House of Commons Hansard Debates for 14 Mar 1990

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Mr. Rowe : The hon. Member for Bridgend (Mr. Griffiths) has described what prima facie appears to be a clear conflict of interests. If that is the case, I have no hesitation in condemning it. However, in a structure of the size and diversity of the National Health Service, at every level there will be conflicts of interest and it is essential that we are alert to them. For example, we all know that many Health Service personnel augment their salaries by working partly in the private sector. I have absolutely no doubt that that provides them with opportunities for cross-fertilisation.

Mr. Win Griffiths : I agree with the hon. Gentleman that if Dr. Keith Davies was carrying out tests for a private pathology laboratory owned and controlled by someone else for £10 an hour or whatever, there would be no conflict of interests. However, he is the director, company chairman and a shareholder in the private company while he is responsible for getting such work into the Health Service pathology laboratory. The Minister should make it quite clear that that should not be allowed.

Mr. Rowe : I have absolutely no brief for such a practice and I condemn it wholeheartedly if that is the case.

I am sorry that the hon. Member for Workington (Mr.

Campbell-Savours) is not in his place--I apologise, he is not in his usual place, and he does not appear to be paying attention. The privatisation publication of his union is unlikely to list the large number of contracts which have been discharged successfully, because the union is interested only in those which have failed to deliver the goods. I happen to find some consolation and comfort in the long list of contracts which have been terminated because they have not reached the standard required by the health authority because it shows that the health authorities are keeping a close eye on the quality of the contractors delivering the service. Throughout the National Health Service millions of pounds are being saved and in many cases a very much higher standard of service is being delivered by private contractors.

There is one element, however, on which I hope that my hon. Friend the Minister will be able to reassure me. When the necessary breaking up of the trade union dominated monopoly of services to the health authorities was started, it was written into the law that health authorities had to accept the lowest tender. That was a mistake, as I know from my own experience. A constituent of mine told me that he worked for a highly ethical cleaning company with high standards which made a point of never diminishing the salaries and conditions of service of staff whom they took over. That company added immense value by a combination of training and technology, but when it tried to break into tendering for the National Health Service it found it impossible because it was unable to underbid other contractors. It tendered to break in at the point at which it was paying exactly the same salaries and conditions of service and to improve the service over the 12 months in which it had the first contract until it became apparent that it was offering good value for money, but that was not possible.

I hope that my hon. Friend the Minister can assure me that the new system will not contain such an artificial barrier to high quality services due to some routine rule which dismisses anyone who does not offer the lowest price.

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10.30 pm

Mr. John Maxton (Glasgow, Cathcart) : I shall be brief because we are trying to keep to a timetable and I suspect that we may be running a little behind.

The case that my hon. Friend the Member for Bridgend (Mr. Griffiths) cited is not unique. Greater Glasgow health board recently employed a person to get its laundry service into shape for privatisation--to prepare the contracts and reorganise the service in a certain area of Glasgow. Then it was discovered that that same man and his son were setting up a laundry company to bid for the contract. What did the health board do? It rightly removed the man from the job that he had been doing, but it did not fire him. Moreover, it did not stop his company from taking part in the tender process. That seems to me to be quite wrong.

My hon. Friend the Member for Workington (Mr. Campbell-Savours) may sometimes seem abrasive and his remarks may sometimes rile people, but he is right to talk of the sleaze factor in the privatisation process, of which there is a genuine fear. The Opposition and large sections of the public feel that there is something sleazy about privatisation, and "sleazy" is the right word. The Conservative party is advancing an ideology and arguing in favour of what is supposedly a great principle--the principle of privatisation--which benefits it, its friends and supporters and, in some case, its members. We should remember, too, that in laundry and catering services, competition is almost non-existent. The competition is between the in-house tenderers and large multinational companies which do not compete with each other but carve up the contracts between them. There is no competition at that level ; the only competition is against the in-house tenderers.

Mr. Campbell-Savours : But in an industry in which between 70 per cent. and 90 per cent. of the costs are labour-related, surely the real competition has to do with who can secure the lowest costs. That is the real competitive position and that is why I find the whole business so utterly immoral.

Mr. Bill Walker rose --

Mr. Maxton : I hope that the hon. Gentleman will at least allow me to answer my hon. Friend the Member for Workington, who referred to a second sleaze factor. The first is that the large multinational companies involved are mostly contributors to the funds of the Tory party, whose election expenses they pay. A lot of nonsense is talked about Labour's election expenses, but the Conservative party spends much more money than we do and the multinationals pay their election expenses.

Mr. Bill Walker : I thank the hon. Gentleman for giving way to me again. He is well aware of the position. Does he suggest that a company such as Fishers based in Aberfeldy in my constituency is part of a multinational company? Where does that company--one of the leading companies in its field in Scotland--figure in his calculations?

Mr. Maxton : Of course, some small companies are involved. No one is suggesting that the multinationals have an absolute monopoly. What I suggest, though, is that 81 per cent. of catering is in the hands of two or three major companies and that they are nearly all contributors to Tory party funds. That is the first sleaze factor.

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The only point that I want to make--[ Hon. Members :-- "Only?"] It has been a long day. I have been in the House since 8.30 yesterday morning and I must admit that it is beginning to show.

The profits that the companies make and the savings which Ministers claim accrue--they are dubious savings--are almost entirely at the expense of some of the lowest-paid people in the country. That is what we find so disgusting. People in the Health Service who are paid just over £2 an hour, which hardly provides them with a high standard of living, are being forced to take wages of £1.60 or £1.70 an hour. If I take my wife out to dinner, we spend between the two of us what these people are expected to live on for a week. The friends of the Conservatives are lining their pockets at the expense of low-paid workers.

The factors that I have mentioned are what make the process of privatisation sleazy and what give it a corrupt feel. It is a distasteful business, and we will continue to fight it for a long time to come.

The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman) : The hon. Member for Workington (Mr. Campbell-Savours) hascontinued his campaign of attacks on my hon. Friend the Member for Stirling (Mr. Forsyth). I am sure that I speak on behalf of all my hon. Friends when I say that my hon. Friend has behaved fairly, correctly, honestly and in accordance with the rules of the House.

Mr. Brian Sedgemore (Hackney, South and Shoreditch) : Does the Minister agree that if the hon. Member for Stirling (Mr. Forsyth) has operated in accordance with the rules of the House, there may be something wrong with the rules?

Mr. Freeman : I repeat the support that my Government colleagues and all Conservative Members extend to my hon. Friend, and our condemnation of the wholly unjustified innuendoes and attacks made by the hon. Member for Workington.

The hon. Members for Workington and for Glasgow, Cathcart (Mr. Maxton) fail to distinguish between privatisation and contracting. Privatisation is about the change in ownership of assets and services, but we are talking now about contracting. There is a big difference. Contracting can be about services provided within the public sector and from the private sector. The arguments advanced by the hon. Member for Cathcart do not accord well with the reason of our earlier debates. He argues that all contractors are spivs, that they all contribute to the Conservative party, and that something stinks about the whole operation. I do not believe that most hon. Members would sympathise with that argument, nor would anyone observing the debate regard it as a fair representation of what is a sensible procedure. We have introduced into the NHS compulsory tendering for catering, cleaning and laundry. The Labour party manifesto, I understand, commits the party to ending compulsory tendering in those three services--a process which has saved £110 million for the NHS, money that has gone back into improving patient care.

Most of these services are labour-intensive. Both in-house groups and private companies which tender should seek to make the most efficient use of the staff to be employed. That does not mean only wage rates, but it

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includes them because this is a free country in which we have a free economy. Other factors are numbers of staff employed, equipment and motivation. All those factors must be taken into account, and that is why some private tenders win. I must tell the House, however, that only some 20 per cent. of all contracts have been won by private sector companies outside the NHS.

Mr. Campbell-Savours : We know why.

Mr. Freeman : I can tell the hon. Gentleman why--because the redundancy payments that private sector companies have to pay must be borne by those companies. Although payment may be spread over the term of the contract, it presents a great impediment to those companies competing for such work.

Mr. Couchman : Does my hon. Friend agree that the fact that direct labour has been successful in winning so many of the contracts is a measure of the old "Spanish" practices which operated before tendering? Direct labour now works much more effectively and efficiently than previously.

Mr. Freeman : I am grateful to my hon. Friend.

Mr. Maxton : What about VAT?

Mr. Freeman : Where VAT makes a difference between the price tendered by a private company and an in-house bid, it is not taken into account. The hon. Gentleman will know that VAT is refunded under the Finance Act 1984. It is fair to take that into account when comparing the cost of an in-house tender with that of a private company.

My hon. Friend the Member for Mid-Kent (Mr. Rowe) asked me specifically about contracts and quality. There is no question of NHS authorities always being obliged to accept the lowest tender. I admit frankly that other factors must be taken into account. If quality is such a factor, the authority can opt for the higher tender and it must disclose that publicly. I do not believe that we need to amend the law to deal with the position that my hon. Friend described. The hon. Member for Bridgend (Mr. Griffiths) raised a question which gives cause for concern. If the facts are as presented by him, we must give him the benefit of the doubt. I will study the record. Contracts for consultants and all other NHS employees should provide for the elimination of such conflicts of interest.

Mr. Win Griffiths : The Minister should study the Official Report of 1 March, columns 464-69, where I described in great detail what is happening in those two companies. I did not want to detain the House by doing so again today--I just wanted to mention the issues involved. I am glad that the Minister's response has been positive because the potential for conflicts of interest is serious in the cases that I mentioned.

Mr. Freeman : I am sure that the House shares the hon. Gentleman's concern. I will study the record and draw it to the attention of my hon. Friend the Minister at the Welsh Office with responsibility in that matter.

Mr. Campbell-Savours : I wish to tell the Minister the story of a trade union official who attended a meeting between another person and me some four years ago. He was a regional official and he wept as he told me that he had felt obliged to go to the trade union representatives in a hospital in the north of England and tell them that they

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should accept wage cuts to ensure that an in -house tender won, thus keeping out an outside contractor. Are the Government really trying to build the kind of Health Service in which trade union officials are driven into such quandaries and have to compromise decades of representing of workers' rights?

Mr. Freeman : It is in the interests of all patients in the NHS not only in those three sectors but in others that such activities--be they cleaning, contracting or laundry activities not of a clinical nature--are tested and shown to represent the most efficient and effective combination of employees in the Health Service.

Mr. Campbell-Savours : Garbage.

Mr. Freeman : It is not garbage because that is how we shall ensure that we get value for the £30 billion that the taxpayer spends on the NHS.

We have provided that contracts in the Health Service are open, non- discriminatory, properly timetabled and documented, and that Members' interests are fully and properly declared. I invite the House to resist the new clause.

Question put and negatived.

New Clause 12

Small homes

The provisions of section 1(4) of the Registered Homes Act 1984 shall not apply for the purposes of this Act.'.-- [Ms. Harman.] Brought up, and read the First time. 10.45 pm

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

Madam Deputy Speaker (Miss Betty Boothroyd) : With this it will be convenient to debate amendment No. 21, in page 42, line 18, clause 39, leave out

or is not required to be so registered by virtue of the home being a small home.'

Ms. Harman : I can deal with new clauses 12 and 13 briefly because the Minister is aware of the points at issue, which were well aired in Committee. We have tabled them to give her an opportunity to announce what solutions she has to the problems with which they deal, remembering that in Committee we had considerable sympathy from Conservative Members.

New clause 12 would extend the safeguards provided by the Registered Homes Act 1984 to elderly and disabled people who currently have no protection in their private residential care homes because those homes have fewer than four residents.

The Government have said that they do not know how many homes escape registration and how many residents are therefore unprotected by the law because they do not know how many small homes there are. Between Committee and Report I carried out a survey among directors of social services. I asked them how many small homes they estimated there were in their social services areas, and the results of my survey are worrying.

The directors estimate that one in five of all homes in their areas are unregistered because they are small, having fewer than four residents. That means that the safeguards provided by the 1984 Act--about quality of standards, staffing and premises and about the character of the

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proprieters of homes--do not extend to residents in one in five such homes in Britain. I remind the House that we are talking about people who are vulnerable, elderly and dependent-- otherwise they would not be in residential care.

New clause 13 deals with the problem of people setting up registered care homes--

Madam Deputy Speaker : Order. Is not the hon. Lady referring to amendment 213? I said at the outset that it would be convenient to take that amendment with new clause 12.

Ms. Harman : I apologise, Madam Deputy Speaker.

Madam Deputy Speaker : The hon. Lady need not worry. We are all a little tired.

Ms. Harman : When I saw "213," I thought that it was a typing error and that it should have read "NC 13."

Mr. Kenneth Clarke : No, we are dealing with new clause 12 and amendment No. 213.

Ms. Harman : I am obliged to the Secretary of State for pointing that out, demonstrating that he is still awake.

Amendment No. 213 deals with the problem of people who set up registered care homes but do not disclose that they have criminal convictions which render them unfit to care for elderly and dependent people. There have been numerous cases of dishonest people with criminal convictions failing to disclose those facts to the registration authority. They have been discovered only as a result of some awful scandal--after the residents in their charge have suffered.

There is a clear loophole, but the Government have said that they will address the problem. The problems of small homes and homes being run by people with criminal convictions are related, as I shall illustrate.

Mr. Rowe : There was a great deal of talk in Committee about the television programme, "The Granny Business." The only person against whom a criminal conviction could be sustained, as a consequences of that programme being referred to the police, eventually had all but two of her convictions overturned in the Appeal Court. However, she was found guilty of assault. It is now believed that, although she is disqualified from running a registered home, she still cares for two elderly people. That example seems to make the hon. Lady's case fully and clearly.

Ms. Harman : I thank the hon. Gentlman for giving an example which shows that the safeguards are not working. They cannot be working if, when the registration authority ultimately finds that somebody is unfit to run a registered care home because he or she has a criminal conviction, it deregisters the home, but the person is able to carry on the business of providing residential care. Those people can do so by dropping the number of residents, still claiming income support and running a totally unsatisfactory business at the expense of elderly and dependent people.

I can give another example, the details of which were sent to me by the Association of Directors of Social Services. Olive Waring ran a private home called Oliveen in Blackpool. She was imprisoned in January 1987 for physically abusing a resident. In 1984, Lancashire county council found her running an unregistered home for four people in Jubilee lane, Blackpool. She was fined £1,000 for running an unregistered home, after which she merely

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reduced her number of residents to three and continued to operate. Although Lancashire county council knew about the matter, it could do nothing because the law did not allow it. Last December, Olive Waring was imprisoned on a £30,000 fraud charge involving the forgery of a will of someone who used to live in one of her homes.

That is just one example, but the Minister knows that there are numerous others. There is no problem about dealing with the disclosure of criminal convictions. I hope that the Government will be able to accept the amendment which deals with that issue without any difficulty. It merely extends the safeguards that the Government have already extended to cover people caring for children. We are asking the Government to extend the restrictions and regulations to those who care for elderly people.

The problem is how to deal with small homes. I readily accept that perhaps new clause 12 goes a little too far. NALGO, which organises among its membership the inspectors of private residential care homes, has helpfully made a recommendation that would also be acceptable to the Association of Directors of Social Services. It might be a way forward to give registration authorities the power to enter, inspect and take action against small homes. They are given the power when a problem is identified, but they do not have a duty to require them to register all the small homes which they know to be in their areas. Therefore, when they know that there is a problem they have the power to act, but they are not borne down with extra registration duties when they already have inadequate resources to carry out their present registration functions.

The Bill provides the opportunity to legislate to protect thousands of people who have no protection under the present law. The Government must show not just that they have a vague aim to do something about the matter, but that they intend to act. I want to be sure that we hear from the Government, when the Minister replies, that they have plans to deal with this matter and that the Bill will not become an Act without containing legislative protection for people who are currently guaranteed no protection under the law. It is late, but I hope that tonight the Minister will not flannel about vague aims and intentions. We want not good words, but action.

Mrs. Virginia Bottomley : I think that the hon. Lady has confused her papers. She was speaking to new clause 13, which is not on the selection list--

Madam Deputy Speaker : Order. The hon. Member for Peckham (Ms. Harman) was slightly confused when she started. She was speaking to new clause 12, but became confused with amendment No. 213.

Mrs. Bottomley : The revealing of convictions comes under new clause 13. The hon. Lady was speaking to new clause 13 when she referred to criminal records.

Madam Deputy Speaker : Order. We are dealing with new clause 12 on small homes.

Mr. Rowe : I agree that it is essential that the size of the home is not used as an excuse for allowing people to avoid inspection. I agree with the proposal that inspection should be carried out only where there are grounds for suspicion.

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I want to put on record the fact that a substantial number of people look after one or two elderly people in almost ideal circumstances. They are treated as though they were living in their own homes. That is an extremely good service. I do not want the debate to be taken as some sign that anyone running a small home for one or two people is likely to be some sort of crook.

Mr. Kennedy : The last remark of the hon. Member for Mid-Kent (Mr. Rowe) was fair, but the 1984 Act contains a significant loophole and the Bill provides an opportunity to close it.

When the question of bringing homes with fewer than four residents under the inspectorate was raised in Committee, the Minister said : "That would involve the inspection unit in a great deal of work at a time when they are already embarking on their new tasks, establishing standards and working with those involved to ensure that the policies are effective. That provision would be an additional burden on small units, many of which are already effective."--[ Official Report, Standing Committee E, 8 February 1990 ; c. 794.] I do not doubt the effectiveness of a large number of units in that category, but on the point about inspection and the additional bureaucratic burden I refer the Minister to a quite different matter--recent experience of the poll tax in Scotland. Small units such as those offering bed and breakfast faced considerable difficulty because of commercial rating and the new tax burden on those premises. Within the past week or so, the Scottish Office has announced that units with six or fewer beds operating for 100 or fewer days per year would be exempt. That sort of accommodation is both essential and prolific in the Scottish Highlands. The policing and the bureaucracy to make any sense of the Government's policy will be a major headache. The Government seem to believe that it can be done, although I have my doubts--I believe that they will encounter great practical difficulties.

If the Scottish Office thinks that it can make that policy work in the Scottish Highlands, why does the Department of Health believe that a similar function could not come within the ambit of this legislation, especially as the inspectorate is already in place? Why cannot the inspectorate deal with small units catering for four or fewer people? I should be interested to learn whether the Minister stands by the case that she made in Committee--that she cannot accept the practical implications involved. There is a duty on the Department to provide the funds for additional inspectors. That seems to be the logical accompanying element which is required.

11 pm

Mr. Jeff Rooker (Birmingham, Perry Barr) : The hon. Gentleman has had the experience of the poll tax in Scotland, which we have not had in England. I want to ask him a question. One problem will be finding out where the places are. There should be an automatic exemption from poll tax, because residential care is involved. If home owners have to apply for exemption from poll tax, that should enable a local authority to find out the addresses where there are one, two or three people in residential care. The policing part would be done. How has it been dealt with in Scotland where the exemption should be the same?

Mr. Kennedy : The hon. Gentleman makes a fair point. I will give an example to show how ludicrous the position is, without straying from the amendment into the rights and wrongs of the poll tax. I was speaking to someone who

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provides residential care. Because of the type of people he caters for, he has to have an overnight matron in order to be registered. The matron rebuilt, with a 100 per cent. local authority grant, a house which is a dwelling place, but if she does not register for the poll tax in the private residential home the owner will not get certification because he does not have an overnight matron. As soon as she registers in the residential home, her house will count as a holiday home, even though she could never let it because she had a grant to rebuild it, and she will have to pay a double charge poll tax on it.

One hopes that the method is sufficiently sophisticated to track down small homes, but when at local authority level one hand literally does not know what the other is doing, it does not fill us with confidence. Perhaps uncharacteristically, for one shining moment, the Minister in her reply on this occasion, unlike others, can fill us with confidence.

Mrs. Virginia Bottomley : It is a source of disappointment to me that it is not possible within the scope of the Bill to achieve what we all wish--the registration of smaller homes. We might disagree about the type of registration. As I made clear in Committee, I would like it to be minimal, but it is essential that we have the names and addresses of small home owners. When they go through the process of applying for registration, they should complete a form where they have to reveal any previous convictions. When the list of cancelled registrations was circulated by my Department to local authorities, a local authority would be aware if somebody had previously been refused registration or had had his registration cancelled. Those would be important safeguards. None of us wants to under-estimate the valuable work done in many small homes, but we are all concerned about a gap which needs to be plugged.

The difficulty of the new clause is that it could apply only to those for whom the local authority provides care under the terms of the Bill. We would want to find a way of bringing all small homes within the provisions of the Registered Homes Act 1984, whether their residents had been placed by the local authority or independently. There are many safeguards in the Bill. Under the new regime, a local authority will be placing contracts in which it can specify conditions. For example, it might stipulate that the home should be subject to inspection by the inspection unit which the local authority would have to set up at arm's length. We are making an important provision about complaints procedures ; that will help to eliminate difficulties, as will the establishment of case managers. In the present regime, once an individual is placed in a residential home of any sort with income support, there is no need to follow up or monitor that individual. Under a system of case management, it will be possible to keep in closer touch with the individual to make sure that his needs are properly met.

I hope I have made our intention clear. We hope to find a legislative opportunity to bring units with fewer than four residents under control.

We have great confidence that under the new regime there will be far better safeguards for individuals. Indeed, we have a programme designed to try to improve the quality of residential care. We are spending £2 million on the "Caring in homes" initiative. That is a response to the Wagner report. We are seeking to improve standards across the public and private sectors.

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I shall refer briefly to new clause 13, which was not selected but which the hon. Member for Peckham (Ms. Harman) mentioned briefly. The hon. Lady will be aware that under the Children Act 1989 arrangements are being made for those responsible for children to be checked to ascertain whether they have criminal records. There is an experimental scheme to provide access to criminal records for those involved in the operation of voluntary child care. We are having discussions to see whether that scheme can be extended further to cover those concerned with the elderly.

I agree that smaller residential homes can make a valuable contribution in the provision of care for the elderly. They often cater for the mentally frail, the elderly and vulnerable people generally. It is important, of course, that proper and sufficient safeguards are in place. I hope that with the commitment that I have given--I am disappointed that it has not been possible to plug the loophole at this stage--the hon. Member for Peckham will not press the matter at this stage.

Mr. David Hinchliffe (Wakefield) : Is the Minister able to give us a legislative timescale? My hon. Friend the Member for Peckham (Ms. Harman) has produced an estimate of the number of small homes and Community Care referred last month to there being about 1,000 in east Sussex alone. That means that throughout the country there are many small homes. I accept the argument of the hon. Member for Mid-Kent (Mr. Rowe) that many of these homes are offering excellent care. I would not want to knock them. On many occasions in Committee we were talking about institutions. I believe that smaller homes often offer precisely the sort of provision that is appropriate for many people. I know from personal contact that some small homes offer excellent forms of care. Unfortunately, however, few of the people who run such homes do not have the best motives. Are we to wait for a scandal and an inquiry before we see some action? Can the Minister say when the legislation that she accepts is needed will be introduced?

Mrs. Bottomley : I do not feel able to give the hon. Member for Wakefield (Mr. Hinchliffe) a clear timetable this evening. I hope that it will be possible before long to find a legislative opportunity to introduce an appropriate measure. I think that it will be useful to spend a little longer deciding what form of legislation we think is most appropriate for the units that we are discussing. I do not think that there is any difference between us on this. There is a need for some controls and I wish to work with others to find a moment at which we can tackle the problem.

Ms. Harman : I thank the Minister for her reply. There is no difference between us on the principle, but there is a difference in our determination that something must be done and the pace at which it must proceed.

I hope that the hon. Lady will accept that she must enter into consultation immediately with all the organisations that she said she would consult when she talked about the issue in response to a probing amendment in Committee. I understand that, so far, she has not engaged in any consultation with those organisations. I hope that she will do so at the first opportunity. The first step is to achieve consensus on registration which is appropriate, sufficient to be meaningful and worth having although less than the full registration procedure for

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homes for more than four persons. That is the first thing that the Minister must do. Having achieved that, she must seek--we shall commit ourselves to do this--the first legislative opportunity.

Given the amount of time that the Government spend legislating in respect of local authorities, I feel that it will not be long before we have a Bill dealing with the powers that local authorities used to have, might have in the future or might not have any longer. When that measure is before us, we can look for an opening for the new clause. Similarly, in respect of criminal records, there are always criminal justice Bills going through the House. We shall assist the Minister by looking for a legislative opportunity, but she must enter into negotiations immediately. We do not want to miss a legislative opportunity because she has not undertaken the consultation. She must be ready with the decision in principle and then look for the opportunity.

New clause 15

Advisory Committee with respect to standards

( ).--(1) The Secretary of State shall establish and maintain a committee for advising him with respect to the maintenance and improvement of the quality of goods or services provided by any health service body under an NHS contract.

(2) The committee established and maintained under this section-- (

(a) shall consist of a chairman and not more than nine other members, appointed by the Secretary of State ;

(b) shall include such representatives of the medical and nursing professions and organisations representing consumers as seem appropriate to the Secretary of State ; and

(3) It shall be the duty of the Secretary of State--

(a) to consult the advisory committee, and

(b) to consider any representation made to him by the advisory committee,

on any matter pertaining to the quality of any goods or services provided by any health service body under an NHS contract. (4) It shall be the duty of the Advisory Committee to make recommendations to the Secretary of State with respect to measures which it considers best calculated to maintain and improve standards of goods or services provided by health service bodies.

(5) The Secretary of State may by regulation, approve any recommendations of the advisory committee for the purpose of-- (

(a) giving practical guidance to health service bodies with respect to maintaining and improving standards of goods or services supplied or received ; and

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