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Mr. Simon Hughes: I am listening carefully to the Minister's speech. Is he willing to consider making a start by introducing legislation that would cover all NHS activity? I understand his point about the considerations across Government, but will he consider introducing legislation in the next parliamentary year to ensure that those who felt that they were being discriminated against in NHS treatment would be able to raise that under legislative provision?

Mr. Denham: I always wish to be helpful, but I do not believe that I can make a commitment to bring forward, in the next parliamentary year, legislation such as the hon. Gentleman seeks. As the House will understand, I fear that I could get into deep trouble for making a commitment to introduce any legislation in the next parliamentary year.

At the beginning of my remarks I was careful to set out the difficulty. Use of the Race Relations Act 1976 may be the right response to the Macpherson report, but we need to ensure consistency across Government. We must choose the right legislative approach in connection with other areas of discrimination, and to deal with the NHS specifically would contradict that.

Although a specific review would not be the right way forward, I assure the hon. Gentleman that we shall continue to keep the performance of the NHS under close

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review, in the way that I have described. We shall listen carefully both to those who work in it and those who receive our services.

Mr. Hughes: The NHS is the largest organisation in the country. I do not dispute that the Government's intentions are good, and the Minister has set out their programme of work. Whether that will guarantee sufficiently soon that complaints about unfair treatment can be taken up with some prospect of success remains to be seen. I accept that that is more important in connection with the service provided by the NHS than with the employment that it provides, as other provisions are more effective in that regard.

Because so little time is left, and although I am seriously not happy, I hope that I will be able to speak to the Minister when this debate is out of the way. I shall also ask those of my colleagues who deal with Home Office affairs to meet the Minister's colleagues in the Home Office. I believe that a way forward exists, and that a provision governing the whole of the NHS would be better than one that covers only part of the organisation.

I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

New Clause 8

Health Care and Energy Efficiency Schemes

'.--(1) It shall be the duty of every Health Authority and Health Board to prepare, and to consider at least once a year, a report on--

(a) the benefits; and
(b) the practicality
of setting up and funding a health care and efficiency scheme in their area, and every report shall specify those measures that the Authority or Board consider should be taken in order to alleviate fuel poverty in their area.
(2) In subsection (1)--
"fuel poverty" means the inability to afford adequate warmth because of the inadequate energy efficiency of a home;
"health care and efficiency scheme" means a scheme for enabling or assisting persons suffering from fuel poverty to heat their homes more efficiently.'.--[Sir Robert Smith.]

Brought up, and read the First time.

Sir Robert Smith: I beg to move, That the clause be read a Second time.

The new clause rehearses a proposal in the Health Care and Energy Efficiency Bill, my private Member's Bill whose Second Reading has been begun but adjourned. Given that that Bill will run out of time, the new clause gives the Minister an opportunity to outline how he will deal with this important matter.

The new clause would help health authorities to implement the results of the pilot schemes that have already been held and to help people who suffer health problems as a result of such factors as damp and poor insulation in their housing. I hope that the Minister, when he replies, will set out the Government's approach.

My office and the Department are trying to set up a meeting in connection with my private Member's Bill, which the Department of the Deputy Prime Minister has said it is seeking to improve. Obviously I welcome that, but it is important to hear what the Government intend

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to do. Some successful schemes have been carried out, and best practice should apply across the country. I hope that the Minister will say how the Government plan to do that.

9 pm

Mr. Hammond: The hon. Member for West Aberdeenshire and Kincardine (Sir R. Smith) has been remarkably successful in persuading his colleagues to allow him to put forward his pet project for consideration under the Health Bill. Many hon. Members have followed with interest the progress of the hon. Gentleman's Health Care and Energy Efficiency Bill. We all understand that energy efficiency and fuel poverty are important. We must ask, however, whether the Bill is the right way to deal with those problems. Is the national health service budget the correct budget with which to finance solutions?

We all appreciate the benefits that would be derived from energy efficiency. It is ironic, therefore, that the Government claim credit from the rooftops for having reduced VAT on fuel--while anyone who wanted to stimulate energy efficiency and fuel conservation would not conventionally seek to reduce prices.

The difficulty is that the Liberal Democrats appear to propose that we should spread further and more thinly an already overstretched NHS budget. They are fond of telling us that they will deal with the financial consequences of their proposals by adding an extra penny to income tax, but it is clear that that would not even begin to pay for all the problems facing the NHS. If more and more responsibilities are to be included in the NHS remit, it will become even less likely that any Government can conceivably make available a budget capable of dealing with all those responsibilities.

There may well be a link between poorly heated homes and demands for health care. I do not deny that, and I am sure that the hon. Member for West Aberdeenshire and Kincardine could produce evidence to support that view. However, the link is relatively distant. The hon. Gentleman sought to suggest that the NHS would be making an investment that would save money by reducing demand for health care, but I do not believe that that would work.

Sir Robert Smith: Does the hon. Gentleman realise that for many of the pilot schemes the investment would amount to no more than the production of leaflets so that the general practitioners could ensure that patients who suffer winter illnesses that are clearly exacerbated by housing conditions could have access to resources already available to other schemes for home improvements? The proposal would mean joined-up Government, linking Departments that provide solutions with Departments that would benefit from them.

Mr. Hammond: If I had thought that the new clause would finance only the production of a few leaflets, I would have felt little need to debate it. I thought that the hon. Gentleman wanted rather more substantial intervention.

I do not deny that there is a link between poorly heated, energy inefficient homes and demand for health care. However, the NHS is not equipped to invest in order to

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secure reductions in demand, particularly in casesin which no straightforward causal connection is immediately clear. If the NHS had resources for such investment, many direct preventive treatments exist in which it is currently unable to invest. That would bring a quicker and more direct payback to the NHS.

I am not sure why the hon. Gentleman has focused on energy efficiency. Why not focus on diet, suggesting that health authorities should be responsible for subsidising good eating habits? Why not focus on life style, or even on driving technique? It may be possible to make a case that improved driving technique would reduce the health care consequences of road traffic accidents. The hon. Member for Dartford (Dr. Stoate) appears to find that extraordinary. He may be right to think that it is stretching the point somewhat.

The NHS budget is faced with so many other demands, with so many patients who cannot get the treatment that they need or want, and with ever growing real waiting lists. People in the real world outside this place would simply not understand our motivation if we spread the limited budget still further and made the NHS responsible for doing things that are no doubt worthy and should be done but are not its proper responsibility.

The NHS must focus its effort. It is struggling to do its job--even the Minister would not deny that. It is an uphill struggle to meet the rising tide of expectation for health care. The Liberal Democrats appear to want to divert resources that are already inadequate to meet the demand to what should be another remit altogether.

The Government's position is interesting. Various Ministers and Labour Members have made their position on the Health Care and Energy Efficiency Bill clear. The Under-Secretary of State for Health said that he supports the aims expressed in the early-day motion, which more than 100 Labour Back Benchers have signed. He did not sign it, of course, but he wrote to constituents expressing his support.

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