. That would allow the Assembly to ensure that all complaints or failures of delivery were properly assessed and that the appropriate action is taken.

We covered some of these points in our debates on the Health (Wales) Act 2003, where we gave community health councils in Wales rights of access to obtain documents and information, and gave patient forums in England the same rights regarding complaints about the running of the health service there. It is entirely consistent with the proper discharge of the duties of a body charged with responsibility for inspection and assessment to have rights of entry and access to the necessary documents so that it can produce reports and conclusions.

Question put and agreed to.

Clause 68 ordered to stand part of the Bill.

Clause 69 - Right of entry: supplementary

Clause 91 - Reviews and investigations

Don Touhig (Labour/Co-operative, Islwyn)

I beg to move amendment No. 449, in

clause 91, page 35, line 38, at end insert—

'( ) The Assembly may by regulations require a local authority in Wales to pay a fee to the Assembly in respect of the exercise of the Assembly's function under this section in relation to the functions referred to in section 43(3)(a) and (b) of the Care Standards Act 2000 (adoption and fostering functions).

( ) A fee under this section shall be of such amount, and shall be payable at such a time, as may be specified in the regulations.

( ) A fee payable by virtue of this section may, without prejudice to any method of recovery, be recovered summarily as a civil debt.'.

The clause provides the Assembly with the power to make regulations specifying an annual fee payable to it by local authorities for its reviews and investigations into local authority adoption and fostering services. It is important that the Assembly can raise revenue through fees in those circumstances to ensure that there is a level playing field between adoption and fostering services provided by local authorities and those provided independently. Independent services are liable to pay fees under the Care Standards Act 2000.

Amendment agreed to.

Clause 91, as amended, ordered to stand part of the Bill.

Clause 92 - Studies as to economy, efficiency etc.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

Clause 92(1), like most of the provisions, is enabling in that it uses the word ''may''. It states that the Assembly ''may promote'', not that it should or must do so. However, clause 92(3) states:

''The Assembly must publish or otherwise make available—

(a) any recommendations made by it under subsection (1); and

(b) a report on the result of any studies under this section.''

I am not against the Bill's placing a duty on the Assembly to publish those reports; I simply wonder why clause 92(3) is so singular. It instructs the Assembly to act, whereas every other clause, by using words such as ''may'', gives the Assembly the option of acting. Why should clause 92(3) place a duty on the Assembly when none of the other clauses do?

Don Touhig (Labour/Co-operative, Islwyn)

Clause 92 replicates for the Assembly the powers that sections 33 and 34 of the Audit Commission Act 1998 confer on the Audit Commission for local authority social services. It also mirrors the provision sought for England under clause 78. That means that the Assembly will be able to carry out studies that will allow it to make recommendations for improving economy, efficiency and effectiveness in the provision of local authority social services.

Those provisions do not detract in any way from the Audit Commission's powers. It will retain powers that will enable it to carry out studies of local authority social services. The Social Services Inspectorate for Wales and the Audit Commission will continue to co-operate in carrying out joint reviews of local authority social services in Wales and in bringing together professional services, inspection and audit expertise. Where the primary focus is on social services, it is intended that the Assembly will conduct the study, calling on the assistance and expertise of the Audit Commission as necessary. Where the primary focus is on general local authority services or on services other than social services, the Audit Commission will take the lead in the study, calling on the assistance of the Assembly as required.

To respond to the point made by my hon. Friend the Member for Cardiff, Central, once the Assembly decides to undertake a study, it is under a duty to publish the results. The word ''must'' appears because that is a requirement.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I am satisfied with the Minister's explanation. Clause 90 states:

''Where the Assembly conducts a review under this section it must publish such report as it considers appropriate.''

Clause 91 uses almost the same words, and such wording appears frequently in the Bill, but it does not make a great deal of sense to me to say that a body ''must'' conduct a review and ''must'' publish, and then add the words ''as appropriate'' at the end. The Bill may as well say ''may'' publish, because if the body can decide what is appropriate, what is the point of using the word ''must''?

Don Touhig (Labour/Co-operative, Islwyn)

I hope that my hon. Friend will accept that when the Assembly undertakes a study, it has a duty to publish the results of that study as a report. That requirement exists now, and my hon. Friend is aware of the way that those studies are scrutinised by colleagues in the Assembly. The provision reinforces the fact that a duty is placed on the Assembly to publish a report when it undertakes a study.

Question put and agreed to.

Clause 92 ordered to stand part of the Bill.

Clauses 93 to 95 ordered to stand part of the Bill.

Clause 96 - Right of entry: supplementary

Clause 110 - Complaints about health care: Welsh bodies

Paul Burstow (Liberal Democrat, Sutton and Cheam)

I have concerns about how the powers provided under the clause enabling the Assembly to make regulations will work in practice. How does the clause address the issue of duplications that may occur in the system? That concern applies equally to the practice of dealing with complaints in NHS bodies in England and in Wales. In debating some of the recent clauses, we did not consider in any way, shape or form the provisions dealing with complaints in respect of English NHS bodies, but in respect of Wales I want to tease out from the Minister how the powers might be used and whether they would be allowed to be used in a certain way.

I will use the example of a Welsh NHS acute trust that carries out a poor assessment, resulting in the early discharge of a patient to intermediate care provided by a primary care trust in Wales. That primary care trust then fails to pick up the fact that the patient has been prematurely discharged, and as a result it fails to take the necessary steps for a readmission to the acute trust. In those circumstances, is it reasonable to expect the patient, when complaining about the nature of the treatment that they have experienced, to navigate their way round the system and to decide whether it is the acute trust or the primary care trust—or indeed both bodies—to which they should make a complaint? They might find themselves having to deal with several different complaint processes about different aspects of one ongoing patient journey.

Do the powers in clause 110 provide for regulations to be made by the Welsh Assembly that would require NHS bodies to co-operate in dealing with patient complaints? That applies particularly in terms of sharing information between NHS bodies, or nominating one or other of the NHS bodies dealing with the complaint to act as the lead body for giving a comprehensive response to the complainant. Where issues of negligence come into play, NHS bodies, whether primary care trusts, acute trusts or other bodies, are suddenly more reluctant to share information. They may have an interest in ensuring that they do not end up with the responsibility of dealing with the consequences of a successful negligence claim.

I was anxious to take the opportunity to take up those issues with the Minister under clause 110. It seems to me that they are not entirely addressed within the regulation-making powers. It would be most helpful if the Minister could give me some reassurance on the matter.

Don Touhig (Labour/Co-operative, Islwyn)

Section 20 of the National Health Service Reform and Health Care Professions Act 2002 places a statutory duty on health care providers and on

local authorities to develop well-being strategies. That partly covers the point that the hon. Gentleman made about discharge—the problems of discharge have already been covered in previous legislation. The Health (Wales) Act also gave strengthened powers to community health councils. In England those powers were given to patient forums so that they could act as advocates for a person who had a complaint about his treatment.

The provisions in the Bill will allow us to implement a robust complaints process that reflects the needs and concerns of Welsh patients, and we must ensure that they have confidence in the procedure. The clause gives the Assembly regulation-making powers covering the NHS complaints procedure, but replaces the present direction-making powers. That would ensure that we have a health care complaints system in Wales that could be tailored to the needs and concerns of Welsh patients. The handling of the second stage of the complaints procedure will be different in Wales. In England, it will be carried out by CHAI; in Wales, trained lay people appointed by the Assembly will carry it out. The provisions in the Bill allow for cross-border situations and links in social services to be dealt with. I hope that that helps the hon. Gentleman.

Paul Burstow (Liberal Democrat, Sutton and Cheam)

That is helpful. I appreciate that there are some differences between arrangements in England and Wales. I take from that that it would be possible for regulations to be made by the Assembly to allow for greater co-operation and to place a requirement on NHS bodies in Wales to co-operate when dealing with complaints, so that the patient does not have to go through numerous NHS bodies.

Don Touhig (Labour/Co-operative, Islwyn)

Much of that is covered in the Health (Wales) Act, in which we strengthen the advocacy role of community health councils to ensure that a patient's voice can be heard and complaints in Wales are properly investigated.

Question put and agreed to.

Clause 110 ordered to stand part of the Bill.

Clauses 112, 129, 130 and 131 ordered to stand part of the Bill.

Clause 132 - Co-operation between Assembly and CHAI

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

I welcome the clause. We must ensure that there is co-operation between the Assembly and CHAI. However, will the Under-Secretary explain why the wording is so woolly? Clause 132(1) states that

''The Assembly and the CHAI must co-operate with each other where it seems to them appropriate to do so.''

The words

''where it seems to them appropriate to do so''

are excessively woolly and allow either the Assembly or CHAI to avoid co-operation for any reason whatever. Although I cannot imagine why CHAI would want to avoid co-operation, the wording should be stronger. Would the words ''the Assembly and the CHAI must co-operate with each other where it is appropriate to do so'' not be better? I would like the Government to consider whether the provision can be tightened.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I will add a few more comments to those already made about clause 132, because my hon. Friend the Member for Sutton and Cheam, the hon. Member for Cardiff, Central and others spoke about unnecessary duplication if there was not co-operation.

I want the Under-Secretary to clarify another point in relation to clause 132(1). If the Assembly feels it appropriate that CHAI and the Assembly co-operate, but for whatever reason CHAI does not, does that mean that there need not be any co-operation? Does the wording

''The Assembly and the CHAI must co-operate with each other where it seems to them appropriate to do so''

apply to both of them, allowing one or the other to have a veto on the duty to co-operate, if it seems to one of them not to be ''appropriate to do so''?

Can the Under-Secretary, from his knowledge of other clauses, clarify whether, among the many direction-making powers that the Secretary of State has over the whimsically entitled independent inspectorate that is CHAI, it is possible to impose a direction on CHAI to co-operate for the furtherance of Government policy? Can that be done by means of other directions from the Secretary of State under the wide direction-making powers that he has been given in other clauses?

Don Touhig (Labour/Co-operative, Islwyn)

Amendment No. 331 extends the duties of the Assembly and CHAI to co-operate with each other, where it seems to both of them to be appropriate for the efficient and effective discharge of any of the Assembly's functions under the Care Standards Act 2000. It is a small but important amendment, which seeks to extend the circumstances in which the Assembly and CHAI can agree to work together from private and voluntary health care to other services covered by that Act. That will increase the overall efficiency and effectiveness of the regulatory arrangements. I recall from Hansard that my hon. Friend the Member for Cardiff, Central made that point on 5 June 2003.

It is important to put in place effective mechanisms to ensure that CHAI and the Assembly, through HIUW, co-operate fully in the best interests of monitoring and assessing the performance and quality of health care provision. Amendment No. 331 seeks to strengthen that, and I hope that colleagues will welcome and support it, because it is going in the right direction.

Gary Streeter (Conservative, South West Devon)

Coming down to specifics, I should like to consider the case of a hospital that feels that it is being over-investigated, with too many inspections being carried out by both bodies, perhaps in the course of the same financial year. If a hospital trust, whether foundation or otherwise, were to approach the Under-

Secretary and say that the procedure was too expensive and time-consuming and that it seemed to be getting out of hand, would the Under-Secretary be prepared to intervene and ask CHAI and the Assembly to co-ordinate and co-operate more fully?

Don Touhig (Labour/Co-operative, Islwyn)

That would not fall within my remit; it would be a matter for my colleagues, the Secretary of State for Health in England and the Minister for Health and Social Services in Wales.

We talked earlier about seeking to avoid the unnecessary duplication of a body being inspected by both CHAI and the Assembly. They will have to work closely to ensure that that does not happen, but I do not believe that it will. Those two bodies will develop, and they will collaborate and co-operate together to set their standards and working practices. There is no way, therefore, in my view, that both would inspect one hospital trust one week after another. That would not make sense, and it would be wholly irresponsible and a waste of public funds.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

I am a little confused about the procedure, because I thought that we had just voted on amendment No. 331 and that we were debating clause stand part. The hon. Member for Cardiff, Central asked about clause 132(1), rather than clause 132(2)(d), which amendment No. 331 amends, in relation to the Care Standards Act. The Under-Secretary in his reply may have been reading from the section introducing the amendment that we have just voted on. I apologise if I have got that wrong.

Certainly, however, the Under-Secretary did not address one of my questions, which was whether the Secretary of State had direction-making powers with regard to CHAI's co-operation with the Assembly, where there is disagreement between the two bodies on whether it is efficient to co-operate.

Jon Owen Jones (Labour/Co-operative, Cardiff Central)

Further to that point, I was not raising questions about amendment No. 331, which I thought had already been agreed to, but about whether the clause stand part of the Bill.

Peter Atkinson (Conservative, Hexham)

We are indeed on clause stand part.

Don Touhig (Labour/Co-operative, Islwyn)

I accept that, Mr. Atkinson. I was seeking to explain why the amendment enhanced what we were seeking to do about co-operation through clause 132. I am not clear about the point that the hon. Member for Oxford West and Abingdon (Dr. Harris) made about the powers of Ministers to direct CHAI, but I will investigate it further and write to him and the Committee to clarify it.

Evan Harris (Liberal Democrat, Oxford West and Abingdon)

On the earlier point that I raised, the Assembly may want CHAI to do some of the inspection work in Wales, at least around the border, and would presumably offer some remuneration to CHAI for that work. I imagine that that is how it might work under contract. If CHAI does not like the price, it could say that it does not feel that it is appropriate for the efficient and effective discharge of its relevant function. Does this clause, therefore, provide CHAI with the ability to negotiate from a strong position of non-co-operation if it does not feel

that it is getting the right amount of remuneration or consideration from the Assembly?

Don Touhig (Labour/Co-operative, Islwyn)

I am not certain whether the hon. Gentleman was present when we debated the points about the ability of the Assembly to carry out investigations in Wales where it was appropriate. In those circumstances there would be discussions between the Assembly or HIUW, which would be responsible for the inspection, and CHAI about fees, and an agreement would be reached to the benefit of both sides. Ultimately, we seek to have the best possible quality of inspection and audit in order to drive up standards in the health service.

Question put and agreed to.

Clause 132, as amended, ordered to stand part of the Bill.

New Clause 1 - Duty to have regard to

New Clause 2 - Arrangements with the Isle of Man

David Lammy (Labour, Tottenham)

I beg to move, That the clause be read a Second time.

Peter Atkinson (Conservative, Hexham)

With this it will be convenient to take Government new clause 3.

David Lammy (Labour, Tottenham)

The Governments of the Isle of Man, Jersey and Guernsey have specifically requested that these new clauses be included in the Bill. It is consistent and desirable that the ability to advise and assist should extend to Governments in the Isle of Man, Jersey and Guernsey, and these amendments make that provision.

Simon Burns (Conservative, West Chelmsford)

What happens with regard to Alderney and Sark?

David Lammy (Labour, Tottenham)

I will seek advice on that and get back to the hon. Gentleman, if I may.

These clauses are a response to requests by the Isle of Man, Jersey and Guernsey to allow a procedural

position to be prepared and approved in time for introduction. It is right that we should be able to help our colleagues across the water, should they so wish, and these provisions make that allowance.

Question put and agreed to.

Clause read a Second time, and added to the Bill.

New Clause 3 - Arrangements with the Isle of Man

New Clause 5 - Provision of material

New Clause 6 - Boarding schools and colleges: reports

New Clause 12 - CHAI fees: Wales

New Clause 13 - Duty to have regard to

New Clause 14 - Criteria

New Clause 15 - Failure in discharge of functions: CHAI

Standing Committee E

Clause 167 - Replacement of the Welfare Food Schemes

Patsy Calton (Liberal Democrat, Cheadle)

I beg to move amendment No. 597, in

clause 167, page 84, line 19, leave out

'food of a prescribed description'

and insert

'milk or appropriate alternative and other foods of a beneficial nature.'.

Win Griffiths (Labour, Bridgend)

With this it will be convenient to discuss the following amendments: No. 596, in

clause 167, page 84, line 42, after 'scheme', insert

'must include provision for a benefit to consist of a minimum of one pint of milk per day or the equivalent of formula milk, or the financial equivalent made available through a voucher system, or similar arrangements, and'.

No. 600, in

clause 167, page 85, line 10, at end insert

'to include the provision of 7 pints of whole or semi skimmed milk or appropriate alternative per week to beneficiaries and the provision of a third of a pint of whole or semi skimmed milk or appropriate alternative a day to children under 8 years of age in day or nursing care'.

Patsy Calton (Liberal Democrat, Cheadle)

In tabling the amendment I have more than one purpose. First, my aim is to explore the meaning of the phrase ''food of a prescribed description''. Secondly, I seek to ensure that the value of milk as a food is not downgraded, although I recognise that substitutes may well be necessary and that additional foods are, as healthy start showed, obviously desirable, if not essential.

The historic aim behind the welfare food scheme was to provide a universal benefit that would protect expectant and nursing mothers and their children from food shortages and escalating food costs. It was an important protection for mothers and their children. Over the years, the reasoning behind the scheme has gradually been eroded. However, I should like to hear some recognition from the Minister that there is a group of mothers and children that nevertheless still requires support beyond benefits that are already available.

The aims behind healthy start are laudable. However, I have a difference with the Government over the means to achieve those aims. I am concerned that the values of the scheme as it is currently constituted may not be completely maintained. Amendment No. 598 would remove the proposed new section 13(4) of the Social Security Act 1988 and I will explore some aspects of that, although I shall leave

my comments about that until we debate that amendment.

The Liberal Democrats support the wish to produce a shift to breastfeeding of infants. There is no argument about that: every study by medical and health professionals has shown that breastfeeding is best for babies and their mothers, wherever it is possible. However, although the aims are, as I said, laudable, the means by which the Government intend to effect the shift to breastfeeding will be somewhat problematic. I should like the Minister to examine what the effect of removing formula milk from clinics will be, for example. I completely agree with that proposal. As a prospective mother many years ago, I was absolutely appalled at the way in which we were almost pushed down a sausage tube towards taking up formula milk instead of breastfeeding our children. I remember a film that we were shown that depicted examples of women breastfeeding in just about every place in which it would be embarrassing or difficult for some women to do so. In the end we found out that a certain formula milk distributor made that film. I was very annoyed at the time that women were, in a way, being coerced into taking up formula milk.

However, there will be some difficulties. I understand that the voucher will buy only a third or half a tin in a supermarket. Several groups have expressed concerns about the value of the voucher and what it will enable people to buy. The Maternity Alliance has voiced its total support for the proposal to increase the value of the vouchers for those up to the age of six months. It would be unfair if healthy start effectively cut the amount of support. That argument might also apply to babies in the six to 12-month age group. At all stages, there should be a rounding up to at least the cost of formula milk. The Royal College of Paediatrics and Child Health said that the value of the vouchers would need to be considerably higher than the value of seven pints of milk in the first year of life to allow the purchase of sufficient formula milk for those children who had never been—or were no longer—breast-fed. The Royal College of Midwives said that the Department of Health should ensure that

''the new scheme does not create a potential risk to the health of those infants whose mothers, for whatever reasons, are unable to breast-feed.''

The Community Practitioners' and Health Visitors' Association recommended that the minimum face value of vouchers should be the equivalent of the cost of a 900 g tin of formula milk, not 7 pints of liquid milk. All of those organisations are concerned about the value of the vouchers, and what they will buy. Liberal Democrats support that view. The hon. Member for West Chelmsford (Mr. Burns) will pick up on the point about the value of the vouchers in his contribution on amendment No. 596.

A major concern is that we may well encourage use of cow's milk too early, before 12 months. Access in rural areas to formula milk may well be a problem. There are better ways of encouraging breastfeeding than the methods that the Government seek to introduce. There must be support for women. I recently visited a group in the north of Manchester

which had carried out a pilot study in which women were encouraged before they gave birth, with support from specialist breastfeeding advisers, to breastfeed. The rates of uptake and continuance of breastfeeding was considerably higher in that group of women than the norm. That is better than effectively making it difficult for women to obtain formula milk.

Steve Pound (Labour, Ealing North)

Like everyone else, I have followed the hon. Lady's arguments with great interest. Is she not being overly prescriptive? Things change. When I was born, my mother was prescribed a bottle of Guinness a day, or two bottles of Mackeson milk stout. I was weaned on those substances, which may explain a great deal.

Surely the Bill already provides the flexibility for changes in dietary and medical analysis to be incorporated, whereas the amendments that she proposes are extraordinarily prescriptive, and almost reminiscent of the Stalinist health service of the USSR.

Patsy Calton (Liberal Democrat, Cheadle)

I have the greatest respect for the prowess with which the hon. Gentleman approaches his task. However, if he reads amendment No. 597 carefully, he will see that it is rather wide-ranging. It mentions milk or an appropriate alternative, and other foods of a beneficial nature. I will return to the matter of an appropriate alternative. No one is suggesting that one should force children or their mothers to drink milk stout. I remember that I was advised to drink a pint of Guinness each night, and I wondered why I had a colicky baby for the whole of the first year. It dawned on me after I had my second child that the Guinness might be the problem. I thank the hon. Gentleman for his intervention, but I do not intend to be prescriptive.

I am sure that the Under-Secretary will agree that it is important that mothers should receive support in breastfeeding. I am sure that she is aware of the pilot studies and will mention them later. Undoubtedly, she would want to be an adjunct to the sort of advice that was given to mothers. There are ways and means of doing that, and what I want to say on that is best dealt with under amendment No. 598. Early education has been missed out, and that is one of the problems that occurs because Departments are still acting in the sort of silos that we have complained about in local government, but which we have not yet got away from in central Government. Young people should receive education while they are still at school about their own future diets and those of infants. That would be a much better method than those about which I shall speak later.

There needs, also, to be a change in society's attitude to breastfeeding, not least in this place, which finds it extremely difficult to accept that women might need to work and breastfeed. This place should provide a lead in viewing breastfeeding as being a normal part of life.

Win Griffiths (Labour, Bridgend)

Order. I have allowed the debate to be fairly wide ranging, but I do not think that arrangements for breastfeeding, in this place of work or any other, form part of the amendment.

Patsy Calton (Liberal Democrat, Cheadle)

I do, of course, apologise, and will restrict myself to the importance of milk in the diet. In tabling the amendment, my intention was to ensure that we do not lose sight of the importance of milk in the diet of expectant or nursing mothers or of their young children. Most of us are aware that milk is important for dental health. It provides a range of nutrients, especially B vitamins, and, in whole milk, vitamin A, and calcium—it is the largest source of calcium in the diet—zinc and magnesium. It is needed for bone development as well. It would be a great pity if milk were effectively lost, as it could be in the Bill as drafted.

There is an indication that alternatives to milk, such as fizzy drinks, are linked to obesity and dental cavities. My reference in the amendment to appropriate alternatives recognises the fact that the biggest single set of allergies in young children is milk allergies. As the responses to the healthy start consultation paper show, there would be a need for soya milk and other substitutes where milk was not an appropriate food. It is not necessarily a reference to formula milk. I hope that the Under-Secretary will answer all our points and will explain how the new system can possibly meet all the aims of the Department of Health within the current budget.

Simon Burns (Conservative, West Chelmsford)

Mr. Griffiths, you will be aware that the clause will replace the existing welfare food schemes. I suspect that Ministers will seek to justify that by saying that they need to upgrade the schemes because the current arrangement provides low-income families with small children with a voucher that can be redeemed or exchanged for seven pints of whole or semi-skimmed milk a week, and provides for all children below five years of age at nursery school to have a third of a pint of milk per day. Few would disagree with that. I am not sure, so I shall be interested in the Minister's explanation, why the Government want to change the existing scheme. Is it simply because they believe that, because of the changes in society, the scheme is outdated, and they want to offer either milk or a piece of fruit, for example? If that is the answer, I am a little worried about it because the aim is to benefit children's nutrition and an apple has no calcium.

I suspect that many responses to the Government's consultation process stress the importance of milk. Any changes should be based on sound evidence that they will maintain the highest standards of health for the children who benefit from the scheme. The amendment would minimise any problems that may arise in that respect by stating that the scheme must provide

''a minimum of one pint of milk per day or the equivalent of formula milk''—

the Minister will understand the significance of the proposal because of the difference in price, and the impact that it would have on low-income families—

''or the financial equivalent made available through a voucher system''.

We opted for a voucher system because if the Government were to make money available for the

parent to provide milk or food, sadly, in certain families that money would not be spent as the Government intended. It would be whittled away by expenditure on a variety of other, less wholesome foods for children—not even on nutritious foods for other members of the family—or possibly other things. The argument would always be that there were pressures on the family budget and that they had to use the money in a way that the Government did not intend.

Steve McCabe (Labour, Birmingham, Hall Green)

I agree with the hon. Gentleman's last remarks, but is not the problem in giving vouchers rather than money that vouchers can be traded on the black market and have additional production and administration costs? Direct provision is a more obvious solution to the problem.

Simon Burns (Conservative, West Chelmsford)

There are ways round the problem. A voucher could state that it could be exchanged only for goods such as milk or formula milk to minimise the possibility of abuse and prevent vouchers becoming a currency to be used for alcohol, tobacco or other household goods. I hope that the Minister will seriously consider the thoughts and the motivation behind the amendments, even if she does not accept them. Milk is probably the most important thing for young children, although I can understand her desire to encourage more members of the population to have a healthy diet and eat fruit and vegetables.

I question whether the Government should detract from a system that has, first, worked, and, secondly, been accepted as being highly beneficial to young children for many decades. If the Minister is determined to update the system, I remind her that the nutritional value of milk and milk equivalents is superior in most cases to that of other food. The system should not be open to the sort of abuse by parents that means that children do not benefit from it, however good the Government's intentions.

Andrew Lansley (Conservative, South Cambridgeshire)

I should declare an interest in that my wife is breastfeeding at the moment—well, I do not know about this exact moment. As we know, that would be out of order, so she could not be with us today. I am not aware that we benefit from the scheme.

Simon Burns (Conservative, West Chelmsford)

Not on my hon. Friend's salary.

Andrew Lansley (Conservative, South Cambridgeshire)

No. One could be a beneficiary of the scheme at the time of nursery care, but that is some way off. There is a universal element to the scheme. I also declare a constituency interest, in that the Dunn human nutrition unit is in my constituency.

I have a number of questions for the Minister. I am a little confused about the manner in which the Government have interpreted what I understood to be the original advice from the Committee on Medical Aspects of Food and Nutrition Policy's panel on child and maternal nutrition. There seems to be a discontinuity between the two things. That may be because the Government felt that, in the consultation, compelling reasons arose for why they should shift from what the scientific evidence suggested. However, I may have misunderstood what the Government

propose or the connection between those things, so let me run through them.

In some cases, I understand the nature of what is proposed and the connection. For example, the committee was clear about the fact that there is no material incentive for breastfeeding in the scheme's structure. I understand about shifting, in so far as and when it is appropriate to do so, from the provision of formula milk and milk for mothers. Milk for mothers, as I think the committee suggested, has limited value for the mother. I am referring to shifting at the appropriate point—that is probably somewhere between four and six months, but let us say for the sake of argument that it is six months—so that breastfeeding mothers have a material incentive to continue breastfeeding and there is no disincentive. I suppose the point is that there is no disincentive in the sense that they are missing out on the availability of resources to support a proper diet for their child, because they could have other, complementary foods alongside breastfeeding to the value of the voucher. I understand that, and to that extent I accept it.

However, the timing perplexes me, because unless I have missed something, the ''Healthy Start'' document suggests that the Government propose that, between birth and six months, there should be a shift from the provision of formula milk and milk to the mother—the current system—to a fixed face-value voucher. As far as I can see from returning to the scientific conclusions, that is not what the committee was looking for. It was looking for the provision between nought and six months of an incentive to breastfeed for breastfeeding mothers, and the continuation of the provision of formula milk for mothers who were not breastfeeding.

It did not seem appropriate to me to think in terms of complementary foods until the point at which one was introducing complementary foods into the diet. On that subject, the committee said that complementary foods should be introduced no later than six months of age and not before four months, which is why I referred to between four and six months. As I said, for the sake of argument let us talk about six months. I simply do not understand why the Government propose the fixed-value voucher for all mothers. Surely the design of the scheme that flowed from the recommendations from the scientific evidence would be simply to distinguish between mothers who were breastfeeding and mothers who were not breastfeeding up to the age of six months. For mothers who were breastfeeding, a voucher would be available for complementary foods to support the mother's diet at least as much as the baby's diet. Obviously, that would have some benefit after four months; they could be used in that respect. There would be the provision of infant formula for mothers who were not breastfeeding up to the age of six months. I cannot see why one would go in any other direction.

After six months, I am not quite sure I understand why the Government have constructed a voucher that deals with liquid cow's milk. According to the scientific evidence UK-based control trials have demonstrated that providing infant formula rather

than cow's milk beyond the first birthday significantly reduces the prevalence of iron deficiency anaemia. There is a reference to the desirability of infant formula for children aged up to one year. The evidence states that the current scheme allows a mother to choose between liquid cow's milk and infant formula regardless of her infant's age. Early introduction of liquid cow's milk is associated with low socio-economic status, and the scheme could be adapted to discourage this practice and thereby reduce the risk of subsequent iron and vitamin D deficiency.

The implication of the scientific evidence is that up to a year, in addition to infant formula, the introduction of complementary foods from some time up to four months should be encouraged through the use of the voucher alongside the incentive to breastfeeding mothers, but without the option of simply transferring to liquid cow's milk. I am not sure why the Government have gone down their chosen path.

The third issue is the introduction of vitamin supplements. The committee recommended that the composition of vitamin supplements should be reviewed. The evidence recommended for pregnant women:

''A supplement providing vitamins D, C and folic acid but omitting vitamin A''.

At a later stage, although it is not in the package of amendments to the scheme, it recommended that

''Consideration should be given to extending the provision of free vitamin supplements to groups who are not beneficiaries of the current Scheme, particularly children from ethnic minority groups.''

I have not seen that in the healthy start document. I would be happy to know if the Minister thinks that that has been covered.

The evidence also suggested that the current regime for nought to six months should be extended up to a year for low birth weight babies:

''Low birth weight babies are at increased risk of iron deficiency. Extended provision of infant formula rather than cow's milk is therefore particularly important for this group. As infants are entitled to formula only for the first year after birth, those born very early . . . may receive liquid milk before they attain a corrected age of 1 year post term. Given that a significant proportion of children are born in the UK with low birth weight the Scheme should extend the provision of formula to those babies at the very minimum to 1 year from the expected date of confinement.''

I want to be sure that that is the Government's intention. Although I can see a reference to infant formula for babies aged up to 12 months, if I judge correctly, for the measure to work properly, the value of the voucher would have to be sufficient to meet all the formula needs of a baby of low birth weight up to the corrected term of a year after the predicted date of delivery. That is what the scheme should provide for, which is more than the Government are proposing.

More questions may arise, and I may refer to them later, but the package recommended by the committee does not seem to be the package in the Government's consultation document, which is the basis for the debate on the Bill. There are gaps, and differences between the two. I am interested in finding out why

those gaps have emerged and whether the provisions are going to be more reflective of the scientific evidence on which the Government based their proposals.

Win Griffiths (Labour, Bridgend)

Could I say before I call the Minister that I have been quite liberal here today? That was more of a stand part speech, but as I have two grandchildren of the qualifying ages, I thought that I would let hon. Members carry on. I warn the Committee that we shall not have a clause stand part debate. If the hon. Gentleman wants to make any further points, he should do so in brief interventions.

Hazel Blears (Labour, Salford)

I am delighted that the debate is turning into a family-friendly and warm exchange of views, and I shall try to provide as much information as I can about the healthy start proposals.

I hope that all hon. Members have seen the healthy start consultation document, which sets out the proposals for registration, the scientific basis for the scheme and how we expect the scheme to operate. I hope hon. Members have also had access to the response to the consultation document, which has been published. It contains interesting information, which has been provided by members of the public, health professionals and people who have been involved with the practical details of how the scheme might operate. I also have copies of an extract from section 13 of the Social Security Act 1988. I am told that it is occasionally the convention to provide hon. Members with previous legislation, and I have enough copies of section 13 for all hon. Members, should they be interested in seeing how the scheme operated before. I can make those available if that would be helpful.

The proposals to reform the welfare food scheme are based on evidence from the scientific review by COMA—the Committee on Medical Aspects of Food and Nutrition Policy—to which the hon. Member for South Cambridgeshire referred. The review assessed the scheme's effectiveness in 1999 in the first review of its kind since the scheme's inception in 1940. The scheme has been incredibly long lasting and was originally introduced in wartime, when the nation was concerned to ensure that pregnant mums and young children had access to a reasonable and healthy diet at a time of rationing and great food shortages. At that time, it was a universal benefit. Over the years, however, it has gradually come to be targeted at people on low incomes who receive social security benefits, and that is how it operates now.

The COMA review concluded that the current scheme, which relies entirely on milk, does not meet the wider nutritional needs of pregnant women, mothers and young children from low-income families who would benefit from a wider range of foods. The scheme currently provides just milk and formula. There is no degree of choice and no wider selection of foods. The hon. Member for South Cambridgeshire referred to the way in which the consultation document's proposals vary from COMA's recommendations. Although the proposals follow COMA's recommendations, they do not seek to

implement them in every respect. The COMA review provided a nutritional and scientific assessment of the scheme, from which we have taken the proposals set out in the consultation document.

In view of COMA's evidence, we have set out proposals to broaden the basis of the scheme by including fruit, vegetables, cereal-based foods and other foods suitable for weaning.

George Young (Conservative, North West Hampshire)

Reading the Social Security Act 1988 has refreshed me. The Minister was right that subsection (1) defines welfare food as liquid cow's milk and dried milk, but subsection (2) states:

''The Secretary of State may by order add any foods''.

Why can she not use such an order to do what she is doing in the Bill?

Hazel Blears (Labour, Salford)

In the Bill we are seeking to go wider than simply adding foods to the existing scheme. We raised two other important issues in the consultation document. We are not only widening the range of foods but introducing a fixed value voucher to give people an element of choice in the system. We are also linking the entitlement and the take-up of the foods and benefits to the registration process. That is an important element of the new scheme, because we are seeking to ensure that pregnant mums have access to good nutritional and health advice. Low-income families often do not have access to the same antenatal and nutritional advice as people from better-off families. Variety in the range of foods is a key element of the scheme, but the other two issues are equally important.

Simon Burns (Conservative, West Chelmsford)

Will the Minister say a little more about the fixed value voucher? I can understand that one could try to stop abuse by asking people to specify what the voucher had been spent on, but presumably—the Minister may correct me—it will be for X amount of money to spend on Y products. Given that the cost of the individual product will vary, how does one come up with a realistic fixed price voucher?

Hazel Blears (Labour, Salford)

That is an important issue. Costs vary between rural areas to urban areas and areas where people do not have access to transport and have to use local shops, although many local shops tell me that their prices are competitive with those in other areas. The same point applies to all benefits. Benefits with a specific monetary value will buy different amounts of daily essentials, depending on where people live. Therefore, this is not a new issue for the fixed rate voucher scheme: it applies across the benefit entitlement system—and across wages, too.

Simon Burns (Conservative, West Chelmsford)

But surely if someone is currently receiving a quantity of milk, in a way it does not matter what the milk costs, because they are getting the milk, not X pence to buy it. If one shifts from the product to an amount, will there not be a problem because of the fixed price? If they can spend the voucher on a range of products, the different cost of each product will be a problem. What will happen in three, four or five years' time if the products have increased significantly in price? Will the Minister come back to the House and make another order to update

the voucher? How does the voucher keep pace with inflation?

Hazel Blears (Labour, Salford)

I shall try to deal with all those issues.

The scheme is about getting the balance right between choice and prescription. At present the scheme is hugely prescriptive, as my hon. Friend the Member for Ealing, North (Mr. Pound) has highlighted, and simply applies to milk and formula. Based on scientific evidence and the consultation responses that we have received, we are genuinely attempting to introduce an element of choice. The beneficiaries of the scheme welcome the opportunity to have access to a wider range of food, including fruit, vegetables and cereals. Indeed, we expect the range of food to vary when we take into account further scientific and nutritional advice that is provided to us. The scheme has not changed for more than 60 years, but we believe that it will have to be more flexible in future. That is why we want to be able to make regulations that will provide for future variations to the scheme.

Patsy Calton (Liberal Democrat, Cheadle)

I applaud the desire to increase the flexibility of the scheme. I have no problem with that—most commentators argue that milk and fruit and vegetables are important. What concerns me and many others is that if there is a fixed amount of money to go round and bureaucratic arrangements for individual schemes are set up in different parts of the country—possibly in pilots and so on—is there not a real possibility that some mothers and children on low incomes will not benefit? The direct provision of foods may be done on an area basis, and poor mothers in areas that are generally regarded as better off may not get anything.

Hazel Blears (Labour, Salford)

I am not sure what the hon. Lady's point is.

I shall deal with the important issue of updating the scheme. We envisage that we will need a mechanism, such as increasing the value of the voucher by the rate of inflation, which allows us regularly to take into account the scientific advice that we have received when we want to add different foods to the scheme. That would ensure that the value of the voucher was maintained for families who receive it.

Patsy Calton (Liberal Democrat, Cheadle)

I am sorry if I did not explain my point well. My concern is that the Government are planning a series of schemes that add up to no more than the current provision. If the Minister can tell me that more flexibility and money will be available and that we are talking about adding on to what we have at present, I might go away satisfied. However, I am concerned that some places will just get the basic entitlement and that not everyone will be entitled to the extra.

Hazel Blears (Labour, Salford)

I understand the hon. Lady's point. The scheme costs about £142 million and, as we said in the NHS plan, we want to ensure that we spend the money more effectively and on ensuring that we get more nutritional value out of it. We are not in the business of enlarging the scheme in monetary terms, but I believe that we can get better value out of the money that we spend.

The hon. Lady's amendment would ring-fence the support for milk. I emphasise that both liquid milk and infant formula will continue to be provided as important components in the scheme. We do not intend to displace milk from the scheme or undermine its nutritional value. It is well established that milk has an excellent nutritional value for young children, but it is time to inject greater nutritional choice into the scheme and update it to ensure that it continues to meet the needs of the beneficiaries. Milk is provided in nurseries and day care, and one proposal is perhaps to provide the choice of milk and/or fruit. However, milk will continue to be an essential part of the scheme. I have met representatives of the dairy industry on several occasions and have emphasised to them how important I feel milk is to the young children's nutrition. It will be retained while we introduce the measure of choice.

The amendments would retain the status quo and mean that vouchers would be ring-fenced for specific volumes of milk and infant formula, which is essentially the present system. That does not allow parents to exercise the choice that we want to introduce. If we were to keep such a scheme, it would militate against the hon. Lady's aim and our move to encourage more women both to breastfeed and to breastfeed for longer.

Andrew Lansley (Conservative, South Cambridgeshire)

Is the Under-Secretary not missing the hon. Lady's point, which others are also making, that with the exception of the present allowance of infant formula above the age of six months—which was clearly excessive for the nutritional requirements of six to 12-month-olds—the present scheme broadly provides what children need? If the Under-Secretary is talking about reducing the allocation of infant formula or cow's milk for young infants or older children and directing the resources into other choices of food, the amount of infant formula or milk consumed will be less than the nutritional requirements of those children.

Hazel Blears (Labour, Salford)

In reality, the hon. Gentleman and the hon. Lady are making a point about the value of the voucher and whether, if it were posited at the consultation document level of seven pints of milk, people would not be able to purchase formula and might therefore be inclined to use cow's milk instead. That would clearly be detrimental to those young children.

However, proposals from the consultation process have been strongly in favour of having a higher value voucher for young children in the early months of their life to enable us to provide support. We will consider that in preparing the regulations, which will also be subject to consultation. Some say that more support from the £142 million total should be provided at that early stage when young children are more in need of nutritional support.

Andrew Lansley (Conservative, South Cambridgeshire)

Let me give the Under-Secretary another example. The issue is not just about the value of the voucher. It is about its structure and

whether it is a token for a given amount of milk, plus complementary foods, which would be better. The committee said that liquid cow's milk should not be provided for infants under 12 months of age. However, the Under-Secretary is explicitly providing for a voucher that can be used to acquire cow's milk for children under 12 months of age. That does not flow from the scientific evidence. Why not stick to the nutritional requirements of children in relation to milk and provide complementary foods that would help to meet some of the other nutritional requirements?

Hazel Blears (Labour, Salford)

The voucher does not specify for whom the food is to be made available, mother or child. The mother may choose to have liquid milk to augment her own diet and to exercise the voucher choice in respect of the diet of the child. The whole purpose of the healthy start scheme is to augment the diet of low-income families, which includes mothers and their children. The hon. Gentleman should take that point on board.

The amendments tabled by the hon. Member for Cheadle would retain the status quo and would not enable us to get the incentive into the system to encourage more breastfeeding. In this country, 91 per cent. of women in social class I initiate breastfeeding and see that as the best possible start for their children. Yet just over half—54 per cent.—of women in social classes IV and V initiate breastfeeding and many of them discontinue it at an early stage. It is vital that we at least remove from the scheme the current disincentives to breastfeed.

Patsy Calton (Liberal Democrat, Cheadle)

The Under-Secretary mentions various percentages. She told us that in social class I the figure is 91 per cent. Many of us might have expected that. Can she suggest a reason why women in social class I breastfeed and others do not?

Hazel Blears (Labour, Salford)

Considerable research has been carried out and one of the most compelling reasons is that women from low-income families often do not have role models. Perhaps their friends, mothers or grandmothers did not breastfeed and therefore it is not something that they think that they can do. Many do not have a support network of friends, neighbours and family members who have had experience of breastfeeding. Often women will begin to breastfeed and then get into difficulties. Unless really good health advice and support is available to them—we have talked about bringing in peer-support workers, mums who have been through the process—they are likely to give up breastfeeding. There is a whole range of factors relating broadly to the environment in which women live.

When women have role models who are able to talk them through the process, breastfeeding rates go up enormously. I visited a sure start programme in north Kensington a few weeks ago. It had breastfeeding initiation rates of about 25 per cent. It now has a group of volunteer mums and a co-ordinator talking to and helping other mums and its breastfeeding rates have gone up from 25 per cent. to over 50 per cent.; they have doubled during the sure start programme. Those babies are getting a much better start in life and a much better nutritional foundation because the mothers have been helped to do that.

One of our major thrusts is to try to ensure that mums who breastfeed do not lose out, as currently they do because they do not get the same value from the scheme. Under the current scheme, mothers who choose to breastfeed receive a total of seven pints of liquid milk. Obviously, the retail value of that is substantially below that for infant formula. Infant formula is probably about £3 more expensive than the milk that such mothers currently get. A fixed voucher for all mothers would end the discrepancy and remove the disincentive. In the response to the consultation, there was strong support for putting extra resources in at an early stage of life. We will consider that as carefully as we can.

The hon. Member for West Chelmsford asked about having a voucher system, rather than cash. He wanted to ensure that there was no fraud in the system. I assure him that we intend to have a voucher system, together with strong counter-fraud measures because we are conscious of the need to ensure that the vouchers are not traded on the black market—as my hon. Friend the Member for Birmingham, Hall Green (Mr. McCabe) said—or used to purchase substances other than the intended kinds of food. The process will be rigorous.

For those reasons, I ask the Committee to reject the amendment. It would not take the scheme forward, but would entrench the status quo and militate against our proposals, which will introduce choice, widen the range of foods available to families on low incomes and enhance nutrition.

Simon Burns (Conservative, West Chelmsford)

I do not want to detain the Committee, except to say that I have listened to the Under-Secretary. Although I accept some of her arguments and do not want to force a vote division on the matter, I still think that amendment No. 596 would improve the situation with regard to milk and milk products. I shall therefore seek to divide the Committee on that amendment.

Patsy Calton (Liberal Democrat, Cheadle)

I had not intended to force a vote, but we must consider the point that the hon. Member for West Chelmsford has sought to establish, which is clearly in keeping with amendments Nos. 600 and 597, which try to establish that milk is important. If a vote takes place, we will support amendment No. 596.

The Under-Secretary has addressed some of my concerns but not all of them. We will return to the issue at a later stage because the overall costs of the scheme do not add up and we do not have any actual examples of schemes to give us an idea of their intended benefits. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Steve McCabe (Labour, Birmingham, Hall Green)

I beg to move amendment No. 601, in

clause 167, page 84, line 19, at end insert—

'(1A) Before establishing, or varying, a scheme an order made by the Secretary of State shall be laid before Parliament to implement any Regulations under section 13(1) and shall cease to have effect unless approved by an affirmative resolution of each House of Parliament.'.

Amendment No. 601 is tabled in my name and that of my hon. Friend the Member for Jarrow

(Mr. Hepburn). If it were accepted, it would achieve the opposite of my hon. Friend the Under-Secretary's intentions. Rather than giving her the flexibility and freedom to make changes as she sees fit, it would involve a cumbersome process in Parliament.

There has been lots of speculation about people's futures today, and I should make it clear that I do not intend to push the amendment to a vote. However, I want quickly to explain the reasons behind it, some of which were covered in our previous debates. It is no secret that several members of the Committee were approached by the dairy industry and the National Dairy Council to express their concerns. It is not necessary for me to go through the issue of milk again because we have listened to an extensive debate on the matter. It is sufficient to say that there is widespread concern that parents on low incomes should not be asked to make a choice between milk or fruit and veg for their children. The other night I spoke to someone who reminded me of the resurgence of rickets in some inner-city areas in this country, which is a persuasive argument for our continuing to have a robust welfare foods programme.

The purpose of the amendment is to seek assurances from the Under-Secretary that any changes contemplated in the future will be subject to a reasonable consultation process and will bear in mind people's real anxieties over that choice between fruit and veg and milk.

My other point concerns vouchers. I was encouraged to hear the Under-Secretary say that she will try to produce a fraud-free system. I wish her luck, but I must say that I have never quite understood the obsession that the British civil service has with vouchers. Every voucher scheme that I have ever encountered has ultimately failed, and I genuinely wonder whether this is the best way forward.

When I was a young trainee social worker in Edinburgh, it was possible—under the Social Work (Scotland) Act 1968—to give vouchers to families in particular need. It said in clear print on the top of the vouchers what they could and could not be traded for, but if one went into the local pub round the corner from the social work office, there was a roaring trade in the vouchers, which was nothing to do with their intended aim.

I remain sceptical that vouchers are necessarily the best way to guarantee the outcomes that we are seeking. All our other experiences show that they have production and administration costs and a high impact in terms of fraud through the way in which they are used. If, at the end of the day, our real object is to try to ensure the best of health—particularly for children from the most disadvantaged backgrounds—I am anxious that we should not embark on a cumbersome scheme that costs money, is open to fraud and forces parents to make basic choices between essential products that their children need.

I do not want to press the amendment to a vote, but I hope that my hon. Friend the Under-Secretary will recognise that there is anxiety. We do not want to move from a scheme that has worked fairly well for 60 years to one that could be subject to change on a

popular fashion or whim. I hope that she can assure us that any changes will be subject to reasonable consultation and will take people's anxieties into account.

Simon Burns (Conservative, West Chelmsford)

I strongly support the amendment, which is consistent with the approach that the official Opposition have had on numerous health Bills during the past four years. We have constantly pressed the Government that, where there are or should be regulations in a Bill to operate a crucial scheme or system, those should be subject to the affirmative resolution procedure so that the House of Commons has the opportunity to debate what the Government are doing.

I do not need to remind the Under-Secretary—although I will briefly—that if we had had the affirmative resolution on some of the regulations for the National Care Standards Commission, or the Criminal Records Bureau checks, the Government would not have had the problems and embarrassment of the past 18 months. They have had to do a significant U-turn from their original proposals because they would not listen to the advice given to them following consultation, and get the system right.

I fear that, with something as significant as the changes to the welfare food scheme proposed in clause 167—and in light of the points that a number of hon. Members on both sides have made during our debates on the clause—there is the potential for considerable problems and mistakes with the fine tuning and final decisions that the Government will make on the nuts and bolts of any new scheme.

That is why I think it very important that when the Government come up with their final proposal, the House of Commons should have the opportunity to discuss it properly and in detail to ensure that the Government are not heading for another fall and a dreadful mistake. The only effective way in which one can do that in a Parliament where the governing party has such a large majority is through regulations with use of the affirmative procedure. That is why I congratulate the hon. Members for Birmingham, Hall Green and for Jarrow for the amendment. It is certainly not the habit of Ministers, nor of governing-party Members, to table amendments to regulations insisting that the affirmative procedure be used; 99.9 times out of 100, the negative procedure is used. I urge my hon. Friends to join the hon. Gentleman, who feels so strongly about the issue that he tabled an amendment, and to vote for the proposal to be written into the Bill.

Andrew Lansley (Conservative, South Cambridgeshire)

I share the view of my hon. Friend the Member for West Chelmsford, especially as the character of the scheme that we are discussing is not explicit in the text of the Bill. It all depends on what is in subsequent regulations. With the greatest respect to the Under-Secretary, in my doubtless inadequate fashion I raised a whole series of issues to which she gave only a limited number of responses.

I still cannot see why the structure of the amendment would give mothers who elected to bottle feed an opportunity to divert part of the value of the voucher away from infant formula and into complementary foods in the first six months of life. It is a scientific recommendation that liquid cow's milk should not be provided for infants under 12 months of age. The Government will permit that to happen, and are not following the scientific recommendation.

The Committee said:

''At 6 months of age the allowance of infant formula should halve in favour of providing tokens to purchase complementary foods.''

As the hon. Member for Birmingham, Hall Green said when he moved the amendment, there is a difference between vouchers and tokens. The scheme is structured around tokens that are designed for specific purposes. It should, however, be designed to ensure that there is the uptake of given allowances of infant formula or milk at given ages such as six months, as the Committee recommended.

Clearly, there was an over-provision of infant formula. There is scope in the expenditure of the scheme to reduce that allocation of infant formula to allow complementary foods to be purchased, but that small recommendation by the Committee has been turned into a complete voucher scheme, as though that would somehow meet all the requirements. That carries a great risk that many of the nutritional benefits of the scheme will be diverted. I was, if anything, worried by the Under-Secretary's assertion that this is a supplement to the diet of low-income families as distinct from being focused on the nutritional requirements of children, which is what I understood the scheme primarily to be about.

Win Griffiths (Labour, Bridgend)

Order. May I inquire whether the hon. Gentleman is suggesting that these ideas can be achieved only by the amendment being passed, because he has not mentioned the amendment? [Interruption.] Well, he did once.

Andrew Lansley (Conservative, South Cambridgeshire)

You are right to ask, Mr. Griffiths. I intended to say that if the amendment were not passed, my fear would be that the bulk of the provision would be achieved by negative rather than affirmative procedure. Given what I regard as the absence of answers to my questions, including the one relating to low birth weight children, to which the Under-Secretary gave no reply, we will need a debate in the House at some point to discuss the draft regulations in order to know whether Parliament approves of the scheme. It is inherently undesirable that we should be put in a position of approving legislation and then having to pray against orders to have an opportunity to assess the nature of the scheme to be proposed.

Patsy Calton (Liberal Democrat, Cheadle)

The hon. Member for South Cambridgeshire has made the points that I wanted to make. The provision is a pig in a poke; we do not know what we are getting. The schemes that the Under-Secretary will introduce at a later date may be what everyone wants, but they may not be. Coupled with our concern about whether the Budget will stretch to everything that is hoped for from healthy start, there must also be concern that the uptake will

not be sufficient to make it work or that another flaw will not allow it to work properly for the benefit of all the mothers and children whom we hope will benefit from such schemes.

At the moment, we do not know whether we are talking about just a voucher scheme, direct provision of foods through various outlets, community operations and so on. We simply do not know what mix of schemes might be introduced and it would be helpful if we did, so we support the amendment.

Hazel Blears (Labour, Salford)

I hope that I have given some assurance to my hon. Friend the Member for Birmingham, Hall Green about the way in which the scheme will operate and the importance of milk as a component.

I understand his concern about the effectiveness of vouchers versus cash versus direct provision. We had to consider that important issue when drafting the consultation document and thinking about the responses to consultation. My instinct is generally to incorporate such benefits into a cash entitlement. I do not particularly like vouchers because they single out people who are poor, but women in the focus groups and consultations supported vouchers. They said that vouchers ensured that they and their children actually received the benefits and the food. That is one reason why we have gone for vouchers instead of incorporating the value into the cash benefit entitlement, when it could be diverted into funding other things and not the food that is necessary for the diet of expectant mums and children.

Patsy Calton (Liberal Democrat, Cheadle)

The Under-Secretary mentioned the focus groups and I note from annexe A of the responses to the healthy start consultation that 17 special events were held in November and December. Did she mean those 17 meetings when she referred to focus groups, or were they the parents and users meetings for the sure start local programmes focus groups? Can she provide more information than I have managed to glean from the results of the consultation exercise about those focus groups?

Hazel Blears (Labour, Salford)

The information came from the initial discussions with parents before we formulated our proposals. I was about to say that a decision had to be made on the balance between vouchers, cash and provision and we decided to go for vouchers. I explained why we did not go for cash and we did not go for direct provision, which is prescriptive. Directing families to go to a certain place to collect a certain food singles them out as poor and that is not what we want. In the past, people have had to go to an NHS clinic to collect their formula and we do not want to administer such a scheme. We want to introduce choice so that people can use a range of outlets—shops, food co-ops, community-based schemes and so on—to obtain access to healthy food. We believe that food co-ops and our various community initiatives are key suppliers, as is the retail sector.

Some hon. Members asked whether there should be a choice of foods. The importance of fruit and vegetables in the diet is accepted and it is a fact that one in five children in this country does not eat any fruit at all. That should cause all of us concern; it is

important to introduce more fruit and vegetables into the scheme.

In terms of the affirmative resolution, under the Social Security Act 1988, the current scheme provides for affirmative resolution in relation to the foods. All of the other regulations are subject to negative procedure. The amendment seeks to be even more prescriptive.

Simon Burns (Conservative, West Chelmsford)

I am not sure how the Under-Secretary can use the words ''more prescriptive''. What is the difference between the two schemes? Life has moved on, and there is a feeling that Government should be more accountable to Parliament nowadays. We are asking that, instead of being the negative resolution—so that it slips through with minimal delay—it should be affirmative, and approved by both Houses of Parliament. How is that more prescriptive? It is a different way of giving permission.

Hazel Blears (Labour, Salford)

The hon. Gentleman must accept that if we want to change the scheme regularly, as a result of the scientific advice that we receive from our advisory committee on nutrition, and to ensure that the scheme is kept up to date, the regulations need to be flexible. A scheme of this size benefits 800,000 people and costs £142 million a year. We want to make it as up-to-date and beneficial as we can. We must ensure that we are able to change the regulations, if necessary, more regularly than we can now. There will be the opportunity for hon. Members to pray against the regulations if they feel that they are not appropriate, and there will be opportunity for a proper debate. We have made a commitment to publish the initial set of regulations for consultation in early 2004, and we shall certainly consider consulting on further regulations as appropriate.

My hon. Friend the Member for Birmingham, Hall Green makes an important point. We need maximum consensus about the way in which the scheme will operate because it concerns not just the range of foods but the registration scheme, the voucher and the value of the voucher; all important issues. We want to have maximum consultation with the public and with the health professionals involved, who have a serious job to do in providing nutritional advice to families. The arrangement will provide sufficient scrutiny of the changes at the outset and the flexibility to enable us to respond to the scientific advice that we will continue to receive, so that we can update the scheme as it develops.

Steve McCabe (Labour, Birmingham, Hall Green)

I am grateful to my hon. Friend the Under-Secretary for restating the point about the importance of milk, and for reassuring us that parents will not be faced with a difficult choice between milk and, say, fruit and vegetables. I remain a touch sceptical about vouchers, but I am prepared to accept them if they were the result of consultation with the people who are going to use them. It would be wrong of me not to respect their views. I am pleased to hear what she says about seeking maximum consensus for any changes that she makes.

In the circumstances it seems that, despite the warm and encouraging words of the hon. Member for West Chelmsford, it would not make a lot of sense to have

spent the past few weeks in this Committee arguing about trying to reduce bureaucracy and to speed up processes in the health service for me to introduce a device that will be unnecessarily cumbersome.

Simon Burns (Conservative, West Chelmsford)

Will the hon. Gentleman explain how the affirmative resolution is more bureaucratic and cumbersome than the negative procedures?

Steve McCabe (Labour, Birmingham, Hall Green)

The point I was about to make was that the object of introducing the amendment, as I said at the outset, was to ensure that we did not have a succession of changes to the regulations without people having a proper opportunity to be consulted and to discuss them. The Under-Secretary has answered that point, so it would be superfluous for me to press the matter to a vote. Therefore, I beg to ask leave to withdraw the amendment.

Simon Burns (Conservative, West Chelmsford)

I beg to move amendment No. 594, in

clause 167, page 84, line 21, leave out 'the Scottish Ministers and'.

I shall be very brief as this is a probing amendment. In clause 167, line 21, we propose to leave out ''Scottish Ministers''. I should like to know two things. First, does the reference to Scottish Ministers mean Ministers of the national Government of the United Kingdom, or Ministers of the Scottish Parliament? Secondly, given that the Bill primarily deals with England—although there is some overlap with Wales—is it necessary to have any reference to consultation with Ministers of the Scottish Parliament on this matter? If the answer is yes, is it because the welfare food scheme is a national scheme throughout the United Kingdom?

Hazel Blears (Labour, Salford)

I hope that I am able to give the hon. Gentleman the assurances that he seeks. The welfare food scheme is a reserved matter because it is based on social security benefits. The hon. Gentleman will know that most health functions are devolved. The power to prescribe a range of foods—and nutritional and health advice—has been transferred to the National Assembly for Wales. After the Bill receives Royal Assent, we intend to transfer power to Ministers of the

Scottish Parliament, with their approval, in recognition that other health functions are devolved.

We also intend to transfer powers to allow Scottish Ministers to direct bodies administering the scheme in relation to matters relating to the operation of the scheme in Scotland. It is important to consult Scotland and Wales on policy proposals and legislative change because their Ministers might need the flexibility in the future to adapt the scheme to meet local needs. It is a three-way process; we also wish to provide for the possibility that the National Assembly for Wales or Scottish Ministers could make a decision on matters that could affect the operation of the scheme. If they wish to make recommendations about how the scheme operates that might have implications for England, they have to consult the Secretary of State. The policy is aimed at ensuring that the scheme is, as far as possible, uniform.

We wish to minimise the amount of money spent on administration so that we can maximise the amount of money we spend on nutritional benefits for the families. We do not want a wide diversion of operational issues because that would lead to spending more on bureaucracy rather than delivering a better diet for pregnant women and their families, which is the intention of the scheme.

We have included the provision to ensure that we get the right balance between the devolved Assemblies being able to have a proper input on health, while keeping the operation of the scheme uniform, coherent and cost-effective. I hope that that has explained the situation to the hon. Gentleman, and I hope that he feels able to withdraw the amendment.

Simon Burns (Conservative, West Chelmsford)

Yes, it does. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Patsy Calton (Liberal Democrat, Cheadle)

I beg to move amendment No. 598, in

clause 167, page 84, leave out lines 27 to 41.

On reading the clause for the first time, I had to be held down because of my outrage at the idea in subsection (4) that a benefit, which I assume the Government think is absolutely essential for mothers and children, should be made contingent on a mother registering for a scheme and agreeing to a number of conditions. She must

''attend a hospital, clinic or doctor's surgery''—

not necessarily her own doctor—

''determined in accordance with the scheme''.

She must

''allow herself, or a child of hers, to be examined by a doctor or nurse''.

She must

''allow a visit to her home by a health professional or other prescribed description of person''.

She must also

''receive advice of a prescribed description about nutrition, diet or other matters relating to health.''

No one would argue that attendance at a clinic, a doctor's surgery or obtaining nutritional advice are undesirable, but to make a benefit that the state

considers necessary for one's health and well-being contingent on submitting to that sort of coercion seems absolutely wrong.

Several organisations have voiced great concern. I shall be very interested to hear what the focus groups have to say about the linking of a benefit with requirements of a sort that may be desirable, but about which people must nevertheless have a choice. Subsection (4) is a step too far, and I want it to be removed. That would not harm the clause and it would acknowledge the fundamental human rights issues that are involved.

A number of organisations such as the Royal College of Nursing, the Royal College of Midwives, the Royal College of General Practitioners, the Maternity Alliance and the National Childbirth Trust have made similar points about the provision. They are concerned that the onus should be on the health service to provide services that are meaningful and accessible to low-income families, and not on individual families to use health services because of ''financial coercion''. That is their phrase.

The Royal College of Nursing says that

''There is no evidence cited which suggests that placing a financial incentive on low income families to use health services will improve health service uptake, or importantly, which links ante-natal or child health service uptake comprehensively and conclusively to health outcome.''

It mentions that evidence from the United States is mixed, but adds that

''comparing ante-natal care in France with England and Wales suggests that despite French legislation that requires pregnant women to attend for ante-natal healthcare in order to be eligible for ante-natal allowances, there is no significant difference in pregnancy outcome between the countries.''

Those issues need to be carefully considered. The royal college says quite clearly that it believes that

''welfare foods should remain a universal low-income benefit intended to improve the health of poorer children without additional conditions applied to their receipt.''

and that

''the onus should be on the health service to provide services which are meaningful and accessible to low-income families, not on individual families to use health services through any form of financial coercion.''

There is a real concern that children

''will not receive their entitlement based on the behaviour of their parents.''

That must be wrong in human rights terms. I ask the Minister to address those issues. I believe that subsection (4) will be counter-productive. It may well breach human rights. Has she received advice on whether it does?

The measure is coercive. It requires registration and submission to medical examinations and lectures about nutrition, without which the benefits cannot be received. Astoundingly, it could damage the relationship between medical practitioners, nursing staff, midwives and the patient. Medical practitioners are worried that that crucial relationship, which should be a positive one, could be damaged, which could lead to a reduction in uptake. I asked the Minister earlier whether the calculations that have been made show that the set of schemes that she

intends to introduce will meet budgetary requirements. Has an assessment been made about whether the stumbling block of registration will reduce uptake of the scheme? If it does, that is absolutely wrong and the scheme must not be allowed to proceed.

All the educational, nutritional, medical and clinical aspects of the scheme, as well as the desired outcomes, are important, but, as the royal colleges say, the services that mothers wish to take up can be provided through education and support, instead of in this coercive and authoritarian way. I did not expect a Government in this day and age to put that kind of requirement in a Bill.

Hazel Blears (Labour, Salford)

Under the reformed scheme we intend to support the healthy food benefit with the provision of information on nutrition, health and infant feeding for parents. The objective is to address health inequalities by means of preventive action and thereby to improve the scheme's effectiveness.

As I said before, another key aim is to increase the initiation of breastfeeding. There is now extremely good evidence to suggest that low-income families have poorer access to preventive healthcare and poorer health outcomes. The Acheson report on inequalities shows that targeted intervention at this stage of families' lives can help to reduce the risk factors for the children, yet amazingly contact with the NHS is not an integral part of the present scheme: tokens are simply dispatched by the Post Office to beneficiaries if they qualify for certain income-based benefits. Important opportunities are being missed for contact between the families and the NHS that can help to improve things.

Under the reformed scheme, we want to try to redress the imbalance so that parents have access to information from a health professional, whether a midwife or a health visitor, and can make good, nutritional choices for themselves and their family. We know that poor diets early in life can lead to subsequent problems such as coronary heart disease, diabetes and obesity—all the problems that we as a society currently face. We believe that building robust links to the NHS by means of the proposed new registration system will be the most effective way to maximise the number of families that have access to antenatal care. The evidence is clear that parents from better-off families have significantly more access to antenatal classes, advice, encouragement and support than families on low incomes.

I refer the hon. Lady to page 19 of the consultation document, which I am sure she has read, which sets out how families will be able to register for healthy start. We are trying to make it as simple and the least bureaucratic we can. We do not want families to have to jump through a series of hurdles and hoops before they gain access to benefits. The patient focus groups with which we discussed those issues generally welcomed registration. They thought it would give them increased opportunities to access the nutritional information that they need to help their children. They said it was especially important for new mothers, who might lack experience and knowledge, but equally they wanted it to be simple because they would be busy

mums and they did not want to be bound down with lots of form filling.

We are therefore looking to link the scheme with existing intervention points—the early ante-natal booking or the new home birth—so that a series of new interventions is not involved. We also want to establish closer links with sure start, where every family in the sure start area is visited in the first couple of months of the child's life. As well as providing nutritional advice, there is a whole range of services now, as most of us will know from our constituency experience of the sure start programmes, which are hugely valued and welcomed by the families they support.

I do not accept the hon. Lady's view that encouragement and education will be sufficient to ensure that such families on low incomes, who do not currently have access to the nutritional advice that the NHS can offer, obtain the maximum benefit from the scheme. Often certain rights to benefits come with responsibilities: for example, people must be actively seeking work if they are to be entitled to jobseeker's allowance—they have to take steps to do something in return for that benefit. We are therefore not importing an entirely new principle in this respect. Of course we have to ensure that the proposed interventions are proportionate in human rights terms. The advice that I have received is that article 8 of the European convention on human rights might be engaged, and that our response would be regarded as proportionate. The evidence is overwhelming that low-income families have poorer health outcomes than families not in receipt of low incomes.

Andrew Lansley (Conservative, South Cambridgeshire)

The Minister told us earlier of the virtues of the consultation carried out, one conclusion of which reported in the regulatory impact assessment is that:

''There was strong concern that children should not be punished if mothers failed to register for the scheme''.

I presume that the Minister has taken that on board and that a failure to register will not mean any reduction in access to benefits.

Hazel Blears (Labour, Salford)

The hon. Gentleman may be aware that in the proposals as set out we indicate that there would be provision for benefits to be carried forward for several months to ensure that children would not lose access to the scheme because of non-registration. There will be a responsibility on the NHS actively to go out and encourage registration—not simply to wait for parents to come to be registered, but to seek them out. That is exactly what is happening with sure start now. The sure start maternity grant is available through a system of registration. Many families have taken advantage of that grant, for which they need to register.

In trying to make the process simple, we are considering whether we might get self-declaration of entitlement on proof of pregnancy and on proof of having received the nutritional advice. Again, we want to make it as simple as possible for families to register.

We are not in the business of penalising children who already suffer tremendous health inequalities as a result of their families' lack of income. We want to do the reverse.

Patsy Calton (Liberal Democrat, Cheadle)

I want to be absolutely clear. If someone submits themselves to registration, would they then have a choice of the hospital, clinic or doctor's surgery

''determined in accordance with the scheme''

to which they would be expected to go?

Hazel Blears (Labour, Salford)

Where would be most convenient and accessible is the sort of issue that we can consider in the regulations. We certainly would not want to provide a surgery miles away from where a family lived: that would be utterly counter-productive. We want to make it as easy as we can for people to be registered under the scheme. It is not about punishing people but ensuring that as well as getting food benefits, people receive nutritional advice that will make a difference to their long-term health outcomes.

Patsy Calton (Liberal Democrat, Cheadle)

May I ask the nature of the examination that a doctor not necessarily of one's own choosing might need to carry out when one attends a hospital clinic or doctor's surgery?

Hazel Blears (Labour, Salford)

Examinations may be necessary to assess children's progress. Many people have their babies weighed, and health visitors carry out a range of developmental checks on children to ensure that they are progressing properly. Those examinations are routine, as I am sure the hon. Lady knows from her own experience, and parents find them helpful in judging whether their children are making progress.

Patsy Calton (Liberal Democrat, Cheadle)

I am grateful to the Minister for her answer. However, it appears that not only will the children be examined, but that the women might also be required to submit to an examination. I well remember the types of examination, and I would much prefer those examinations to be carried out by a doctor whom I knew and trusted. In those circumstances, how can the Minister assure us that the relationship between the prospective mother and the people that she has to see will not break down?

Hazel Blears (Labour, Salford)

The hon. Lady makes an important point about the relationship between doctors—and, indeed, practice nurses—and their patients. I am sure that we can take that matter into account when we consider the regulations. We would not want women to be faced with intrusive examinations by someone with whom they had no relationship. The hon. Lady's point is relevant and constructive. We want to ensure that the women concerned want to take part in the scheme. As I said, the women with whom we have discussed the scheme are looking forward to it, because they believe that it will give them enhanced benefits over those to which they currently have access.

I have virtually finished making the points that I wished to make. I have dealt with the human rights issues—article 8 will be engaged, but the advice that we have received is that our response is proportionate. I believe that I have dealt with the points about the consultation document.

Steve Pound (Labour, Ealing North)

Much has been made over the past 10 minutes of the concept of ''punishment.'' Does the Minister not agree with me that there can be no greater punishment than that inflicted on a child by a parent who does not engage with the range of benefits and advice that may be available to them? Any mechanism that exists in the real, rather than the ideal, world and that cements the relationship between the parent or carer and the provider of advice or benefit should be welcomed.

Hazel Blears (Labour, Salford)

I agree entirely with my hon. Friend.

Patsy Calton (Liberal Democrat, Cheadle)

Let me extend the point that the hon. Gentleman makes. If that is important for poorer mothers, it should also be important for wealthy women.

Hazel Blears (Labour, Salford)

The scheme is designed to provide benefits for people on low incomes, and the registration scheme should be appropriate for them. For all the reasons that I have set out, I ask the Committee to reject the amendment.

Patsy Calton (Liberal Democrat, Cheadle)

I have listened to what the Minister had to say. I am grateful that she is as concerned as I am about the nature of the relationship between the expectant or nursing mother and children and their medical advisers, but I remain concerned that the Bill as it stands could be taken to mean that expectant or nursing mothers could be expected to go willy-nilly wherever they are sent by the scheme. I am pleased that the Minister said that that is not the intention. None the less, I would like to see something included in the Bill or in other provisions that makes it clear that relationship-building is an important part of the scheme.

Subsection (4) is authoritarian; I would be very concerned if it were to remain in the Bill in its present form. I would like to return to it at a later stage. The Minister has indicated that she might consider some of the points that have been made. On that understanding, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed, No. 596, in

clause 167, page 84, line 42, after 'scheme', insert

'must include provision for a benefit to consist of a minimum of one pint of milk per day or the equivalent of formula milk, or the financial equivalent made available through a voucher system, or similar arrangements, and'.—[Mr. Burns.]

Question put, That the amendment be made:—

The Committee divided: Ayes 4, Noes 11.

Patsy Calton (Liberal Democrat, Cheadle)

I beg to move amendment No. 599, in

clause 167, page 85, line 9, after 'vouchers', insert

'or, on request, a tax credit or cash benefit'.

This is a simple point. There is a concern that an entirely voucher system might lead to the stigmatisation of some mothers. I have had discussions with a variety of people over the past few weeks about the possibility of a wholly voucher system or otherwise, and the conclusion that I have reached is that while the current method is, in a sense, a private transaction between the supplier and the person handing over the vouchers or tokens, to use vouchers of the kind that is envisaged would be difficult for at least some people. It would be better if the system could allow them to choose a tax credit or a cash benefit instead.

Chris Grayling (Conservative, Epsom and Ewell)

Is not the idea in this context of a cash payment absurd? That absolutely guarantees that some children, not all, who benefit from the scheme at present will cease to do so because their parents choose to spend the money on something else.

Patsy Calton (Liberal Democrat, Cheadle)

Thank you. I did not spend a great deal of time coming to my conclusion. I have throughout my working life heard that there are people who cannot be trusted to use what is supplied for the benefit of their children. I have a great deal more faith in poorer mothers than that. While, undoubtedly, some will not use the benefits in the way in which those of us who regard ourselves as being much wiser and more experienced would expect them to do, nevertheless I believe that parents would want to ensure that the money provided as a state benefit in recognition of their low income is spent properly.

Simon Burns (Conservative, West Chelmsford)

The hon. Lady says that she has no doubt that parents would want to use the money properly. Is she not aware that, for example, child benefit was paid to the mother rather than the father because under the previous system of child allowances, the father often did not pass the money on? Is she honestly saying that she believes that the money from cash payments would in even the vast majority of cases get to the children? Sadly, the reality is that all too often the money does not get to the children, because the parents are in some way dysfunctional.

Patsy Calton (Liberal Democrat, Cheadle)

I am sure that that happens in a very small proportion of cases, and mothers-to-be and parents will need support, but to claim that that will happen simply because someone is poor is wrong. I dissociate myself from the hon. Gentleman's remarks. Poor people are not necessarily feckless and will not necessarily use money incorrectly. I stand by my suggestion; on request, a tax credit or cash benefit should be payable.

Hazel Blears (Labour, Salford)

In answer to a previous question from my hon. Friend the Member for Birmingham, Hall Green, I said that it was a matter of deciding which was the most appropriate way to proceed; cash benefit, tax credit or voucher. We have gone for vouchers, rather than including the provision in the cash entitlement, because parents wanted that to ensure that their children received the benefit.

If we went down the route recommended by the hon. Member for Cheadle, we would have to administer three different schemes for vouchers, tax credits and cash distribution. We are trying to maximise the money available from the £142 million for the benefits to families and their children. Setting up three different administrative systems would eat into the amount that we have available for making a difference to the diet and health of the children in poor families.

I hope that the hon. Member for Cheadle will reconsider the issue and join us in trying to benefit families and their children, rather than seeking to see money eaten up in unnecessary bureaucratic schemes. I urge the Committee to reject her amendment.

Patsy Calton (Liberal Democrat, Cheadle)

I listened to the Under-Secretary carefully and was pleased that she made an economic argument rather than one about parents not choosing the correct things for their children. In those circumstances, I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Hazel Blears (Labour, Salford)

I beg to move amendment No. 562, in

clause 167, page 86, line 34, at end insert—

' ''women'' includes persons under the age of 18.'.

The amendment is intended to ensure that all women can have equal access to the reformed welfare food scheme regardless of their age. Not all women under the age of 18 have access to the current scheme, and those who have access do so by a variety of complex and diverse means. Some of them are eligible for income support in their own right so they can be passported through, but young mums between 16 and 18 are not directly eligible for benefits and can have difficulty in getting access.

Some young mums' training allowances take them above the eligibility limits for income support, so they do not come through the scheme. For 16 to 17-year-old mums, access is about 40 per cent., but for 19-year-old mums, it is up to 80 per cent. We want to ensure that all women, particularly teenage mums, have access to the scheme.

Simon Burns (Conservative, West Chelmsford)

What happens if a young father, rather than mother, is bringing up the child?

Hazel Blears (Labour, Salford)

The scheme applies to people who have parental responsibility for children.

Simon Burns (Conservative, West Chelmsford)

Even if they are under 18?

Hazel Blears (Labour, Salford)

Indeed, as long as they have parental responsibility.

We have not yet decided whether we would give universal entitlement to young mums under 18 or whether we would still want there to be a means-tested element. We shall examine the financial implications, because we might be able to help all young mums within the financial parameters of the scheme; I am interested in exploring that option. At the moment some younger women have to get access through their parents' entitlement to benefit. That is not the right way to administer the scheme for those young mums.

We want the flexibility to introduce another system, so I commend the amendment.

Andrew Lansley (Conservative, South Cambridgeshire)

I support the amendment, but the Under-Secretary will recall from the scientific committee's evidence that the younger the pregnant woman, the greater her nutritional requirements yet the lower her intake is likely to be, so extending the scheme to teenage pregnant mothers is desirable. She will not be surprised if I come back to some specific questions. She knows that I am still interested in vitamin supplements and how they are to be provided, since healthy start does not say that they will be made available to pregnant women.

Although we have talked about the incentives for breastfeeding, I am still not clear on one or two other points. Why do the Government persist, in the face of the scientific evidence, in offering an alternative to breastfeeding or infant formula for infants under the age of six months? Why are the Government providing an option under the scheme to move away from breastfeeding or formula before the age of 12 months? Finally, have the Government accepted the recommendation that low birth weight babies—this is particularly relevant to teenage mothers—be entitled to receive formula until at least one year from the expected date of delivery, not the date of birth?

Hazel Blears (Labour, Salford)

I am happy to respond to the hon. Gentleman on the points that he made earlier. We want to examine how we can provide longer access to formula for low birth weight babies, perhaps in the regulations, in order to make up the difference. I am told that that could be administratively difficult, but the scientific committee has nevertheless raised that important issue and I would certainly want us to explore how we can provide the right support for those infants.

I thought that I had already responded fairly robustly to the hon. Gentleman's point about moving away from COMA's recommendations on infant formula and/or breastfeeding. The fixed-value voucher does not specify for whom the food is to be made available, because we want to ensure that there is choice in the system. Those mums who are breastfeeding may choose to spend their voucher on other items of healthy food, such as fruit, vegetables, cereals and so on, whereas those mums who are not breastfeeding will spend their vouchers on the formula to be available to them.

The important point is the value of the voucher in that early period. In the response to the consultation—I tried to make this point to the hon. Gentleman earlier—there was a great deal of support for the idea of perhaps making available a voucher of a higher value during that early period of life than during later periods. We are going to consider that issue, so that we can provide enough monetary value to enable that access. However, the hon. Gentleman seeks to limit the scheme and to dictate to those families exactly what they should have at which period of the child's development. We have genuinely tried to get the balance right between ensuring that there is access to that extra support and introducing an element of choice so that we do not dictate to those families what they can have at exactly what point. That is an

important principle. I accept the fact that the hon. Gentleman does not agree and thinks that we should have a more prescriptive scheme, but I cannot agree with him on that.

Amendment agreed to.

Clause 167, as amended, ordered to stand part of the Bill.

Clause 168 - Appointments to certain health and

Patsy Calton (Liberal Democrat, Cheadle)

I beg to move amendment No. 370, in

clause 168, page 86, line 44, at end insert—

'(1A) This section applies to the CHAI and CSCI.'.

My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) was supposed to be here to move the amendment, but the Committee will have noticed that he has much to do. The amendment is probably self-explanatory. The clause is headed

''Appointments to certain health and social care bodies'',

and subsection (1) states:

''This section applies to a body (however established) which has functions relating to—

(a) health;

(b) social care;

(c) the regulation of professions associated with health or social care.''

We simply seek to establish that the clause also applies CHAI and CSCI.

Hazel Blears (Labour, Salford)

Amendment No. 370 seeks to ensure that the clause covers CHAI and CSCI. The clause provides for the Secretary of State to delegate to a special health authority his function of making appointments to certain health and social care bodies. It is clear that CHAI has functions relating to health care and that CSCI has functions relating to social care. By definition, therefore, they are already covered by the clause. A previous debate about the independence of CHAI and CSCI went on for some time, and the hon. Member for Sutton and Cheam acknowledged then that the policy intention was for the Secretary of State to delegate his appointments functions in relation to CHAI and CSCI to the NHS Appointments Commission. I can restate that intention today, but we should not reopen that debate on the basis of the amendment, which I ask the Committee to reject.

Patsy Calton (Liberal Democrat, Cheadle)

I am grateful to the Under-Secretary for that explanation. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Hazel Blears (Labour, Salford)

I beg to move amendment No. 547, in

clause 168, page 87, line 23, at end insert

'and includes any function relating to the appointment to or removal from (whether permanently or otherwise) any particular office in the membership of the body.'.

The amendment is designed to allow for the delegation to the NHS Appointments Commission of the power to appoint or remove people from specific posts. It is intended to clarify that the commission will

have the power to deal with people who hold offices as well as being members of the various organisations.

This is very much a technical amendment, which is judged necessary to clarify that decisions can be made in relation to such posts. It will ensure, for example, that the commission can appoint or remove chairs or vice-chairs in the way that the Secretary of State would have been able to do had he not delegated his authority to the commission. I therefore ask the Committee to support the amendment.

Amendment agreed to.

Clause 168, as amended, ordered to stand part of the Bill.

Schedule 11 - Privy Council appointments

Hazel Blears (Labour, Salford)

I beg to move amendment No. 548, in

schedule 11, page 128, line 14, after 'exercise', insert

'to the extent specified in the direction'.

Win Griffiths (Labour, Bridgend)

With this it will be convenient to discuss the following:

Government amendments Nos. 549 to 558.

Hazel Blears (Labour, Salford)

This group of amendments serves to clarify a couple of points about schedule 11, which deals with the way in which lay members are appointed to regulatory bodies for health professionals, such as the Nursing and Midwifery Council and the General Medical Council. At present, the Privy Council appoints such members but, in practice, that is generally done on the advice of Health Ministers.

We are keen to strengthen the regulation of the professions and to make them more clearly independent of Government, and schedule 11 does that by letting the Privy Council delegate appointments. We have it in mind that such decisions will be delegated to the NHS Appointments Commission, and the amendments make it clear that the Privy Council could delegate the whole appointments process—that is what we think is most likely—or specify which parts of the process are to be delegated to the commission. For example, the Privy Council might want the Appointments Commission to conduct the interviews and to make the recommendations, and it might want to hang on to the right to make the final choices.

One final detail is that amendments Nos. 553 and 554 make it clear that the Privy Council may delegate its function of appointing the chairman of the General Optical Council from among the members that it appoints. The General Optical Council is the only regulator whose chairman or president is appointed by the Privy Council; the others elect their own chairmen from among their members. The amendments are sensible and contribute to a more transparent way of appointing lay members. The lay members will be seen to be impartial and at arm's length from the Government. I commend the amendment to the Committee.

Andrew Lansley (Conservative, South Cambridgeshire)

I shall not delay the Committee. I apologise to the Under-Secretary; if I had thought about it, I would have notified her in advance that I was going to ask her a particular question. I shall ask the question, but I do not expect a reply on this occasion. It would be fine if she were to respond to the Committee later.

When the Health Professions Council was being introduced, the Under-Secretary may recall that one issue about which I corresponded with the Department was the separate recognition of the Society of Clinical Perfusion Scientists of Great Britain and Ireland and its representation on the Health Professions Council, which remains unresolved.

The Under-Secretary says that the Privy Council can delegate the appointments process to the Appointments Commission. I am worried that that will mean that I have less access to Ministers to seek their agreement that we might pursue further the question of the separate recognition of the Society of Clinical Perfusion Scientists of Great Britain and Ireland as a health profession. I am asking her not to discuss the merits of that subject, but to indicate that we can discuss it separately. I hope that Ministers are not omitted from the process because that would raise work force management issues for the health service. I hope that we can continue to make representations and to discuss such matters.

Hazel Blears (Labour, Salford)

My instinct is that recognition is a separate matter from the delegation of the appointments process. I am happy to enter into further discussion and correspondence with the hon. Gentleman to seek clarity on that matter.

Amendment agreed to.

Amendments made: No. 549, in

schedule 11, page 128, line 26, after 'exercise', insert

'to the extent specified in the direction'.

No. 550, in

schedule 11, page 128, line 29, after 'force', insert

'and for the purposes (if any) specified in the direction'.

No. 551, in

schedule 11, page 129, line 2, after 'exercise', insert

'to the extent specified in the direction'.

No. 552, in

schedule 11, page 129, line 25, after 'exercise', insert

'to the extent specified in the direction'.

No. 553, in

schedule 11, page 129, line 39, leave out 'its functions' and insert

'to the extent specified in the direction—

(a) its functions'.

No. 554, in

schedule 11, page 129, line 40, at end insert—

'(b) its functions under paragraph 8 in relation to the nomination of the Chairman of the Council.'.

No. 555, in

schedule 11, page 130, line 8, after 'exercise', insert

'to the extent specified in the direction'.

No. 556, in

schedule 11, page 130, line 21, after 'exercise', insert

'to the extent specified in the direction'.

No. 557, in

schedule 11, page 130, line 35, after 'exercise', insert

'to the extent specified in the direction'.

No. 558, in

schedule 11, page 131, line 9, after 'exercise', insert

'to the extent specified in the direction'.—[Ms Blears.]

Schedule 11, as amended, agreed to.

Clause 169 ordered to stand part of the Bill.

Clause 170 - Validity of clearance for employment

Hazel Blears (Labour, Salford)

I beg to move amendment No. 559, in

clause 170, page 88, line 12, after second 'body', insert

'or an employment agency or employment business'.

Win Griffiths (Labour, Bridgend)

With this it will be convenient to discuss the following:

Government amendment No. 560.

The rest of the debate is in Hansard.