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Mr. Simon Hughes: I beg to move, That the clause be read a Second time.

Mr. Deputy Speaker: With this, it will be convenient to discuss the following amendments: No. 78, in clause 2, page 2, line 20, at end insert--

'(1A) Appropriate arrangements shall be made with a view to securing that a Primary Care Trust's functions are exercised with due regard to the principle that there should be no discrimination on the basis of age, race, sex and sexual orientation, except where clinically justifiable.'.

No. 83, in clause 18, page 23, line 23, at end insert

'with due regard to the principle that there should be no discrimination on the basis of age, race, sex and sexual orientation, except where clinically justified.'.

No. 80, in page 23, line 23, at end insert--

'(1A) The reference in subsection (1) to monitoring includes the monitoring by ethnic origin of individuals receiving health care.'.

No. 172, in clause 20, page 24, line 6, at end insert--

'(c) the function of assessing equality of access to treatment within the NHS of persons of different race, gender and age, of reporting on any such inequalities which it considers inappropriate and of making recommendations for their elimination.'.

No. 81, in page 24, line 18, at end insert--

'(1A) Appropriate arrangements shall be made with a view to securing that the functions of the Commission for Health Improvement are exercised with due regard to the principle that there should be equal opportunity for all people.'.

No. 79, in schedule 1, page 78, line 22, after 'effectiveness', insert 'and equal opportunities'.

No. 82, in schedule 2, page 84, line 5, after 'year', insert

', and such a report shall include an assessment of performance in relation to equality of opportunity'.

Mr. Hughes: Just so you, Mr. Deputy Speaker, and colleagues know, our plan is that, because we are now subject to the guillotine, we have literally just over an

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hour, and there are 22 groups of amendments that we would have liked to have got through. The first seven are led by new clauses that have been tabled by my hon. Friends and me. We hope to take a few minutes at most on any of the amendments, allowing time for a ministerial reply and for participation by our Conservative colleagues. We will divide on the important ones if ministerial replies are not adequate.

The issue is to do with discrimination in the health service. The straightforward proposition in new clause 7 is that there should be a review to examine and to make recommendations about ending such discrimination. All sorts of discrimination exist. Age discrimination is a recurrent issue and, until recently, people have been turned down for treatment because of their old age. My hon. Friend the Member for Twickenham (Dr. Cable) has persistently raised that issue in the House. Disability, race, sex and sexual orientation discrimination impact in two respects--on treatment and on staffing.

We have health inequality in Britain. It is often the people at the lowest end of the income scale--the poorest people in our society--who include those from minority ethnic communities, who do not receive as good health treatment as others. In relation to staff, persistent problems relate to the fact that some people--again, often from minority communities--find they do not get the same opportunities for promotion or for advancement in the health service as others.

At the top end of the staffing complement, the problem of discrimination relates to consultants. There is plenty of evidence to suggest that people who are black or Asian--often it is black people--have difficulty in getting senior posts. At the bottom end, that discrimination affects other posts.

The new clause and amendments simply follow up the debate in the Lords, which was led by my noble Friend Lord Clement-Jones, and the debate in the Standing Committee in the House, which was led by my hon. Friends. On both occasions the Government supported the principle behind our argument, but said, "Hang on. We need to look into things." We have tried to be constructive in response to that because we accept that there may be a need for information. The new clause simply says that if the Government are not willing to include a non-discrimination clause, they should at least set up an independent review. We need that because it is not provided in current NHS legislation or legislation dating back to the 1940s. There is regular Government resistance to placing non-discrimination provisions in legislation. It happened on the Greater London Authority Bill and it has happened again now.

The insertion of our new clause would bite on clause 2, which is about discrimination in primary care trusts. We believe that the primary care trusts now being set up should exercise their function with an explicit duty of non-discrimination. They will be a formal part of the health service and that duty should be written into their constitution. Amendment No. 79 to schedule 1 would have the primary care trusts report on their non-discrimination policy. Amendment No. 80 to clause 18 would provide a duty on the health service to monitor quality by ethnic origin. It is important to ensure that all ethnic groups receive equally good health care.

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Amendment No. 83, also to clause 18, seeks to ensure non-discrimination in the exercise of the duty of quality. Amendments Nos. 81 and 82 relate to the Commission for Health Improvement--CHIMP--which is a body being set up by the Government and which we welcome in general terms. A mechanism for health improvement should function according to the principle of non- discrimination and there should be a report back on that.

8.30 pm

It is an issue of concern to the Commission for Racial Equality and bodies such as Age Concern. We hope that the Government will see our new clause 7 as a compromise. It says that we should have an independent review so that we can all have the facts and that it should be conducted in the context of the Bill. If the Government are not willing to do that and leave us with the promise of some inquiry at some time, with no certain date to report back and no absolute commitment in the Bill, we shall seek to press new clause 7 to a Division.

Mr. Hammond: The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) has referred to problems of discrimination in the national health service in terms of employment and treatment. I intend to address the issue of discrimination in treatment because I believe that there is adequate legislation in place and adequate institutions in this country to deal with discrimination in employment. That does not mean that I am complacent about the effectiveness of those institutions in relation to the national health service, but my hon. Friends and I do not feel that the issue is necessarily appropriate for primary legislation. The Minister has an arsenal of weaponry at his disposal and the Secretary of State has already made it clear that he considers this to be an important issue and we support him in that.

As I understand its wording, new clause 7 offers a one-off approach to discrimination. It requires an independent review and a single report of its recommendations. It is a rather indiscriminate approach to the problem of discrimination. Unlike amendments Nos. 78 and 83, also tabled by the Liberal Democrats, there is no concept in new clause 7 of distinguishing between discrimination which is clinically justified and pejorative discrimination which is not and cannot be justified.

The Conservative party's approach to the problem of discrimination in treatment is enshrined in amendment No. 178. Rather than tabling a new clause, for tactical reasons we have sought to address the problem by amending the Bill. That seems a better way of dealing with an issue if it is possible to do so. Our amendment would make it one of the functions of CHIMP to assess equality of access. It would place a duty on it to make recommendations. That would be a permanent duty--a continuing process. Amendment No. 172 clearly acknowledges the distinction between appropriate and inappropriate discrimination.

Equality of access to treatment, at least in theory, is or was--until the Secretary of State's recent decision on Viagra--one of the fundamental principles of our national health service. I said last night in the debate that I believe strongly that the Government have crossed the Rubicon with the proposed rationing arrangements--or limitation on availability, as the Minister would prefer to call it--for Viagra.

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As the hon. Member for Southwark, North and Bermondsey said, the issue was debated in another place, and Baroness Hayman said that she would give further consideration to the amendments tabled in the other place. She also said that the Government would investigate the best way of taking "the points forward". Although I accept that the Government may determine that the best way of taking those points forward is not in primary legislation, as far as I am aware we have not yet heard anything from them about the outcome of their deliberations after that commitment was made by Baroness Hayman. Perhaps the Minister will tell us the current state of the Government's thinking on the matter.

It seems to us that discrimination in itself presents a problem for the Government, because of the inevitable link to the problem of rationing--the taboo word. Clearly, there should be no discrimination on the grounds of a patient's race, for example, when there is no clinically justifiable reason for such discrimination. It is equally obvious that there will be occasions when it would be absurd not to discriminate on grounds of gender or race in seeking to design appropriate screening programmes, for example, in which one should consider groups at risk and, inevitably, exercise some form of discrimination. We must be careful, therefore, not to fall into the trap of thinking of discrimination only in its pejorative sense.

In considering the problem, and in the context of the overall limits on resources available for health care delivery, I wonder what it means to say, "There should be no discrimination on the grounds of sex unless it is clinically justifiable." The point is directly connected to the question that I asked the Minister in the previous debate on the cost-effectiveness of treatments for a single condition, the cost-effectiveness of treatments for different conditions, and on a comparison of the two. What would a direction against discrimination on grounds of sex tell us, for example, about the allocation of resources to the diagnosis of breast cancer or of prostate cancer?

Within an overall resource constraint, enhancing a service provided to one person inevitably will involve curtailing a service provided to another. We seek, and have always sought, to ensure that that should be doneby a rational process, eliminating discrimination in its pejorative sense--as irrational and unjustified discrimination--and ensuring that there is transparency in prioritisation and resource allocation.

If the Government were to admit both the existence of and continuing need for rationing in the national health service--so that we could have a mature debate about the criteria by which resources should be allocated, and the proper discrimination that should be introduced, when appropriate, in allocating health care resources--we should be able to evaluate objectively the competing claims of different treatments and of people with different conditions for limited health care resources. We might then have a clinically credible system for prioritising access to health care.

I tell the hon. Member for Southwark, North and Bermondsey and some other Liberal Democrats Members--such as the hon. Member for Twickenham (Dr. Cable), who has been very concerned about the issue of age discrimination--that I believe that it is perfectly possible that a clinically credible system for prioritising access to health care would prioritise treatment for an otherwise healthy 30-year-old above the same treatment

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for an 80-year-old who was in generally poor health. In other words, I suspect that any clinically credible system would, or might, include an element of discrimination on age grounds. However, such discrimination would have to be clinically justified and justifiable, and I should like it to be done transparently and openly.

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