Preventive Health Care

HC Deb 10 June 1998 vol 313 cc1010-33

11 am

Dr. Peter Brand (Isle of Wight)

I am grateful for the opportunity to raise the issue of preventive health care and home insulation. People might wonder why I want to discuss home insulation in June, but the purpose of the debate is to take the crisis out of winter. Each winter, many people suffer from illness and even premature death because of drops in temperature—much more so in this country than in, say, Scandinavian countries or even Siberia.

I am pleased that a Minister from the Department of the Environment, Transport and the Regions will respond to the debate. However, I am disappointed that the Minister for Public Health is not gracing the Benches this morning. The Government's public health statement was full of warm words, and there is an opportunity this morning for them to make a commitment to warm homes; that would do much more to help people than the leaflets, advisory papers and so on that are made available to keep people warm.

Many initiatives have been taken by local health authorities, often working with local authorities. Such schemes are commendable, but they are just drops in the ocean. It has been estimated that about 8 million households in the United Kingdom suffer from fuel poverty. People cannot afford to heat their homes properly, which means that about 10 million people shiver unnecessarily in the winter. That is a matter for the individuals concerned, who should be our priority, and it is also amazingly wasteful of energy resources, which are finite not only in this country, but elsewhere in the world.

There have been commendable initiatives. The home energy efficiency scheme was a good start. Unfortunately, its funding has been pegged.

Mr. Bernard Jenkin (North Essex)

Cut.

Dr. Brand

Cut, in real terms.

The regulations have been changed, so that people can no longer use the schemes to improve the insulation that their properties so desperately need. Homes need to be fitted with materials and appliances that stop energy loss and provide sufficient heating. I come across too many homes where people cannot afford—or believe that they cannot afford because of the uncertainty of fuel payments—to use the heating that is installed. They rely instead on paraffin heaters and gas-bottled heaters, with all the accompanying danger that goes with such appliances.

A proper scheme for home insulation and proper heating would save money in the long run. It would cut costs, not only for the national health service, but for the Department of Social Security. We rightly pay much lip service to keeping people in their own homes, which is where they want to be. We must make sure that their homes are fit for them and, unfortunately, we are failing to do that. The debate is supported strongly by several organisations, such as the Association for the Conservation of Energy, the Child Poverty Action Group, Friends of the Earth, Help the Aged, the National Housing Federation, the National Right to Fuel Campaign, the National Energy Association and Unison. Those groups have banded together to emphasise the multidisciplinary nature of the problems of cold homes. It is a health problem and also an environmental problem. It is a problem for the most vulnerable members of our society—the very old and the very young.

The Government have an opportunity to do something dramatically useful. The new deal correctly identified opportunities when people who have been unemployed or young people who have not found employment can work in environment task forces. It is important that those task forces learn from the experience of the home energy efficiency scheme and that they are resourced properly to carry out the work that we all know needs to be done. It is also important that the change in the rules for the home energy efficiency scheme is reversed, so that people can return to homes where only minimal work has been done.

Each winter, we have heated debates—I am sorry, that is the wrong phrase; we have concerned debates about the effects of cold weather on our constituents. It is interesting that at least four of the long list of private Members' Bills relate directly to that issue, such as the Energy Efficiency Bill which is promoted by my hon. Friend the Member for Torridge and West Devon (Mr. Burnett). There is also the Energy Conservation (Housing) Bill, the Warm Homes and Energy Conservation (Fifteen Year Programme) Bill and the Cold Weather Payments (Wind Chill Factor) Bill. I am proud to be a Member of the House of Commons where such an issue is so important. Many of us are very concerned about it.

As I said, the Government have an opportunity to take action. We must ensure that materials are made available and, if they have to be paid for by people who can afford them, let us exempt such materials from value added tax. It is nonsense to charge a tax on materials that stop us using finite fuel resources. During the next 15 years, there should be a proper programme of action to insulate the 1.5 million homes that need to be insulated. The new deal programme and environment task forces must work together with HEES and, if we can get that package together, the Government can show that they are truly committed to public health.

11.7 am

Mr. Matthew Taylor (Truro and St. Austell)

I warmly congratulate my hon. Friend the Member for Isle of Wight (Dr. Brand) on introducing such an important debate. The issue has a great deal of cross-party support and the list of private Members' Bills to which my hon. Friend referred clearly shows that. The matter combines social poverty, health care and environmental concern, about which I speak for my party. It draws attention to the fact that, if we are to have a society that is environmentally sustainable, it will also be socially and economically sustainable. The environment is not isolated in that sense; it links up with other issues.

It is extraordinary that as many as 8 million people in the United Kingdom are still suffering from fuel poverty. It affects some families more than others; single-parent families are particularly affected. Almost half of Britain's 1.5 million lone parents, let alone the 2.3 million children for whom they care, are on incomes of less than £100 a week. That often leads to cold homes. One in five lone parents report dampness; one in five lone parents have no central heating.

It is not just a personal issue of being cold in the home. It costs the Government and the NHS, in particular, vast sums. At present, the Secretary of State for Health is wrestling with the monster of increasing waiting lists. This is not easy to tackle, but those hon. Members who care to visit hospitals will be told that they are overwhelmed in winter with patients who are cold at home and who are therefore suffering the associated health problems.

It is estimated that the NHS wastes £1 billion a year on extra hospital admissions—let alone the knock-on impact of increasing waiting lists. Government figures show that, every winter, between 30,000 and 60,000 people die prematurely as a result of the cold. We might think that that is inevitable. Of course, when it is cold, wet or damp, people suffer increased health problems.

We might think that would be true anywhere in the world, but statistics from other countries show that they do not have the same level of problems. Of course, they have an increase in ill health during the winter, but not on the same scale as us. For instance, Sweden suffers a 14 per cent. increase in deaths in winter; in Norway, it is 10 per cent.; and, in Germany, 12 per cent. In the United Kingdom, it is 31 per cent. That is a great worry.

Tens of thousands of people should not die prematurely because they cannot keep themselves warm at home. I have already mentioned the environmental impact of the energy that is wasted through the roofs of those who are fruitlessly attempting to warm their homes. The unnecessary burning of fossil fuels costs money, and it also harms the environment.

Several systems are in place to tackle the problem, but they are not adequate. The cold weather payments scheme suffers not least because it is based on statistics rather than the reality of how cold people are at home; it takes no account of wind chill. We all know that a biting wind makes us feel far more cold than the ambient temperature about which we hear on the television news. That problem needs to be tackled. A private Member's Bill on the subject has been tabled. I hope that the Government will accept the case for taking account of wind chill.

The home energy efficiency scheme is brilliant in principle, but it is underfunded and suffers in the way in which it is administered. In particular, only one corrective measure is allowed per house. That leads to a waste of resources. A team enters a property to assess what needs to be done to insulate the home and then carries out the work. It seems nonsensical that, if the team lays insulation in the roof, it cannot cover the cracks around the doors and windows; if it does the cracks around the doors and windows, it cannot insulate the roof; and, in either case, it cannot lag the water tank.

Once a team has started work, it makes sense for it to do a comprehensive job—obviously within limited funding—and to do a range of work, rather than only one job. The irony is that, although the funding is limited, in those properties that need a mix of work to be done the money available cannot be spent because no more than one piece of work can be done. It is not necessarily a question of limited finance; it is merely one of bureaucracy.

Worst of all, the work of the Energy Saving Trust remains massively limited by the gas regulator's block on a levy being raised to carry out that work. The Government urgently need to undertake to change that through legislation. A utility regulation Bill should be introduced before too long; it could reverse that block and put a clear obligation on the regulators to take account not only of price but of environmental and health issues.

The previous Government, when setting up the Energy Saving Trust, promised a programme amounting to as much as £1 billion a year. They secured the Treasury's acceptance that the levy would not count as Government spending. The Conservative Government did the necessary background work, but they failed to deliver by not ensuring that the money was made available and by not overcoming the problems caused by the gas regulator. As yet, we have seen no progress on the matter from the Labour Government.

I hope that the Minister will say not only that the Government are aware of the problem, but that they intend to overcome it. The industry has the potential to invest vastly more money than has been put into home energy insulation. It should particularly target the poorest groups, who need it most.

VAT is charged on energy-saving materials. It is a great disappointment that the Government have not felt able to carry through what the Labour party said before the general election, although some Government schemes—we do not yet know which—will be exempted. All schemes should be exempted. Although the Government claim that European Union rules prevent that from happening, I note that at least one other European country has not found itself so restrained, but has already implemented such a policy.

The Government frequently refer to the new deal, and the environment programme within the new deal, as an opportunity to carry forward home energy insulation. Indeed, when questioned on the matter, the Prime Minister and other Ministers spoke of a massive programme of home energy insulation. I have spoken in detail with those administering the new deal, I have met the head of the agency involved, and I have detailed statistics.

I shall not bore the House with those statistics, but they amount to a few programmes being signed for home energy insulation under the new deal, which involves a small number of people. The programmes are handicapped above all by the fact that there is no funding available for the extra material costs, other than the small amount allowed for those participating in a new deal programme. It makes no sense to do that, unless a great deal more material is made available. Indeed, it is most likely to result in different people carrying out the same old schemes, rather than more people carrying out many more schemes.

There is plenty of room for Government action. From all that the Government have said, I believe that their heart is in the right place, as do many Labour Back Benchers. The hon. Member for Plymouth, Sutton (Mrs. Gilroy), who will shortly seek to speak, has been an outstanding campaigner on the matter before and since the election. I am sure that she will reinforce many of the points that I have made. I hope to hear a strong and robust statement from the Minister supporting what we have said and showing that the Government will take action at the earliest possible moment.

This afternoon, my hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes) will introduce the Preventative Health Care and Home Insulation Bill. It has cross-party support, and I hope that it will be taken up in the next Session of Parliament—by a member of any party—and that it receives Government time. It would require health authorities to assess their role in getting people warmer homes, and how to carry through a programme of preventive health care to prevent people from having to go to hospital.

Several local health authorities have already done that on a trial basis. Cornwall and Isles of Scilly health authority has spent £300,000 insulating the homes of people with asthmatic children. That has led to a significant and dramatic reduction in the incidence of severe asthma attacks, as a result of which children have not had to take time off school, and have not had to go to hospital or receive so much treatment. That sort of preventive health care, rather than the traditional role of health authorities insulating homes or even simply identifying problems, has a lot going for it. I hope that the Government will take a positive attitude to a Bill that commands cross-party support in the House and has huge support among the relevant organisations.

11.19 am

Mrs. Linda Gilroy (Plymouth, Sutton)

I warmly welcome the debate initiated by the hon. Member for Isle of Wight (Dr. Brand). I also welcome the Preventative Health Care and Home Insulation Bill referred to by the hon. Member for Truro and St. Austell (Mr. Taylor). It certainly has the backing of the campaign for warm homes. Indeed, we discussed it at recent meetings and hoped that it would come to the attention of the House. I welcome this early opportunity to debate the matter. It is certainly necessary to engage all public agencies and private businesses. I pay tribute to the Association for the Conservation of Energy, which supports us all in our work. As has already been mentioned, the matter enjoys cross-party support, as evidenced by the Bills that the hon. Member for Isle of Wight read out, including my Warm Homes and Energy Conservation (Fifteen Year Programme) Bill.

In the fight against fuel poverty, the Government have an enormous task, which I think is recognised by all hon. Members present, but we must put that message across to others. Mention has been made of 8 million households—hence the 15-year programme envisaged in my Bill, to tackle that problem by measures for 500,000 houses during each year of the programme. We have examined both what needs to be put in place to achieve that and the programmes that were developed under previous Governments.

Our recent estimates suggest that about half the resources required for the purposes of my Bill are already available and dedicated to such work. The challenge is to ensure that we get every penny of value out of such programmes, as well as identifying and dedicating new resources to the fight. I know that the Under-Secretary of State for the Environment, Transport and the Regions, my hon. Friend the Member for Wallasey (Angela Eagle), has attacked the problem with great passion and focus in the Government's early months.

The initiative to engage and focus health authorities and trusts, which is the subject of this debate, is most welcome, because the size of the challenge is truly daunting. We have mentioned the 8 million households that are thought to have to spend 10 per cent. of their income to achieve adequate warmth. However, we should also bear in mind other figures, such as the 1.5 million people who live in severe poverty and who would have to spend 20 to 30 per cent. of their disposable household income to achieve adequate warmth, and the 1 million people in extreme poverty who would have to spend more than 30 per cent. to do so.

I invite hon. Members to consider what that would mean in terms of our disposable incomes, and to imagine the effect that would have even on us, were we to be presented with a bill for £3,000—if it were to be 10 per cent. of disposable income, or thereabouts; hon. Members' circumstances vary. Imagine a bill for £7,000 to £8,500, which would reflect 20 to 30 per cent. of expenditure from disposable income.

That is enough to cause a sharp intake of breath. I suggest that it might increase hon. Members' blood pressures significantly. The incidence of coronary heart attacks might rise suddenly—we do not want to promote by-elections, so I sincerely hope that that will not happen. However, it could drive some hon. Members into deep depression; everybody's reaction is different. However, that is happening for real to many of our constituents who are in far more straitened circumstances and have far less disposable income remaining after paying their fuel bills. In the part of the country from which the hon. Member for Truro and St. Austell and I come, water bills add to the pain of that experience.

The relationship between ill health and inadequate heating has been known for a long time. When I worked for Age Concern Scotland in the 1970s, my hon. Friend the Member for Croydon, North (Mr. Wicks) was one of the first people to publish a study on hypothermia and excess deaths in winter. When I was involved in organising conferences across the country, working with colleagues in Age Concern in England, Wales and Northern Ireland on the manifesto on the place of the retired and elderly in modern society—more than 20 years ago—a paper by my hon. Friend was developed. Sadly, although some progress has been made in the intervening years, the issue is not taken seriously enough. We are about to engage on a conference with a similar theme, "The Debate for the Millennium", with much progress still to be made.

In the 1970s, Jack Benny, the comedian who was then only in his 80s—he lived to be 100—said that age was a case of mind over matter: if people don't mind, it doesn't matter. I used to use that a great deal in the talks that I gave for Age Concern. However, what must be added to that is, "as long as you have your health," because health is probably the key issue that makes for a happy and fulfilling old age. A key factor in maintaining that health, and in relieving ill health, is warmth, with the relief of fuel poverty and the promotion of energy efficiency.

Engaging health authorities and agencies is an idea that has been mooted for a number of years, but actions speak louder than words. It is good to hear of an increasing number of places where practical projects are being developed. Mention has been made of the Cornwall and Isles of Scilly health authority; I pay tribute to what it is doing. Initiatives are also being developed in Birmingham, Doncaster, Northampton, Eastleigh, Nottingham and Shropshire.

This morning, I asked the local energy advice centre in Plymouth how its work was going and whether it was engaging in such activities. It informed me that, yesterday, it spoke to about 20 health care professionals in Plymouth, outlining the services that local energy advice centres offer.

I am sure that hon. Members recognise, as I do, the great service that more than 30 such energy advice centres provide throughout the country. Health authorities can help, working jointly with local energy advice centres. I understand that the energy advice centre in Solent has a programme working closely with its health authority on such issues.

I am reminded of a constituent, for whom I recently sought help from the energy advice centre in Plymouth, an 80-year-old lady who had inherited a rather dilapidated property, with all the usual accompanying energy efficiency problems. She made a plea to me for help. She was going out during the winter looking for wood to burn in a fire to augment her heating. When the energy advice centre visited her, it found that her property had a standard assessment procedure rating of only 1. I am glad that it can work with her. Another organisation that contributes a great deal working with health authorities as we envisage is Care and Repair. It will work with my constituent to try to deal with her heating problems to ensure that her next winter is more comfortable and, I hope, more healthy for her.

Hon. Members might expect me to be slightly more effusive in acknowledging what my hon. Friend the Under-Secretary and other Ministers have already done. We have taken the issue of fuel poverty seriously. We have cut VAT on fuel to 5 per cent., which is worth £18 a year to an average family. We have introduced special winter fuel supplements for pensioners this year and next, which of course is worth more to the poorest and to people who struggle to pay fuel bills. We should not underestimate the capital receipts initiative, which channels more money into housing investment. Much more work is in hand. I shall leave it to my hon. Friend the Under-Secretary to remind us of what is in the pipeline, emerging from the consultative document "Our Healthier Nation" and the Green Paper on utilities regulation, which has been mentioned.

I thank the hon. Member for Isle of Wight for initiating the debate and for bringing the matter to the attention of the House. I look forward, as I am sure he does, to working with the Under-Secretary and her team throughout this Parliament to ensure that we make significant progress.

11.30 am

Mr. Simon Hughes (Southwark, North and Bermondsey)

I am happy to follow the hon. Member for Plymouth, Sutton (Mrs. Gilroy). My hon. Friend the Member for Isle of Wight (Dr. Brand) corrected himself when he said that every winter in this place there is a heated debate about insulation of people's homes and deaths. He need not have done so, because there is such a heated debate. I have been in the House for 15 winters and questions have been tabled on a regular basis, especially from colleagues who represent Scottish constituencies. The hon. Member for Moray (Mrs. Ewing) is noted for campaigning for proper recognition of the colder climes that people in her part of the country experience. My colleagues in Wales have done the same. The winter issue has arisen every year I have been here, because that is what constituents and news, radio and television reports tell us is important. We know that people die in this country because they are cold.

My constituency is different from that of my hon. Friend the Member for Isle of Wight, who introduced the debate. One of the great benefits of this Parliament is that we have a sprinkling of medical doctors which we did not have in the previous Parliament. They have brought with them practical experience of their surgeries and their hospital and public health backgrounds. My hon. Friend made it clear that we must get our public health priorities right—he has made that point to me at more meetings than I wish to remember. He represents what seems to me to be a relatively affluent constituency off the south coast of England.

Dr. Brand

rose—

Mr. Hughes

I was being careful to say that it seems to me to be relatively affluent. That is my perception from one of the most deprived inner-city constituencies. No doubt my hon. Friend is about to say that rural and coastal areas of Britain have as many problems, including those of public health, as areas that are identified as centres of regional or national deprivation.

Dr. Brand

My hon. Friend gives me the opportunity to put it on record that the Isle of Wight has a gross domestic product of 64. The European average is 100. We have the lowest male wages in the country and the highest unemployment on the south coast. Only 3 per cent. of the population are higher-rate income tax payers. We have real problems and I am certainly aware of the problems of fuel poverty.

Mr. Hughes

My hon. Friend the Member for Truro and St. Austell (Mr. Taylor) and his predecessor used to make similar points. My former hon. Friend the Member for Eastbourne, Mr. Bellotti, and all my hon. Friends who represent southern seats, which are perceived as being relatively affluent, have also made similar points. When I was canvassing in the Christchurch by-election I met elderly couples who were complaining about the issue. I put the matter in that context because I know that one of the paradoxes of my constituency—I represent more council tenants than any other English Member—is that people spend a great deal on heating their homes. However, most of that heat goes out the window and through the doors.

The hon. Member for Sutton made the point very well. The bills that some people run up are phenomenal and they get into terrible financial predicaments. Their fuel supplies are eventually cut off in spite of the protections in the system and their children suffer. Those people experience terrible stress and mental health problems, and families can break down. I am sure that the hon. Lady has the same undercurrents in her constituency. The alternative, especially for single or elderly people who are afraid of the cost, is not to turn on the heating. They sit in their homes doing—if I may say so—the Edwina Currie act of putting on a woolly hat and another blanket. That may be fine for a couple of hours, but it is not fine through the night and into the morning.

The issue is real. I am glad that we are debating it in June, and I share the views expressed. I think that the Government want to address the issue. I was with the Minister the other day when she came to my constituency to launch the showroom of an environmentally sustainable building suppliers. It was so good that, when I do the bit of building work that I have to do on my house, I intend to go back there. However, it may not be as cheap as other supplier. If we are to have environmentally sustainable buildings, let us have environmentally sustainable results, with good public health.

There are good practices. Like most hon. Members who have been in the House for a while, I get invited—I think every year—by the neighbourhood energy action group to visit one of its activities in a constituent's home during Neighbourhood Energy Action Week. I have done that regularly and have seen that the suggestions make a great difference. Last year, I watched a simple process of insulation in which relatively cheap strips were put around windows and doors as draught excluder. Even those of us who are privileged enough to be in fairly good circumstances really notice a draughty place in the winter.

This is a good debate. My hon. Friend the Member for Isle of Wight has done us a service by introducing it. I am glad that there is such consensus. I should like to flag up a couple of the health aspects associated with the issue, in which my hon. Friend the Member for Truro and St. Austell said that I have an interest. We hope to combine our concerns with those of other colleagues who have put the issue on the agenda.

Before I do that, however, I want to make a specific objection. I did not think that I would have to make it without the presence of the right hon. Member for Bromley and Chislehurst (Mr. Forth). By blocking the Bill promoted by our hon. Friend the Member for Torridge and West Devon (Mr. Burnett), the right hon. Gentleman is doing the House and many old people no service. That Bill concerns mortgage valuation and energy efficiency.

I have looked at the list of Bills to be debated on 3 July. To do service to the business on that day, we would have to sit for about year because of the number of private Members' Bills tabled, which includes the Bill promoted by the hon. Member for Sutton—the Warm Homes and Energy Conservation (Fifteen Year Programme) Bill. Those are not silly Bills that people are introducing for party political purposes; they all have cross-party support and wide backing outside the House. I hope that, in protecting the interests of Back Benchers, we will not allow them to abuse the interests of a huge number of our constituents and citizens when we are trying to improve their health and welfare.

My Bill, which I will present this afternoon—the Preventative Health Care and Home Insulation Bill—adds to the Bill that my former hon. Friend the Member for Christchurch, who is now Baroness Maddock, got through the House as a result of the private Members' ballot in the previous Parliament. I have entered the private Members' ballot for 15 years and have never got near the top 20. She managed to promote two Bills in her four or five years in the House. Life is not fair, even for Members of Parliament.

Dr. Brand

Especially for Members.

Mr. Hughes

As my hon. Friend says, especially for Members.

My Bill would do for health authorities what my former hon. Friend did for local authorities. It would require health authorities to include in their annual reports best practice and what they could do to improve matters. They would have to state the benefits and practicality of possible measures. The purpose of the Bill is to establish a preventive health care scheme to improve the health of people by tackling the problems that cause ill health. It would set out how a health authority, working with the local authority, should proceed.

Six matters are specified which have health consequences. We are always reading and hearing about health outputs not inputs—it is not what is spent, but what is purchased that counts. That is true. We need to reduce the risk of hypothermia and the number of people who suffer from it. That is an output. My hon. Friend the Member for Isle of Wight explained that in much colder Scandinavian countries hardly anyone dies prematurely in winter; in our country, which is much warmer, people die prematurely all the time. That is unacceptable. I know that the Minister would agree and I hope that we will have made progress by the end of this Administration.

We need to deal with circulation problems, which have a huge effect on people; stress and mental health problems; cold-related illnesses, such as bronchitic and asthmatic conditions; and hospital admissions. My hon. Friend the Member for Isle of Wight knows the reality as well as I do. I often visit Guy's hospital and see people who regularly go in and out of it. They are discharged to places that are not good for their health. That is unacceptable. I am not an expert on the demand for general practitioners' services, but my hon. Friend could no doubt produce an assessment of how we could reduce the demand on surgeries.

There obviously has to be consultation. A local health authority would consult the community health body and local authority with the intention of working with them. That could be done. It is consistent—I am sure that the Minister and even her absent colleague the Minister for Public Health would accept this—with the Government's public health strategy to ensure that the health of the nation is improved.

I want to make a couple of points that have telling conclusions. First, an assessment was conducted by Dr. Brenda Boardman of Oxford university—it was not conducted by my party and it has no party political base—which showed that the NHS spends £1 billion a year from its budget of £45 billion on additional admissions, visits and prescriptions because appropriate work is not being carried out. That significant sum, which constitutes 2 per cent. of the health service budget, could be saved and redeployed to support policies for which we argue all the time.

Secondly, the Department of Health could promulgate good practice among health authorities and share it around. It could pick up an initiative in one region and convey it to another region. The hon. Member for Sutton rightly said that the saving to households that resulted from the Government's cut in VAT is already about £20 a year, which is welcome. A similar point is made in the briefing that I received—and I still remember last year's briefing. My understanding is that, if a home insulation programme began with the lowest-income households—my hon. Friend the Member for Truro and St. Austell has more knowledge of this matter than I do—one could reduce a household's cash expenditure by about £85 a year, although the same costs were involved. Taking appropriate action is relatively cheap.

The Minister may be in a better position than I am to comment on the fact that plenty of good practice is around—many health authorities, for example, have good practice. The hon. Member for Sutton discussed the general position in Nottinghamshire. I gather that Newark and Sherwood district council, which covers a relatively small area, estimated that home insulation could save the local health authority £4 million a year, which is a valuable saving.

My hon. Friend the Member for Truro and St. Austell has first-hand experience of a pilot programme that his county's health authority established in the Isles of Scilly, which was targeted at children with asthma. I do not have first-hand experience of it, although I am interested in it. No one knows exactly how asthma is brought on, but we know which factors appear to trigger it. Quite honestly, the figures are amazing. The programme examined a group of the islands' children, who suffered from asthma, before and after their homes were insulated. Those independent statistics show that the number of days off school that those children took reduced from 4.1 days over the study period to less than one day—0.6 of a day.

I was privileged the other day to spend our most recent half-term week in the Isles of Scilly, which I visited for the first time. It is a beautiful place, but in winter some of the cottages on those islands would not be the warmest places on earth if they were not heated. The same is true of coastal areas, and we must make progress in that regard.

Mr. Gareth R. Thomas (Harrow, West)

I am interested in the hon. Gentleman's comments on health authorities, and I shall read the Bill's details carefully. Does he agree that one of the problems affecting local energy conservation programmes is often the fact that key stakeholding organisations have not worked in partnership with one another? Will not health improvement programmes, which are a key reform in the Government's White Papers and Green Papers, help to encourage partnership between local authorities and to spread good practice, of which he gave isolated examples?

Mr. Hughes

In the interest of straight talking, my answer to those questions is yes. My local authority has a different priority, although it has a health action zone, which the Government designated and which I welcome. I hope that I shall carry the hon. Gentleman with me on this issue. I believe that in our near political lifetimes the logic of running together health and social services will become overwhelming, and that we shall wonder why it was not done previously. That will also save much management money. If we take that step, the experts on the ground and the people's democratically elected representatives will be able to plan together.

I have no idea what the hon. Gentleman's views are, but I hope that I will carry him with me and persuade the Government that health and local social services authorities need to work together to plan services. They should also involve the same people, as they do in Northern Ireland. My hon. Friend the Member for Isle of Wight, who sits on the Select Committee on Health, studied the situation in Northern Ireland, and I believe that the Committee will produce its report before the summer.

We are getting used to the fact that people can go to their doctors to get a prescription not for drugs but for something else—they might be sent to a local health centre or fitness centre, or they might be advised to carry out insulation. The Minister for Public Health described the situation clearly earlier this year. One scheme allocated money to general practitioners, which enabled them to write a prescription that allowed people to cash in a receipt to pay for insulation. That is lateral, intelligent thinking and it helps to meet people's needs. Instead of giving a patient a drug to cure his bronchitis, the cause of the problem is being faced.

We have an opportunity to get our act together and to establish a coalition, and we thank all the people who have encouraged us, including our constituents. I hope that we can serve them well and that between us—whichever Bill is lucky enough to make progress—we might persuade the Minister and her colleagues to persuade the Government to make such legislation one of the goodies in the next Queen's Speech, which I am sure still contains some spaces. We cannot consider constitutional legislation and nothing else during the coming year. The Bill is a prime contender for one of those spaces, and, if the Minister wants us to join a small lobbying group, we shall be happy to oblige her.

11.46 am

Mr. David Drew (Stroud)

I begin with an apology for not being here at the start of this debate—I had an urgent meeting at the Ministry of Agriculture, Fisheries and Food which overran slightly. I congratulate the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) on what he is trying to achieve, and should like to add some brief points on this important subject.

I want to continue the debate about fuel poverty which was initiated some months ago by my hon. Friend the Member for Bury, North (Mr. Chaytor), who highlighted the fact that people's inability to heat their homes is an important aspect of poverty. In that debate I spoke about home improvement agencies.

I should declare an interest: for the past 10 years, I have been a member of a home improvement agency in my constituency, Care and Repair England, and I still sit on its board. In a speech in May, my hon. Friend the Under-Secretary, who is to reply to the debate, emphasised the importance of energy efficiency measures. Partly in response to that speech, Care and Repair England wrote to her suggesting how advances could be made in home improvements and especially energy efficiency. I shall repeat some of the points that it made, in the hope that my hon. Friend will respond to them.

Home improvement agencies, including Care and Repair England, emphasised the need to secure funding in the longer term. The part of the voluntary sector that works in capital repair—and, indeed, the voluntary sector generally—finds it hard to organise one year's funding at a time. It is therefore asking not necessarily for more money but for funding that is secure and stable: a three-year programme might be one way to achieve that.

Secondly, although Care and Repair England has a good relationship with local authorities, the danger is that cuts may have to be made because of the problems that local authorities currently face. The organisation therefore asked whether some kind of ring fencing should be considered, especially as it has to rely on grant funding, which is an elastic way of providing funds. It has asked not necessarily for arbitration between local and central Government but that there should be the possibility of appeal in cases where local government does not provide the funds for the voluntary sector that it should.

I am sure that my third point was raised earlier but I want to emphasise it in my own way. There is a need for appraisal and for the assessment of quality, which will help us to measure outcomes. The National Energy Audit suggests that there should be one measure—which I am sure was discussed earlier—the idea being that we can promote energy efficiency only by dealing with the whole house: the household as well as the house. Educating people in the use of central heating and other methods of ensuring that their property is warm and dry is an important part of the process. When appealing, as always, for funds, we need to recognise that informing and educating people is important. I am sure that the Government will be take that on board.

I referred to the impressive speech of my hon. Friend the Member for Bury, North, and anything that can be done to help is important. We know that there is real poverty out there. Fuel poverty is something that we can identify and do something about. I am sure that the House will play its part and that the Government will reply accordingly.

11.50 am

Mr. Bernard Jenkin (North Essex)

I join other hon. Members in congratulating the hon. Member for Isle of Wight (Dr. Brand) on securing the debate. The subject is most important and obviously gives him a certain amount of work in his constituency. While he was referring to the statistics it occurred to me that he is probably one of the hardest-worked Members of the House, being the Member of Parliament for the most under-represented constituency in the United Kingdom. So that he may represent his constituents more effectively in future, I hope that he will argue for a smaller constituency in the Isle of Wight—but that is a controversial matter and I shall not pursue it.

The hon. Gentleman identified the crux of the problem: we need to ensure that more homes are properly insulated and fitted with energy-saving appliances. He was attracted to the idea of exempting from VAT energy-saving materials. It is ironic that, when our hands are tied by the European Union, the Liberal Democrats conveniently ignore the constraints and remain the most enthusiastic party for further integration into the European Union. That is one of the luxuries of being a Liberal Democrat.

The hon. Member for Truro and St. Austell (Mr. Taylor) concentrated on the impact on the health care system and highlighted the number of winter deaths. I am told that one should only ask questions in the House to which one knows the answer. I have a question to which I do not know the answer. There is a suspicion in my mind that the statistics used for international comparisons are not strictly comparable. In a genuine spirit of inquiry—that is allowed during Wednesday morning debates, which are effectively held in private—I should like to know whether any work has been done on the international comparability of the statistics. I should be interested to see the results of any such work.

The hon. Member for Truro and St. Austell, who is now in his place, referred to the environmental impact of wasted energy. That must be included in our consideration and I shall return to it later.

The hon. Gentleman also referred to the cold weather payments scheme and said that it takes no account of wind chill. I hope that he will not think that I am souring the atmosphere with party political debate if I say that many hon. Members who now occupy the Government Benches, and even one or two on the Opposition Benches, including my hon. Friend the Member for Ribble Valley (Mr. Evans), campaigned very hard for the wind chill factor to be taken into account. Many of those Labour Members have now gone rather quiet on the subject. In the heated party political pre-election atmosphere, the issue was exploited to the full, but the Government now seem to have no intention of taking any action on it. We considered the matter when in office, but we remain to be convinced that it is the answer, so we reluctantly support the Government's attitude on the inclusion of the wind chill factor. We need to take into account the difficulties of measurement and of deciding how much compensation should be provided, and the difference between different houses in different locations suffering different degrees of wind chill. The matter is very complex. I would not begin to question the Government's sincerity in dealing with the problem of poor people paying their fuel bills: accusations of cold-heartedness or callousness benefit no one.

The hon. Member for Truro and St. Austell said that not enough money is being devoted to the Energy Saving Trust. Money seems to be one of the main issues in this debate. It is easy to call for more money to be spent, but it is irresponsible unless we can identify where the money will come from.

Mrs. Gilroy

Will the hon. Gentleman acknowledge the step taken by the Minister to restore funding to the Energy Saving Trust? I intended to refer to that when speaking of the local energy advice centres, which welcome that restoration of funding.

Mr. Jenkin

I am coming to the hon. Lady's remarks. The energy advice centres were set up by the previous Government and have proved to be very successful. We welcome the money that is being devoted to energy advice centres.

Mr. Matthew Taylor

May I clarify the Conservative party's position on funding the Energy Saving Trust? When it was set up by the previous Government, they intended to introduce a levy on gas, which would have provided much higher funding for the Energy Saving Trust. That was the then Government's policy. If, as I hope, the new Government amend the position through the utilities Bill and restore the potential for that levy, will the official Opposition support that?

Mr. Jenkin

The hon. Gentleman is absolutely right to say that we considered the matter when in government. It was a fantastically ambitious project and it saddened us that we could not proceed with it. The plans foundered on the attitude of the Director General of Gas Supply, which was that regulatory bodies were not set up to become tax collectors. If that problem can be solved, we shall consider favourably any proposals from the Government, but not until we have seen those proposals. I recognise the nifty little trap that the hon. Gentleman is setting and 1 shall not fall into it.

The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Angela Eagle)

Will the hon. Gentleman admit that the difficulty was caused by the way in which the legislation creating the regulatory system provided an individual regulator with the capacity to take that view? When the Conservative party was in power, that was contrary to its stated policy, but because the then regulator said that he did not agree, the legislation setting up the regulator gave him the power to make that choice and so defeated the then Government's laudable aims.

Mr. Jenkin

One of the delightful features of the Labour Government is that they are now engaging, responsibly and constructively, in the debate about how the privatised utilities are managed. Had they engaged in constructive debate when we privatised those industries, instead of showing blanket opposition and blocking their ears to the benefits of privatisation, I might be more inclined to take the Minister's comment as an admonition. Those privatisations were hugely successful. They contained a large experimental element and there is no doubt that, like any other legislation, they can be perfected and improved. If the Government bring forward proposals to that effect, we shall consider them, but will not commit ourselves to any hypothetical proposals.

The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) spoke of his 15 winters in the House dealing with this subject. I was a little wary of the concept of directly involving the health service too much in the process of home insulation. GPs are busy enough as it is without making them consultants on home insulation. Perhaps, in forming commissioning groups, a GP should be appointed with responsibility for home energy efficiency. However, I imagine that people who work in the health service will think that the ability to compartmentalise such problems is essential for the efficiency of the health service, and that it is the responsibility of other bodies to ensure that people are not queueing up in doctors' surgeries because they have home energy efficiency problems.

Dr. Brand

I agree that GPs have neither the expertise nor the will to take on that expert role, but the hon. Gentleman must recognise that members of the primary health care team go into people's homes, day in, day out, and know the real consequences of fuel poverty. We can make enormous steps, by providing access through the primary health care team, which nominally includes GPs, and by allowing health authorities and local authorities to do that sort of work, provided that they are properly funded. There is nothing worse than identifying a problem and finding that the only thing one can do to alleviate it is to hand out an advisory leaflet. That is not helpful.

Mr. Jenkin

I fully accept what the hon. Gentleman says. Funding is inevitably part of the debate, and one to which I shall return in a few moments.

Mr. Simon Hughes

May I make two quick points? First, health authorities, the public health bodies responsible for ensuring the general public health of the community, can have responsibility for saying what is good practice, and should promote and sell that as the evaluating body.

Secondly, in some practices—I believe that Birmingham is one example—grants were made available from public funds, and GPs nominated which of their patients should be the recipients of those grants. They did no more than that, but they said, "This person should qualify for this insulation scheme because it will be more useful to her or him than to others." So there are two different areas of potential responsibility. As my hon. Friend the Member for Isle of Wight (Dr. Brand) said, it may involve other primary health care members, who may not be GPs, but there are functional things that health service practitioners can do.

Mr. Jenkin

I am bound to say that the way in which the hon. Gentleman explains that now is less scary than the idea of GPs being asked to write out prescriptions for home insulation, which is how he described it before.

I am extremely wary of putting additional statutory burdens on the NHS, which is already deluged with bureaucracy and obligations. This is not my portfolio and I should probably shut up, but there is a case for considering how we can deregulate the health service so that it can better get on with its job, rather than Members of Parliament—bless their cotton socks—looking for good headlines by introducing new measures which may be wholesome in principle and intent but which do not make life easier for people.

I concede to the hon. Member for Southwark, North and Bermondsey that the problem is that so much of the energy that poor people burn in their homes goes out of the window. There is an instructive page in the Library brief on the Energy Efficiency Bill about how much simple measures save. Although the leaflet on its own may be frustrating—if one thinks that nothing will be achieved by handing over the leaflet—it says that loft insulation, which might cost £75 as a DIY job, will save £35– £40 in a single year. Draught proofing a whole property may cost £50, but will, on average, save £15– £25 a year. Those are two or three-year paybacks on the investment, which makes it a good investment—certainly better than leaving money in the building society, which is what many elderly people do. They leave money in the building society instead of having the information explained to them and perhaps having someone younger and more able to help them with those simple tasks. The new deal has a role to play in getting young people to come into elderly people's homes to help them with simple tasks that need not cost any public money. Information and voluntary help, or help from another Government programme, are perhaps a more practical answer.

The hon. Member for Stroud (Mr. Drew) spoke of the need to assess the quality of what we do. That is always a problem with Government programmes; there is a fanfare of intent and the allocation of money, then weaknesses occur in the implementation. That underlines why public money is not always the answer.

This debate is primarily motivated by the record of terrible suffering, particularly of elderly people, and the huge implications for the NHS. The figure of £1 billion mentioned by the hon. Member for Southwark, North and Bermondsey is not one that I have heard before, but it is a useful reminder. We all know that our local casualty departments become choked with elderly people because GPs are no longer able to cope with the influx of people into their surgeries. If energy efficiency can contribute towards reducing that misery and suffering, we should all join forces to tackle the problem.

The previous Government set up the home energy efficiency scheme grant, and since 1991, 2.3 million vulnerable homes have benefited from grants. So it is not as if nothing happened under the previous Government, and I hope that the Minister will acknowledge that in her reply. However, I suspect that her greatest problem is the Treasury, and that the message she receives from the Treasury is the same message that I am trying to give—that more money is not necessarily the answer to the problem. In some respects, the Government have already cut off their nose to spite their face. Yes, we know that VAT on fuel was politically suicidal, but there was something rational about it in terms of increasing energy costs to encourage energy conservation and to make more money available for the Exchequer, which might, perhaps, contribute to such schemes.

Against the background of privatisation, VAT on fuel was perfectly rational. According to the Library, electricity prices have fallen by 9 per cent. and gas prices have fallen by 8 per cent. over the past five years, even taking account of the residual VAT on fuel that still exists. Indeed, gas prices have fallen by 26 per cent. since 1987. The danger of those falling prices is that people start to believe that it is no longer worth insulating. If we had continued to gather the revenue, we could have spent it on the information and the extra grants that most hon. Members who have spoken this morning seem to think necessary—that would have been a better use of resources.

The Library briefing paper on the Energy Efficiency Bill states: the introduction of competition in electricity and gas markets is leading to falling energy prices", which must be good for alleviating fuel poverty. It continues: According to DTI evidence received by the Trade and Industry Committee, every 10 per cent. drop in energy prices stimulates demand by 2 per cent. We should consider the extent to which falling prices and the reduction of VAT on fuel have contributed to the amount of fuel that is wasted.

Mrs. Gilroy

I believe that VAT has significantly helped those who are poor to afford warmer homes. Another figure that the hon. Gentleman can find in briefing papers—it is significant to the health debate that we are having—is that people in the poorest households tend to take 50 to 60 per cent. of the benefit of energy efficiency works in added warmth. The decrease in VAT has helped people immediately, whereas other measures may take longer to implement.

Mr. Jenkin

I question that judgment, although we are talking about water under the bridge and I do not intend to dwell on the subject.

Our role as an Opposition is to scrutinise Government policy, but one of the glories of being in opposition is that we can start with a clean sheet. [Interruption.] The Labour party cleaned the sheet a few times in opposition, and much good it did it—Labour became a good deal more palatable as a Government than it would have been a few years ago.

I conclude my remarks by inviting representations to the Opposition from all the organisations that are concerned with energy efficiency and poverty, and from those who have to struggle to pay their fuel bills. Our policies are in a state of flux, and we want to include all points of views in our debate about the future of policy—if people want to contact me, they are extremely welcome to do so.

12.12 pm

The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Angela Eagle)

I congratulate the hon. Member for Isle of Wight (Dr. Brand) on securing this debate and on drawing our attention to the role of preventive health schemes in reducing the number of people who live in uncomfortable and unhealthy surroundings. I also take this opportunity to welcome the hon. Member for North Essex (Mr. Jenkin) to the Dispatch Box in his new role. I hope that he continues to revel in the glory of opposition for a long time. He may think that he is starting with a clean sheet, but the Conservative party has form on these matters as long as all of our arms put together, as we shall continue to point out. However, I would be the first to say that not all that form was completely bad—we inherited some good practice as well as some things that we wish we had not.

I assure the hon. Member for Isle of Wight that I am working closely with my hon. Friend the Minister for Public Health—although she is not sitting beside me at the moment, the hon. Gentleman can rest assured that there is much co-operation between our Departments on this matter. The hon. Member for North Essex did not seem fully to appreciate that we are trying to switch spending from the symptoms of a problem to its causes—a theme which ran through what I believe has been a worthwhile debate on one of the most important issues that we face.

Being cold at home in winter and unable to do anything about it is clearly a form of social exclusion—it reduces the quality of life for many people, including the most vulnerable. Moreover, it represents a barrier to progress towards achieving our Kyoto environmental targets, which form a background to the whole debate; those targets will force a change in the way in which we live and behave, and will be the focus of much Government policy. How can we expect the conservation message to be successful when too many families are facing an increased risk of ill health because they cannot keep warm at home, even if they consume fuel at a rate that they cannot afford?

When we came to office, I was deeply concerned about the problems associated with fuel poverty. I quickly set up an interdepartmental group of officials—they come from a surprising number of Departments—to take a hard look at the issues surrounding fuel poverty and to work up imaginative policy options. We are looking from all directions and angles for the best ways forward, which I hope will lead in the medium term to a more coherent and integrated strategy for dealing with the problem. To extend the discussion, I invited interested bodies to enter into a national debate about the best ways in which to overcome the problem of too many cold homes.

The inability of households to enjoy adequate heating without spending disproportionate amounts of their income means that they lack affordable warmth. As hon. Members have pointed out, that means that there is an increased risk of ill health, with all the consequent economic and social costs. Typically, 30,000 more people die in winter in the United Kingdom than would be expected at the average death rate for the year. Several thousand of those deaths are likely to be associated with cold conditions in homes.

The hon. Member for North Essex asked about the statistics. The statistics that countries bandy around are national ones—we have not been able to find any internationally comparable statistics on cold-associated deaths. We can make comparisons only by using the figures that are collected nationally, which may be incompatible. Nevertheless, we must accept that, as a nation, we have an unacceptably high excess winter death rate, if I may use the jargon.

Mr. Simon Hughes

The hon. Member for North Essex (Mr. Jenkin) may not like everything about European organisations, but, as it is difficult to find good comparables, the collection of statistics is exactly the sort of job that we could reasonably devolve to either the Community statistical office, the Council of Europe or one of the other European bodies. Such comparative figures would be useful—the information could enable European Union social policy to be targeted at helping the countries that are at the bottom of the league table.

Angela Eagle

I do not disagree with that. International statistics are always interesting and sometimes—if they are coherent and justifiable—very revealing.

As I was saying, several thousand of the 30,000 deaths are likely to be associated with cold conditions in homes. The excess is highest in the elderly—the main causes are heart attacks, strokes, respiratory illnesses and accidents. There is good evidence that temperature contributes to winter mortality—there are more deaths in colder winters, and in colder spells within winters, and there are known physiological mechanisms by which temperature can affect the major causes of excess deaths. Excess winter mortality may arise partly from acute exposure outdoors, but it is greater in the United Kingdom than in countries that have colder winters but warmer homes. It has decreased as home heating has improved—that is another sign of its causes—and many deaths occur among those people who do not go outdoors, which must also be taken into account.

In a typical winter, 2.5 million households in England occupy homes cold enough to increase the risk of ill health—in very cold weather, that figure rises to 3 million. Below 12 deg C, there is an increased risk of cardiovascular disorders and hypothermia. Up to 15 deg C, there may be a risk to cardiovascular and respiratory health, but a less acute one than at below 12 deg C. Illness and death could be reduced if living room temperatures were at least 16 deg C. Those risks apply to all people, but certain groups—elderly people, infants, and people with long-term illnesses who do not work—are especially vulnerable to cold-related ill health. People in those groups are found in half of all households, and, because they are more likely to be at home all day, their homes can be assumed to require heating for longer periods than those of other households, so their bills start to rise.

The prime causes of fuel poverty are lack of income and energy efficiency, and the size of the home. In the poorest households, keeping warm in housing of typical size and energy efficiency can easily take more than 20 per cent. of income, and more than 1 million households—about 6 per cent. of all households—spend more than that amount. Many households are neither able nor willing to spend that much, so those homes will be under-heated, and the occupiers cold.

A household may be cold because less is spent on fuel than a satisfactory heating regime in that home would dictate, so actual expenditure on fuel as a proportion of income is not necessarily an indicator of fuel poverty, or its degree. We consider that households in cold homes that need to spend more than 20 per cent. of their income on fuel to achieve satisfactory heating are in severe fuel poverty. Households that need to spend more than 30 per cent. of income may be described as being in extreme fuel poverty. In setting priorities, those households are obviously our prime target group, and there are about 2.5 million of them in England.

Big homes are an important, and largely ignored, factor contributing to the large number of households in fuel poverty. The fuel-poorest people tend to have larger homes on average than those who are not fuel poor. That is of particular concern in local authority housing, where most "under-occupation" involves low-income households, especially lone-pensioner households. As many vulnerable households seem to be concentrated in the least energy-efficient types of houses, allocation policies and housing management could help to tackle fuel poverty, as well as physically improve the stock.

If we are to examine effectively the effects of housing quality on health, we need a reliable yardstick against which to identify housing that presents the worst health risks. Earlier this year we issued a consultation paper on the housing fitness standard. The main proposal is to develop and test a fitness rating approach as a replacement for the current fitness standard. A rating approach would give an overall rating to a dwelling rather than using the current pass-or-fail test. It would encompass the important health risks in the home and distinguish between their varying degrees of severity. It should provide a more effective mechanism for identifying and targeting action on the worst housing, including the worst-insulated and the worst-heated housing. Responses to the consultation paper are still being considered.

People in extreme fuel poverty tend to occupy housing with low energy efficiency. In 1991, the mean energy rating of their homes was 17 points as measured by standard assessment procedure, against a mean rating for all housing of 35 points. Since then, the overall picture has improved a bit. The latest English house condition survey suggests that the mean value has risen by about four points.

Part L of the building regulations dealing with energy conservation matters is currently under review, with the aim of establishing the maximum possible contribution that building regulations can make to carbon dioxide reduction targets while still observing proportionality, allowing flexibility for designers and avoiding unreasonable technical risk or excessive cost. In addition to reviewing measures affecting new construction, we want to see how the existing stock of buildings can be brought more under control. All that will help us to improve the energy efficiency of buildings.

In terms of absolute numbers, half the fuel-poorest are owner-occupiers, but that reflects the fact that most households are in the owner-occupied sector. In percentage terms, the incidence is greater in the rented sectors. Ten per cent. of owner-occupiers, 18 per cent. of social housing tenants and no fewer than 30 per cent. of private rented tenants are in severe or extreme fuel poverty. Hardly any of them actually spend more than 20 per cent. of income on energy to achieve a satisfactory heating regime, so most of them live in cold homes.

There is a clear correlation between severe fuel poverty and household type. Lone pensioners account for 44 per cent. of all households in that category, and for 37 per cent. of the total. Most of the rest are pensioner couples, lone adults and single parents.

Mr. Drew

Surely one of the key issues is education. There has been significant success in using home safety checks to help pensioners to make their homes much safer. A similar co-ordinated approach on energy efficiency could make a useful hit.

Angela Eagle

I welcome my hon. Friend's comments, and those of everyone who has spoken and who has fed ideas to my Department's review. We have clearly identified the problems, and, as I have said, we have begun to deal with some of them. We came to Government determined to do more to tackle poverty—both general poverty and fuel poverty. We have cut VAT on fuel to 5 per cent. That is worth around £18 a year to an average family and impacts most effectively on those in severe or acute fuel poverty. We introduced winter fuel supplements for pensioners for this year and next, and those, too, are worth more to the poorest pensioners.

We have started to deliver on our promise to increase energy efficiency activity and investment. The capital receipts initiative is channelling £750 million more into housing investment, and our welfare-to-work programme is making more activity possible through help with employment and training costs. Very soon, there will be a reduced rate of VAT on energy efficiency grant schemes, which will increase their output by about 10 per cent. As the hon. Member for North Essex said, there is the question of European Union regulations and potential further reductions, and we are bringing that matter to the attention of our EU partners. We hope to make some progress, but I have none to report yet.

I am particularly keen to see how existing programmes might do more to get to the heart of fuel poverty. The main one concerned with improving the insulation of homes is the familiar home energy efficiency scheme, which has already given extra insulation and other measures to 2.5 million homes, giving benefit worth an average £45 a year to each household through a combination of more comfort and reduced energy consumption. The scheme is at present improving the energy rating by about 3.5 standard assessment points on average.

Last year I agreed to the changes announced by the previous Government, because they were almost implemented when we came into office. However, I said that I would review the scheme as soon as possible to see if it was meeting customers' needs. That review is not complete, but it is becoming clear that we could do more to direct benefit to people in the worst fuel poverty, rather than to those who are simply poor. A large proportion of grants goes to people whose homes are more energy efficient than the average for the housing stock, and many of the recipients are not in any degree of fuel poverty in terms of actual expenditure on heating. The scheme is not successfully reaching private tenures.

The scheme was recently examined by the National Audit Office, whose report was considered by the Public Accounts Committee. As a result, we are committed to making a number of changes to the way in which the scheme is administered. Changes that I expect to emerge from the present review will address those issues. I want to make a good scheme even better, and will look carefully at the present structure of the scheme to see whether there are any barriers to giving real help to the most fuel poor. I want to consider particularly whether we can target grants better, and achieve greater improvements to the insulation standards of the very worst homes.

I have no doubt that my present review will conclude that there are arguments for modifying the home energy efficiency scheme to make it work better.

Mr. Matthew Taylor

Does the hon. Lady hope to be able to lift the gas regulator's block through changes that are due in utility regulation?

Angela Eagle

The hon. Gentleman will know what our Green Paper said about that. We hope to ensure that Ministers will be responsible for that policy. The consultation process is not complete, and it would be wrong for me to make any announcement about what we intend to do. The hon. Gentleman will know that we have a great deal of sympathy for his points.

The task ahead is to integrate present policies and programmes into a strategy for a concerted and coherent assault on the social exclusion that fuel poverty causes. We will consider whether it might be more cost-effective to concentrate more on the quality of housing, and to make houses easier and cheaper to heat, rather than to help people with the cost of fuel. We might in that way be able to take more households out of fuel poverty, thus improving their quality of life while making a real impact on the consumption of energy, which will help us to achieve our challenging Kyoto target, increase people's health and do something about social infrastructure.

A strategy with investment in more energy-efficient housing at its heart would succeed only if it brought the homes of the fuel poorest up to acceptable standards. We would have to bear it in mind that, for some households, energy efficiency is not the major factor causing fuel poverty, and other solutions would still be necessary to help them. However, for people for whom energy efficiency is a solution, we need to consider how much we would have to improve their homes to take them out of fuel poverty.

I agree with much of what was said about linkages to health authorities. My hon. Friend the Minister for Public Health and I are seeking innovative ways to pursue those.

I have launched a national debate on how we might best achieve our aim of getting rid of the evils of fuel poverty. My officials are actively studying how we might produce coherent and integrated strategies that go to the heart of the problem and we are reviewing existing programmes to see if they can be targeted better. We have not been helped by the Conservative party's legacy of years of under-investment, and we intend to address that neglect.