Lords Sitting of 26 May 1994

Preamble
The House met at eleven of the clock: The LORD CHANCELLOR on the Woolsack.
Prayers—Read by the Lord Bishop of Lincoln.

Newly Qualified Drivers
Baroness Gardner of Parkes Baroness Gardner of Parkes asked Her Majesty's Government:
Whether they are considering the introduction of new controls on newly-qualified drivers.
The Parliamentary Under-Secretary of State, Department of Transport (Lord Mackay of Ardbrecknish): My Lords, we are considering the introduction of a scheme to require these drivers to re-take the driving test if they commit serious traffic offences.
Baroness Gardner of Parkes: My Lords, I thank the Minister for that Answer, but of course it is quite inadequate. Is he aware that although only 10 per cent. of licence holders are between the ages of 17 and 21 they are responsible for 20 per cent. of all road accidents and 25 per cent. of all road deaths? Is he not aware of the great benefits achieved in Northern Ireland and Australia where drivers carry either "R" for restricted or "P" for provisional plates for a period after they are granted their licence?
Lord Mackay of Ardbrecknish: My Lords, I am sorry that my Answer did not totally satisfy my noble friend. She is right to point out that statistics show that drivers under 21 account for a disproportionate number of accidents on the roads. We are studying the results of the experiment in Northern Ireland in which a P-plate is carried on the car of somebody who has recently passed the test to see whether there are benefits. Obviously if there are benefits we shall consider applying the scheme more widely. In the meantime, we have to await a proper evaluation of the effect of the plate on the accident rate of drivers under 21.
Lord Merlyn-Rees: My Lords, is the Minister not aware that the scheme in Northern Ireland is not an experiment? It has been going on for years. Surely the Department of Transport could evaluate that scheme. It is a very good idea. As you are driving you can see that the driver in front has only recently passed the test, so you are wary.
Lord Mackay of Ardbrecknish: My Lords, perhaps I should not have said that the scheme in Northern Ireland was an experiment. However, we are evaluating that scheme. The noble Lord, Lord Merlyn-Rees, points out the obvious advantage of the scheme. It alerts other drivers to the fact that the driver in front, or perhaps even behind, is newly qualified. However, it is the effect
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on the driver himself or herself of carrying that plate on the car that interests us most. That: is why we are continuing the evaluation.
Lord Boyd-Carpenter: My Lords, is it not a very dangerous rule that someone can obtain a full licence without ever having driven on a motorway and then promptly go out and drive on the motorway as much as he wants? Is that not one of the main causes of the large numbers of accidents involving young drivers?
Lord Mackay of Ardbrecknish: My Lords, I understand what my noble friend is saying, but the statistics show that the problem on motorways is not great. In fact, accidents occur largely on roads other than motorways. The other problem about including motorway driving in the driving test is that so many people and so many driving test centres are situated quite a distance from motorways. Therefore, the practicalities of conducting part of the test on a motorway are considerable.
Lord Bruce of Donington: My Lords, in his reply the noble Lord suggested that the Government are in the process of evaluating what has happened in Northern Ireland. May we have the assurance that the Government will not have to call in yet another firm of management accountants to make up their mind for them and that the Government can make up their own mind without any extra cost being incurred?
Lord Mackay of Ardbrecknish: My Lords, I can assure the noble Lord, Lord Bruce of Donington, that Ministers in the Department of Transport will make up their own minds.
Lord Clinton-Davis: My Lords, the House will regard that as something of a change. Will the Minister indicate how long the consideration of re-taking the driving test when serious offences are committed— which seems to me to be an eminently sensible idea —is likely to take before the Government can come forward with specific proposals?
I fully support the idea put forward by the noble Lord, Lord Boyd-Carpenter, concerning motorway driving. Does the Minister agree that driving on a motorway requires driving of a quite different quality from driving on other roads? Will he therefore not close his mind to the idea that was put forward, which I thought he tended to do in answering that question? Will he give an undertaking to the House that this is a matter to which he and his colleagues will give further consideration?
Lord Mackay of Ardbrecknish: My Lords, to answer the second part of the noble Lord's question, obviously we think all the time about ways in which the driving test might be improved. However, the problem about the motorway aspect is the one that I mentioned. Approximately 50 per cent of driving test centres are a very long way from motorways. Indeed, in the constituency which I had the honour to represent in the other place it would have been impossible to impose on people taking the test in that area a section on motorway driving.

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In relation to the first part of the question concerning re-testing, there are some problems with regard to the legal position. We are looking into the kind of situations in which re-testing would be triggered and whether secondary legislation would be required or whether primary legislation would be necessary.
Lord Clinton-Davis: My Lords, will the Minister take it from me that in suggesting that motorway testing should be undertaken I am in no way advocating the idea so dear to the heart of the Government that more motorways should be built so that more driving tests can be applied?
Lord Mackay of Ardbrecknish: My Lords, I never gave that possibility a thought. But I shall take it away and think about it again.
Baroness Gardner of Parkes: My Lords, is the Minister aware that when we debated the last major traffic Act in this House we had facts and figures from the Chief Constable of Northern Ireland about the great improvement due to the R-plates which even at that time seemed conclusive? Will he assure us that the use of P-plates, which statistics show have proved so successful in Australia, will be considered in any study?
Lord Mackay of Ardbrecknish: My Lords, yes, of course I can assure my noble friend that we shall look carefully at the studies taking place in Northern Ireland to see whether such use reduces the accident rate among those young people. We have a number of issues in mind. We intend to impose a separate theory test in the course of the driving test as from 1st July 1996.
Lord Swinfen: My Lords, courts already have the power to order someone who has been banned from driving for a short period to retake the test before he can obtain a licence again. Does the Minister agree that that power should be applied far more often than at present to drivers of all ages?
Lord Mackay of Ardbrecknish: My Lords, my noble friend is quite right that the courts already have the right to order someone to retake the test at the end of that person's banned period. However, the proposals that we are discussing would be of a more automatic nature, perhaps linked to the points system or the nature of the offences. The situation would be different from the current position in which it is up to the discretion of the courts to decide whether to impose re-testing.
Viscount Cross: My Lords, I support my noble friend Lady Gardner of Parkes. Is the Minister aware that in France the plating system for newly qualified drivers has been in existence for many years, together with the figure "90" placed on the back of cars, indicating a limit of 90 kilometres per hour? Does he agree that the teaching of driving in areas off the road is to be encouraged because the length of the course is less, the cost is less and congestion on the roads is removed for the general public?
Lord Mackay of Ardbrecknish: My Lords, I am not entirely sure whether I can go along with the latter part
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of my noble friend's question. The real problem is that people have to be taught to drive within the environment and situations in which they will have to take the test, and drive thereafter if successful.
On the first part of my noble friend's question, I shall draw the attention of my honourable friend Mr. Robert Key, the Minister for Roads and Traffic in the department, to the various points made by your Lordships on the question of probationary plates.

Boxley Valley: Channel Tunnel Rail Link
11.17 a.m.
Lord Thomson of Monifieth Lord Thomson of Monifieth asked Her Majesty's Government:
What environmental protection they propose for the Boxley Valley in Kent in view of the proposed high-speed Channel Tunnel rail link.
Lord Mackay of Ardbrecknish: My Lords, measures which will minimise the environmental impact on the new rail link in Boxley Valley are currently being studied. They include a length of cut-and-cover tunnel to the south of Boxley village and various landscaping measures.
Lord Thomson of Monifieth: My Lords, I thank the Minister for that reply. Will the Government bear in mind that the Boxley Valley is an area of outstanding natural beauty which serves the great conurbation of the Medway estuary, and gives great pleasure and recreation to people? For the benefit of future generations, would it not be worth the price to put the high-speed link in the Boxley Valley under the North Downs rather than implementing the half-way measures that the Government propose? Might there not be some funding from Brussels to help pay for the transport networks and the environmental protection involved?
Lord Mackay of Ardbrecknish: My Lords, I am not sure whether there would be funding from Brussels for specific measures, although there may well be funding from Brussels for the whole project.
As regards the specific problem in the valley, we indeed appreciate the scenic beauty of the area, which is why the whole project has twice been reviewed by the Government and Union Railways. On both occasions the conclusion reached was that the extra expenditure —it is £65 million if we have to drive only one tunnel and £115 million if we have to drive two—did not seem to be worth while, set against the way in which the small portion of the cut-and-cover and other environmental improvements which can be made on the line above ground can help to ameliorate the environmental impact.
Lord Renton: My Lords, is my noble friend aware that, although tunnelling is much more expensive, it protects the landscape for the rest of time? Do we not owe it to future generations so to protect whenever feasible?
Lord Mackay of Ardbrecknish: My Lords, I appreciate that tunnelling puts the railway, so to speak,

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out of sight and perhaps at least out of the mind's eye. However, we have to consider the cost. If too much of a railway line is tunnelled, the whole economics of the project become impossible. I believe that there has to be a balance between the economic and the environmental sides.
Lord Astor of Hever: My Lords, is my noble friend aware that environmentalists regard Cobham Park, where the line will be raised by five metres through Repton's unique 18th century landscape, as an even greater area of concern than Boxley Valley?
Lord Mackay of Ardbrecknish: My Lords, I do not wish to become involved in a discussion about what part of the project gives rise to the greatest anxiety. I know of my noble friend's interest in Repton's work at Cobham and can assure him that Union Railways are aware of the special sites there. The firm has met representatives of the Cobham Park Trust and the National Trust to try to ensure that the new railway line, which will go as close to the roadway as possible, will cause the minimum impact on Repton's work.

South Africa: Development Programme
11.20 a.m.
Lord Judd Lord Judd asked Her Majesty's Government:
What progress has been made in the Commonwealth, the United Nations, the European Union, the World Bank and other appropriate international institutions towards developing, togeth-er with the new South African Government, a sustained development programme for South Africa.
The Parliamentary Under-Secretary of State, Department of Employment (Lord Henley): My Lords, the new South African Government have adopted a reconstruction and development programme. We and other donors are ready to discuss priorities for assistance.
Lord Judd: My Lords, with all our involvement in South Africa, our membership of both the Commonwealth and the European Union and our responsibilities as a Permanent Member of the Security Council, does the Minister agree that we have a special responsibility to ensure effective international co-operation with the South African Government in their plans? What are the priorities as seen by the Government? Do they include land reform and the building of a strong voluntary sector, as envisaged in the impressive European special programme of recent years? Above all, does the Minister agree that we must lead by example? As the South African people face up bravely to their future, the £100 million so far pledged is a pretty minimal start, especially when compared with the £234 million for one questionable dam in Malaysia.
Lord Henley: My Lords, on the latter part of the noble Lord's question, I do not believe that the £100 million pledged by my right honourable friend the Secretary of State for Foreign and Commonwealth affairs is a pretty minimal amount. I further add that, as
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well as our own direct contributions through aid, both bilateral and through the Community, there is a considerable degree of United Kingdom direct private investment. I know that the noble Lord may not like to admit it, but I believe that private sector investment can often be of far greater use than anything that governments themselves can do.
As regards our objectives, they will include good government, especially public administration and police reform, education, health and small business development. We are obviously keen to discuss the priorities for aid with the new government as soon as they are ready. We will continue to work with South African non-governmental organisations where appropriate.
Lord Dean of Beswick: My Lords, is it not the case that in regard to the African continent, South Africa is one of the richest countries in basic materials and wealth which need to be exploited? Does it not follow that in addition to money, a wide reservoir of technical advice and specialist know-how should be made available to them on how to exploit the natural riches that lie below the ground?
Lord Henley: My Lords, the noble Lord is, of course, quite correct. South Africa is naturally a very wealthy country. It has a per capita income of the order of 2,500 dollars, but obviously there are wide disparities between those at the top and those at the bottom. We would certainly like to see growth in the income of the less well off.
I can give an assurance that all our bilateral assistance will be in the form of technical co-operation. We believe that South Africa must look to the private sector, international financial institutions and development finance organisations for most of its financial investment.
Lord Harmar-Nicholls: My Lords, will the Government keep in mind the risk that leading by example may be interpreted in South Africa as interfering with what should be local decisions?
Lord Henley: My Lords, I quite agree with my noble friend. That is why I was keen to stress that we are anxious to discuss the priorities for aid with the new Government of South Africa.
Lord Taylor of Gryfe: My Lords, will the Minister agree that South Africa is not in the same category as many third world countries in Africa? It has a reasonable infrastructure as regards economic develop-ment. Can the Minister give two assurances: first, that aid, bilateral and multilateral, which is being directed to South Africa will not be at the expense of some other countries in Africa which require considerable assistance? Secondly, may I have an assurance that the DTI is alerted to the importance of private investment to raise the standard of living of the people of South Africa and to encourage economic prosperity by partnerships and other initiatives?
Lord Henley: My Lords, on the noble Lord's second point, as he will be aware, I was keen to stress the importance of direct private investment by the United Kingdom. Our record is pretty good: in the developing

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countries, something of the order of half the total EC direct private investment comes from this country. I am sure that my right honourable friend the President of the Board of Trade will take note of what the noble Lord said about encouragement from his department.
As regards whether money should come from other funds, obviously there are only limited resources available for overseas aid. We maintain a substantial aid programme, the sixth largest in the world. However, difficult decisions have to be made as to where the resources come from and where they should be directed.
Baroness Sharpies: My Lords, does my noble friend agree that there is a great deal of expertise already in South Africa in all the communities, whether black, coloured, Asian or white?
Lord Henley: My Lords, my noble friend is absolutely correct, but I believe that there are certain sectors where we can offer a great deal of assistance. That is what we have promised to do.
Lord Mackie of Benshie: My Lords, is the Minister aware that while ultimately the most important aid is investment in the development of employment and prosperity, the expectations of the newly enfranchised electorate are such that visible progress needs to be made? Probably the most important way in which we could help is in housing and improving the standard of housing. If we give aid to that, let it be in the form of a grant, not a loan.
Lord Henley: My Lords, as I made clear, most of our aid will be in the form of technical co-operation. As regards priorities, that is a matter for the South African Government. Their reconstruction and development programme provides a framework for their development policies in government. At the moment, it lacks detail but it envisages fairly moderate economic policies and priority for restructuring education and health. That will certainly form the basis of their discussions with donors such as ourselves.
Lord Astor of Hever: My Lords, is my noble friend aware that the South African Government are enormously grateful for the Molteno project which aims to teach basic literacy to black primary school children? It is funded by the ODA.
Lord Henley: My Lords, my noble friend is right to draw the House's attention to the Molteno project which helps many black primary school children, first in their indigenous language and then bridging into English. The ODA has supported the project since 1985. Phase 2 of our support began in April 1993 at a cost of £460,000 over three years.
Lord Judd: My Lords, will the Minister agree that precisely because of the relatively strong infrastructure in South Africa and the potential of that country, we can make particularly good use of an aid programme there, not only for the impoverished people of South Africa itself but because of the contribution which South Africa will be able to make in the future to the regeneration of the entire African continent?
Lord Henley: My Lords, I think that for once there is nothing with which I could disagree in the noble Lord's remarks. I am prepared thoroughly to endorse them.
Viscount Brentford: My Lords, is my noble friend aware that timing is important? Will he ensure that the South African Government are encouraged to look at priorities reasonably quickly? It is important that much development takes place in South Africa before the next elections and the matter should not be allowed to drift.
Lord Henley: My Lords, I am sure that the South African Government themselves will be aware of the importance of such problems, but it must be a matter for the South African Government to decide on their own priorities for development and reconstruction.

European Elections: Sitting of the House
11.28 a.m.
Lord Beaumont of Whitley Lord Beaumont of Whitley asked the Leader of the House:
Why the House is sitting on Thursday 9th June, the day of polling in the European Elections, when the House of Commons is not sitting and many Peers will be wishing to vote and campaign in the constituencies in which they live.
Viscount Ullswater: My Lords, it has not been the practice in the past for the House to adjourn during either European or local elections. Peers are of course eligible for postal votes or indeed for proxy votes.
Lord Beaumont of Whitley: My Lords, is not that practice a relic of the time when the only nationwide popular elections were for another place, with which traditionally we have nothing to do? The whole position has now changed because other elections affect the whole country, elections in which it is perfectly proper for us to vote and campaign. That is particularly so since a high proportion of the effective politicians of this country are in your Lordships' House. If it is too late to do anything about it this time, will the usual channels look at this matter again before 1998?
Viscount Ullswater: My Lords, of course I will take that into consideration when I am holding this job at that particular time. The noble Lord is quite right. All elections are very important; whether they are local or European makes no difference. However, the House will recall that both Houses thought it quite proper to arrange business on the last local election day, 5th May. Also of course, both Houses sat on the previous European parliamentary election days in 1989 and 1984. But I take note of what the noble Lord said.
Lord Graham of Edmonton: My Lords, perhaps the House will allow me, in the presence of the noble Lord, Lord Mackie of Benshie, to convey to him, on behalf of the whole House, our deep regret at the sad news that his brother, John, died this morning. John was a dear friend of ours and a good servant of the people. It struck me as appropriate that in the presence of his brother I should convey those sentiments.

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Turning to the Question, will the Government Chief Whip accept from me that the arrangements were made in good faith and through the usual channels? But will he also accept that the reason why from time to time this House sits when the Commons does not sit is that the Government persist in producing Bills of inordinate length and complexity? That causes this House to sit, in this instance, for one week longer. Even as late as yesterday the Government, for their own political ends, being under pressure from certain quarters, have decided unilaterally not to have the House of Commons meet on the Monday when it was due to come back. Is it not time that government Ministers in both Houses grasped the nettle and produced what might be called Jopling-like proposals to make sure that the business of the Government which must be got through is got through in better circumstances to allow hardworking Peers at least to do their job and to do it comfortably?
Viscount Ullswater: My Lords, I believe that the whole House, including noble Lords on this side, would wish to join the noble Lord in his remarks about the sad news of the death of Lord John-Mackie.
I am grateful to the noble Lord for saying that the business for that week was agreed through the usual channels, as it was. Arrangements for business in the other place are not a matter for me. I am sure that noble Lords would like a longer Recess. I have to confess, so would I. But were the Recess to be longer, then the consequences would be twofold. Either noble Lords would be asked to consider legislation in more haste, and perhaps less fully than I believe the House would wish; or your Lordships' well-earned summer holidays might be curtailed.
Lord Renton: My Lords, is it not a fact that in the later part of each Session noble Lords have far more legislation to consider than Members have in another place, and that we have to make our own arrangements in order to perform that duty adequately?
Viscount Ullswater: My Lords, I agree with my noble friend Lord Renton. The Government's legislative programme is clearly something that the House is keen to discuss. Both my noble friend the Leader of the House and I are equally keen to ensure that sufficient time is available for noble Lords to examine government legislative programmes thoroughly. It is in that spirit that the arrangements for 9th June have been made.
Lord Dean of Beswick: My Lords, is the Minister aware that my noble friend and colleague on the Front Bench, Lord Graham, is quite correct? There is an extension of holidays in the other place. Is the Minister further aware that it is causing something of an embarrassment? The other House is now having so many weeks off that there are not enough weeks to accommodate the number of Supply Days there.
Viscount Ullswater: My Lords, again, that is a matter for another place and not for me. However, I believe that it would be wrong to curtail the very
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important discussions that we have on important Bills which pass through this House in order perhaps to prolong our Whitsun Recess.
Lord Tordoff: My Lords, from these Benches I should also like to convey the sympathy of my colleagues to my noble friend, which we shall also do privately. I have no doubt that he will be grateful for the expressions of sympathy that have been offered throughout the House.
To return to the Question, as noble Lords will be aware, the noble Lord, Lord Rippon, is sitting with a small group of people at the moment on the subject of the sittings of the House, and will doubtless have taken on board what has been said. It is surely unsatisfactory that this week we have had two major Committee days on the Criminal Justice Bill, with the House sitting until midnight or half-past midnight, legislating for criminal matters late into the night, when full discussion cannot take place on such important issues. I blame nobody except ourselves. We have to find better ways of doing things. I hope that the committee of the noble: Lord, Lord Rippon, will come up with some ideas that will be of help.
Viscount Ullswater: My Lords, I have to agree with the noble Lord, Lord Tordoff, in many respects. This House is a self-regulating Chamber. Sometimes we fail to apply the self-regulator, and the debates on particular Motions overrun. However, it is the arrangements through the usual channels which are important in order to make certain that the number of days that are set aside for the discussion of a particular Bill are appropriate to that Bill.
Lord Mackie of Benshie: My Lords, I thank noble Lords for their expressions of sympathy on the death of my brother.
Perhaps I may raise a point with the Chief Whip. Why is the Scottish local government Bill being debated on a Thursday? I thought that it was an old convention that Scottish affairs were taken rather earlier in the week and not on a Thursday, when Scotsmen like to go home.
Viscount Ullswater: My Lords, I sympathise with the noble Lord. I understand that he has particular difficulties on 9th June. But I have to say to the House that I think the House is now well used to sitting four days a week, and equally used to taking business without discrimination between days of the week for the convenience of the House as a whole. I believe that that applies to Scottish business, as it does to business relating to other important parts of the United Kingdom.
Lord Annan: My Lords, can the Minister recall any summer when there has not been a complaint from the Opposition Benches, whichever party occupies them, that the legislative programme has been too heavy and that the Bills are of such extreme complexity that the timetable is unreasonable? In my 29 years I have never heard anything other than that.
Viscount Ullswater: My Lords, it is perhaps an irony that this House, which does such an important

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revising job in regard to legislation, and considers itself quite rightly to have an influence on that legislation, somehow wants to curtail its own ability to review it.

Royal Assent
11.38 a.m.
The Lord Chancellor (Lord Mackay of Clashfern): My Lords, I have to notify the House, in accordance with the Royal Assent Act 1967, that the Queen has signified her Royal Assent to the following Acts:

Insolvency (No. 2) Act,

Intelligence Services Act,

Church of Scotland (Properties and Investments)

Order Confirmation Act,

Greater Manchester (Light Rapid Transit System) Act.

Vehicle Excise and Registration Bill [H.L.]
Read a third time, and passed, and sent to the Commons.

Railways Pension Scheme Order 1994
11.39 a.m.
Lord Mackay of Ardbrecknish Lord Mackay of Ardbrecknish rose to move, That the draft order laid before the House on 9th May be approved [19th Report from the Joint Committee].
The noble Lord said: My Lords, noble Lords will recall that during the final stages of the Railways Bill last year my noble friend Lord Caithness undertook that there would be further consultation with all interested parties before the orders implementing the detailed future railway pensions arrangements were laid before Parliament for approval. The industry and the present trustees were fully involved in working out the detailed arrangements on which we went to wider consultation on 31st March with the trustees, the employers, the trade unions and the pensioners' representative bodies. We have taken account of their comments as far as possible. I wish to thank all those consulted for the clarity and promptness of their representations.
In particular, we have reached full agreement with the British Rail pension trustees on all major points of principle relating to railway pensions after privatisation. The arrangements that we have agreed honour the commitments given by the Government in Parliament and elsewhere. I can assure the House that the pensions of all railwaymen and railwaywomen, both past and present, earned in their service with British Rail are safe and that the future arrangements will give them security.
We have before us this morning the first two draft orders. Let me deal first with the draft Railway Pensions (Protection and Designation of Schemes) Order which will give the promised statutory "no less favourable" protection to "protected persons"—broadly, people who were in service or retained benefits in the schemes on
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5th November 1993—and which incorporates (in Article 11) the "indefeasible right" to remain in equivalent (that is, "shared cost") sections of the joint industry scheme, which will be called the "Railways Pension Scheme", for so long as their employer remains a part of the railway industry. We have agreed to extend this right so that it will not now be lost where employees change jobs voluntarily within the industry. This right will provide valuable security for staff moving voluntarily around the industry in the future.
This order is difficult stuff but so are the matters which it addresses. If any noble Lord wishes clarification on any particular point I shall certainly do my best to give it at the end of the debate, or I may even have to take refuge in writing afterwards such are the complexities of this issue.
I should like to clarify two points on this order. First, that with regard to the definition of "designated scheme" in Article 1(2) the intent is to protect relevant pension rights at the date of the order, including the right to future accrual of such rights on a "no less favourable" basis. Secondly, that there is an area of concern between my department's and the trustees' lawyers over the precise drafting of paragraph (4) of Article 7. Should it be agreed that an amendment is necessary in respect of this latter point we shall make it when we make the transfer order. I intend to lay a draft of that order next month.
For the purposes of the "indefeasible right" which is conveyed by Article 11, paragraph (4) of that article defines the "railway industry". The intent is that the term should comprise activities presently carried on by BR which may in the future be carried on by successors, but only to the extent that they are activities connected with, or provided for, the railway industry.
The order also designates the existing pension schemes to which it applies for the purpose of enabling their members or beneficiaries to be protected persons. A handful of British Rail employees retain membership of pension schemes operated by Associated British Ports and the National Freight Company. If we did not specify these schemes, those BR employees would not be given statutory protection. I wish to emphasise that this is the sole reason why we are designating the ABP and NFC schemes. I give an assurance that the Government have no intention of using the powers in relation to "existing schemes" contained in Schedule 11 to the Railways Act to amend either of these schemes.
The Railways Pension Scheme Order formally establishes on 31st May 1994 (under the powers provided in paragraph 2 of Schedule 11 to the Railways Act 1993) the railways pension scheme which it is planned will succeed the existing main BR scheme, the BR pension scheme, which I gather is shortened to BRPS, on 1st October 1994. The order also appoints the Railways Pension Trustee Company Limited as the first trustee to the scheme, and designates the scheme as "the joint industry scheme" for the purposes of paragraph 8 (the "indefeasible right") of Schedule 11. The key provisions are in the schedule which contains the pension trust and the different scheme section rules.
Existing BRPS pensioners and deferred pensioners will be transferred into the 1994 pensioners' sections of

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the RPS. Initially, there will be two such sections, the reason being a practical one related to valuation of the Government's liabilities to them under the 1980 Transport Act. Those people who were already pensioners and deferred pensioners at 31st March 1994 will join the A section, while those retiring or deferring their pensions between 1st April and 30th September this year will join the B section. The two sections will have similar rules and will be amalgamated as soon as possible thereafter.
The Secretary of State will be under a duty to give a solvency guarantee to those sections. The guarantee will secure the continued payment of fully indexed-linked pensions. The proposed draft of the guarantee, the details of which have been agreed with the present trustees, was deposited in the Library last Friday. The members will have rights under the rules to share in any future surpluses in their fund. The rules are contained in Appendix 1 to the schedule. Distributed surpluses will be shared 40 per cent. to the pensioners and 60 per cent. to a special reserve retained in the fund. The Government cannot withdraw those sums while the fund continues.
Serving staff who are members of the BRPS will be transferred into the BR section of the RPS. They will move into their new employers' sections, which will have materially the same rules (affording them the security and continuity that they have sought), as their employment is transferred; for example, from BR to a subsidiary which is to become a franchised railway operating company. The rules are contained in Part 1 of Appendix 2 to the schedule. They provide that pensionable service will normally be treated as continuous, even on voluntary transfers between the equivalent sections of participating employers, subject to Inland Revenue restrictions. The Railtrack and European passenger services sections will be set up almost immediately.
The method for determining the initial split of assets between the sections of the railways pension scheme will be agreed with the trustees after taking the advice of our respective actuaries. The transfer order, another affirmative order, a draft of which will be laid before Parliament next month following the formal establish-ment of the scheme, may be used to split the assets between the sections of the RPS. Because we have to consult the trustees of the RPS first, the transfer order cannot be laid until the RPS has been formally established and the trustees appointed.
To maintain flexibility, employers will be able to admit new employees either to their section which succeeds BR's section, or to other new sections providing alternative pension arrangements. This will make the RPS more attractive to new employers and give their employees the comfort of belonging to a large, well-managed pension scheme. A template for the rules for defined benefit and defined contribution sections is contained in Parts 2 and 3 respectively of Appendix 2 to the schedule.
The remaining appendices to the schedule contain detail subsidiary to the main constitution of the scheme.
Equal employer/employee representation will continue on the trustee board and the pensions committees
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(the management committees) of all sections. For legal and technical reasons, we are having to form a new trustee company, the Railways Pension Trustee Company Limited, to act as trustee to the RPS. At 1st October this company will also take over as trustee of the other BR pension schemes for which the present trustee company acts, so that the existing investment pooling and management arrangements can continue.
It is our intention that all the participating employers in the RPS will share in the ownership of the trustee company so as to prevent a single employer having sole influence over it. To facilitate this the trustee company will be wholly owned by a holding company, Railtrust Holdings Limited, which will be a company limited by guarantee (making change of ownership easier when employers join or leave the scheme). The first directors will be the directors of the present trustee company together with two nominated by Railtrack, and one each by the British Transport Pensioners' Federation and the Retired Railway Officers' Society. The present trustees have suggested that these last two posts should be directly elected by the pensioners from the outset, but I have been advised that an early election would be difficult to organise. However, those nominees will only serve for the first two years until direct elections can be organised.
Although the articles of association provide for direct election of employee/pensioner directors after an initial two-year period, they empower the trustee board to devise alternative arrangements provided the equal employer/employee representation is maintained. Copies of the memorandum and articles of association of both companies, which were incorporated by the BR board yesterday, were placed in the Library last Friday.
For historical reasons, BR has a number of other pension schemes, all listed in the designation order. Those schemes will stay in place. We see no requirement for the time being to transfer members (either serving staff or pensioners) out of their schemes. I should make it clear that no changes are proposed to the BT police scheme.
In relation to the closed fund for pensioners—in other words, the pensioners' sections—we have honoured the memorandum of understanding entered into with the trustees and the BR board last July, which was debated at great length in this House last Autumn. We reached agreement with the trustees on arrangements for partial deferral of government cash support payments under the 1980 Transport Act to the pensioners' fund to take account of the government solvency guarantee-. Any deferred payments will remain an obligation of government, earning interest, and will be accounted for as an asset of the section. We intend to bring an order before Parliament before the Summer Recess giving effect to this agreement, which we intend will take effect in October.
It was agreed last July that the Government must give their consent to decisions affecting its financial exposure under the guarantee. Originally, this consent was to have been exercised by a "government director" on the trustee board. Because of potential conflict between his fiduciary duties under general trust law and his responsibility to the Government, we have decided,

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as I said at Question Time, not to proceed with that proposal. Instead, the consent of the Secretary of State will be required (within the terms and conditions of the guarantee) to strategic decisions about the fund, but not its day-to-day operation. Accordingly, there will be no government director on the trustee board. But there can be a non-voting "government representative" if the powers delegated by the trustee board to the committee running the pensioners' section of the scheme are withdrawn.
When the orders were laid before Parliament on 10th May there was one issue in relation to the pensioners' fund on which we had failed to reach agreement with the trustees. It is my understanding that when the trustee board, including the trade union nominees, last met on 5th May, they were content with all the significant elements of the Government's proposals but this one. Although we had accepted that pensions should not be reduced in cash terms in the event of a deficit in the fund (even if they include unguaranteed discretionary increases) we had not resolved the procedure which would apply (in the absence of other agreement) if the fund went into deficit and subsequently returned to surplus.
However, we have now reached agreement on the basis of a compromise proposal put to us by the trustees. The compromise was fully endorsed at the trustee board meeting on 5th May which mandated the chairman and chief executive to negotiate it with the Government. In the event of a deficit, the special reserve will be applied in full first before any freezing of pensions. I should emphasise that the pension prevailing at the establishment of the closed sections on 1st October 1994 will always be indexed for inflation. Total pensions may subsequently include discretionary real increases, and it is the total that may as a last resort be temporarily frozen until the indexed guaranteed pension exceeds it. After those sources have been exhausted, government guarantee payments will be made. A subsequent surplus would be applied in the reverse order. The trustees have also offered changes to our original agreement on 1980 Transport Act payments to reflect the ramifications of this proposal. Both we and the trustees regard this position as a fair way of dealing with a problem which was not foreseen at the time of the memorandum.
Even though the pensioners' section rules do not presently reflect this revision of policy, there is no need to amend the order. We are considering with the trustees changing the rules, in particular, rules 13, 14 and 16, on which re-drafts have been agreed, after formal establishment through the amendment procedures written into them. That procedure would also be used, with the agreement of the trustees, to make other agreed amendments to the pension trust or rules to clarify the existing drafting where that is considered necessary, particularly in relation to the provision in Clause 8C of the pension trust for "seamless" voluntary transfers between railway employers within the RPS in normal circumstances. Failing that, the required amendments will be made together with the forthcoming transfer order.
In respect of seamless transfers, we have agreed that
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where a person who has the right under Article 11 of the protection order to remain in the RPS moves voluntarily to another section within the scheme there will be automatic credit of pension years provided that his pensionable salary is not increased on transfer by more than 7.5 per cent. A greater figure may be agreed between the trustees and the new employer and the new employer may pay into the scheme to augment his benefits. In normal circumstances we would expect the trustees and the employer to be able to increase that automatic floor from 7.5 per cent. to around 10 per cent. We fixed that limit to protect the interests of other members of the transferee section. Actuaries advise that 7.5 per cent. is a prudent automatic figure taking account of all relevant possibilities. We believe it delivers the promise that such voluntary transfers will normally be seamless.
I do not propose to withdraw the order to make such amendments because that is not necessary and would make it impossible for the new scheme to commence operation on 1st October. A delay would cause unnecessary uncertainty and concern for all involved.
Lord Clinton-Davis: My Lords, perhaps the Minister will give way on that point. On any showing, including the Minister's statement this morning that there is an area of possible dispute on legal issues which may have to be dealt with subsequently, why was there such haste that we could not come back to this issue during the week of 6th June? That would give everybody an opportunity to resolve those issues properly when we still have the possibility of disagreement, albeit not on matters of major principle, still overhanging the orders.
Lord Mackay of Ardbrecknish: My Lords, I believe that we had to proceed. If an element of disagreement emerges in the discussion then that can be attended to in other orders. However, we believed it was necessary to proceed so that the two orders can be completed by 31st May. There is much uncertainty about these matters. I understand that. As I was about to say, there must be uncertainty among the people involved, the actual pensioners or the employees. What we have tried to do, and I believe we have succeeded in doing, is remove entirely any uncertainty. We delivered our undertakings and we are providing in these orders the promised security, protection and peace of mind to BR's existing staff, pensioners and deferred pensioners. I hope that the House will support the two orders. I beg to move.
Moved, That the draft order laid before the House on 9th May be approved [19th Report from the Joint Committee].—(Lord Mackay of Ardbrecknish.)
11.57 a.m.
Lord Peyton of Yeovil: My Lords, I welcome the opportunity to thank my noble friend for an eloquent and comprehensive speech which, so far as I was able to follow the detail, covers all the outstanding points. It is now on the record for careful examination by anyone who feels so inclined. Perhaps I may take up a few moments of your Lordships' time with the background to this development.

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It was the promise of the Government at the time when the idea of privatisation first made its appearance that pensioners would receive no less favourable arrangements than they did previously. Nevertheless, the Bill reached your Lordships' House with no guarantee of the solvency of the closed fund or any acceptance of the need to index link it. A number of your Lordships, including myself, pointed out persistently that it was not the choice of the pensioners in any way that privatisation should take place; in so far as this would necessarily impact on their interests, it was essential and only fair that those arrangements should be absolutely watertight. The closed fund which the Government proposed to set up, the amount of which was to be actuarily determined, was, in the view of many of us, vulnerable both to inflation, tax changes and also to the possibility of pensioners living longer than actuaries thought appropriate.
The Government considered in July that discretion was much more praiseworthy than an absolutely foolish adherence to the position which they had taken up. A memorandum of understanding was issued in July. It had the effect of averting a Division in your Lordships' House which the Government might well have lost. Thereafter there were talks and more talks over quite a long period—interrupted from time to time by a series of almost audible hiccups—when the Government were at least giving the appearance of saying that they would not do what they had promised to do, particularly on one point—that is to say, the phasing of capital payments by the Government into the closed fund. It was declared in the memorandum that the phasing would be agreed with the trustees. Subsequently the Government thought that all they could do was to consult the trustees.
I am very glad—it would be churlish of me not to acknowledge it—that the Government have moved a long way to make sure that the words which they spoke at the beginning should survive and mean something. According to my information, on 5th May there was a meeting of the trustees at which it appeared that everything was settled except for one issue of how any deficiency which might arise in the fund should be handled. The chairman of the trustees put to his colleagues, so I am informed, a compromise. The whole body of trustees agreed that if the whole package, including the compromise which they were then suggesting, was accepted by the Government, the trustees themselves would accept it in turn. The Government did accept that alternative.
Now, so my information goes, 10 out of the 12 trustees have declared themselves to be satisfied with the agreement which they reached with the Government and which is more or less enshrined in the two instruments which are before your Lordships. Two of the trustees have not commented and no single trustee has asked for a meeting of the whole board at which the matter could be re-examined. So the remaining barrier seems to be only one of words. The Minister agreed to the proposals in another place and my noble friend has gone into more detail this morning.
I would like to refer to what the Minister of State said on 23rd May. There is no need to go into detail, but for the record I would like to refer to the Official Report of
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the other place and include the references. They are cols. 130, 131, 134 to 136 and 151. They all contain indications of the Government's intention to amend the scheme in certain respects. It is quite unnecessary for me to take up a lot of your Lordships' time. To me it is a source of great satisfaction that we can now say that the British Rail pensioners are fully protected, which they were not before. It has taken a very long time to reach this point, but nevertheless it must be a source of great satisfaction to all of us. I believe also that it is a source of great satisfaction to your Lordships' House that these very useful developments were launched from here.
I cannot resist the temptation to refer very briefly to some of the wording in the Railway Pensions (Protection and Designation of Schemes) Order 1994. I ask your Lordships to turn to page six and Article 7(4) (b). Your Lordships will find sufficient there to whet your appetites and to go further into the detailed wording of the scheme. I shall quote just that paragraph:
"without prejudice to the obligation imposed by sub-paragraph (a), the person who is required under article 4 to provide the scheme to which those rights are transferred shall pay or secure the payment to the trustees of that scheme of such part of any difference between the amounts calculated under article 6(2) and 6(5) (a) as is not paid to the trustees of that scheme under that sub-paragraph".
The profound respect which I have for your Lordships leads me to believe that many of you would find it very easy to rise to your feet to explain exactly what that means, but it is beyond me. I wish to follow up what I said to my noble friend just now in thanking him for his speech. I praise him without hesitation as having talents reflecting those of William Shakespeare and Einstein. Therefore I am confident that in winding up and without taking up too much of your Lordships' time, he will be able to say precisely what the words mean which I have just quoted.
Lord Clinton-Davis: My Lords, and without a brief.
Lord Peyton of Yeovil: I shall not detain your Lordships any further. There are those who believe that your Lordships do not achieve very much in the set-up of modern politics. But with the limited experience which I have had of your Lordships' House, I believe that there are occasions when a point of very great seriousness tends to get overlooked and that the forum provided by your Lordships' House offers a most valuable opportunity to put right what might have been a very serious wrong. I believe that that has occurred in this case.
12.9 p.m.
Lord Cochrane of Cults: My Lords, first, I wish to congratulate my noble friend on his eloquent and well-informed speech and also to thank my noble friend the Minister for his admirable exposition of an immensely complicated subject. I share with my noble friend difficulty in understanding considerable parts of it. I draw his attention to the thin book at Article 9(b). I shall not ask for an explanation now. In due course, after the Recess, perhaps he will favour me with a reply as to what that part actually means in practice. I was unable to decipher it.

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It was indeed unfortunate that these pension proposals were first made public at the same time as the great Maxwell scandal became apparent. That caused a great deal of apprehension because it seemed—I believe on the whole totally unjustifiably—that the Government were attempting a Maxwell on the railways.
I am glad that there has now been a considerable retreat from the original proposals and that railwaymen, past, present and future, seem to have obtained a valuable and worthwhile deal from the Government as a result of the objections which were made to the Railways Bill in this House. There is an immensely long time-spell in these pension affairs. When I spoke on the Bill I mentioned that there were already 90 pensioners over the age of 100, of whom the eldest was 105, and that there were also some 900 or so aged between 90 and 100. That means that actuarial advice to the trustees and others involved is of immense importance.
I should like to make two other points. In this House one of my noble friends, whose name momentarily escapes me, mentioned that a very unsatisfactory division of pension assets had taken place in the case of Welsh Water and that in the event one part of the fund had been left very unliquid. I should like to be assured that that point will be borne in mind when any division is attempted and that appropriate advice will be sought.
I am also particularly pleased to see that the proposal, which bore all the hallmarks of Great George Street, that a government director be appointed has now mercifully been withdrawn. I am grateful to my noble friend for that concession. I look forward to the industry being prosperous and contented and I am glad that these things have been done.
It may amuse my noble friend momentarily to refer to page 87 of the thick book where he will see that possibly some of his former constituents are to benefit. Perhaps I may save him the effort of looking it up because I have the book open. It states:
"Scheme No. 243. Highland Railway—artisans in workshops at Inverness—50 pence per week".
I am grateful to my noble friend and to all those who have achieved a satisfactory solution and I look forward to seeing it in its final revised version before too long.
12.12 p.m.
Lord Tordoff: My Lords, first, I think one should express thanks and indeed sympathy to the noble Lord, the Minister, for having to come into this whole exercise at so late a stage. He has obviously done a lot of homework to get himself up to speed on what is a very complicated matter. The noble Lord, Lord Peyton, is quite right to say that, had it not been for your Lordships' House, many of these matters would not have been properly dealt with. Among those who deserve the greatest credit, there is no question that the noble Lord, Lord Peyton, himself should put this on his family battle honours to be flown on every possible occasion.
The matter also perhaps refers back to the discussions that took place at Question Time this morning on the way in which we conduct our business. The idea that some of these extremely complicated matters can be
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dealt with at times approaching midnight or even the early hours of the morning is something we need to examine ourselves on, because, quite clearly, on such matters people cannot be as on the ball as they ought to be and cannot get themselves properly briefed. Many things slip through your Lordships' House that ought to have better consideration. Fortunately, on this occasion, thanks to the noble Lord, Lord Peyton, and others, we were able to spot problems. There was also some fairly excellent briefing from outside which drew our attention to the problems that existed.
I want to touch on the timing. I well understand the point the Minister makes that people need to be given assurance as to what is going to happen, but the consultation process was, I understand, a very short one and the trustees were not at all happy with the speed of the consultation, which closed on 25th April. Apart from giving assurance to pensioners and members of British Rail, I wonder what the hurry was all about. It is not as if there is a huge rush to buy up this network. Mr. Branson, having failed in the lottery, may now change direction and buy up half of British Rail, but it does not seem at the moment that there is a collection of people rushing to buy up what was and still is British Rail.
As we have heard today, the truth is that the position has not yet been finalised. There is still some fine tuning to do. I think it would have been better if the Government had withheld this order until such time as all the i's had been dotted and all the t's had been crossed. However, agreement has now been reached and compromises have been made. It looks as though the scheme will be satisfactory so far as concerns pensioner guarantees. Nevertheless, I think it is true to say that if the scheme is examined in detail it still does not quite measure up to the memorandum of understanding. It is not as good as the old scheme. It will do. The pensioners are not at risk but it does not leave them in precisely the same state that they were in before, which is what the memorandum of understanding said would be the case. I do not blame the Department of Transport for that. One realises that it is the heavy hand of the Treasury which is always lurking in the background of such arrangements. Thank Heaven that we were able to step in early enough to stiffen the Department of Transport to fight the Treasury to get this whole thing right.
However, having said that, there is a moral dimension to this. If the Government will privatisation, they must will the payment of the costs of that privatisation. I hope that they have learnt their lesson from this whole exercise. When they go into these schemes they have to make quite sure that every angle is covered. No doubt from now on, when any such scheme comes forward on a privatisation Bill, they will know that the House of Lords is watching them like a hawk. Please let us make sure that if the Government will the end they also will the means, even if it is expensive. However, compromises have been made and the size of the surpluses is such that they can more than cover any deficiencies. Unless a catastrophe strikes, the actuarial situation is such that there is a very, very, very small risk, although it is still finite, of there being problems in the future.

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Perhaps I may also echo the thanks for the fact that the government director has been removed from the scene. Noble Lords will remember that we felt very strongly about the matter when the Bill was passing through the House. It was impossible to consider him as being an independent member of the pensions board.
Lord Peyton of Yeovil: My Lords, there was another view expressed at the time. I welcomed the presence of a government director because I felt he would realise the difficulties. I thought that the trustees would have the government director's fingers well and truly stuck in their mangle, and a very good thing too.
Lord Tordoff: My Lords, I accept that the noble Lord, Lord Peyton, had that point of view, but I think generally there was a feeling that it was a form of non-independent interference with the trustees in carrying out their duty towards the pensioners.
It has been put to me that in paragraph 13C on page 57 of the Railways Pension Scheme Order the terms of secondment are not as good as they are at the moment. That may or may not be right, but it appears that people who have been seconded for more than three years could find themselves in difficulty whereas in the past that has not been the case. I think of people being seconded to the United Nations and other international bodies. In future people may be penalised. It depends on how one takes the words,
"or longer if the Inland Revenue permits".
Knowing the Inland Revenue, it will not permit much, so I should be glad of some reassurance on that point.
I am glad that ways have been found of involving the pensioners' societies and federations, such as the Retired Railways Officers' Society and the British Transport Pensioners' Federation. I know that that is difficult because pensioners are a very disparate group of people and it is difficult to find an organisation that is democratically accountable to all pensioners. Noble Lords will remember that we said at the time that it was unfortunate that the pensioners themselves had no direct representation with the trustees and that it was possible for the employers and the trade unions representing the current workers perhaps to carve things up to the disbenefit of the existing pensioners. That seems to have been put right, and I am grateful for that.
Finally, in thanking the Minister for putting the order before us so clearly, I suppose there is no hint of hybridity in it.
12.21 p.m.
Lord Clinton-Davis: My Lords, I join the noble Lords, Lord Peyton, Lord Tordoff and Lord Cochrane, in thanking the Minister for giving us the explanation. I thought that he went well beyond the requirements of his duties when at five o'clock two days ago, acting as a postman in person, he delivered a vast bundle of documents to me in my office—I think with a sense of mischief that it might occupy my bedtime reading for two nights. I hasten to add that it did not—any more than I suspect it did for the Minister. Nevertheless, we are grateful to him and it would be churlish not to recognise that the Government have departed from the position that they occupied at the very beginning of this
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debate in a major number of circumstances, most particularly in relation to the interpretation of "no less favourable arrangements".
I too have some difficulties about some of the matters that are still outstanding. I am not wholly convinced that it is simply a matter of words, because words are terribly important when it comes to the construction of documents and testing them in the courts. It is a pity that the matter was not deferred. The mere fact that the magical date of 31st May appeared on the draft order does not seem to me to be a very compelling argument when we could have been given further time to review the matters legally. I certainly have not had time to take legal advice on these issues. We are not talking only about this order, to which the noble Lord, Lord Peyton, referred; we are also talking about the vast and huge documents that I have with me. I confess that I do not have any more capacity to absorb these matters than the noble Lord, Lord Peyton—in fact, probably far less.
Having said that, I think that it is right that we should place on the record what actually occurred and what has given rise to this great anxiety. It is a matter that ought to be inscribed on the record. On any showing, the railway pension orders are of huge importance to something like 380,000 railway pensioners. They have been members of one of the best, most efficiently run schemes, bearing comparison with any other—certainly in the private sector. The Government have chosen to meddle in it, disastrously in some respects.
These issues have been under discussion for approximately 18 months. Until recently they were handled in a catastrophically cack-handed way by the Government. One has only to recall how initially the pensioners became seriously alarmed when they took the view that the Government—in other words, the Treasury—were planning to collar half their hard-won savings. The Government were then forced to change their stance repeatedly, albeit under protest, and relied on a constant stream of hastily conceived excuses which we in this House were successful in showing to be a pretence. The noble Lords, Lord Peyton and Lord Marsh, played a significant role in exposing that. I am. sure that the great body of pensioners will appreciate that. The two opposition parties also had a role to play.
The House will recall the extraordinary events which followed the hastily devised memorandum of un-derstanding just a few hours before the amendment in the name of the noble Lord, Lord Peyton, was due to be debated in the House. The noble Lord has rightly drawn attention to that fact. That memorandum of understand-ing was devised simply to forestall imminent defeat. It may be remembered that it was falsely alleged on that occasion that all the trustees had given their agreement to the memorandum. The Government were later forced into some humiliating concessions.
It is for those reasons—essentially the fact that the Government got it wrong on so many previous occasions—that I understand that the pensioners remain anxious despite the Government's assertions that all their claims have been met or, if the Government have not got it quite right yet, that those concerns will be met by 1st October. The Government must know after all this time that, deeply sensitive though the issues are,

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they have hardly been conducted with the consummate care and skill that they deserved, yet the Government have perpetuated to this moment their quite extraordin-ary handling of the affair, in respect of which I would not charge them with deceit when the simple allegation of crass incompetence will suffice. That unquestionably has been the situation.
I do not believe that we should be debating the orders today. The orders and the documents on which they are based are hugely complex. Indeed, I was reminded of an expression that was used by the noble and learned Lord, Lord Oliver, in a case in the Court of Appeal. He referred to those circumstances as being,
"a minor masterpiece of opacity".
That phrase could appropriately be applied to these documents, and not simply to the part to which the noble Lord, Lord Peyton, referred. The documents required diligent consultation and, more than that, explanation so that the pensioners could understand what was happening.
What happened? Why the haste, so that on the eve of a Recess we come to discuss these very important matters this morning? I really cannot believe that it would have been inappropriate to give us a little more time to take appropriate advice on these matters because we as legislators have a role in that. The trustees may be perfectly satisfied, but we know that there are still some matters outstanding, albeit not of principle. We have a role and a duty to try to understand these matters, but we have not had the time. I do not believe that the unions have had sufficient time to consider a situation which affects so many of their members.
I should like to give the chronology of what occurred. On 31st March, the detailed documentation having been completed, the Government say that they went out to consultation, just before the Easter Recess. That documentation was not received by the unions until 7th April. They were given until 25th April to respond to those immensely difficult documents. On 21st April, the unions, acting, I think, with commendable speed, presented their response to the Minister at a meeting which he held with them at which he agreed to extend the consultation period so that he could provide a considered view of that detailed response from the unions. On 5th May, the trustees met, and it seems that, while it was the view that more time might have been given by the Government, the chairman and chief executive were mandated to negotiate a compromise based on the proposal presented by the Government.
It was originally designed that the debate in another place on the draft orders would take place on 19th May. Yet at that time the documents were not even complete; amendments were still being made. It was not until last Friday, 20th May, at five o'clock in the evening, under cover of a document stating,
"On Her Majesty's Service. Express service at all stages. I certify that the papers transmitted under this label are official and of great urgency and require to be delivered by 5 p.m. today"—
with all that panoply—that the documentation arrived at union headquarters, when the matter was to be debated on the Monday. It is extraordinary. After 18 months of discussions, massive legal fees being incurred by everyone, that is how the Government went about their
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business—biking their response to the union's detailed reply of 21st April, the intention being, despite Opposition pleas for some delay, to debate the matter after the weekend.
Even since then further amendments were made, and it appears now that more are to follow. As I have said before, on 24th May the Minister went out of his way —I am grateful to him for that act of extraordinarily good postmanship—and came to see me and the noble Lord, Lord Tordoff. We are grateful to him. I do not know whether he had a childish wish at one stage to be a postman, but that has been fulfilled.
There has been no time to call a meeting of the trustees, which would have been desirable.
Lord Tordoff: My Lords, I am most grateful to the noble Lord for giving way. The Minister may be looking forward to taking over the Post Office when it is privatised.
Lord Clinton-Davis: My Lords, I have no doubt that he would be better rewarded financially than he is at the moment.
It would have been desirable—notwithstanding the mandate given to the chairman—for the trustees to have met and to have given a firm validation of what had occurred.
There are some points which remain outstanding, and I gave notice of them to the Minister. I shall just put them on the record. The TSSA faxed me yesterday to say:
"Two aspects remain of major concern to us: We are not sure that the definition of the railway industry Clause No. 11 (4) would cover all current employees of BR in say Central Services, the Audit Office and in general the non operating aspect of work. Many of these staff have been long serving members of BR and we remain concerned that in a sell off situation they could lose their no less favourable rights under the Act. However, to be fair the definition is better and does talk about services but it shows one aspect where the lack of time being given to us to look at documents causes the Association and our members some sense of insecurity".
Then on the question of the transfer and full protection of the accrued pension rights of the staff it states:
"It is quite possible that the staff transferring with long service may well be fairly senior staff who in the privatisation situation may be head-hunted",
And then it states that the Minister's letter to me of 24th May, paragraph 4 on page 3,
"seems to us inadequate at setting a 10 per cent. salary increase limitation qualification for seamless transfers. It seems to us that it does not deliver the no less favourable promise the House of Lords was given during the memorable debates that took place…in the latter part of last year".
Those are two points of which I gave the Minister notice yesterday. I hope that he will be able to take them on board.
In the course of this debate I received another fax, which is difficult to read, in which the RMT raises an issue about the solvency guarantee:
'The Solvency Guarantee could, following a deficiency, result in increases to Pensioners' Pensions not being applied until the Reserve has been replenished. Under existing arrangements Pensioners would not have to forego such increases. These arrangements are, therefore, 'less favourable'. The Winding-up Rule permits the Secretary of State to institute winding-up proceedings at any time after 31st December 2012. Only 40 per cent. of any resulting surplus would be applied to improve benefits. The remaining 60 per cent. would go to the Treasury".
That is another matter that needs to be dealt with.

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The fourth point that I raise relates to the situation of future railway staff. Is it not right that there is no assurance given that they will have access to membership of an industry-wide scheme for railway staff? That was the position prior to privatisation. That was the purpose of amendments moved in Committee by my noble friend Lady Turner which would have provided for that contingency but, regrettably of course, we lost that on a vote.
It is fair to add that we also lost votes, as the noble Lord, Lord Tordoff, has said, on the question of the appointment of a government director—notwithstanding the intervention of the noble Lord, Lord Peyton— when we argued forcefully that there was clearly a potential conflict between his fiduciary duties as a trustee and his responsibility to the Government. Those arguments were dismissed out of hand by the then Minister and the noble Lord who sits there.
At that time the Government said that our ideas were effectively unrealistic and illusory, but now they are belatedly accepted. That is the problem. Who knows whether the Government have it right? Everyone is convinced that they may have it right now, but who knows? Many other matters were conceived badly at the time, but I want to be fair. Following the debates in this place the Government have tried to meet most of the anxieties that we represented to the House which have been elaborated upon by the trustees and the unions.
I hope that I am wrong in the sense that I have conveyed that there may be serious errors. I am not in a position to justify that, but I worry about it.
In conclusion, what has happened over these past months has been—this must be recognised—a huge change of stance by the Government. We appreciate that latterly they have made great efforts to reach a fair agreement, but mistakes which should have been averted long ago occurred, and that is unfortunate. It was for those reasons that I was motivated at one stage to consider putting down a Motion to defer consideration of these draft orders to enable full advice to be taken on these matters. But I am persuaded that the Ministers are acting in good faith. I think therefore that they should be given the benefit of the doubt, although, as I have indicated, some doubts will remain.
12.38 p.m.
Lord Mackay of Ardbrecknish: My Lords, we have had an interesting and slightly complicated debate on pensions. When I discovered that dealing with that matter was part of my role, I was concerned because about four years ago I was appointed chairman of the Sea Fish Industry Authority, and the first matter with which I had to deal was that of pensions, something which the accountants among your Lordships will recognise instantly as SAP24. It required a cold towel and a great deal of effort to begin to understand what that was about. Pensions are, I am afraid, complicated. This experience with British Rail pensions has not changed my view on the complicated nature of pensions. Your Lordships might share my feeling, at the end of trying to follow all this, of hoping that someone
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understood my pension arrangements, because. I did not think that I would have the energy or the intellectual capacity to understand them myself.
Noble Lords have asked a number of questions, and I shall respond to them as best I can. My noble friend Lord Peyton of Yeovil has of course taken a keen interest in this matter and caused some waves, it might be said, in your Lordships' House last Autumn. I am especially pleased to hear that he is satisfied with the arrangements as they have emerged. He asked me about Article 7, paragraph 4(b). As I said in my opening speech, the effect of this article is that the new importing employer of a transferred pensioner must make up any shortfall in the transfer value if the exporting employer is not able to do so; for example, because of insolvency. We are looking with the trustees at the exact wording to see whether it requires improvement.
My noble friend appeared to imply that the difficulty in understanding legislation such as this was entirely new. I shall resist the temptation to spend next week in the Library reading some of the legislation which he as a distinguished Minister put on the statute book in order to see whether it is entirely comprehensible or whether he created legislation which is a little complicated.
Lord Peyton of Yeovil: My Lords, I hope that my noble friend will not take up any of your Lordships' time in answering, but I am tempted to ask him in due course to detail to me the large number of statutes for which I was responsible in which huge complexities occur. I am sure that the statutes for which I was responsible have areas of complexity but there are few of them and they are quite short.
Lord Mackay of Ardbrecknish: My Lords, I told my noble friend that I should resist the temptation to make any study. I assure him that the wording is being looked at and if improvement is required that will be done.
The noble Lord, Lord Cochrane of Cults, asked me about paragraph 9(b) in the same vein. Rather than reading that out and discussing it, perhaps when I have studied what he said I may write to him, I hope, to his satisfaction. The noble Lord also asked me a difficult question about the existing pension fund's assets being split and what would happen if the split turned out to be unfavourable to one of the funds which was the recipient of that split. The most equitable division of assets on establishing the JIS will be agreed between the scheme's actuary and the Government's actuary. The scheme's actuary has proposed a basis for apportionment which we are presently considering and the split will be notified to Parliament when the required order transferring pension rights is laid. There will be no advantage to the Government in over-funding, say, the new closed fund at the expense of the serving BR employees' fund. Even if that could be agreed with the trustees, who have a fiduciary responsibility for ensuring the proper provision of benefits for all members of the existing BR pension fund, including serving members who will not transfer to the closed fund, over-funding of the closed fund would lead to under-funding of the balance remaining for serving employees. That would be likely to make that fund

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unstable and hasten any call on the Government to exercise their power to issue a solvency guarantee for that section too. I hope that that answers my noble friend's anxieties.
The noble Lord, Lord Tordoff, raised the issue of secondment and rightly pointed to page 57, Rule 13C, of the order. That states:
'The Designated Employer may decide to treat any Member who is on secondment as still in Pensionable Service for up to 3 years (or longer if the Inland Revenue permits), so long as there is a definite expectation that the Member shall return to Service and he does not join another occupational pension scheme".
The BRPS scheme at present makes no specific provision for secondments. Members can remain in the scheme for as long as they remain in service. The definition of service includes any period during which the member is absent or on leave of absence, whether paid or unpaid. Implicitly, this is subject to Inland Revenue approval. Therefore, there is no real difference between the two schemes. We believe that the RPS rule is clearer.
In answer to the noble Lord, Lord Clinton-Davis, non-operational staff will be protected. While they continue to carry out their works for an activity connected with or provided for the railway industry they will retain their indefeasible right. But even if they lose that right, their statutory, no-less-favourable protection will continue provided that their transfer of employment has been compulsory.
I discussed the other point that the noble Lord made about the 7.5 per cent. salary increase on seamless transfers. Perhaps I may reiterate and expand on that by saying that we need to balance the respective interests of the person transferring, the other members of both the transferor and transferee schemes and the employer. However, the trustee and the employer can agree a higher percentage if the state of the fund allows. In normal circumstances we would expect the trustee or the employer to be able to increase this automatic floor from 7.5 per cent. to around 10 per cent. Alternatively, as I explained in my introductory remarks, the employer can pay into the fund to augment his recruits' benefits as part of the overall employment package agreed.
The noble Lord, Lord Clinton-Davis, read out a fax which he received this morning from RMT. This method of dealing with surplus following an earlier deficit was part of the trustees' compromise proposals. I do not consider it to be less favourable. At present there is no guarantee. If, when the noble Lord manages to read the fax, there are any points which he wishes to draw to my attention, I shall be delighted if he would write to me and I shall attempt to respond.
Lord Clinton-Davis: My Lord, I managed to decipher the fax with reasonable accuracy and it is on the record. Therefore, I look forward to receiving a letter from the Minister.
Lord Mackay of Ardbrecknish: My Lords, I shall read what the noble Lord said, and if I have not covered all the points I shall write to him.
As regard future railway staff, it is not now within our powers to guarantee membership of the BRPS to new staff. However, the RPS has been set up and there
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is flexibility to encourage employers to put new staff into it and to encourage the staff to see it as a pension fund that they wish to join.
In the holiday spirit of the coming week's Recess, I shall allow to pass over my head the criticism of the way in which the Government have handled the matter during the past few months. I say merely that the outcome of parliamentary debate and the way that government works, listening to views and negotiating, in this case, with the trustees is important. Whatever noble Lords' views on privatisation, which I understand, all appear to think that the outcome that we have before us today gives the guarantees which my noble friend Lord Peyton and others have asked the Government to provide. Those people who are retired on British Rail pensions, who are deferred pensioners or who are currently employed and wonder what will happen on privatisation will be able to be confident in the future security of their pension schemes.
I wish to put on record that my right honourable friend Mr. Roger Freeman has done a great deal of work on this issue. He has attended a large number of meetings with the trustees, the BR board and the employees' representatives in order to reach the position we are in today. Finally, perhaps I may pay tribute to my noble friend and predecessor Lord Caithness. While he held this post he played a major part in attempting to explain these difficult matters to the House and in finding the solution that I am presenting today.
Baroness Turner of Camden: My Lords, the Minister said that he hopes that pensioners and present staff will be satisfied with what has been achieved. Will steps be taken to ensure that these arrangements are explained in simple and clear language to the people who are covered by them; otherwise, those people will remain very suspicious?
Lord Mackay of Ardbrecknish: My Lords, I am not sure how easy it will be to translate these orders into simple and clear language. However, we in Government and in the House, the trustees and the unions, have an obligation to explain to anyone who is worried that guarantees have been given, that the security of their future pensions is safe, and that they do not have to concern themselves about them. I shall certainly look into what the noble Baroness says. I would welcome warmly a one-page explanation of all of this, as perhaps your Lordships would have done when I introduced the order about an hour ago.
On Question, Motion agreed to.

Railway Pensions (Protection and Designation of Schemes) Order 1994
Lord Mackay of Ardbrecknish: My Lords, I beg to move.
Moved, That the draft order laid before the House on 9th May be approved [19th Report from the Joint Committee].—(Lord Mackay of Ardbrecknish.)
On Question, Motion agreed to.

International Transport Conventions Act 1983 (Amendment) Order 1994
12.50 p.m.
Viscount Goschen Viscount Goschen rose to move, That the draft order laid before the House on 26th January be approved [6th Report from the Joint Committee].
The noble Viscount said: My Lords, I beg to move the Motion standing in my name on the Order Paper.
This is a very simple and uncontroversial order. Its purpose is to put the Government in a position to ratify a number of detailed amendments to the convention concerning international carriage by rail, to which the United Kingdom is a signatory.
The convention provides positive benefits to passengers travelling abroad by rail and to freight companies shipping goods by rail internationally. It creates a uniform basis for claims in the event of loss or damage. Without the provisions of the convention, individual railway operators would need to negotiate separate carriage agreements with their counterparts in all the countries through which they would wish to provide an international through rail service. With the opening of the Channel Tunnel, there will be greatly increased international rail traffic between the UK and the Continent and the convention will become that much more important for us.
The amendments to the convention make detailed changes to the procedures for its administration and to the rules applicable to the international carriage of passengers and freight. The amendments were agreed at the 1990 general assembly of the states which are signatories to the convention. They comprise the 1990 protocol, reproduced in Command Paper Cm. 2232.
The convention is given the force of law in the UK by the International Transport Conventions Act 1983, as amended by Order in Council in 1992. The draft order will amend the Act, enabling the amendments to have effect in United Kingdom law from the date when the 1990 protocol comes into force. This will be 12 months after its ratification by two-thirds of the member states. So far, 13 out of the 36 member states have ratified.
Moved, That the draft order laid before the House on 26th January be approved [16th Report from the Joint Committee].—(Viscount Goschen.)
On Question, Motion agreed to.

Land Drainage Bill [H.L.]
12.52 p.m.
The Earl of Lindsay: My Lords, I beg to move that this Bill be now read a second time.
The Bill before the House today is intended to give greater weight to conservation in existing land drainage legislation in England and Wales. It is designed to build upon the very real progress that has been made in recent years in providing essential land drainage and flood defence services to the public in ways which do not damage the environment but rather protect and enhance it. As such, I hope that the measures that the Bill contains commend themselves to the House.
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I should add that I have a very real appreciation, as a landowner and farmer, of the need to combine sound drainage policies with a regard for the surrounding environment. At home we have what I have always called a snipe bog but which is more accurately known as periodically flooding wetland. It sustained a wide range of wetland plant species and wildlife. In so doing, it presented a rare and attractive sight on a piece of ground which will never have any agricultural or commercial use.
A few years ago, the local authority adjusted its drainage policy with fatal consequences for the bog, which no longer exists. That is to the regret of everyone from myself as a landowner to the local school which used it for its nature studies. The loss was neither foreseen nor intended. The land was not necessary for any purpose nor useful to anyone. The irony is that had a very simple regard for the environment been exercised within the needs of that drainage policy, the same drainage objectives would have been achieved at less cost to the ratepayer and the bog would still exist.
That is an historic example. Therefore, I stress that in this day and age the vast majority of farmers, landowners and authorities are very aware that a simple regard for the environment in such matters can amount to little more than good common sense, good rural practices and good economics.
I return to the Bill. Many Members of the House will be aware that under present legislation, a number of bodies are empowered to undertake land drainage and flood defence works in England and Wales. First and foremost is the National Rivers Authority, whose chairman is my noble friend Lord Crickhowell. The authority has a range of responsibilities in relation to the aquatic environment, including the prevention of flooding for which it has powers to undertake flood defence works on major watercourses.
Secondly, there are 250 or so internal drainage boards or IDBs, some of which have existed in one form or another for over 100 years. Those boards exist only in areas of special drainage need such as the Fens and the Somerset Levels, for example, and can carry out arterial drainage and flood defence activities in their (districts. The boards are run by a combination of elected representatives of the agricultural drainage ratepayers in the district concerned and nominees from local authorities in the area.
Thirdly, local authorities may undertake land drainage or flood defence works in areas outside internal drainage board districts which are not designated as main rivers and therefore not dealt with by the NRA. The Bill is concerned with the environmental role and duties of internal drainage boards and local authorities as currently laid out in the Land Drainage Act 1991. It would not amend the role or duties of the National Rivers Authority as currently set out in the Water Resources Act 1991. In fact, as I shall explain, in some respects the Bill would confer on internal drainage boards and local authorities provisions which already apply to the NRA, so putting the various land drainage and flood defence bodies on a more consistent footing.
Under the Land Drainage Act 1991, Ministers approve proposed capital works on land drainage and

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flood defence undertaken by internal drainage boards and local authorities before making grant aid available towards the costs of the works. In recent years the Ministry of Agriculture and the Welsh Office, which are the departments responsible, have made it clear that only those schemes which are judged to be environmentally acceptable can be approved. In making this judgment weight is given by the departments to the advice of the statutory conservation organisations and particularly English Nature and the Countryside Council for Wales. Hence proposed capital works are thoroughly vetted for technical, economic and environmental acceptability before they can go ahead.
The Bill before your Lordships is primarily concerned with the day-to-day operation and maintenance of the existing land drainage and flood defence infrastructure rather than capital works. Operational matters remain the responsibility of the body concerned —the NRA, the internal drainage board, or the local authority. These are the bodies with the relevant local knowledge, expertise and legislative powers. But it is important to note that the day-to-day operation of pumping stations, sluices and other water management devices can have a profound effect, not only on the alleviation of flooding, but also on the environment; effects which may be just as significant as the original decision to put the structures in place. The Bill is designed to help drainage boards and local authorities to strike an appropriate balance between flood defence and conservation in their day-to-day activities.
A number of sites of high conservation value owe their existence or their special interest to drainage or flood defence structures. I have in mind the Ouse Washes in Cambridgeshire, and the Pevensey Levels in East Sussex. I am glad that two Members of the House are to speak today who come from those two counties and will therefore know them well. These sites and many others continue to require sensitive management of water levels to maintain their conservation interest. Many such sites are designated as sites of special scientific interest. It is estimated that there are some 200 SSSIs in internal drainage board districts. Some will be candidates for designation at the European Community level, as special protection areas under the EC birds directive, or as special areas of conservation under the EC habitats directive.
In order to build on the work already being done by internal drainage boards, in partnership with local conservation bodies, to protect these sites, the Bill I am putting forward would amend present legislation in three ways.
First, local authorities carrying out land drainage and flood defence activities would for the first time be placed under a duty to have regard to the environment. At present internal drainage boards are under such a duty, by virtue of Sections 12 and 13 of the Land Drainage Act; and the NRA, as befits a national environmental agency, is placed under even more comprehensive environmental duties. But at present there is no such duty on local authorities when acting in that field.
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The Bill would remove that anomaly by bringing local authority environmental duties broadly in line with those applied to IDBs. I can assure the House that, in consultations prior to the preparation of the Bill, local authority associations saw no difficulty with that. I am sure that the overwhelming majority of local authorities are already fully mindful of the need to protect and enhance the environment in all that they do.
The second proposal in the Bill is that Ministers—in this case the Agriculture Minister and the Secretary of State for Wales acting jointly—would be enabled to issue codes of practice to internal drainage boards and local authorities in England and Wales. Those codes would guide them on how to discharge their environmental duties when carrying out their drainage and flood defence functions.
The departments already publish advice on the incorporation of environmental considerations into flood defence policies and practice, but that guidance, while generally recognised as helpful, has no formal status. Under legislation governing the National Rivers Authority, Ministers may already issue codes of practice to it. It seems sensible to enact a similar provision referring to the other drainage bodies, so that consistent advice in that area of policy can be issued to all of them.
I should emphasise to the House that it is proposed that the codes would be drawn up after consultation with a range of bodies, including the NRA and the major conservation organisations. It is not intended to make the code legally binding, and contravention of the code would not in itself constitute an offence. However, Ministers would be required to take compliance with the codes into account when exercising their functions under the Act. The codes would be confirmed by order, subject to negative resolution procedure. I hope that the House will agree with me that such codes would help foster good environmental practices among drainage boards and environmental authorities.
The third new measure contained in the Bill would enable either of the Ministers to issue a direction to an internal drainage board if it was considered that the board's activities were likely to destroy or seriously damage an environmental asset of national or international importance. That proposal clearly needs a little explanation. I hope that your Lordships will bear with me while I give it.
At present, internal drainage boards have a large measure of freedom of action in the way that they manage the drainage structures in their districts, and quite rightly so. The boards are, after all, controlled by elected representatives of drainage ratepayers and by local council nominees, the latter often in a majority. Those bodies are well placed to deploy their local knowledge and expertise in such matters to the benefit of the local community that they serve. In the vast majority of cases, that presents no problem. Most boards have adapted readily to the changes in environmental policies and practices which have taken place over the past 10 years, and work constructively with conserva-tion interests to enhance the local environment in all that they do. The Association of Drainage Authorities, to which the vast majority of internal drainage boards belong, and of which my noble friend Lord De Ramsey

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is President, has done much to encourage and strengthen this environmental awareness among its members. I pay tribute to the association for that.
I should point out that my noble friend Lord De Ramsey had very much hoped to be present today to speak in support of the Bill. It is with great regret that an unavoidable commitment has prevented him from so doing. I should also point out that shortly before the debate commenced I received a letter from the noble Lord, Lord Beaumont of Whitley, who had also hoped to be able to speak in support of the Bill, expressing apologies for his absence today.
It is important to note that at present there is no "back stop" in the legislation for those hopefully rare cases where an IDB, by accident or design, fails to take adequate account of the effect of its activities on the environment. Such a "back stop" does however exist in the case of the NRA, to which Ministers may issue a direction in certain circumstances. The proposal in the Bill is that a Minister should be able, in the last resort, to direct an IDB in the exercise of its functions, if he or she is satisfied that an environmental asset of national or international importance would otherwise be seriously damaged or destroyed.
The environmental assets principally envisaged here are sites formally designated under European Community or UK legislation. The Bill proposes that, except in an emergency, Ministers would consult with the board in question before issuing a direction, thereby giving every opportunity to resolve the matter through discussion. I would also add that use of a ministerial direction would have the advantage of precision; in other words, rather than pass draconian regulations restricting the freedom of action of all internal drainage boards, the remedy would be carefully targeted where it is needed, leaving the generality of boards to continue their good work as they see fit.
In brief, the Bill aims to reinforce the current trend towards more environmentally-friendly flood defence and land drainage policies and practices. It does that through the three changes to existing legislation which I have outlined, which will put the various public bodies involved on a more equal footing and encourage them to strengthen their conservation roles. I believe that the Bill complements action being taken in related areas —for example, through implementation of the European Community habitats directive —in helping to protect and where possible enhance our wetland environment. I therefore hope that your Lordships will give the Bill your support and I commend it to the House.
Moved, That the Bill be now read a second time. —(The Earl of Lindsay.)
1.5 p.m.
Baroness Nicol: My Lords, I am glad to be able to support the Bill. I am also most grateful to the noble Earl, Lord Lindsay, for the comprehensive way in which he introduced it, which has left the rest of us with very little to say. As the noble Earl explained to us, wetlands provide important habitats for many species, especially birds. As a council member of the RSPB, I am well aware that the society wholeheartedly supports the Bill.
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About 40 per cent. of our wetlands have disappeared since the 1930s. That was for the best possible reasons originally because, obviously, we were trying to grow more food and there were all kinds of reasons why we needed to drain the land. However, things have changed. I agree with the noble Earl that the atmosphere has also changed and that now there is a great spirit of co-operation between all concerned as regards the preservation or the use of such wetlands. I have had discussions in recent years with the drainage authorities and I know that they are taking a much happier approach to this kind of exercise.
In what remains of our wetlands there are sites of national and international conservation importance which need to be treated with special care. That is why the provisions of the Bill are so important. Among the very useful provisions in it, the Bill allows for the relevant Minister to issue directions to drainage boards in some circumstances where there is a threat to a site of national or international importance. That is the one provision which might cause a little discomfort between the drainage boards and the Minister. However, I believe—and I hope that the Minister will be able to answer this in his response—that the power which already exists over the NRA has been used very infrequently. Indeed, the number of occasions when such a situation is likely to arise would be very small. I am quite sure that the provision would be used with great care if the occasion arose.
As I said, I am very glad to be able to support the Bill and I hope that it has a safe passage through the House. However, at the risk of introducing a slightly discordant note, I must say that I worry about its future. I say that because this House was engaged for some weeks with work on the National Parks Bill. That Bill came forward in very much the same way as the Bill now before us: that is, a Bill with Government backing; a Bill which was drafted in a government department; and a Bill with support on all sides of the House. Yet, the Bill has fallen flat in the other place on the voice of one Member—or, perhaps I should say, two Members because I believe that there were two attempts to get the legislation through. That Bill has now had to be withdrawn. I should be very sad indeed if we were to work as hard on this Bill as we did on the latter and then see it meet with the same fate. Therefore, should anything go wrong with the current Bill I hope that the Government will be prepared to adopt it in another place as a government Bill and put it through in government time.
I shall not treat your Lordships to a long harangue about the necessity for the Government to be braver about such Bills which they appear to want. However, it worries me very much that a Bill which is so necessary should be subject to such a potential danger. I hope that when the Minister responds he will assure us that the Government intend to see that this Bill succeeds.
1.10 p.m.
The Earl of Lytton: My Lords, I too should like to congratulate the noble Earl, Lord Lindsay, on his introduction of the Bill. I welcome the opportunity to debate the subject. I must say straightaway that I support the principle of ensuring that there is due regard for the

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needs of the environment as regards the activities of the internal drainage boards. Therefore, my concerns, so far as there are any, are merely matters of fine tuning as to the way in which environmental compliance in this important area of nature conservation is procured by the Bill. I am also a little concerned about the absence of an express duty to take socio-economic factors into account. The National Fanners Union and the Country Landowner's Association have both expressed anxiety to me on those points.
The problem arises because in general there are inadequate provisions for bench marking existing qualitative and quantitative aspects of environmental goods, and for assessing the alterations that have occurred in the past and those which might occur in the future. The way in which this bill is worded is no exception.
In managed landscapes—and drainage is a management tool —there is no birthright in the sense of natural goods. It is hard work, diligence, and often brings little reward. Therefore, there is anxiety that there may be an imposed form of managed retreat, which we have heard about so often, in relation to the activities of certain internal drainage boards or that the cautionary principle —again about which we hear so much—may remove effective management freedoms.
I turn now to specific clauses in the Bill. Clause 61C requires the conservation agencies to notify internal drainage boards and others of any area of land which is of special interest by reason of its flora, fauna and so on. The reference to "any area of land" is not qualified in the Bill. I feel that it ought to be. It can be presumed that the sites of special scientific interest referred to in the margin are those identified by various agencies under the Wildlife and Countryside Act 1981, but there is nothing in the Bill to say that that is the case. I feel that that should be clarified because there is great potential for confusion between statutorily designated sites and other sites which are presented to local authorities by local county wildlife trusts and others with a request that they be incorporated into local planning authority plans. While noting the comments of the noble Earl, Lord Lindsay, on that point, I should be grateful if the Minister could give me an assurance that the aim is to restrict Clause 61C to those sites which have been officially recognised under the Wildlife and Countryside Act 1981.
In respect of Clause 61D there is a similar but slightly different situation. Under that clause the Minister may give directions regarding the effects on environmental features which in his or her opinion are of national or international importance. Again, the description is not qualified by anything other than a reference to the opinion of the Minister. It would be inappropriate to rely solely on the opinion of the relevant Minister when advisory bodies and agencies and procedures already exist, or may be introduced in due course, for the careful assessment of such sites, whether they are of special scientific interest or of international importance.
It seems strange that a decision of this importance is left purely to a Minister. The National Farmers Union in particular believes that the power of direction could
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seriously undermine its members' interests if the measures which are incorporated in the Wildlife and Countryside Act 1981, which safeguard the interests of owners and occupiers, are not to apply. I hope that the Minister will give me an assurance that it is intended that the normal basis for the assessment of national or international importance of a site under that Act will apply in this case.
I referred earlier to the question of social and economic interests. I believe that this Bill neglects that aspect. The noble Baroness, Lady Nicol, referred to the National Parks Bill. I, too, am sorry that it has not survived in another place because we were given a particularly welcome assurance by the Minister at the end of our discussions on that Bill concerning the importance of social and economic factors following the provisions of Section 37 of the Countryside Act 1968.
I make no apology for returning to that aspect with this Bill. I believe that a parallel provision is needed here and that it should be on the face of the Bill. I shall be most grateful if the Minister will explain how the important needs of agriculture and forestry and the social and economic interests of rural areas can be safeguarded.
In view of the fact that time is getting on I shall curtail my further remarks. I feel that there is a great need for legislators and those who are the guardians of our environmental assets in this country to take careful stock and wake up to the reality of life at the sharp end. By that I mean the chap in his Wellington boots who has responsibility for the hands on, and in this case perhaps the feet in, management of the land. We need clarity of purpose and proper procedures to protect legitimate interests.
It is that economic activity which pays for management and financial investment and which creates business satisfaction. It also feeds families and educates children. Most importantly, it maintains the countryside. Lack of management, or inadequate management, is one of the greatest single threats to conservation objectives. I am concerned that if economic interests are not taken into account or are harmed in a way that is outside the control of the person pursuing them, then abandonment of traditional land management is the inevitable consequence.
Therefore, I particularly welcome Clause 61E which relates to codes of practice. I merely ask again that some reassurance can be given that in the formulation of those codes there will be the widest consultation with the owners and occupiers of the land as well as with other bodies.
1.17 p.m.
Lord Gallacher: My Lords, I thank the noble Earl, Lord Lindsay, for explaining his Bill in such detail to the House today. I also thank him for writing to me in advance of that explanation to tell me what the Bill was all about.
It has already been established that the Bill has the support of the Government. For that reason such comments and questions as I have will be directed to the

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Minister rather than to the noble Earl. I am sure that he will understand the wisdom of and necessity for such an approach.
To set the scene for the Bill, a Written Answer to a Question in another place on 1lth May took my eye. A Member asked the Minister of Agriculture:
"if she will make a statement on the place of arterial drainage infrastructure and sea defence works on British agriculture".— [Official Report, Commons, 11/5/94; col. 145.]
Mr. Jack responded for the Government:
"The Government's flood and coastal defence strategy for England and Wales recognises that over 50 per cent. of grade 1 agricultural land is situated in areas which depend on flood defence or arterial drainage works to maintain their productive capacity. The maintenance of this infrastructure is supported through central Government's financial support for local authorities.
As far as capital works are concerned, the Ministry no longer provides financial support for new rural arterial drainage schemes which are intended primarily to increase agricultural production but assistance may be available for works intended to alleviate flooding or coastal erosion in rural areas provided these meet the Ministry's technical, economic and environmental criteria".— [cols. 145–6.]
Arising from that Written Answer, I should like to ask whether the Bill before us will increase public expenditure in meeting higher environmental standards, and, if so, who will meet those added costs.
On the codes of practice which the Bill proposes to establish, perhaps I may ask the Minister or the noble Earl, Lord Lindsay, which bodies other than Ministers may draft codes of practice for approval under the Bill. Where a code has been drafted other than by Ministers, will its parentage be acknowledged when the relevant SI is laid before Parliament?
Perhaps I may say by way of an aside that on this side of the House we have been looking in recent days at the growth of government SIs. Indeed they featured quite strongly in preceding business of the House this morning. In 1983, SIs presented to Parliament totalled 1,965. Ten years later, in 1993, the number of SIs had increased to 3,359. That is a staggering increase by any standard. Sometimes one thinks in the early hours of the morning that Parliament may soon need a third Chamber to be called the "House of Scrutiny".
The Bill is due to come into force in two months, beginning with the day on which it is passed. Does the Minister consider that period adequate as regards notice? What will the effect of the introduction of the legislation in two months' time have on work in progress? Will such work be governed by existing or new legislation?
While acknowledging the provisions contained in the Bill for emergency action, I should like to ask whether the consultation provisions required of Ministers under the Bill will have a delaying effect on implementing work under its provisions. Consultation is a fine and worthy institution but it is introducing in this country long delays in getting anything done. It is important to have some indication of whether delays will result from the provisions of the Bill.
We acknowledge the support which exists for the Bill. It has been described in some detail by the noble Earl, Lord Lindsay. In view of that support and the improvement potential over existing procedures
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contained in the Land Drainage Act 1991, we are supportive of the Bill. I look forward to hearing what the Minister may say in answer to the questions I raise.
1.22 p.m.
The Parliamentary Secretary, Ministry of Agriculture, Fisheries and Food (Earl Howe): My Lords, the debate we have had on the Bill that my noble friend Lord Lindsay has introduced has, I think, amply demonstrated the importance of the work that is done by internal drainage boards and by local authorities on land drainage and flood defence. The services which these bodies provide are often unsung, but are nonetheless vital for the continued well-being—in both economic and environmental terms—of many of our urban and rural areas.
As my noble friend has said, his Bill enjoys the Government's full support. The measures it contains; will, I hope, commend themselves to all sides of the House. I believe they enjoy a broad range of support from conservation bodies and from the flood defence authorities themselves.
In many ways the theme of the Bill is nothing new. Its provisions fall squarely within the policies and principles set out in the Government's strategy for flood and coastal defence in England and Wales which was published by my right honourable friend the Minister of Agriculture, Fisheries and Food in October las;t year. It might be helpful to the House if I were to outline the key principles behind our strategy.
First, our overriding priority will always be to safeguard human life. This consideration is clearly a major determinant of the resources which we allocate to flood defence every year. Secondly, environmental considerations must be integral to flood defence policy. The potential impact on wildlife habitats and the environment generally is a key consideration both when capital works are being formulated and equally when existing structures are being managed and operated. Thirdly, we emphasise the need for a strategic approach. Measures to address flooding should not be looked at in isolation from their wider impact on the river catchment. Whenever we decide what action, if any, to take we must bear in mind the natural processes involved and the effects of defence measures on adjacent areas. Fourthly, a factor which cannot be overstated is the importance of consultation with those affected by flood defence and land drainage activity. Once again, that applies not only to proposals for major capital works, but also to the day-to-day operation of flood defences.
I turn now to the three measures set out in my noble friend's Bill. I should like to say a few words about each in turn. The first of the Bill's provisions would place a duty on local authorities carrying out land drainage or flood defence works to have regard to the environment. The Government believe it entirely appropriate that local authorities, along with other drainage bodies, should be under a duty to have regard to environmental matters, and the associations representing local authorities share that view. They also agree with us that the change would not impose any significant additional

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burdens on authorities, given that the majority of them are already mindful of environmental concerns in all they do.
I believe that that is my cue for answering one of the questions posed by the noble Lord, Lord Gallacher, when he asked whether any measures in the Bill would increase public expenditure. The Bill will have no such effect. In practice, local authorities are already very environmentally aware. I hope that the House will agree that that first measure is sensible.
The second of the Bill's new provisions is the power for Ministers to approve, by order, codes of practice giving guidance to internal drainage boards and local authorities on how best to discharge their environmental duties under land drainage legislation. There are a number of reasons why the Government support that.
In the last three years departments have produced a number of guidance booklets advising on the integration of environmental concerns into flood and coastal defence policy and practice. We believe that the existing guidance is very valuable, commands widespread acceptance and is generally followed. That acceptance is in no small part due to the extensive consultations carried out during its preparation. But the Government believe that further encouragement would be given to best practice among authorities if the guides were formally approved as codes.
The noble Earl, Lord Lytton, expressed concern about the extent of consultation in this area. The Bill makes clear that wide consultation will take place before such a code is approved and that codes will have to be confirmed by order. I can assure the House that it is the firm intention of Ministers to continue their present practice of holding thorough and comprehensive consultations before issuing guidance documents on flood defence and land drainage. Those consultations will continue to extend well beyond the major organisations listed on the face of the Bill. I can assure the noble Earl that that would include landowning and farming interests alongside others concerned.
In relation to the codes of practice, it is worth re-emphasising what my noble friend said: the Bill would place local authorities and IDBs on the same footing as the National Rivers Authority, to which Ministers are already empowered to issue such codes under the Water Resources Act 1991.
The third provision in the Bill is the measure enabling Ministers to direct the activities of an internal drainage board when a Minister considers that a board's actions would otherwise result in an environmental asset of national or international importance being destroyed or seriously damaged. Relatively few new flood defence capital works are undertaken by local authorities and internal drainage boards nowadays, although some £2 million a year in total goes mainly on refurbishment of existing works. But the operation and maintenance of the existing structures are an important and continuing task for those bodies. Ditches have to be kept clear, pumping stations operated and water levels managed. Those operations greatly affect the local environment. Land use and economic activity in the catchments concerned may have changed greatly since the original
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drainage works were undertaken. The environment and wildlife habitats may also have changed; and the needs and aspirations of local people, as well as national policy, also change.
I believe that in the vast majority of cases the local drainage bodies have adapted to these changes and where necessary modified their operations. These bodies are, after all, representative of local people and interests. But whereas at present Ministers stand as ultimate custodians of the national interest in respect of capital works—and in addition have a power of direction over the National Rivers Authority—there is no such backstop or power of last resort over the day-to-day flood defence activities of IDBs or local authorities. The Government believe that in respect or IDBs at least there should be such a backstop, and that is what the Bill proposes.
The purpose of the ministerial power of direction is, therefore, to provide a mechanism whereby in the last resort, if very important environmental issues are at stake, the Minister can ensure that the national interest will prevail. Specifically, the wording of the Bill means that Ministers would intervene only if a number of conditions were met. First, the environmental asset at risk must be of national or international importance. This means that Ministers would not intervene in matters of purely local importance. This would be entirely inappropriate as the local bodies concerned are best placed to resolve such difficulties. In determining what is of national or international importance, Ministers would give weight to the views of the statutory conservation advisers: English Nature, English Heritage, the Countryside Commission and the equivalent bodies in Wales.
Secondly, the environmental asset in question would need to be at risk of destruction or serious damage. Again, weight would be given to the advice of the statutory conservation bodies in assessing this. I can assure the House that such a judgment would not be made speculatively but on the basis of expert advice and sound science.
Thirdly, the Bill provides that the Minister should consult the IDB in question before issuing a direction, except in an emergency. I can assure the House that we would wish to enter into full and frank discussion with a board were such a set of circumstances to arise. I hope that in the majority of cases such explanation and discussion would result in the board concerned deciding to make the necessary changes to its practices voluntarily without the need for recourse to a formal direction. Where boards have agreed water level management plans already in place, the need for directions is likely to be even less.
The noble Baroness, Lady Nicol, asked how often the ministerial power of direction has been exercised over the NRA. To date, it has never been exercised. The NRA has been in existence for only five years and has a very good record of achievements, as I am sure the House will agree.
The noble Earl, Lord Lytton, raised a point about the new Section 61C. He wanted to know whether the phrase,
"any area of land … of special interest",

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was meant to refer solely to sites of special scientific interest under the Wildlife and Countryside Act 1981 or whether it had a wider meaning. It is right for me to remind the House that the part of the present Bill to which the noble Earl referred carries forward the existing provisions in Section 13(1) of the Land Drainage Act 1991. The Bill which my noble friend has introduced simply extends those provisions to local authorities. The short answer to his question is that the phrase,
"any area of land … of special interest",
goes wider than just sites of special scientific interest under the Wildlife and Countryside Act. In practice, however, the notifications given by the statutory conservation agencies to internal drainage boards and local authorities have been of SSSIs. So far as I am aware, the provision to which the noble Earl, Lord Lytton, referred, which I understand has been on the statute book in that form since 1989, has not created problems. There is no reason to believe that it will do so in the future. At this stage, therefore, the Government have no plans to amend the clause in the way that the noble Earl suggested.
The noble Earl also sought clarification of the new Section 61D which sets out the proposed ministerial power of direction to which I referred. Perhaps I could elaborate on one or two of the points I have already made. The intention under the clause is that Ministers would be guided by the views of the Government's statutory conservation advisers, as I have already said. Those bodies' views on the seriousness of the risk to the feature in question would also be sought so that Ministers would have the benefit of the best available scientific advice from both within and outside the department. I can assure the House that Ministers will expect to see compelling evidence before making use of the provision.
I do not think it would be appropriate to restrict application of the ministerial power of direction to those SSSIs in which a nature conservation order is in force. Those orders are primarily, though not exclusively, designed to deal with the activities of landowners and occupiers of SSSIs. The proposed power of direction, on the other hand, is intended to apply solely to one class of public body, namely IDBs, and to put them on a similar footing to the NRA, which is another public body acting in the same field. The Bill will therefore complement rather than duplicate the nature conserva-tion order procedure.
I must make it clear that it is not the Government's intention to rely on the present Bill to implement their obligations under the EC habitats and species directive. Separate regulations will be made under the European Communities Act to achieve that. The present Bill is intended to be complementary to those regulations.
I hope that what I have said will reassure the noble Earl that the decision to proceed by ministerial direction would not be taken lightly. It would be taken in the last resort only and on the basis of advice backed up by comprehensive scientific evidence. Equally, however, I hope that the noble Earl will accept that if the procedure
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is made too formal or too cumbersome, its advantages —namely, those of a quick and precise remedy to isolated and serious problems —will be lost.
The noble Lord, Lord Gallacher, raised a number of other queries. He asked what effect the Bill would have on work already in progress. The effect will not be retrospective. The power of direction will be used only if there is firm evidence of damage on works that are in prospect rather than those which have already been approved. He also asked whether two months' notice, as prescribed in the Bill, was adequate. I believe that that period will be adequate, bearing in mind that environmental considerations are in practice already taken into account by operating authorities.
The noble Lord asked who may draft a code of practice other than the Government and whether that fact will be acknowledged, if it applies. I envisage that the Ministry of Agriculture, Fisheries and Food will lead on the drafting of such guidance. However, that exercise will involve the statutory conservation bodies and the flood defence authorities themselves, in addition to the involvement of landowners, as I have already made clear to the noble Earl, in the consultation process. I hope that what I have said on the record today will be a sufficient indication of the Government's debt to all concerned in the codes of practice.
I hope that I have given the House a clear view of how the Government regard the Bill, why we think its provisions are necessary and useful and how they might be applied in practice. I commend my noble friend Lord Lindsay for taking it on in such a capable way. I hope your Lordships will agree with me that its effect would be to strengthen the environmental aspects of land drainage and flood defence activity in a way which is sensible and proportionate and which avoids excessive regulation. It has the Government's full support and I hope that it will command that of your Lordships' House.
1.39 p.m.
The Earl of Lindsay: My Lords, this has been a most valuable debate and I am grateful to all noble Lords who have taken part. I should particularly like to thank the Minister for his expression of the Government's support for the Bill and his explanations of how Ministers see its provisions being implemented.
A number of important and interesting points were made on aspects of land drainage and conservation by all speakers. I will endeavour to answer the points that still need to be answered. I am grateful to my noble friend for answering some of the specific points raised. If any remain unanswered, I shall endeavour to write to noble Lords.
I am very grateful that the noble Baroness, Lady Nicol, is able to support the Bill arising from her role within the RSPB and more especially because of her extraordinarily wide experience of all countryside matters. Much of this Bill is based on that breadth of vision, and therefore that balance of vision.
The noble Baroness quite rightly identified the spirit of co-operation and consensus which now exists in the countryside on many matters. Some of the old battle lines which people anticipated four or five years ago

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between conservation and the environment on the one hand and farmers and developers on the other have not materialised as was expected. Indeed, a great sense of co-operation and of mutual benefit and interest has been identified.
The noble Baroness mentioned the National Parks Bill and her distress that this Bill might suffer a similar fate. I stress that this Bill contains three fairly modest and simple proposals designed to strengthen the conservation aspects of local land drainage and flood defence duties. They were the subject of very wide consultation before they reached this House. On that basis, there seems to be a good chance that this Bill may be successful both in this House and in the other place. I also add, from a personal and rather pragmatic Back-Bencher's point of view, and given the weight of legislation that is consuming the time for the Government's programme, that if I were not to present the Bill there would simply be a delay in the introduction of this sort of measure. Therefore, it seemed well worth taking the risk and hoping that we might achieve something with it.
The noble Earl, Lord Lytton, raised a number of very interesting issues. I assure him, first, that I understood exactly what points of reassurance he was seeking. Apart from having an interest in environmental issues, I am a member of the CLA. I am a farmer and I own land which is not of any agricultural use, but is quite wet land. We have an SSSI and although the land consists of only 700 to 800 acres, we have an extraordinarily complex pattern of ground. There are many migratory species tracking through it. My role in introducing this Bill was based only partly on my interest in environmental issues.
I looked at the Bill very carefully and at the implications for landowners and for farmers. I would not be standing before your Lordships today if I felt that there was a material threat to their interests. The noble Earl made a remark about this Bill threatening the reality of life at the sharp end. I believe that that is not a threat that is posed by this Bill in any way whatever. I would not in any way want to be associated with a Bill that did pose that sort of threat. Like all small farmers, I am very anxious that the other, so to speak, socio-economic activities involved with the countryside are properly protected.
I therefore mention specifically that internal drainage boards have considerable experience of balancing the needs of flood defence and socio-economic activities. I remind the House that the boards are governed by representatives of agricultural drainage ratepayers and local authority nominees. The legislation under which they act rightly gives precedence to flood defence considerations, and that will not change. Therefore, I hope that the noble Earl, Lord Lytton, will feel reassured. It is a point that we could take up either in writing or in discussion after today's debate if he would like to do that.
I am grateful to the noble Lord, Lord Gallacher, for his support. I am conscious of the fact that he wisely directed most of his questions to the Minister and that they have been answered. I would add one footnote. The
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noble Lord was worried that, by raising environmental standards, costs might also be increased. I believe that the example that I gave earlier in the debate put that doubt to rest. Very often, by increasing respect for the environment, costs which might be associated with engineering or with day-to-day operations are actually decreased. One of the great realisations of the past year or two—it goes back to what the noble Baroness said —is that many environmental activities are not the bottom-line cost activities which were anticipated in the 1980s. Many of them reduce costs or produce bottom-line profits. Therefore, increasing the environ-mental consideration of flood defence and land drainage uses will not necessarily increase costs and might well reduce them.
In conclusion, I thank all noble Lords who made a contribution to today's debate. I think it is fair to say that the Bill enjoys a good measure of support from both the land drainage and flood defence authorities and the conservation bodies. I hope that it has support from all sides of this House, and certainly from the noble Lord, Lord Beaumont, who is unable to be here. I hope that the level of agreement will make for the speedy passage of the Bill both in this House and in the other place. I feel sure that it will help to foster and strengthen the provision of environmentally friendly land drainage and flood defence measures to the benefit of local communities and the public interest generally. For that reason, I commend the Bill to the House and I hope that your Lordships will give it a Second Reading.
Earl Howe: My Lords, with the leave of the House, I am told that I gave a slightly misleading answer to the noble Lord, Lord Gallacher, which I certainly did not intend to do, on the question that he asked me about the effect that the Bill might have on works that are currently in progress. I answered the noble Lord that the Bill is not retrospective —which is absolutely right. Conceivably, it could apply to the current or indeed the future operation of infrastructure work which has been installed in the past. I should like to make that point absolutely clear.
On Question, Bill read a second time, and committed to a Committee of the Whole House.

Chiropractors Bill
1.47 p.m.
Lord Walton of Detchant: My Lords, I beg to move that this Bill be now read a second time.
Exactly a year ago I had the privilege of standing before your Lordships' House to open the Second Reading debate on the Osteopaths Bill. I little thought then that I should be performing a similar role so soon on behalf of the chiropractic profession. I am however delighted to be opening this debate on the Chiropractors Bill. My sense of pleasure is enhanced because, as many noble Lords will know, I had the honour to serve on the two working parties set up by the King's Fund to look into the question of statutory regulation for the osteopathic and the chiropractic professions. Both working parties were chaired by the right honourable Sir Thomas Bingham, now Master of the Rolls. I would like

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to record, on behalf of both the professions and myself, our appreciation of his sterling work. I think it is fair to say that had the King's Fund not taken the initiative and set: up the working parties, neither profession would be where it is today.
Before I move on to the Bill itself, may I remark how swiftly things have changed in the field of complemen-tary medicine. Thirty years ago, American chiropractors in some states of the USA were convicted of practising medicine without a licence. A little under 10 years ago the then mainstream attitude among my colleagues in the medical profession gave no indication of the great developments that were in store. Today, by contrast, the Osteopaths Act is already on the statute book and the chiropractors stand poised to become, should this Bill be successful, the second profession from the complementary medicine field to achieve statutory regulation.
Complementary medicine does, of course, cover a very wide range of approaches and professional activities. In many ways the only thing which all practitioners of complementary medicine have in common is that they do not form part of orthodox medical treatment as it is practised in most European, and indeed most Western, countries.
Chiropractic itself is a bio-mechanical therapy based on the premise that the spine carries and protects a large part of the body's central nervous system, a matter with which as a neurologist I am much concerned. Therefore it has a key role in maintaining the body's effective functioning. When the mobility of the spine is affected either by becoming inflexible and stiff or even by becoming too mobile, the nervous system may also be affected in turn. In many cases severe pain can result, but it is often experienced not only in the back but also in the limbs or indeed in other parts of the body. Chiropractic treatment provides a means of assessing the position of the spine to discover the presence of such a condition and then making an adjustment or manipulation to correct it.
That very brief explanation makes chiropractic sound very like osteopathy. It is true that the two professions share many similar concepts and procedures. While it is very difficult to define briefly what precisely distinguishes the two professions, it is fair to say that they have somewhat different philosophical and practical approaches to training and to the exact types of manipulative techniques that they use. Their own history, especially in their separate development as professions, means that the two professions will often approach the same problem from rather different angles.
I have come across a rather endearing story which is somewhat analogous to the situation and which, like all similar anecdotes, might upset the purists but should appeal to others as possibly coming close to the truth. It relates to a small railway station in the west of Ireland which had two station clocks showing different times. A traveller who was unfamiliar with the local ethos asked the station master why there were two clocks and why they each told a different time. "Well," said the station master, "if they both told the same time, we would only need one of them."
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Returning to more serious issues, perhaps I may say first that having personally visited the Anglo-European College of Chiropractic in Bournemouth, I was much impressed by the quality of instruction and the rigorous application of scientific methods which I saw there. The King's Fund working party came to the conclusion that the differences between osteopathy and chiropractic, though relatively minor, fully justified independent regulatory machinery for each profession. Many noble Lords will be aware that a few years ago a Medical Research Council trial, which compared the manage-ment of low back pain by chiropractic, on the one hand, and by more traditional hospital-based techniques such as physiotherapy, on the other, demonstrated that chiropractic was significantly superior.
The Bill seeks to establish a statutory registration scheme for chiropractors which will regulate the profession and require all persons calling themselves chiropractors to be registered with a new statutory council. That new statutory body, the General Chiropractic Council, will have the duty to regulate, promote and develop the profession of chiropractic and lay down standards of professional conduct and education.
The Bill also provides for the establishment of four statutory committees to advise the general council on matters relating to chiropractic education and training and to ensure that any complaint or allegation made about a registered practitioner's fitness to practise chiropractic is properly investigated and effectively resolved. The general council itself is to consist of 10 chiropractors elected by the profession, six lay members representing the interests of patients and consumers and four members, one of whom will be appointed by the Secretary of State for Education, to advise on matters of chiropractic and professional education. The general council's statutory duties will include preparing and publishing a professional code of conduct and a standard of proficiency required for the safe and competent practice of chiropractic; appointing a registrar to establish and maintain a register of practitioners; and appointing members of the Education, Investigating, Professional Conduct and Health Committees.
Entitlement to registration is to be determined primarily on whether a person holds a "recognised" qualification. For example, the Anglo-European college in Bournemouth now offers a four-year honours degree course followed by one year of practice under supervision before full registration would become possible. The qualifications to be accepted under the terms of the Bill will be any qualification which the general council, on the advice of its education committee and with the approval of the Privy Council, "recognises" as equipping the practitioner with the education, training and skills necessary for the safe and competent practice of chiropractic.
The Bill also provides transitional arrangements to enable those practitioners who may not now hold a recognised qualification but who have been practising chiropractic lawfully, safely and competently over a period of years to be registered. The Bill further enables the general council to introduce, after consultation with

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the profession, a system of provisional registration— normally a year—during which a practitioner will be entitled to practise only under the supervision of a fully registered chiropractor; and to make continued registration subject to the condition that the practitioner undergoes regular post-registration training.
The Education Committee is to be responsible for promoting and reviewing standards of education and training in chiropractic and for advising the general council on all matters relating to chiropractic education and training, in particular the qualifications entitling a practitioner to be registered. To assist it in fulfilling those duties, the education committee will be empowered to request, from training institutions offering or seeking to offer recognised qualifications or post-registration training et cetera, information on the courses and facilities that they provide and to appoint visitors to report on the standard of training given.
A key function of the committee will be to advise the general council on the recognition of qualifications offered by training establishments. It is to do that on the basis of whether the qualification provides evidence of having reached the standard of proficiency laid down by the general council for the safe and competent practice of chiropractic.
The investigating, professional conduct and health committees are to investigate and, if necessary, take action on allegations made against a registered chiropractor concerning his or her professional conduct, competence or fitness to practice. In carrying out investigations, the committees would have the power to order the immediate suspension of a chiropractor's registration where such action is considered necessary for the protection of members of the public. To protect the interests of the practitioner, the Bill provides a right to a hearing with legal representation if the practitioner so chooses and with full rights of appeal before such a suspension is imposed.
The Privy Council is to be given the responsibility of overseeing the work of the general council and its four committees. If the Privy Council believes that the general council is failing in its duties, it will have the power to direct the general council to perform any of its statutory functions. In the last resort the Privy Council would be able to take over entirely the functions of the general council and do anything that the general council is able to do. That supervisory role and the accompanying powers are similar to those exercised by the Privy Council under the regulatory schemes of other groups of health care professionals. However, I have to say that there is no known case of the Privy Council ever having to use its default powers in that way.
The reason that statutory regulation is being sought by the profession is quite simple. As the honourable Member for Aylesbury said when the Bill had its Second Reading in another place, there is at present nothing to stop anyone fixing a brass plate to his gatepost and immediately setting himself up in practice as a chiropractor. That poses a real risk to anyone unlucky enough to find himself in the hands of such a person. The manipulation of necks, backs or even limbs by the hands of an untrained person could have very
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serious consequences. In addition, a considerable part of chiropractic training is devoted to the recognition of those conditions which chiropractic cannot treat, and especially those where immediate referral to a medical practitioner is warranted. The potential risk to a patient of a serious condition remaining undetected by an untrained manipulator is obvious. While the profession remains small, it would have been more difficult to practise, but with the recent expansion of the profession, the possibilities for bogus or cowboy chiropractors, if I may use those terms, will increase.
There are now around 900 chiropractors currently working in the UK, about twice the number there were only a few years ago. If we add in the number of students currently on chiropractic training courses, the profession may well be set to double in size again before the end of the century. The achievement of statutory regulation would, furthermore, enable chiropractors to take their proper place alongside those in other long-established caring vocations. They would be recognised as a mature and responsible profession, capable of being entrusted with the regulation of their own affairs within the framework provided by the Bill. Statutory regulation would also provide patients with the necessary assurance that their treatment was skilled, competent and appropriate, and may well encourage more people to take up chiropractic as a career.
By far the majority of, if not all, practising chiropractors in the UK are at present members of a voluntary registration scheme. The profession recog-nises, however, that a voluntary system of control is inadequate in that it cannot provide members of the public with the level of assurance many would wish to have about their personal practitioner. For example, if an incompetent practitioner were to be struck off a voluntary register, he or she would remain free to continue in practice and to continue describing himself or herself, perfectly legally, as a chiropractor. A patient injured in those circumstances by an incompetent practitioner has no opportunity for redress outside the civil law. As around 75,000 patients consult chiropractors each week, I am sure noble Lords will agree that the profession's pursuit of statutory regulation is entirely appropriate.
As I mentioned earlier, the Bill follows closely the precepts of the Osteopaths Act and indeed, like the latter Act, is broadly modelled upon the medical Acts which regulate the function of the General Medical Council, of which I had the honour to be president from 1982 to 1989. The system of regulation which it contains may serve in future as a model which other professions may choose to adopt should they in the future seek to follow the lead of the osteopaths and chiropractors. It would therefore, I believe, be wise to take advantage of the unique opportunity presented by the Chiropractors Bill to make a small number of what have been described as fine-tuning amendments to the Osteopaths Act. Those have also been incorporated in the Bill which is before your Lordships today.
The Bill received detailed examination as it passed through its stages in another place. It is a striking and substantial example of current thinking on the question of professional self-regulation. It is a Bill in which the

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profession and all who contributed to it can be confident and by which they may feel duly rewarded for all their efforts. It would be appropriate for me to mention in particular at this point the quite remarkable and dedicated work done by members of the Chiropractic Registration Steering Group, some of whom were also members of the King's Fund Working Party. The profession and all patients of chiropractors owe them, and notably the assiduous Ian Hutchinson, a sincere debt of gratitude for all their hard work.
Should the Bill succeed, as I fervently hope it will —Private Members' Bills are delicate objects at the best of times—it will, in addition to achieving the result for which the profession has worked tirelessly, mark and recognise that this model of regulation, already enshrined in the Osteopaths Act, is both workable and sound. I commend the Bill to your Lordships' House.
Moved, That the Bill be now read a second time. —(Lord Walton of Detchant.)
2.4 p.m.
The Earl of Clanwilliam: My Lords, it is my privilege to be the first to follow the noble Lord, Lord Walton of Detchant, and to thank him and congratulate him on the preparation and content of the Bill. I am sure your Lordships will agree that he does himself little justice in praising so many other people. We all know that it was his driving force that brought forward both the Osteopaths and Chiropractors Bills and we thank him for doing so.
On a personal note, I should perhaps thank the noble Lord for coming to the Chamber at all today. I understand that Lady Walton is not well and it must be an extremely difficult time for him. I was told that Her Ladyship was a little better today and I am sure that the whole House joins me in wishing her well.
I speak not as a practitioner of this activity, but as a lay promoter of alternative medicine. The noble Lord gave a comprehensive review and referred to the similarity of this Bill with that of the Osteopaths Act. It is good news that both services will now be available both to NHS hospitals and fundholders alike. I am sure that there will be great relief in the minds of all existing practitioners that they will not have to go back to school for another four years.
The conditional registration arrangements are also generous and encouraging to younger and less experienced practitioners. The new register will have important provisions to declare full details of practitioners' qualifications which will be available to the public in order to provide complete transparency. Chiropractors have an existing, well established and excellent school at Bournemouth. The noble Lord complimented them upon the school and it is right that he should do so. They have made great efforts to promote the school and have prepared a system of registration and preparation for all chiropractors of which we, as a nation, can be proud.
The professional conduct and health committees' powers to regulate members is a reflection of the increasingly important need to protect the public. In many ways I am against the promotion of the nanny state which attempts to remove all responsibility from
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the individual. But reluctantly I must say that in this instance it is not only good and laudable, but vital. The problem of perceived success or failure in any medical treatment is often extremely subjective, especially where the patient believes that he or she is the victim. In that situation there must be clear evidence of the treatment given and the case history for judgment by the committees to maintain public confidence in the practice of chiropractic whose long history and record of success is now being recognised.
We should have short speeches—I am sure that the noble Lord is anxious to get home to the bedside of his wife—but I would say that there are other therapies, particularly in the alternative medicine field, which I should like to bring to the attention of my noble friend the Minister, especially the Chinese system where a combination of modern medicine, herbal medicine and acupuncture provide a remarkable source of successful medical practice which is already in use in some parts of the country. I would hope that that might soon also be recognised by the medical profession.
2.8 p.m.
Lord Ennals: My Lords, it is also my pleasure to congratulate the noble Lord, Lord Walton, on introducing this Bill with a very lucid explanation—no less so than when, as he said, a year ago he put before your Lordships' House the Osteopaths Bill. It is a very happy occasion that with only a year in between we are seeking to put on the statute book a system for the control and training of chiropractics as already exists for osteopaths. I should like to add my thanks to the King's Fund, which by its studies has initiated both these Bills, and to Sir Thomas Bingham as chairman of the working party. I do not think we should allow the occasion to pass without congratulating David Lidington, a Member of Parliament in another place, who piloted the Bill through another place with considerable success.
I very much agree with the noble Earl, Lord Clanwilliam, in that many of us hope that we have notched up two on the ladder and that the ladder will go higher. He is right in saying that we should be looking at acupuncture as the second choice. I am glad that the noble Earl, Lord Baldwin of Bewdley, is here to speak in view of his excellent work in terms of registration of those who are practitioners of acupuncture.
The proposed legislation has received widespread support from other health service professions. I was particularly glad to see the comments of the physiotherapists, who in a sense would like to have had a Bill for themselves. They would like to see regulation because they have no control over the many people who claim to be physiotherapists but have not necessarily undertaken the training. To that extent chiropractics will be at an advantage as a profession. It is good for the professions that they should have rules and regulations to provide for the confidence of the public.
There is no doubt that there is a need for the profession of chiropractic. I was looking at some facts which show that 310,000 people in the United Kingdom are off work each day with back pain. Not necessarily all but most of those cases could be treated by chiropractic. Back pain costs the country more than £3 million in lost

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production every year. Disability from low back pain is increasing faster than any other form of disability. In fact, the incidence has doubled in the past 10 years. It would be interesting if the Minister could give some explanation for that remarkable and disturbing increase.
There has been great progress by the profession. There are now about 900 chiropractors working in Britain. About 75,000 patients consult a chiropractor each week. We can see, therefore, that the numbers dependent on this form of manipulative treatment are very large. A recent study by Which? in November 1992 showed that chiropractic was the second most frequently used complementary therapy. The Medical Research Council's clinical trial, reported in the British Medical Journal on 2nd June 1990, found chiropractic to be considerably more effective than hospital outpatient treatment for low back pain, particularly for those with chronic or severe pain. That was the first large-scale trial to compare a complementary method with orthodox medical treatment. It came out with flying colours. I very much agree with the noble Lord, Lord Walton, that it is encouraging that public attitudes, and particularly the attitudes of the medical profession, towards complementary therapies have gone through tremendous change. That is enormously encouraging. Were that not the case we would not have this Bill before us today. The very fact that it is the noble Lord, Lord Walton—a former president of the British Medical Association—who has piloted both Bills through the House means that he more than anyone else has led to this great improvement in relationships and understanding.
A report on back pain which was published in August 1993, commissioned by the Canadian Government, stated that,
"the safety of chiropractic care and higher satisfaction levels expressed by patients offer an overwhelming case in favour of much greater use of chiropractic".
It is a very happy occurrence that this Bill is introduced now because chiropractic celebrates its centenary in 1995. It will be very nice if it is able to implement the Act, as it then will be, in the year in which it celebrates its centenary. I am certain that the House, with the extraordinary generosity which it always shows, would want to say to the profession, "A happy 100th birthday".
I end by quoting three short paragraphs from Sir Thomas Bingham's report. They are paragraphs 17, 18 and 19. Paragraph 17 says:
"We are of opinion that legislation to regulate the practice of a profession such as chiropractic which offers manipulative techniques which, if wrongly applied, could be harmful is necessary for the protection of patients. Although the profession is small in number, demand for chiropractic treatment is growing and the number of students in training increasing at such a rate that the profession is likely to double in size in the next five years".
Paragraph 18 states:
"Chiropractic is statutorily regulated in most countries where it is practised. Alone among English speaking nations, Great Britain and Northern Ireland are content to rely on voluntary arrangements".
We are not content to rely on voluntary arrangements which is why we hope that the Bill will go on to the statute book. Paragraph 19 also states:
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"Voluntary arrangements of this kind do not work in practice. Voluntary registering bodies have no effective sanctions against unlicensed, untrained or professionally negligent practitioners. They cannot prevent such practitioners from continuing to practice even though it is against the interests of patients for them to do so".
I believe that these are most powerful arguments for a statutory regulation system. The profession itself wants to see the change as did the osteopaths.
As I say, I hope that we shall now have on the statute book the second of what I hope will be a series of measures. It is right to take them one by one although I must add, as I did in the debate about a year ago, that I do not believe that it should be dependent on the vagaries of the system of Private Members' Bills. In the past two or three weeks we have been very tragically reminded how a good Bill can be lost in the processes of another place. Thank Heavens your Lordships do not treat Bills in that sort of derisory way. I wish this could have been a Government Bill. It is really the luck of the draw if one can persuade a Member of another place to take up this particular cause out of the 13 Bills which are likely to succeed. We were fortunate that it happened. I hope that the noble Lord, Lord Walton, is right in thinking and hoping that this measure will reach the statute book. If it is, it owes very much to his work and commitment.
2.17 p.m.
Earl Baldwin of Bewdley: My Lords, I welcome this Bill and congratulate all those whose hard work has made it possible. With the Osteopaths Act of last year to light the way we are now within reach of seeing both sets of manipulators—I say that in the best sense of the term—safely on to the statute book. This is surely the right road to take. The more that standards are established for all to see, the greater the protection for everyone concerned and the less the need to go down the route of banning therapies with all the restrictions on innovation and freedom that that entails.
It is an admirable Bill, as was the Osteopaths Bill. It will not come cheap for the profession, but that is the sort of price that complementary therapists will expect to have to pay for any worthwhile self-regulation. There are no short cuts.
Although I wear the hats of Joint Chairman of the Parliamentary Group for Alternative and Complementary Medicine and Chairman of the British Acupuncture Accreditation Board, I see these things mainly through the eyes of a patient. I have two concerns here, one of which I voiced at the time of the Osteopaths Act. In gaining your place in the sun it is easy to lose your soul. Something of the kind has happened in the USA. If I go to a chiropractor, I do not want to find a watered down medical practitioner by another name. There are skills and attitudes to chiropractic which are worth preserving, and I hope they will be preserved.
In the case of chiropractic, there are three schools with different approaches. The King's Fund Report commented rightly that there was no intention, in levelling standards, to do away with diversity. It even suggested that the professional register should show what school a practitioner came from, but I do not see

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this carried forward into the Bill. I do hope that individualities will not be lost among the unequal size of the three schools. I believe that the public are more concerned and discriminating here than one might actually expect.
It is nearly a hundred years since the birth of chiropractic, and it is worth commenting again that this is an extremely long time to have to wait for acceptance from an orthodoxy which for most of that time regarded it as dangerous quackery. My noble friend Lord Walton alluded to that in passing but without drawing any particular conclusion from it. If we have patients' interests at heart we may have to look hard and long at the attitudes and methods of assessment which produce this kind of situation.
I say this, my Lords, because it has lessons for the future. As the noble Earl, Lord Clanwilliam, and the noble Lord, Lord Ennals, have already mentioned, other professions are already on the road, notably the accupuncturists, the herbalists and the homeopaths. Various authorities have been staking out the conditions which they believe must be fulfilled before a profession can be regulated. I think we must look at these critically, always with the patients' interest at the front of our minds. The Secretary to the King's Fund, in his foreword to the chiropractic report, insists on solid foundations in science. In one sense, of course, this is unobjectionable. But the trouble is that it is too often interpreted to mean the-body-of-knowledge-as-it-is-currently-understood-in-the-Western-world, which is not quite the same thing though it may be convenient for the medical scientists of 1994. All too often the question How does it work? is put before Does it work? It is the latter that is important, and that brings patients to chiropractic, acupuncture, healing and the rest.
Another condition comes from government, and was restated by the Minister, Mr. Tom Sackville, at Second Reading in another place. It is that the profession concerned should secure the support and acceptance of the medical profession. My Lords, this is highly desirable, and there could be real difficulties if it were not done. But in view of the past track record which I have alluded to, I just wonder whether the Government are wise to elevate this to the status of a firm principle. I would like to hear a bit more argument about this some time.
This brings me to a final plea, which I have made before. The Government have stated in the past that they are "benignly neutral" towards complementary medi-cine. Since the health of the nation is involved, could they not be a little more benign and a little less neutral? We all now accept that chiropractic is a "Good Thing". Should not this have been a Government Bill, as the noble Lord, Lord Ennals, asked? In view of the large and growing public use of complementary therapies, which has national policy implications and will not go away, I feel sure it would be in the general interest if government made it easier for the up-and-coming professions which have always lacked money and research expertise to establish just what they can and cannot do. Good health is too important to leave solely to the market place.
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Meanwhile, my Lords, we have an excellent measure before us, most clearly and ably introduced by my noble friend Lord Walton of Detchant under severe personal difficulties with which we greatly sympathise, and I am sure we will all wish the Bill a speedy passage.
2.23 p.m.
Lord Harmsworth: My Lords, I speak not as any kind of expert, but as a very satisfied patient of the British School of Osteopathy, a profession which has already jumped the various and well thought-out hurdles which ended in the 1993 Osteopaths Act.
In a previous incarnation at the then Department of Health and Social Security, I was for a time the source of some merriment owing to my habit of lying on my back in my office, papers aloft, as I suffered what was to become excruciating back pain. It is no small tribute to the department that, while I was there, I was never able to detect any prejudice against what is known as "complementary medicine": uncompromising scrutiny of efficacy, perhaps, but not the kind of attitude that might close the mind to initially doubtful-seeming approaches to therapy, some of which have achieved respectability with time.
I suspect that your Lordships' House is no place in which to make remarks off the record, but if I may lower my voice slightly, it was on the unofficial advice (many moons ago and well before the Osteopaths Act) of a very good friend and colleague of mine—I hasten to state that it was a colleague on the administrative, not medical, side of the department—that I hurried off to obtain the treatment for which I shall for ever be grateful.
For my part, the Bill's promoters are, as it were, preaching to the converted. I have no direct experience of chiropractic as differentiated from osteopathy, and I thank the noble Lord, Lord Walton, for his valiant attempt to put us all right on that score. To my untutored eye, the two activities seem sufficiently similar, and their supporters adequately and equally enthusiastic. I hope that your Lordships will forgive me if, for the purposes of the Bill, I take for granted the bona fides of the practitioners of chiropractic. In 1990 the Medical Research Council largely endorsed what many individual patients have experienced in practice. I am in good company.
There are areas upon which I should like to hear from my noble friend the Minister. I am in no doubt that joint adjusting procedures, manipulation, massage and other techniques to treat muscular/skeletal complaints are cost-effective for the nation. Treatment is already available under the NHS through fundholding GPs and non-fundholding GPs if, in most cases, FHSAs can be persuaded to reimburse the cost from cash-limited funds for GP staff and premises, and DHAs. There is a shortage of practitioners in the specialty. What measures and encouragement are in place for a better supply of the service?
Secondly, will my noble friend assure the House that adequate safeguards are in place to protect not just the public from malpractice—I am content on that score —but the practitioner from vexatious accusations on grounds that would be the concern of the professional

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conduct committee. There is much at stake for the practitioner and much scope for misplaced troublemak-ing in such a "hands-on" activity.
Thirdly, I am in some confusion over the evidently subtle distinction between, first, osteopaths and chiropractors, and, secondly, the several schools of chiropractic. Now is not the time or place to explore the merits of the two practices amalgamating both legislatively and administratively, but might there be some benefit to the patient if they did so eventually?
This is a worthwhile Bill. I congratulate its promoter in another place, my honourable friend David Lidington; and the noble Lord, Lord Walton, on steering it through your Lordships' House. I am sure that he will do so as deftly as he did the Osteopaths Bill. I wish him and the Bill well.
2.28 p.m.
The Earl of Kintore: My Lords, I welcome the Bill. I use a chiropractor in Scotland. Although I enjoy excellent general health, following some overweight parachuting, compounded by falling off an army horse on my 23rd birthday, my spine is weak in places. A review of my X-rays usually results in a certain amount of tongue clicking. Some years ago there was always a petition to sign at the chiropractic clinic to get recognition for the profession as an acceptable alternative therapy. I hope that the Bill gives the chiropractic profession the recognition that it desires and deserves. I congratulate my noble friend Lord Walton of Detchant and everyone else involved on getting the Bill this far.
All the chiropractors whom I know will have no trouble in complying with their new responsibilities under the Bill, and, once passed, chiropractic skills will be recognised as an acceptable form of alternative medicine which will be available to many more patients if they are referred by their GPs. Horses also benefit from chiropractic skills. Presumably horses must be referred by their veterinary surgeons.
2.30 p.m.
Lord Colwyn: My Lords, once again I too am delighted to be able to make a contribution to the process which will establish statutory registration for chiropractors. I say "once again" as I have supported the case for the statutory regulation of osteopaths and chiropractors on several occasions since taking my place in your Lordships' House in the mid-1960s. I must congratulate the noble Lord, Lord Walton, on the way in which he introduced the Bill and say how much I admire the way in which he has taken up the cause for the chiropractors in the same way as he did for the osteopaths. His explanation was clear, erudite and concise and left little extra to be said.
As joint president of the all-party parliamentary group for alternative and complementary medicine, I wish to associate myself with the remarks of the noble Lord, Lord Ennals, and the noble Earl, Lord Baldwin. This Bill has all-party support and I am glad to hear that
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much of the work has been covered with the osteopaths and that there are very few differences between that Act and the Bill before us today.
I know that my noble friend Lady Hooper is sorry not to be here—she has a previous appointment. She would join me in saying how much I regret that my friend Lord Ferrier did not live long enough to be able to take part in our debate today. He was a tireless supporter of chiropractic. He regularly initiated debates and asked Questions to successive Ministers in successive governments about the availability of chiropractic and its integration into the NHS. The Library has kindly supplied me with copies of two debates which he initiated; one in May 1976 and one in November 1979, to which I was privileged to be able to make a contribution. I hope that noble Lords will forgive me if I mention two occasions on which Lord Ferrier debated chiropractic. I know that he would have seen today and the passage of this Bill as a culmination of his great support of the profession.
In May 1976 Lord Ferrier asked Her Majesty's Government whether they would be prepared to contemplate any amendment to the Professions Supplementary to Medicine Act 1960 to encourage osteopaths and chiropractors to qualify for registration. The noble Lord, Lord Wells-Pestell, replied on behalf of the Government. He stated:
"There is nothing to prevent any group from beginning themselves the process of self-regulation; indeed, this is commonly the way in which professions set about establishing themselves".—[Official Report, 12/5/76; col. 1038.]
He went on to say that the Government had approached the Medical Research Council with a view to having some planned research done and they expected much more research to take place on the matter.
In 1979 Lord Ferrier asked what plans the Government had to integrate chiropractic into the NHS. This time the noble Lord, Lord Wells-Pestell, was in opposition and was much more supportive. He quoted figures from the Cochrane Report which had been set up by the noble Lord, Lord Owen, who was Minister of Health in 1976. He urged the Government to implement the recommendations of the Cochrane Committee and stressed the importance of setting up without delay trials by the three non-medical organisations—the osteopaths, the chiropractors and the acupuncturists—with the co-operation of the General Medical Council.
In winding up the debate, my noble friend Lord Cullen of Ashbourne, stated:
"I am aware … that chiropractors have sought to secure state registration as members of a profession supplementary to medicine under the provisions of the Professions Supplementary to Medicine Act 1960. I am equally aware that, when the Council for Professions Supplementary to Medicine rejected their application, it declined, and could not be compelled by the Privy Council, to give its reasons for doing so, and that chiropractors and the Chiropractic Advancement Association are aggrieved. However, I believe that, if the chiropractors sought by their application to achieve a longer-term acceptance by the medical profession of what they have to offer and their own ultimate integration into the National Health Service, then their action in making the application was correct. My right honourable friend the Minister of Health has already commended to them that they should seriously consider making a further application".— [Official Report, 21/11/79; col. 270.]
That was 15 years ago.

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Several speakers suggested that moves to statutory regulation should be set up without delay and the Minister was very supportive. I suppose that 15 years in government timing is without delay. We have the osteopaths on the statute book and this Bill is for the chiropractors. I look forward to similar moves with regard to acupuncturists, homeopaths and herbalists in the near future.
In 1979 back pain cost Britain 18 million lost working days; £900 million in lost production; and £90 million in social security payments. Today, 310,000 working days per day are lost at a cost of £3 billion. I believe that the noble Lord, Lord Ennals, may have given the figure as £3 million but it is in fact £3 billion. Statutory recognition of osteopaths and chiropractors must go some way towards dealing with that problem.
It is a pleasure to see another complementary therapy about to achieve statutory recognition. Noble Lords must appreciate how much pleasure it gives those of us who have long supported natural medicine to see the way in which orthodox medicine is finally recognising and realising the potential of many of the complemen-tary therapies. I wish the Bill a speedy passage through this House.
2.36 p.m.
Baroness Robson of Kiddington: My Lords, I join other noble Lords in thanking the noble Lord, Lord Walton of Detchant, for introducing the Bill and for explaining so clearly its aims and purposes. The make-up of the council, the rules of registration and the educational requirements are all in line with the Act governing the profession of osteopathy. I welcome also the amendments which have been made to the Osteopaths Act in the present Bill.
I hope that the House will forgive me if I refer to a profession which the noble Lord, Lord Ennals, mentioned; namely, that of chartered physiotherapists in this country. I must declare an interest because I am president of the Chartered Society of Physiotherapy.
That is one of the largest professions complementary to medicine. There are 25,500 chartered physiotherap-ists in Britain compared with what I am told is something like 700 chiropractors. Some 5,000 chartered physiotherapists are in private practice mainly dealing with bad backs, necks and other skeletal problems. While the NHS and independent hospitals insist that all physiotherapists employed by them are state registered —that is, properly qualified—there are no regulations governing the private practice of physiotherapists in this country. Anyone can call himself a physiotherapist and practise privately. There are probably over 1,000 such people who have either no qualification at all or who have been on a variety of short, unrecognised courses.
That situation does not apply to chiropractic or osteopathy because there is no evidence of any unqualified people according to David Lidington. They do not have that problem. The Chartered Society of Physiotherapy merely asks for the same protection for the patients of physiotherapists —and there are many times more people at risk—as exists in relation to osteopaths and chiropractors.
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Chartered physiotherapists in private practice and those who are unregistered treat a wide range of conditions, including spinal and joint problems, shoulder and back pain and use a range of techniques including manipulation. It is obviously right that all professions complementary to medicine should be properly registered to protect the public and to guarantee that practitioners receive adequate training, both if they wish to work in the NHS or in private practice. I hope that the Minister will take that problem on board.
2.40 p.m.
Lord Rea: My Lords, I am sure that the whole House —though I am afraid that much of it is not present today as it is the last day of term—and, even more so, the whole profession of chiropractors and their patients will be grateful to the noble Lord, Lord Walton, for the time that he has put in as regards the preparation of the Bill and its predecessor the Osteopaths Bill. I am sure that all of us are grateful to him for the very clear way that he presented the Bill. As other speakers have said, we are especially grateful to him for his presence here today because of the serious illness of his wife. I join other noble Lords in sending out strong messages of support to the noble Lord and to Lady Walton, together with hopes for the continued improvement which I am pleased to hear is occurring.
As a general practitioner with more than a third of a century's experience, I welcome on board any body of men and women who can help to calm the rough sea of symptoms which sometimes seem overwhelming to those of us who are on the beach facing the breakers of complaints coming at us from patients. There is no doubt that GPs and the National Health Service as a whole cannot, and probably never will, be able to relieve everyone's pain. That is partly because we do not have enough time with our patients, but also because we do not have the training—or sometimes the patience—to cope with many of the chronic symptoms, especially back pain, which patients continue to present even when serious or life-threatening disease has been excluded or treated.
Chiropractors are one of several bodies of practitioners of alternative—or, like other speakers, I prefer the term "complementary"—medicine who have disciplines and skills which can tackle some of those intractable problems which doctors seem unable to cope with, where often bodily symptoms and psychological stress merge and are difficult to separate. I am strongly of the opinion that depression and anxiety underlie and exacerbate much chronic physical pain. But many people do not wish to go down the psychotherapeutic road and strongly deny that there is anything wrong with their mental or emotional balance. I have to say here that perhaps many people protest too much, for which of us is not vulnerable at some level? However that may be, attention to physical symptoms is often of enormous help. If the practitioner has a healing disposition, the whole person is helped while the bodily pain is being attended to.
There is no doubt that many people have been greatly helped by chiropractors. The Medical Research Council trial which was mentioned by at least three noble Lords

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demonstrates that fact. I have no doubt that similar studies could—and should—be mounted by the other strands of complementary medicine. Like the osteo-paths, chiropractors have got their house in order and have shown that they can conform to the quite exacting (but I think necessary) framework for registration and regulation which this Bill constitutes.
As well as the osteopaths, the psychotherapists and the psychoanalysts are also going down similar roads, so that there is now an increasing group of professions allied and complementary to medicine to which patients and their doctors can safely turn. I very much back the plea made by the noble Baroness, Lady Robson, for physiotherapists. I believe that that also applies to a number of other professions allied to medicine.
My only quibble with the Bill is that chiropractors have been allowed to get away with their misuse of the customary way that Greek is incorporated into the English language. Perhaps that is because chiropractic originated across the Atlantic in the United States. I am not a general practor, nor do I undertake general practic. Why can we not have chiropractitioners who undertake chiropractice?
The noble Earl, Lord Baldwin, said that he did not wish to see chiropractors behaving as watered down doctors, as they sometimes do in the United States. That is partly because in the United States there is not a good system of primary health care and the chiropractors have taken over that role. Is the word chiropractor not perhaps derived from doctor? Perhaps there is something in that because in the United States chiropractors sometimes take on a rather wider role than we would like to see them take on here.
Leaving that aside, we on these Benches are basically very happy with the Bill and wish chiropractors in this country well. Like the noble Lord, Lord Colwyn, I hope that further similar Bills will come before Parliament to allow statutory self-regulation for the other main branches of complementary medicine when they are ready. The Osteopaths Bill and this Bill should stimulate that process.
2.45 p.m.
The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, perhaps I may begin by adding my congratula-tions to those which have already been expressed to the noble Lord, Lord Walton, on bringing this Bill before your Lordships' House. I am sure the noble Lord will play a fundamental role in the success of this Bill as he did for its forerunner, now the Osteopaths Act. He has been an outstanding member of both the working parties set up by the King's Fund to examine chiropractic and osteopathy. In addition I am aware, as many of your Lordships will be, that he has been an unfailing source of support and advice for both professions as they have moved towards their goal. The Government fully support this Bill and hope that it will speedily take its place alongside the Osteopaths Act on the statute book. As the noble Lord, Lord Ennals, said, this is indeed a
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happy day. I share his aspiration that other professions should grow in stature and retain the confidence of the public.
Chiropractors have a very important role to play in helping people to remain mobile and free from discomfort and pain. However, I could not help but smile the other day when I saw a newspaper report on the Second Reading debate in the other place headlined:
"Welcome for Bill on Care of Feet".
There are issues of semantics here but I shall not go into the same detail as the noble Lord, Lord Rea, did.
The noble Lord, Lord Walton, has already described in detail what the Bill would entail. He has also been careful to outline a description of chiropractic as a therapy. As the noble Lord, Lord Ennals, said, chiropractic is probably the second most widely used complementary therapy. When we are fit and well and free from pain we rarely stop to ask ourselves how or why that is, but an increasing number of people owe their continued good health to the skilled intervention of a chiropractor. It never fails to astonish me how many people, including some of your Lordships, have benefited from treatment by a chiropractor. My sympathy lies with my noble friend Lord Harmsworth and the noble Earl, Lord Kintore, whose experience brought into sharp and painful focus the need for promoting and regulating chiropractic.
I recently heard of two cases of members of Her Majesty's Armed Forces who are responding well to courses of chiropractic treatment. These servicemen are not people who spend all day lifting heavy objects. One is a naval helicopter pilot and the other an RAF electronics flight engineer. Both have cost the country millions of pounds to train, and yet both face the possibility of being discharged because of a bad back, exacerbated by the need to sit for hours in their aircraft. After chiropractic treatment one has already returned to full duties and, although it is still too early to be absolutely sure, there is every indication that the other will soon join him back at work. I am sure that your Lordships will know of other examples where chiropractic treatment has made a crucial difference to the quality of people's lives.
The noble Lord, Lord Ennals, raised the issue of the increasing incidence of back pain and asked whether we knew the reason. It is a difficult question since the increasing levels of disability due to back pain are the result of a complex mixture of physical, psychological and social factors. The problem has been recognised by the Clinical Standards Advisory Group, which is a statutory multi-professional group set up by the Chief Medical Officer and Chief Nursing Officer. A report from that group is currently being considered by the Secretary of State, so perhaps we shall be able to enlighten the noble Lord in due course.
As the noble Lord, Lord Walton, has said, medical opinion has undergone something of a sea-change in recent years. This has been strongly influenced by the growing experience which many doctors have of patients being successfully treated by chiropractors. Perhaps more importantly, there is now sound scientific evidence of the effectiveness of chiropractic. The most significant example is contained in the 1990 report of

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the Medical Research Council's trial. This compared the recovery from low back pain using chiropractic techniques with traditional hospital outpatient treat-ment. The report concluded that for those with low back pain chiropractic "almost certainly" conferred worth-while, long-term benefit, especially for those experiencing chronic or severe pain.
The report also stated that consideration should be given to introducing chiropractic into NHS practice. Last year the National Association of Health Authorities and Trusts published its report Complementary Therapies in the NHS. This showed that the NHS is prepared to purchase more complementary therapies. It also made the point that health authorities would welcome continuing thorough review of therapies in order to be able to assess their effectiveness. The Clinical Standards Advisory Group has recently submitted a report on the management of back pain to the Secretary of State. It is likely that this will also add weight to the argument that manipulation by appropriately trained therapists or practitioners should be more widely available on the NHS.
My noble friend Lord Clanwilliam described himself as a promoter of alternative medicine—and I would add, an energetic and doughty promoter. He expressed his pleasure in the widening use of alternative therapies in the NHS. We share his views. The NHS reforms have enabled health authorities and GPs to purchase a wider range of alternative and complementary medicine, including chiropractic. For example, GP fund-holders, with their new freedoms are employing complementary practitioners on a sessional basis. As the noble Lord, Lord Rea, said, alternative therapists are extremely valuable as part of the primary healthcare team. We endorse that. Hospital and community based provision depends on the professional clinical judgment of clinicians and on decisions taken locally by district health authorities on how best to meet the health needs of their population.
My noble friend Lord Harmsworth asked how we could further encourage the greater use of chiropractors in the NHS. But that is likely to depend largely on those doctors who already make use of them persuading more of their colleagues of their effectiveness. However, we expect that by establishing statutory schemes, the development of closer links between chiropractors and the medical profession will be established and encouraged.
The Bill is not designed to affect the provision of chiropractic services in the NHS. What it will do is to provide a system which enables the General Chiropractic Council to regulate, promote and develop the profession. The general council will act as the standard bearer, with the responsibility for raising standards, leading the profession and improving the quality of service offered to patients.
The coming years will be a time of great change for chiropractors. The system of voluntary registration, which has in one case existed since 1925, will be overtaken by statutory regulation backed by provisions to ensure that only those practitioners registered with
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the general council are entitled to call themselves chiropractors. The four associations will transfer most, if not all, of their duties to the new council.
It would be understandable if some people in the profession, perhaps those about to embark on their career or even students still in training, were to feel uncertain about the future. There is no attempt in this Bill to be prescriptive, nor to dictate to chiropractors how professional issues should be handled. That will be the responsibility of the general council, at least half of whom will be practising chiropractors elected by the profession.
The noble Earl, Lord Baldwin—whose chairmanship of the all-party group, I have to say, is masterly and much valued by myself—and the noble Lord, Lord Ennals, suggested that the Bill should be a government Bill. We gave this matter careful consideration. However, we believe that the route of Private Members' legislation is the correct one as it frees Parliament from traditional party influences, allowing it to make up its own mind on this important issue on the merits of the case.
The noble Earl and the noble Baroness, Lady Robson, asked about other therapists who seek to close their title. Other therapy professions which seek statutory regulation are advised to follow the same route as both the chiropractors and the osteopaths, but first they must reach a consensus within the profession, agree on the need for common standards of education, training and professional conduct and seek the support of the medical profession. Then, if the way seems clear, they need to test the will of Parliament through a Private Member's Bill.
I am grateful to my noble friend Lord Colwyn for putting the Bill in its historic context. I am conscious that I am a johnny-come-lately to your Lordships' House, but like my noble friend I wish to pay tribute to all those who have broken the ground and worked so hard over the past 15 years to achieve the Second Reading of the Bill. We hope to see in enacted.
In conclusion, however quickly the profession has moved in recent years, chiropractic as a therapy is not new. It has been in existence for almost a hundred years. In fact, the profession worldwide plans to celebrate its centenary next year. What better reward could British chiropractors have than the achievement of statutory self-regulation through this Bill? I commend it: to your Lordships' House.
2.56 p.m.
Lord Walton of Detchant: My Lords, I am deeply grateful to the noble Earl, Lord Clanwilliam, and others for their kind personal message to my wife. Over the past two weeks she has been desperately ill but has received the most skilled, dedicated care in the John Radcliffe Hospital in Oxford and I am glad to say that she is now well on the road to recovery. Thank you for your kind words.
I also thank all noble Lords who have spoken in the debate for the support which they have given to the Bill. Like the Osteopaths Bill, which is now an Act, this Bill is in a sense another historic step on the road towards the

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formal recognition by Parliament of complementary medicine and its role in assisting the improvement of human health.
Like the noble Lord,Lord Ennals, I wish to pay a special tribute not only to other members of the King's Fund working party but also to David Lidington for the way in which he steered the Bill so effectively through another place. To the noble Earl, Lord Baldwin, I say that the purpose of the Bill is to regulate the entire profession of chiropractic, with every intention to preserve the interests of those who are educated in the three schools of chiropractic in the United Kingdom. That is, not just the Bournemouth school but the other two to which he referred. I believe that the standards they provide will be protected by the Bill.
Of course, every doctor is delighted to receive comments from grateful patients. I am sure that the speeches made by the noble Lord, Lord Harmsworth and the noble Earl, Lord Kintore, will have left chiropractors who may have listened to or read the debate feeling a sense of gratitude to them both for their kind comments. The sea change which has taken place in the attitude of the medical profession to which many noble Lords have referred resulted not long ago in a member of my family being referred by an excellent GP to a chiropractor. I am glad to say that there was effective treatment of low back pain. In that regard, it was fascinating to hear the historical background narrated so clearly by the noble Lord, Lord Colwyn, of which I was not previously fully aware.
I entirely share the views of the noble Baroness, Lady Robson and the noble Lord, Lord Ennals, about the outstanding contributions made physiotherapists in this country. In the National Health Service, their activities are regulated by the Professions Supplementary to Medicine Act 1960, but the point which the noble Baroness made that many now practise outside the NHS should, I am sure, be noted. Those involved may well wish to move along a similar road towards professional self-regulation.
I am very grateful to the noble Lord, Lord Rea, for his support as a general practitioner and for his lesson in etymology. A rose by any other name would smell as sweet, but the terms "chiropractic" and "chiropractor" are hallowed in usage. They are like the word "doctor", meaning a doctor of medicine, not of philosophy or literature, which is also hallowed by usage. I believe that the Bill properly hallows that group of traditional terms.
I am particularly grateful to the noble Baroness the Minister for the outstanding support that she has given, and for the way in which she has made it clear that the Government support this Bill. I wish to say in passing how much I appreciate the very great help that members of her department have given in providing very detailed notes relating to the content of the Bill and its purpose. I trust that she will pass on to them my sincere thanks and, I am sure, the thanks of all those who are involved.
It only remains to me to say that I trust that your Lordships' House will give this Bill a fair wind and that we may see its progress, unamended, through this House so that very soon it will be, like the Osteopaths Act, on the statute book. That is something which I
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know the chiropractic profession and the medical profession, and indeed the caring professions in general, will welcome. In the meantime I ask, having been privileged to present this Bill for its Second Reading in this House, that the House should give it a Second Reading.
On Question, Bill read a second time, and committed to a Committee of the Whole House.

Breast Cancer
3 p.m.
Lord Ironside Lord Ironside rose to ask Her Majesty's Government in what ways they expect to improve diagnosis and surgical treatment of breast cancer and to avoid hazardous radiotherapy treatment of this condition.
The noble Lord said: My Lords, I am very glad to have this opportunity of drawing parliamentary attention to a subject which is causing widespread public concern—concern which has been building up for six months or more now. It has caught the attention of the press, television and radio from different angles, all of which I believe have been fairly and accurately represented, without their dramatically overstepping the mark.
If there was a moment that triggered off this issue, I think it was the public meeting that was held by RAGE (Radiotherapy Action Group Exposure) at the London School of Economics on 4th September 1993. The meeting was brought about by the enraged feelings of thousands of women who suddenly discovered for the first time that their brachial plexus injuries—that is to say, the injuries to the network of nerves, blood vessels and lymph glands in the upper arm and front of the shoulder around the collar bone —such as unremitting and irreversible pain and arm paralysis—were a direct result of the radiotherapy treatment that had been prescribed as a precautionary measure following breast cancer surgery. Yet they had been told that the treatment would involve no greater side-effects than temporary nausea and discomfort.
I follow the good example of my noble friend Lady Cumberlege and draw on the dictionary for the definition of "side-effect". It refers to: "an unwanted but subsidiary effect". I believe the House will agree with me that paralysis and unremitting pain go far beyond the phraseology of "side-effect", about which we so often hear from practitioners, often as a euphemism for something worse, to sooth the patient. One can understand why the members of RAGE are, to put it bluntly, so enraged by being misled.
There are some 1,029 members of RAGE in England who are the known victims of radiotherapy treatment and countless unknown others who are either too afraid or too embarrassed to come forward, or have never thought of doing so, and there are those from Scotland who have contacted RAGE numbering some hundreds —I believe probably over 400. I shall say more about that later. But those who are still alive are probably alive in spite of the treatment.
Noble Lords will wonder why I raise this Question. I have been closely involved with the issues as my wife is president of RAGE, and I declare an interest— particularly as compensation is on the RAGE agenda —to seek amends for the very large number of innocent victims of horrific injuries. The question of compensa-tion arises as so very few of them—in fact, those whose incomes are low enough to qualify for legal aid—can afford to take legal action. This is an aspect of the issue which RAGE wants the Government to consider. I am very grateful to those noble Lords who are taking part in this debate and for their willingness to address many of the implications of my Question: for example, consequential injuries such as fibrosis, heart damage, brittle bones, lymphoedema (that is the swelling of the arm) and even amputation.
I would like to say how grateful I am to my noble friend on the Front Bench, as the Minister with responsibility for breast cancer matters, for the serious attention that she has given to this issue and for holding a meeting with RAGE, as well as for arranging subsequent discussions for RAGE and others to examine with the Chief Medical Officer the way forward. I assure her that she has the full co-operation of RAGE, which has the basic information of when and where its members were treated, in the absence of central government records being available. That has been done without divulging names.
While victims are afraid of being critical in front of those from whom they still have to seek treatment, they are prepared to confide in RAGE in the knowledge that their collective voice will be heard. What has come to light is horrific. Thousands of women have had their lives shattered, not by cancer but by radiotherapy treatment, about which they had absolutely no warning —they had no warning at all of the serious consequences—after having it prescribed as a precau-tionary measure or a mopping up process, as in my wife's case. She has given me permission to tell the House that two years later, when her injuries became apparent, she was informed, too late, that for administrative reasons, to increase patient through-put, treatment had been given not in doses every day but every other two and three days in alternate weeks for six weeks. That meant higher doses for each fraction and the nerves cannot take that kind of bombardment— which was known from many professional papers at the time. Dreadful complications have thus occurred, after being totally misled about the consequences and having put trust in the practitioner.
However, that is not, as noble Lords might expect, a part of history. The frightening thing is that injuries are still occurring at radiotherapy treatment centres. My wife had textbook screening, early detection and expert private surgery. But all for what? To be crippled for life by RT treatment designed to put a lethal finishing touch to the surgeon's knife, as a precaution.
The pattern of treatment in the UK varies from centre to centre and different regimes are operated according to guidelines—we are told, very strict guidelines. I shall corne back to that point later. RAGE has supplied a list of 525 members showing the incidence of brachialplexus injury at radiotherapy treatment centres with dates
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going back some years. Of the 53 centres in the United Kingdom, there were 12 with 10 or more injury cases, five with 20 or more cases and one with 59 cases. The remainder had fewer than 10 and many much fewer. If an all-embracing analysis of complete data was earned out, and not just those data from the RAGE membership, the likelihood is that the same injury pattern would manifest itself.
The question that has to be asked, therefore, is why that disproportionate effect apparently exists in the United Kingdom and why the radiotherapy treatment is apparently such a lottery. Incidentally, much the same thing is said about breast cancer surgery. My noble friend on the Front Bench has said that it is important to investigate now, even though the data are not complete —and I agree with her—to find out what has happened, where it happened and why it happened; and to prevent it happening again.
I can assure my noble friend that I am closely involved in following this matter through, at her suggestion, with those professionals most involved, so that, as agreed with the Chief Medical Officer, an audit can openly take place. It is not a matter that can be brushed under the carpet.
I return to the question of guidelines. As I said, we have been told by Ministers that the National Health Service operates strict guidelines on RT treatment. But that does not go far enough. These days we hear a lot about guidelines and that magic word sounds good. But guidelines do not necessarily ensure that things go the right way. Quality assurance to a national standard is needed in radiotherapy treatment, as guidelines are not compulsory and can be interpreted in different ways by different people. In fact, I would say that there is a crying need for quality assurance in RT treatment. I am glad to see that the Expert Advisory Group on Cancer in my noble friend's department has made that recommendation in the consultative framework docu-ment which has just been published. I congratulate her on the publication, which goes to the heart of the matter, and which I hope will now put everything right.
Reading the detailed working party report on quality assurance in radiotherapy, which draws on the practices at the Bristol oncology unit and the Manchester Christie Hospital, I am glad to see that quality assurance in radiotherapy is to be looked at on a national basis in line with the British National Standard BS 5750. Like the MOT test certificate for vehicles, approval to the standard will have to be renewed at regular intervals. It is suggested that that should be every six months. If that is to be the plan, then firms making the assessment must, if the certificate is to be worth anything in the eyes of patients, be accredited by the DTI as having the expertise needed to make the assessment in this radiotherapy field. On the other hand, there may be arrangements for that to be done in-house by the Department of Health as the Ministry of Defence used to do some years ago, though it is now put out to contract. However, I note in the quality assurance manual—I do not know its status but it is a fairly detailed document and I do not know whether it is temporarily in force or what—under paragraph 3.10 on page 8 it says:

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"Formal certification of a system against BS 5750 will require regular external audit by an assessment body whose accreditation covers radiotherapy organisations. At present (April 1994) no such body has such experience and auditing can only be offered by companies specialising in professional organisations".
One can see from that that a lot of work needs to be done to find firms capable of making assessments.
I will go on to say that screening, diagnosis, surgery and all therapeutic treatments need to be thoroughly integrated so that the habit of passing the parcel—or in this case passing the patient—from one doctor to another can be regulated. The habit of passing the parcel in medicine in any case calls out for quality assurance to a national standard. I recall, after my recent Question to the House in relation to quality assurance in radiotherapy, that I was approached by the British Medical Association. I was asked what my worries were. I said that I was expressing public concern over the need for QA to BS 5750. The BMA said, "What is BS 5750?" I hope it now knows. If it does not, it should read the report and manual on QA in radiotherapy.
Finally, we must not forget that there is a Scottish element to be reckoned with. If breast cancer is a UK issue, then I am concerned that the pace and direction of efforts in Scotland—and Northern Ireland for that matter—may conflict with that in England and Wales. I hope that my noble friend can ensure that there will not be a North-South divide between the Expert Advisory Group on Cancer and the Scottish Cancer Consultative and Advisory Committee. Perhaps I begin to detect a hint of Scottish cancer being present and a different problem. I hope not.
There is grave public concern about all aspects of breast cancer and there are now references almost daily in the papers or on television about it. I hope my noble friend can give specific assurances that she intends to resolve the issue related to the injuries in radiotherapy treatment and get results. I am well aware that clinical opinion is always regarded as paramount and every patient is different. But so is every doctor. To my mind, and I hope to the Government's mind also, that justifies the necessity for practice to be tempered with quality assurance. There may be resistance to quality assurance in professional medical circles. But the MoD, as a customer, calls for it and other public sector bodies, as customers, are also calling for it. I hope that every woman will call for it before she goes into a radiotherapy treatment centre as it must help towards providing the right solution and reducing the risk factor to where it should be; ideally zero.
3.15 p.m.
Lord Molloy: My Lords, I am sure that the whole House and the many medical organisations in our country will be most grateful to the noble Lord, Lord Ironside, not only for introducing the debate, but also for the manner in which he did so, covering almost every aspect. I made a little study myself and I have been reading the endeavours of probably the biggest organisation in Europe, the trade union UNISON. It did a thorough search on this matter. When I was listening to the noble Lord I thought I was hearing the words of
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UNISON all over again. The union, in conjunction with other organisations, conducted a thorough examination of the situation.
For example, in this morning's Nursing Times, one of the major articles is, "Cancer: a special case". It goes on to cover not only the points made by the noble Lord but many others as well. If I can say so, speaking parenthetically, they have full confidence in the Minister here today to take part in future discussions as she has done in the past. The endeavours of the Minister therefore should also be placed on record.
One of the points that seems to be disturbing people is the fact that many district hospitals are substandard and do not seem to know a great deal about all the treatments required for anyone suffering from this appalling disease, breast cancer. Another aspect is that consultants see too few cases to be able to specialise later on in trying to find a rapid cure for the disease. Proposals to reorganise put forward by the advisory group chaired by Sir Kenneth Caiman are urging the department to iron out the inequalities of care around the country. The group is of the opinion that there is a strong case for an independent inquiry into the use of radiotherapy. Other medical organisations join the advisory group in that plea.
Any possibility of breast cancer should mean prompt referral to a specialist team of a surgeon oncologist and a radiotherapist with access to specialist breast care nurses. That is sometimes not happening, probably because people just do not know what to do. GPs should be informed exactly what they have to recommend. That is another vital aspect that we would like the department to look at.
Breast cancer kills 300 women a week. I did not believe the figures and so I made certain. I was shattered when I was given detailed information about what it means not only to die from breast cancer but to suffer in the period when you are dying from breast cancer. No civilised nation would allow this to go on. Unfortunately, my country has one of the world's worst death rates. The disease affects one woman in 12 and therefore there is a special need to have screening immediately there is any danger of cancer.
There is an urgent need to train specialist doctors, specialist surgeons and specialist nurses but that is not enough without distinct and specialised research from which the specialist doctors, surgeons and nurses can learn. A massive endeavour is required to prevent or cure this disease, with more research required either ultimately to cure or to prevent in the early stages women suffering from breast cancer.
Breast cancer is most evil and frightful. When the children of a mother with breast cancer discover that she has that disease, the entire home is affected. That is how serious I believe the subject to be and we must take cognisance of it. I believe that in our country we have the ability and resources to provide more cancer specialists, doctors and nurses. I hope that the noble Baroness will look into this plea, which comes from many distinguished breast cancer specialists as well as from the organisations with which they work. They feel that there should now be a special national conference involving specialist breast cancer doctors, surgeons and

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—very important—specialist breast cancer treatment nurses. There should even be specialist hospitals to control and ultimately defeat this terror.
There is an urgent need for more specialist nurses for the operation, not only at the time when it is carried out, but also to return home with the patient to help out. That is a vital aspect of the work. There are not enough specialist cancer nurses. Let us hope that something can be done. I am sure that the noble Baroness has read the reaction of RAGE (Radio Action Group Exposure), which make some very valid and telling points. They are experts in what is required and what needs to be done.
In conclusion, our National Health Ministers have the desire and the ability to tackle this problem. I am convinced that our Ministers in this House and in another place, when they come to grapple with the problem, will make a massive contribution which will be looked on as something wonderful by all families where a mother or a relative has breast cancer. Therefore, I believe that the Ministers concerned with our National Health Service deserve the full support of us all to bring about many of the improvements which the noble Lord, Lord Ironside, has called for and the few suggestions which I have submitted in his support. Thank you.
3.23 p.m.
The Countess of Mar: My Lords, the noble Lord, Lord Ironside, has tabled this Question at a particularly appropriate time for me, and I am very grateful to him for asking it. Three-and-a-half years' ago my closest friend found a lump in her left breast. Very soon after her discovery she had a mastectomy and was given a single dose of radiotherapy as a precautionary measure which lasted 11 minutes. She was also given tamoxifen. She subsequently, at different times, developed secondary tumours in her skull, ribs and liver. On each occasion she was subjected to a single dose of radiotherapy for several minutes.
Towards the end of last year she began to feel sensations of pain and numbness in the first two fingers of her left hand. This was reported to her consultant who offered no explanation, advice or prognosis. Since then I have watched the muscles melt from her arm. I have seen her in excruciating pain as her digits turn into the palm of her hand in spasm, and, worst of all, I have seen her distress at the lack of an explanation for her suffering. It was not until this Monday, when I read the article by Lady Ironside entitled "The Safeguard Killing Patients" in a parliamentary brief of October 1993, that all the pieces of the jigsaw fell into place. I am profoundly disturbed that in 1994 a consultant radiologist should fail to fully inform his patient of the hazards, known for 30 years, of the treatment he is going to give her and that he should fail to give her an explanation when a known side effect manifests itself. It may be that the consultant, knowing that she was a nursing sister, believed that she would know the possibilities, but surely it was incumbent upon him to make sure.
My friend's case almost parallels that of Lady Ironside. She was today to ask her consultant about the possibility of having a sympathectomy or a nerve block
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to eliminate the pain in her arm. Armed with a copy of Lady Ironside's article, she will now be able to approach the subject with more understanding and without the unquestioning acceptance of the consultant's opinion so ingrained in her by her training.
It is too late for my friend. It is not too late for other women who may discover that they have breast cancer in the future. It is shock enough for a woman to learn that she may have to lose a breast. At least her public image can be retained if she is properly counselled and has a good prosthesis. The loss of the use of an arm, or even the arm itself, is even more distressing as she loses with it a great deal of independence. To discover that she is not a unique case may be a small consolation, but what a poor reflection it is upon members of the medical profession who are responsible for the treatment of women with breast cancer.
I have read with great interest the consultative document, A Policy Framework for Commissioning Cancer Services, prepared by the Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales. I have also read about the Scottish Cancer Therapy Network. I am delighted to see. that the Scots have taken the initiative. Since the 1992 policy statement Scotland's Health, a network has been established and preliminary action on six out of eight site-specific cancers has been taken, with cancer of the breast and colon being given priority.
May I ask the Minister why it has taken the English and Welsh Chief Medical Officers so long to get around to solving the problem of the inconsistency of treatment and outcome for cancer patients when it has been known for many years that the prognosis has differed according to the treatment centre? It would appear from the consultative document that the advisory group does not expect quick results. I urge the Minister to use her influence to impress upon all those responsible for both primary and secondary care of women with breast cancer to note particularly paragraph 3.6 of the consultative document, entitled "The Relationship of Cancer Services with a Primary Health Care Team"—I am tempted to add, "and with the patient".
I am aware that there are some excellent cancer centres where the patient is totally involved and fully informed at every stage of her treatment, with information provided according to the patient's level of comprehension. I know a number of cancer patients and their relatives who have received a tremendous amount of support from Cancer Relief Macmillan Nurses and I cannot sing those nurses' praises too highly. They have among their assets that very important ingredient: time for their patients. If each woman who has had breast cancer diagnosed was allocated a specialist nurse who could explain procedures to her and provide support for as long as she needs it, many of the psychological effects of the disease would be ameliorated.
Diagnosis of breast cancer is no longer the death knell it once was. Many women survive to live long and fruitful lives. I can see no logical reason why the lessons learned about the survivors should not have been accepted by those consultants, whether they be surgeons, physicians or radiologists, who have proved to be less successful in their management of the disease.

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The incidence of breast cancer is known to be increasing and, until the cause or causes can be pinpointed and preventive measures taken, there is a need to ensure that all women receive the treatment which is currently known to have not only the highest success rate, but subsequently lead to the best quality of life. It is simply not good enough for a women who is left with a useless, painful limb, fragile bones and the fear of other unknown side-effects of radiology to be told, "You are lucky to be alive. What more do you expect?"
3.28 p.m.
Baroness Gardner of Parkes: My Lords, this is a most interesting Unstarred Question and I am grateful to the noble Lord, Lord Ironside, for tabling it. Over half a million women worldwide develop breast cancer every year, but the distribution is not spread evenly throughout the world. Over half of the cases occur in North America and Europe, although those countries contain less than one-fifth of the female population of the world.
Japanese women in Japan have low breast cancer rates, but second and subsequent generations of those who migrate to the US have the same rates as their host population. That would seem to indicate that social and environmental factors, not just genetic factors, are significant. Breast cancer is a disease which occurs mainly in Western developed countries.
As we all know, a woman's chance of survival is increased greatly by early detection. The increase in mortality rates reveals that those in the older age group are helped even more than those in the younger age group by early detection and screening. Some years ago the Forrest Report recommended the introduction of a general screening programme for all 50 to 64 year-olds. At the time I represented the women of the UK on the UN Status of Women Committee. We were concerned that the recommendations of the Forrest Committee might not bé implemented. Women throughout the country wrote to the Prime Minister who then implemented the programme. Screening of women in that age group produces 10 per cent. of women with the disease.
I am privileged to be the new chairman of the Royal Free Hampstead NHS Trust. I should like to share with Members of your Lordships' House some of the latest and best procedures which we are using for all our patients. Before I do that I should like to comment briefly on a point made by the noble Lord, Lord Ironside. Radiotherapy treatment has improved greatly in many hospitals as a result of the use of conformational radiotherapy. The patient is put on a simulator which assesses in a three-dimensional way the exact size, location and density of the lesion. Instead of radiotherapy which is a wide scatter system affecting other tissues, the treatment can be much more localised, and that is a great improvement.
Chemotherapy is often given in pre-operative treatment to reduce the size of tumours before surgery. That is proving to be successful. Different drugs are used according to the age of the patient. Tamoxifen is
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the common drug for the post-menopausal patient. There are many different varieties of cancer. One of our experts estimates that there is something like 100 different varieties of breast cancer. Under the old system a patient had a mammogram. It was then decided whether something required investigation. The patient was given a general anaesthetic and while under the anaesthetic a biopsy was done to see whether the lesion was malignant. Now a different technique is used. It is fine-needle cytology. Through that, the type of lesion and the type of treatment required can be determined. That is a big advance and saves many women. I have a friend who went through the terrible experience of having an anaesthetic. She was told that the tumour would be benign. The doctors did not obtain her consent to further surgery, and then while she was unconscious they discovered that the tumour was malignant. They had to bring her back to consciousness to obtain her consent to further surgery. That is a terrible trauma for anyone to face twice. Under the new system people would not have to do that.
I shall return to some of the work being done by the Royal Free Hospital. I draw my noble friend the Minister's attention to the fact—this is important—that Dr. Parbhoo, who is the director of the Royal Free Breast Cancer Unit, has been conducting some surveys on older patients in the 10 years after the end of the official screening programme. Of 1,000 patients screened in that age group, over 20 per cent. have been found to have breast cancer, although in the younger age group it was only 10 per cent. Those figures do not relate directly one to the other, because many fewer people in the older group are being seen, and those who come in to be checked are those where there is a suspicion that treatment might be required. Nevertheless, 20 per cent. is a significant figure. The other significant figure is that relating to the survival benefit for all breast cancer patients; it is 26 per cent. better than before the screening programme was introduced. Therefore, screening has had a major impact on survival.
The incidence of the disease does not double in old age. The aim is to reduce deaths from breast cancer by 2,000 a year by the year 2,000. Those figures may sound like a neat pattern but it is the medical target. The disease occurs mainly in women but not solely; 1 per cent. of breast cancers occur in men and it is treated in different ways. The diagnosis of breast cancer can be done by mammogrammes and fine needle aspiration and can be shattering, as was said by the noble Countess, Lady Mar. It is not just the fact that one has a terrible disease; there is also the emotional content. Women feel that to lose a breast is to lose some essential part of themselves and their nature. That is an important point and counselling is valuable in helping patients to understand what they face and to reassure them that they will be in good hands and will receive the most caring and best treatment.
At the Royal Free Hospital we have an established charity called Cancerkin. It was established in 1987 by Mrs. Gloria Freilich in conjunction with Dr. Parbhoo, the breast surgeon. The charity has raised more than £1 million through the breast cancer appeal. On 4th July this year, Cancerkin will move to a special purpose-built

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centre within the hospital. It will provide a unique service with one of the only dedicated lymphoedema clinics for breast cancer. It will also have a counselling room and an information and resource centre. Lymphoedema was mentioned by the noble Lord, Lord Ironside. The arm of a patient visiting the centre might be four times the size of a normal arm. I did not know what form of treatment was available but I now understand that it is physiotherapy which encourages the flow of the lymph through the arm and increases the movement. It is reasonably effective and it is encouraging for patients to feel that someone is caring and trying to do something about the condition.
The Cancerkin centre will also provide important data for the Royal Free's research programme into the causes, prevention and manipulation of the risk of breast cancer. Work in molecular biology, genetics and molecular endochrinology requires finance and space. The National Health Service will never have enough money for the amount of research that is still to be done to prevent this spread of disease. The Cancerkin centre is playing an important role in providing additional resources for that purpose.
There is limited time today and this is a vast subject. There are three essential requirements for women. The first is access to diagnoses and treatment. The second is a multi-disciplinary team to provide the necessary treatment. The noble Lord, Lord Molloy, touched upon those points. The third is a surgeon—not just a surgeon but one with a special interest in breast cancer. Women should be able to see a specialist surgeon operating on not less then 50 breast cancers a year. Surgical and non-surgical expertise is necessary.
Dr. Alison Jones is our physician oncologist specialising in breast cases. We are fortunate to have such a medical expert because they are in short supply and one cannot create enough to meet the need overnight. There are only 80 experts with that qualification in the United Kingdom. I ask the Minister to assure us that the Government are aware of the need for a planned increase over the next 10 years.
An important team member is the counsellor—a nurse specialist in breast cancer. The multi-disciplinary approach—surgery, radiotherapy and medical oncology —give any woman with breast cancer the best prognosis. In the recent Caiman Report, the Government have recognised that situation and more specialist centres for cancer treatment will be planned. Women will welcome that.
Meanwhile, I say to those women who have cause for concern: ask about what is available and where; ensure that you are referred to a centre which can provide the care that you really need; it is your life.
3.40 p.m.
Lord Ennals: My Lords, as a patient of the Royal Free Hospital, I am delighted to know now who is my new chairman. I assure her that I shall keep her busy with questions, sometimes complaints and sometimes a need for reassurance. But it is good to know that I know who is the chairman of the trust.
I wish to congratulate the noble Lord, Lord Ironside, on raising this issue. The debate has probably proved to
922
be even more topical than he thought it would be when he tabled the Question. His purpose is to draw attention to the seriousness of the issues that we have been debating. He referred in particular to the injuries caused to a large and identifiable group of victims of radiotherapy who were treated in the UK and who are suffering disastrous consequential effects from avoid-able radiation damage.
The pattern of injury has shown that cases are clustered around some but not others of the 53 treatment centres. Some lessons must be learned from that. There is a crying need to find out what happened, where and why it happened and how to prevent it from happening again. Thus a complete investigation is called for. A demanding search through all the links in the chain is needed; namely, from screening and diagnosis through to surgery, radiotherapy and other therapeutic treatments.
The noble Lord, Lord Ironside, is a formidable champion on behalf of his wife and RAGE. I find it interesting that since there was an exchange in the House on this matter I have received many letters from people who were clearly motivated by RAGE. It has become an extremely effective charity. Through the noble Lord, perhaps I may congratulate his wife on her great courage following her own treatment. I shall not describe her treatment as "disastrous" because we come through disasters, but she has earned the respect of many people in this House.
Many of your Lordships will have seen a leading article in The Times on 15th January of this year. That article dealt with a survey of 417 women who had been diagnosed as suffering from breast cancer which was published in the British Medical Journal only a day before that leader was published. It showed that the guidelines for the treatment of the disease were in many cases not being followed. Since the survey was carried out in 1990, some progress had been made. More than 1 million women were being checked each year under the NHS screening programme which offers women aged 50 to 64 an X-ray check-up every three years. Of course, that is very good. More than 6,500 cancers were detected during 1992. But much more should be done. That is the message which the noble Lord, Lord Ironside, has brought to the debate.
Better diagnostic services are needed for younger women. The law still does too little to help a woman with breast cancer whose condition is misdiagnosed through medical negligence. The main area of concern should be an apparent arbitrariness with regard to much of the treatment following diagnosis. In spite of guidelines published in 1986, the manner in which radiotherapy, chemotherapy and other forms of treatment are used is far too variable and diverse.
The British Medical Journal survey showed alarming disparaties in techniques used to treat women of the same age with cancers of similar severity. For example, four out of 10 premenstrual patients in whom the disease had spread did not receive the recommended chemotherapy. Moreover, in only one in four cases was the severity of the cancer correctly assessed. I shall quote now from The Times leader on 15th January which said:

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"In particular, there is a strong case for an independent enquiry into the use of radiotherapy to treat breast cancer".
That was the plea made by Lady Ironside in the article to which reference has already been made under the heading "The Safeguard Killing Patients".
I believe that that demand is right. Since then, the Cancer Relief Macmillan Fund to which reference has already been made—indeed, in a congratulatory tone, I think that we already have tremendous admiration for the work done by the Macmillan nurses—has said that women with breast cancer should be promptly referred for specialist treatment. That does not always happen. It is often a belated diagnosis which leads to some of the problems that have been mentioned.
In response to growing public and patient concern, the Department of Health has now announced a new cancer treatment programme. That followed the recommendations of the committee over which the Chief Medical Officer presided. I hope that the Minister will say something about those proposals as they relate to the concerns that have been expressed by many speakers during today's debate.
There are further grounds for fearing that treatment in Britain is often of a poorer standard than in other countries. No doubt the Minister will want to comment on some of the allegations that have been made. Experts have said that Britain lags behind the rest of Europe. Proportional to the population, there are fewer cancer specialists in Britain than, for example, in Poland.
Professor Karol Sikora (who many of us will know is an outstanding expert in the field of oncology) from the Hammersmith Hospital in West London has claimed that some cancer patients would be better treated in the third world. That coming from an expert is a very damning criticism of the quality of treatment in Britain. I hope that the Minister will also comment on that. It is estimated that only one in two patients will see a specialist and that thousands die unnecessarily.
It is worrying when one hears criticism of the quality of treatment by the National Health Service as all of us have so much pride in that service. It is also deeply distressing to hear of so many cases being diagnosed each year, with so many people dying, one may feel, unnecessarily. I hope that the Minister will give a sterling response to the concerns that have been expressed during today's brief exchange.
3.50 p.m.
Lord Colwyn: My Lords, I listened with great interest to the moving way in which my noble friend Lord Ironside initiated the debate. I hope that the experience of his family will contribute towards significant advances in the diagnosis and treatment of this disease which affects one in 12 women and is probably the most important public health factor which women face today.
It seems that any improvements in case survival or mortality rates are being overshadowed by a real increase in the incidence of the disease. It is reported that of the 16,000 deaths each year, 5,000 British patients die because they do not receive the best treatment. The claim that one in 10 of those patients
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could survive if treated in any other Western European country is a sad reflection on the British record of treatment.
I would welcome the report of the expert advisory group on cancer, A Policy Framework for Commissioning Cancer Services, published on 18th May. I have only just been able to obtain a copy so cannot claim to have read the document fully. But I was sent a copy of the press release by Susan Butler from the Cancer Relief Macmillan Fund office yesterday.
The report, which has been prepared by the Chief Medical Officer, Dr. Kenneth Caiman, for my right honourable friend the Minister does not admit to any failings but implies criticism of Britain's record and notes substantial variations in patient survival in different parts of the country.
I am aware of the survey by the College of Radiologists which it admits produced disturbing results when treatment protocols were compared for similar cancers in different regions. Treatments varied dramatically and there was no evidence of standardisa-tion. I gather that a grant has been made available from the department to do something about the problem.
I hope that the Minister will be able to say that extensive reforms of cancer treatment are likely to be implemented by the end of next year, with the possibility of a network of regional hospitals becoming high-tech specialist centres, each serving a population of not less than 660,000 people. These centres will have the latest diagnostic equipment, specialist surgeons, services for child cancer patients and the latest drug and radiotherapy treatment facilities.
I think that the report implies that the doctors working in the units will be expected to spend at least half their week treating cancer patients so that they can become experts. There are only 342 cancer doctors in Britain and 65 per cent. of patients never see one, some being treated solely by their GP, who cannot be expected to have gained sufficient experience from relatively small numbers of patients.
Like the noble Lord, Lord Ennals, I should like to support the minimum standards of care called for by the Macmillan Fund. I shall not detain your Lordships by repeating them, but they call for prompt diagnosis, referral and access to treatment, with back-up information and psychological support from specialist breast care nurses. The fund stresses the need for accurate information and explanation of the disease, its treatment and associated aftercare.
Speaking to the All-Party Parliamentary Group on Breast Cancer on 22nd March (regrettably I could not be there as the meetings of the group are always scheduled for mid morning when many of us have to work—and that is a public plea for the group to change the time of its meetings) Professor Michael Baum said that the best prospect for the primary prevention of breast cancer is to concentrate on using some form of chemical intervention. I am sure that that is correct for some cases, but as a supporter of natural medicines I feel sure that the answer lies in earlier screening for deficiencies in basic nutrition and hormonal chemistry.
The actual mechanisms by which cancer is caused are still speculative. The genetic theory which proposes that

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cancer is the product of chromosomal DNA damage induced by radiation, viruses or toxins, which—as the patient gets older—the natural ability to repair is prejudiced is now replaced by the epigenetic theory, which suggests that correcting and maintaining a healthy intracellular environment will prevent cancer and lead to successful non-toxic treatments for the disease.
Both breast and endometrial cancer are health risks which tend to surface in women at a time when oestrogen is dominant and progesterone is low. The cancer protective benefit of progesterone is clearly indicated in a prospective study in which pre-menopausal women with low progesterone levels were found to have over five times the risk of developing pre-menopausal breast cancer and a tenfold increase in deaths for all malignant neoplasms compared with those with normal progesterone levels.
As women approach menopause, breast and endometrial cancer are two of the greatest fears. When the cause of a cancer becomes known, prevention becomes a reality. Lung cancer, for example, can be almost completely prevented by avoiding cigarettes. A great deal is known about the hormonal factors in breast and endometrial cancer. I hope that the new initiative will include trials and tests on the use of progesterone and its opposition to the carcinogenic effects of estrogens.
I thoroughly commend the setting up of a proper programme for the screening of men and women for cancers and heart disease. Risk factors are only rarely considered when it is too late. I hope that the Government will listen carefully during the three-month consultation process. I am grateful to my noble friend for asking the Question and I hope that our debate will perhaps contribute to those consultations.
3.55 p.m.
Earl of Baldwin of Bewdley: My Lords, I, too, welcome the chance to support the noble Lord, Lord Ironside, in putting this crucial question to the Government, which he has done with great clarity and skill. I look forward to hearing the reply of the Minister, although of course we know something of what she will say from the recent reports in the press, about which other noble Lords have spoken: and most welcome they are too.
My interest in the subject is twofold. I have been active for some time in the world of complementary medicine, which has led me to look closely at alternative approaches to cancer, among other conditions, and by extension to keep an eye through the medical press on what is going on in the mainstream. And, like the noble Lord, Lord Ironside, my wife is a breast cancer sufferer, and the last many months have been fraught with difficult decisions about possible lines of treatment.
From the very beginning we learnt that the figures were stark and there was no place here for rose-coloured spectacles. Breast cancer in the UK, as we know, is rampant. Statistics show that only three women in 10 live out a normal lifespan. The treatment options are extremely unattractive. Radiotherapy was urged on us, after an unavoidable mastectomy. We established that it
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might not be necessary, since no one knew if the cancer would recur; that if it was necessary, there was no guarantee it would work; that if it did work there would be side-effects which, though probably as insignificant as surgeons and oncologists like to claim, could possibly be as devastating as some of the cases we have heard about this afternoon; and finally—this from a major published review of studies of radiation to the chest—that if you have the radiation you will probably die a bit sooner than if you do not. At the end of this I thought, "What kind of medicine is that?"
It was only later that I was able to study the POST report of last month and learn of the extraordinary complexity of the various steps in radiotherapy treatment, with its countless opportunities for error, to say nothing of the lack of consensus about treatment regimes, about which we have already heard. To my mind, my Lords, this is the unacceptable face of aggressive, technological medicine. There must be a better way, and in a moment I shall return to this theme. So far as diagnosis and surgical treatment are concerned, our experience has been of the best: swift, efficient and as painless as anything so awful can be. But I know that this is far from typical, alas, and would join my voice to those who want to see a levelling up and a better organisation of facilities and expertise round the country. As an aside, I must express some scepticism about the merits of screening which have been put forward by one or two speakers, in view of the continuing controversy in the medical press as to whether it actually brings the benefits that lay people like us would think that it ought to bring.
There is another area where from my recent experience there is room for improvement, though it does not only apply to breast cancer. I read last December that the Minister said at a College of Health conference that effectiveness bulletins on the best means of treating different conditions were to be produced in patient-friendly form. In view of the Audit Commission's findings in November on the poor quality of communication from doctors to patients this is to be welcomed, though it is only a part of the picture. It is not at all easy for a patient to discover the facts about her illness and treatment—full, clear, unbiased facts, with figures where needed, and side-effects not glossed over. Breast cancer is a stressful enough experience without having to fight for the information on which to base decisions which are no longer the preserve of the paternal figure behind a consultant's desk. I hope that the medical profession will take this on board with all seriousness.
The question is, in what ways the Government expect to improve the situation. That there is room for improvement is surely common ground. Variations in treatment, as we have heard, go way beyond the bounds of legitimate clinical judgment, and the damage done to patients, even on standard treatment regimes, is or should be unacceptable. We have heard many of the details from the noble Lord, Lord Ironside, and there is no need for me to repeat them. There used to be. a medical maxim: "Above all, do no harm". I wonder what happened to it.

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The report of Dr. Calman's committee is to be welcomed, as far as it goes, and I shall say no more about it here. Other noble Lords have spoken eloquently on the subject. But when you stand back and survey the cancer scene over time, a grimmer picture emerges. I have said that this is no place for rose-coloured spectacles. There can be few areas of endeavour where so many resources, so many billions of pounds and dollars and francs and yen, have been expended for so many decades to so little effect. Promises of breakthroughs, yes. Actual effects on the mortality figures of breast and other major cancers, no. This is not a layman's view: you can read it almost any day in the medical press. Last year, on 6th February 1993, the Lancet published a challenging editorial entitled:
"Breast cancer: have we lost our way?"
After cataloguing some of the failures of the past, due largely to,
"the extraordinary capacity of the profession for self-delusion",
it asks,
"would it not be more scientific to ask why this approach is failing and recognise that any more of the same could be the medical equivalent of the surgical excesses of the middle years of this century?"
This editorial foreshadowed a breast cancer conference held in Belgium last month. With growing dismay, but perhaps with rather less surprise, I read the summary report of that conference:
"Have we lost our way? … With confidence we can say no …".
There was little hint of recognition of the seriousness of the situation, the prescription being roughly for the mixture as before, and I was left wondering what other profession could show such calm assurance in the face of so many years of conspicuous failure, and still retain the respect of government and public.
The noble Baroness knows, because I have referred to them before, that there are a number of alternative approaches to breast and other cancers, and I hope she may agree that the time is right for some more radical thinking in this direction. I know that the noble Lord, Lord Colwyn, would agree. The US Congress Office of Technology Assessment published a report on them in September 1990, and I have asked for a copy to find its way into the Library of your Lordships' House. Let no one think that so-called alternative treatments are good for hay fever and mild psychosomatic complaints but lack a real punch when it comes to the big league. When you cease to focus on the rogue cell, tumour or virus and concentrate on massive reinforcement of the host body and its immune system it is remarkable what can be achieved, as many cancer survivors will testify.
It is not that these treatments have been examined and found wanting: they have never been properly looked at. But it demands new thinking, and a willingness to learn, and it seems to me that both these qualities are in short supply in the cancer field at present. It also demands a better scientific attitude than was brought to the study of the breast cancer patients at the Bristol Cancer Help Centre, whose publication in 1990 did so much harm.
Interestingly, however, only a month ago a report appeared in the press which some of your Lordships may have seen about the apparent recovery of some
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Danish breast cancer patients in a study on a fruit and vegetable diet with vitamin supplements. These are by no means the only examples I am aware of from that particular nutritional field.
My Lords, we need rapid improvements in the treatment of breast cancer, and I fully support the noble Lord, Lord Ironside, in the case he is making. It should be possible to bring most centres and regimes up to the standard of the best. But my wider concern is that the best is still, in absolute terms, pretty bad. I greatly doubt that the situation will change until there is a real willingness to explore other avenues which have shown promising results, if need be from other cultures. I am convinced that anything which the noble Baroness can do to further research in this direction will prove immensely worth while.
Viscount Brookeborough: My Lords, I, too, thank my noble friend Lord Ironside for initiating this debate. I wish to declare an interest and, in doing so, explain why I, as a total lay person in these matters, am taking part in this debate. For just over a year I have been a non-executive director of the Green Park Trust group of hospitals in Belfast. Within that group we have Belvoir Park Hospital, which contains the regional oncology unit for the whole of Northern Ireland. I ask my noble friend the Minister: why on earth was Northern Ireland not included in this consultative document by the Expert Advisory Group on Cancer? The Minister will no doubt say that it is an advisory group for chief medical officers of England and Wales. However, I notice that the Scottish Office was included while the Northern Ireland Office was not.
In case there should be any doubt about the quality of care in the Province, on the fringe of the United Kingdom, I would like to point out the following general points. First, we have in the Green Park group the largest and most modern joint replacement unit in the United Kingdom—1,700 joints last year. It has the only on-site joint factory in the United Kingdom, which uses x-rays and computers to make them. Where else can you be measured up one day, fitted the next and back home in five days? Secondly, we have the most sophisticated gait analysis laboratory in the UK. Thirdly, coming to cancer, we have one of only two (so far as I know) intensive therapy units—the modern equivalent of bone marrow transplant units—so there is no lack of quality provision to call on. In addition to all that, according to RAGE, we have had only one incident of significant brachial plexus injury, and that was in 1989.
The question has to be asked: why exclude the Province, especially when its size of population falls directly in line with what is recommended in paragraph 3.3.5 of the consultative document and it would therefore seem to be an ideal sample unit?
I can see that the consultative document is a very valuable piece of work. But it has fairly long-term planning and financial implications. I would like to look at and discuss how immediate improvements with few financial implications could be made to the diagnosis and treatment of breast cancer.

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It is not for me to argue for the increase or otherwise in the age bracket for recommended cancer scanning. However, more encouragement should be given to people within those age groups to attend. In rural areas in Northern Ireland the uptake is fairly good. However, more must be done in urban areas. The health department should look not only at its advertising but also at the location and accessibility of its units in built-up areas.
We already have six breast cancer clinics where women may go. There they may be given fine needle aspiration (FNA) if necessary and can be told immediately of any problem. This is a good system. However, there is an alternative; namely, the old system whereby women can go to their GP, who may use his own judgment as to whether to refer the patient to the general hospital. I would suggest that that is not good practice and, if in doubt, all GPs should be obliged to refer patients to breast cancer clinics for FNA, and so obtain a surer diagnosis from stage one. I realise that there may be a problem with the supply of histopathologists. However, since the life span of samples is, I understand, from two to three hours, it would be quite possible to centralise that part of the service and the test could be done very quickly.
From that point, patients diagnosed as having the disease go to a hospital and are operated on by, more often than not, a general surgeon. Many of those surgeons may see only half a dozen breast cancer patients in a year. That cannot be good practice. Rather than many surgeons doing a few operations, it must be right to reorganise their allocation of operations so that most, if not all, cancer operations are carried out by a reduced number of surgeons. Even without additional training they would become more specialised by practice. At this stage, it is the surgeon's opinion as to whether or not to refer the patient to the regional oncology unit—in our case, Belvoir Park Hospital.
It is my impression that up to this stage we have too many unspecialised people taking decisions on referral and all too often obtaining no specialised advice. In Northern Ireland out of 5,000 cancer patients a year of all types, only about 2,800 were referred last year. That seems to reflect the national average.
For those with breast cancer who are referred to an oncology unit, there are variations of technique and treatment throughout the UK, some of which may result in lower quality of treatment and complications, such as brachial plexus injury. It is thought that certain techniques might carry a higher risk of injury, but no one knows which are involved. Therefore it is not any lack of quality in the oncologists but the lack of research that is at fault. We must await the results of analysis of the information that will be contained in cancer registers.
Meanwhile, it appears that although all oncology units have a medical physics department, it is not always consulted in the planning stage of treatment. It is equally important to decide not only whether to use radiotherapy but also the size and number of fractions used and the target areas. Fear of leaving large gaps in the junctions between fractions should not lead to too much overlapping, which perhaps carries a higher risk
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of injury. It could be suggested that the planning by medical physics departments is more important than some oncologists might believe. Every case is different and the medical physicists must be of a uniform standard and must be consulted.
Consideration should be given to such matters as stronger fractions and a smaller number of treatments or weaker fractions in a large number of treatments. Although the treatments are cumulative in strength, it is important to note that cancer cells react to different strengths of treatment compared to nervous tissue. Much more research needs to be done. We hope that the Government will encourage it.
In conclusion, the way forward seems to be indicated by the consultative document prepared by the expert advisory group in the medium term. In the shorter term, much improvement could be obtained with more consultation vertically and laterally within the medical profession, together with some administrative reorganisation, to achieve maximum availability of quality treatment. Clinical directors must be given guidance on how to implement immediate change, where it can be carried out in the short term. In their trust status, this will be new to them, as it used to be the task of the department. They need leadership. I hope that in future Northern Ireland will be consulted when this problem is further examined.
Lastly, there has been talk of counselling, especially on the patient's side, which I support. At Belvoir Park Hospital consideration is being given to counselling of oncologists and the other bearers of bad news. There seems to be room for such counselling. They have an extremely hard job to do. We feel that counselling will help greatly to improve their methods and their efficiency.
4.12 p.m.
Baroness Robson of Kiddington: My Lords, I also should like to thank the noble Lord, Lord Ironside, for raising this subject, which is of such intimate concern to women.
Cancer in general is mainly a disease of the elderly and is increasing in our society. That is not so astonishing because the age of the population is also increasing. But breast cancer is quite different. First, it is tremendously difficult to diagnose early enough. It has a tremendously high incidence and death rate. There are 30,000 women diagnosed as having breast cancer every year.
The problem with breast cancer is that there does not seem to be a single identifiable factor which causes the disease. We are quite happy to assume that cigarette smoking is responsible for lung cancer. I say "assume" because I am a smoker, although I accept that it is a correct diagnosis. It is certainly thought that a high fat and low fibre diet could be a factor in breast cancer. Breast screening, either through self-diagnosis or through the NHS programme, has had a small impact, but has not significantly reduced the death rate.
Dr. Beral of the Imperial Cancer Research Fund has carried out some studies. She recorded a fall of 400 in the death rate from cancer between 1989 and 1992. She

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states that it has been known for some time that having children, especially having the first at a young age, reduces the risk of breast cancer.
After the Second World War the average age when women had their first baby fell from 26 to 24 and the percentage of childless women halved from around 20 per cent. to 10 per cent. It is in those women that the breast cancer incidence has fallen. By contrast, the women with increasing death rates were those of child bearing age at around the time of the depression when many women put off having their first child until much later or had no children at all. That is a theory of Dr. Beral. If there is anything in it, it is worrying that the present population of women who want to develop a professional career are putting off having their children later and later. It is therefore something which should be investigated.
One feature of the treatment of breast cancer is that it can sometimes be many months after the initial visit to the GP before the diagnosis is made, and then there is a further delay before treatment is started. When the diagnosis results from screening, the process is usually quicker and the patient usually has surgery within four weeks of diagnosis. However, it may take several more weeks before radiotherapy begins. In some cases that may be due to the fact that hospitals with radiotherapy departments have insufficient funding and as a result considerable delays may occur. Also, as a result of the reforms in the NHS, the service is not now under regional control. The way it now works is through local purchasers buying treatment. As a result, sometimes through lack of money, many purchasers put their emphasis on less specialist services. Lack of resources increases the risk of errors. Examples of that have given rise to the recent problems with radiotherapy such as the cases in Stoke where underdoses were given and in Exeter where overdoses were given.
The Department of Health is now doing something about the issue of central advice to purchasers. But it is important that we make certain that the lack of resources is not the reason for the treatment not being given efficiently or on time. Of course, breast cancer patients can obtain high quality service in most units, and in low quality units patients are beginning to realise that they can demand better service. But there are still a large number of patients in the NHS who are not receiving good service and the division of hospitals into individual provider units will cause that number to increase.
Errors can occur in any form of treatment. Systems of quality assurance and quality control for radiotherapy are developed and are used, but again there can be errors along the line. If resources are not enough, there may be shortages in the number of physicists and radiographers so that they are working beyond their normal hours. Errors can creep in through fatigue. It appears that lack of resources is directly linked to errors. It is directly linked to the overdosage incident in Exeter which was partially the result of there not being enough physicists and consultant oncologists. In addition, the management structure was poor so that there were unclear lines of responsibility.
932
The same faults occurred in Stoke where under-dosages were given. The staffing levels of radiographers and the provision of equipment were below the recommended levels. Again, insufficient physicists and oncologists were employed. This has now been rectified in those two centres, but the accidents have shown that there should be regular monitoring in all centres to ensure that there is good quality control and that clinical audit is carried out.
Recently a survey has been conducted by the Royal College of Radiologists of equipment and non-medical and medical staff in all regions. This has pinpointed the fact that there is no way in the present purchaser-provider system of ensuring that when equipment is wearing out there are funds to replace it. The survey also showed that one of the main causes of stress was not having enough time with patients to give the standards of care that doctors felt was necessary. In this country we have 272 clinical oncologists funded by the NHS and 65 medical oncologists mostly funded by cancer charities. This is the lowest number of cancer doctors per head of population in Europe, apart from Portugal. On average a clinical oncologist sees 560 new patients per year. Those patients are then on that doctor's list for at least five years. So the average number of patients under the care of an oncologist is 2,000 at any time; again not enough time to deal with patients in depth.
There is not always an understanding among the public that all medical treatment will have side effects. That is so with radiotherapy perhaps more than any other treatment. Because it does not look as if anything is happening during treatment, patients completely fail to realise that it is a serious treatment, like major surgery. The long-term side effects can be severe and that needs to be explained to patients. However, good treatment should keep the side effects to a minimum. For most patients with breast cancer radiotherapy is a major treatment for all stages of the disease. It has been proved that radiotherapy increases survival as well as controlling local disease. Therefore it is most important that radiotherapy techniques are good and, whenever possible, improved to minimise long-term side effects.
It follows from this that what patients need most of all is counselling and time to decide which treatment to use. They also desperately need the help of a breast cancer nurse to give psychological support and information. I welcome the Macmillan breast cancer research campaign and the distribution of 3 million leaflets round the country to help women to help themselves. Because of the fear of cancer people withdraw into themselves. They do not want to discuss it. That does not help when it comes to seeking treatment in time. The counselling women need both from their doctors and their nurses is one of the most important helps we can give them.
4.23 p.m.
Lord Rea: My Lords, like other noble Lords and noble Baronesses—I anticipate the Question of the noble Baroness, Lady Castle, on 6th June to ask why when we speak of other noble Lords we include noble Baronesses; and noble Baronesses in this debate are

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playing a major role—I thank the noble Lord, Lord Ironside, and Lady Ironside for bringing this issue into the public arena.
Following the RAGE press conference in September of last year, the very dignified article of Lady Ironside in the Parliamentary Brief last October and the two Questions asked by the noble Lord in this House, the issue has been brought into the public eye. Perhaps Lady Ironside's intervention has accelerated government action.
The visible evidence of that has been the recent and excellent consultative document which other noble Lords have referred to. It is published by the department and by the Expert Advisory Group on Cancer chaired by the Chief Medical Officer. There is also the Department of Health's publication Quality Assurance in Radiotherapy which has been quite difficult to find. The one I have arrived only this afternoon.
I am not asserting that RAGE and the noble Lord were the only influences in getting these publications produced for us. But it is interesting that both reports were published only just before the noble Lord's Unstarred Question. Unlike many Department of Health documents, these documents were not published in a glossy, expensive format. They are quite stark in nature. One has a plain blue cover and the contents look as though they came straight off a word processor. That is no criticism. In fact both reports are extremely useful, particularly the consultative document which has wide-ranging recommendations that I do not believe will be very popular with some surgeons and radiotherapists, especially those working in isolation, and perhaps with some of the 53 centres which may be superseded if the recommendations of this report are carried out. I wish that some other publications of the Department of Health had been so concise, authoritative and businesslike. I am sorry that there is not a fuller bibliography such as that in the excellent Scottish Home and Health Department document on Scotland's diet, which is a model of how such a critical and important topic should be presented. But perhaps rapidly produced reports may be excused such academic finesse.
The consultative document has one deficiency. It completely omits discussing the prevention of cancer. It is true that its remit was to consider treatment services. However, other noble Lords have spoken about prevention and that is in order in this debate. As many noble Lords have already said, this country has the highest rate of breast cancer in the developed world, as well as the highest mortality rate from breast cancer once it has been diagnosed. That means that it is the highest in the whole world because the developed world has higher cancer rates than in the developing world, unlike many other diseases. This is a disease which comes from affluence, if you like, and living in the somewhat artificial environment that we perhaps have in the industrialised North.
Perhaps this is not the occasion to inquire why the rate of cancer is so high in the United Kingdom. The reasons are not fully understood, of course. There are many factors to consider and no one of them is the whole answer. The noble Baroness, Lady Robson, described what is probably the most important factor;
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namely, the late starting of families. The condition is more common in those of higher social class. That is the section of the population where women are educated, start careers and put off having a family more than at the other end of the social scale. Diet has also been mentioned and alcohol consumption may play a part.
The part played by these various factors will become clearer as current and ongoing research is completed, as well as much needed further research.
Here I have to declare an interest, as my son is a trainee oncologist who is at present doing his PhD at the Imperial Cancer Research Fund's laboratories.
What concerns us today is why breast cancer is more likely to kill women in the United Kingdom than in other countries. One possible reason for that is that British women are less likely to present breast disorders to doctors at an early stage than are women in other countries. There is possibly a very British reluctance by women, particularly older women, to know and physically to feel their own bodies, especially the sexual parts of their bodies, than is perhaps the case in other countries. There is a hesitancy to seek medical advice. Two years ago the British Medical Association produced a video with an accompanying text called "Preventing Cancer" for the use of general practitioners and nurses in primary health care. It stated:
"Women should be familiar with the feel and appearance of their breasts. This should not only help women to detect lumps at an early stage but should reduce anxiety about the normal changes which occur during the menstrual cycle … Breast self examination is a skill which ha; to be taught".
That brings me to the role of the general practitioner which, as other noble Lords have pointed out, is absolutely crucial. I do not think that all GPs are referring early enough although most do and are careful and thorough when a woman presents them with a breast problem. I deny what the noble Lord, Lord Colwyn, said —that some GPs try to look after cancer cases themselves and do not refer them. I think that if a GP does that, he is guilty of negligence. The only case in which a GP should hang on to a cancer patient and not refer is that of a very old or debilitated person who perhaps could not stand an operation or a course of radiotherapy or chemotherapy.
Postgraduate education, as well as good under-graduate education, is absolutely essential. The present system of postgraduate education, in which part of the pay of GPs is withheld unless they attend a minimum number of postgraduate sessions, is working. But the detection of early breast cancer is a very practical skill. It is not always easy, if I may coin a phrase, to lay on patients on whose breasts doctors on postgraduate courses can lay their hands. My rule as a GP has always been: when in doubt, refer. I think that the great majority of doctors feel the same way. I have been particularly lucky in having specialist breast clinics in two hospitals within a two-mile radius, one being the Royal Free Hospital which is now under the jurisdiction of the noble Baroness, Lady Gardner of Parkes! Both clinics have a very short waiting list.
Reference has been made to the National Breast Screening service, which was set up following the Forrest Report. That looks like becoming a success story although there is still too wide a variation in take-up

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—for instance, 60 per cent. of women in the eligible age groups take it up in Kingston and Esher while 74 per cent. do so in Southport and Formby. That difference in take-up rates is associated with quite a big difference in the breast cancer death rates in the two areas. I am not saying that that is necessarily due to the effect of screening. It is probably due to the attitudes of the women in the two different areas and perhaps to the breast cancer services there and the women's faith in them so that in Lancashire women are more likely to present early while women in Kingston are less likely to do so.
With regard to treatment centres, I am sure that the recommendations of the Expert Advisory Group on Cancer are on the right lines. The recommendations state:
"Improved outcomes are associated with specialised care for uncommon cancers and many studies also suggest this association for common cancers",
of which breast cancer is the commonest, although deaths from breast cancer are now being overtaken by deaths from lung cancer in women because of the difficulty that women have in giving up smoking.
Some of the rather heroic and higher dose courses of radiotherapy to which some members of RAGE were exposed, have already been modified and improved. For instance, routine axillary irradiation which used to be more common has largely been abandoned. It should be emphasised though that the local variations in radiotherapy practice, pointed out by other noble Lords, are now being addressed—they are still there—by the Royal College of Radiologists, with the support of the Department of Health.
The 1991 report of the Standing Medical Advisory Committee entitled Quality Assurance in Radiotherapy has been followed up by this very recent large document which I am afraid I have not had time to read. It will be interesting to hear from the Minister how the 1991 SMAC recommendations have been followed up. The 1991 report sets out 18 requirements, covering the entire process by which radiotherapy is delivered to the patient. However, as has already been pointed out, a survey reported in the BMJ earlier this year suggested that many deficiencies remain. There are other initiatives, which I shall not go through—I have occupied too much time already—in train, studying what is going on, with the possibility of speeding up the improvements for which we are all hoping.
All that will be made easier if the recommendations of the expert committee are accepted. I shall give just two of its recommendations. Recommendation (iii) states:
"Cancer Centres and Cancer Units should be established to provide an integrated network of cancer care. Communication between … centres is vital".
Recommendation (iv) states:
"There should be a clear understanding of appropriate referral and follow up patterns between General Practitioners, Cancer Units and Cancer Centres. These should be based on agreed guidelines and information on quality and outcome of care".
There are 13 recommendations in all.
Finally, I take up a point raised by the noble Baroness, Lady Robson. Manpower and resources must be discussed. There seems little doubt that even though
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we have the highest rate of breast cancer in the world, the resources devoted to cancer care are considerably less than in other countries. That has been pointed out by several other noble Lords. The noble Baroness, Lady Robson, described the shortage of oncologists in this country compared with France, Germany and the USA which have almost twice as many oncologists per head of population as we have. It is clear that the number of oncologists needs to be increased, but in the past two years only 32 extra were appointed.
There is also little doubt that the NHS is overall a cost-efficient service, but there are areas—this is one of several—where resources are stretched dangerously thinly, too thinly to be efficient and safe. The noble Baroness pointed that out clearly. I am afraid that the sad stories we have heard today bear that out fully, even though rather late in the day the Government now appear to be acting.
Lord Colwyn: Before the noble Lord sits down, perhaps I may say that I did not intend to imply any criticism of GPs. I intended to say that, because of the relatively small numbers of patients they saw, I felt that they may not have the experience to know whether to refer or to watch for a little longer. I was not intending any criticism.
4.40 p.m.
Baroness Cumberlege: My Lords, the Government are most grateful to my noble friend Lord Ironside for bringing this matter to the attention of your Lordships' House. As your Lordships will be aware, my noble friend has worked tirelessly to increase the knowledge of the public about the vexed issues concerning breast cancer and in particular the need for an assured standard in the quality of radiotherapy treatment.
The practice of medicine, like many aspects of modern life, is becoming increasingly complicated. The ability of the health service to offer sophisticated cancer treatments is to be applauded, its potential encouraged and its continuing development informed by up-to-date research. However, the possibility of causing harm has also to be recognised. The Government want people to have justified confidence in their health service and to know that the treatments available are effective and safe.
The diagnosis and treatment of breast cancer are a government priority since each year around 25,000 women in England will be diagnosed and, tragically, around 13,000 women will die prematurely from the disease. Many of those lives can be saved if the cancer is spotted and treated at an early stage.
Prompted by this sad loss of life, and encouraged by the results of multi-centre trials, in 1985 the Government established the Forrest working group. The group's report recommended the introduction of a national population breast screening programme, the first in the European Union, whereby women between the ages of 50 and 64 should be called for three-yearly screening by mammography.
Between 1987 and 1990, £70 million was allocated to set up and run the breast screening programme.

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Resources were invested in four national initiatives: education and training, quality assurance, equipment and information systems.
As was said by the noble Lord, Lord Molloy, the noble Baroness, Lady Robson, and my noble friend Lady Gardner of Parkes, successful treatment depends on the early detection of breast cancer. I know that that view is not shared by the noble Earl, Lord Baldwin, but work on cervical cancer screening has shown a reduction of one-third in cervical cancer in women who have regularly been tested. That is why we have made such efforts to establish specialised breast screening centres nationwide.
It is essential that all local screening programmes have reliable quality assurance systems. These are monitored to ensure that abnormalities detected by mammography screening are investigated as soon as possible.
The Government have a clear objective to reduce mortality and morbidity caused by all cancers. Breast cancer screening offers an effective and measurable intervention in reducing deaths and is a key priority in the Health of the Nation strategy.
But of course we recognise that this cannot be achieved without the help of others. Last week, as your Lordships mentioned, the Cancer Relief Macmillan Fund launched its breast cancer initiative. We welcomed that campaign, which is entirely consistent with our wish to empower patients to give them more confidence to question diagnosis and to exercise choice in their treatment. We want them to be active partners in their care. We also recognise the significant contribution made by other voluntary groups working in research, working with ethnic minority groups and with homeless people raising cancer awareness.
It is vital to have a high quality service for women who believe that they may have breast cancer. The Government's Chief Medical Officer has written to all doctors in England giving advice on the ways in which women can be involved in early detection, outlining the key symptoms and signs.
We now need to ensure that all women with breast cancer receive the best care available. The chief medical officers of England and Wales recently published their consultative report on the provision of services. The report was welcomed today by your Lordships and also widely outside the House. The report, prepared by an expert advisory group which included leading cancer specialists, has far-reaching implications for the future organisation of services.
The report sets out general principles which should govern cancer care. These principles include the need to involve not only patients, but their families and carers; to give them clear information about treatment options; and to respect their views. This seeks yet another change in culture, but health services are beginning to accept the notion that the patient's own opinion is not just relevant but of overriding importance; and it can affect the speed of recovery.
Another principle in the report is that all patients should have access to a uniformly high quality of care. The report proposes a network of expertise at three levels with the patient's own doctor playing a crucial
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professional role, not only in terms of the initial diagnosis, treatment and care, but guiding, supporting, informing, advising and above all listening to the patient and her family. Throughout the whole episode of treatment and care, wherever that may take place, the linking professional should always be the GP.
Recently, there has been criticism of the referral of women to cancer specialists. We understand the anxiety and trauma of those who believe they may have breast cancer. That is addressed in the report, which recommends that there should be detailed discussions between all the GPs in an area and the local hospital service to clarify patterns of referral and follow up.
The second level of care is to be provided by cancer units in local hospitals. Those designated units will treat the more common types of cancer. It is recognised that, in order to gain enough knowledge and expertise, a sufficient volume of work is necessary. The expert advisory group will be discussing with the relevant professional bodies the workload necessary in each hospital to achieve universally the high standards of clinical practice which we seek.
We recognise that many cancer units will not have a sufficient workload to justify the development of services for the more rare and unusual forms of cancer. We are therefore planning for cancer centres which will serve a population of about 1 million. Those centres will also provide services for their local population in the same way as cancer units, in addition to giving the highly specialised and sophisticated treatment to the small minority of women who need it.
The report has far-reaching consequences for the organisation and provision of services. We will, therefore, consult widely and listen carefully to all the views expressed before deciding on how the report's recommendation should be taken forward.
We strongly support the view of the noble Countess, the Countess of Mar, that every woman should receive information on the options available and be offered a choice of treatments. Recent studies of adjuvant therapy indicate that a combination of treatment—surgery, radiotherapy, chemotherapy, adjuvant endocrine therapy—is highly effective, but circumstances differ in individual cases.
Assessing the outcome of different treatment regimes is complex. As my noble friend Lord Brookeborough so clearly explained, treatment depends on a range of factors including cancer size, stage, site, and the overall health of the individual woman. Benefits and side effects may take years to become apparent. But the expert group not only draws attention to the work already done in setting standards for quality assurance and radiotherapy. It also draws attention to the need to pursue clinical audit. With greater concentration of service and expertise, that will be easier and more effective. We would expect nurses to be closely involved in audit because we know that they play a crucial role in supporting women and their families prior and post diagnosis and In any treatment and care which follows.
As my noble friend Lady Gardner and the noble Lord, Lord Molloy, said, breast cancer nurses play a crucial role in answering women's questions and

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explaining treatment options. However, I am sure that my noble friend will support me when I remind your Lordships that staffing in local units is a matter for local decision and we should not wish to direct it from the centre. The expert group on cancer recommended that patients should be seen by appropriately trained members of a multi-disciplinary team.
My noble friend Lady Gardner, the noble Baroness, Lady Robson, and the noble Lord, Lord Rea, addressed the need for an increase in breast cancer specialists. The expert group on cancer believes that there may be a need for more cancer specialists. However, much can be done in organising the existing services better so that doctors become increasingly specialised instead of treating the broad range of diseases.
The number of oncologists in this country is lower than in other European countries, and that is for historical reasons. Oncology specialists are increasing in number more rapidly than other specialists and we now have 200 clinical oncologists in England and 30 medical oncologists, with more than those numbers in training.
Increasingly health professionals acknowledge that a holistic approach to treating patients is not only appropriate but more effective. This is particularly important in a disease like cancer, which is always frightening for patients and their families and for which conventional medicine does not always have the complete answer.
I agree with my noble friend Lord Colwyn that there are many factors which influence cancer. Complementary medicine may have a place in the treatment of many diseases. It is encouraging that the British Medical Association has recognised this in its recent publication Complementary Medicine: New Approaches to Good Practice, and I welcome the increased communication and collaboration between the mainstream clinical professions and other therapists.
Many complementary therapists have a valuable place in the provision of health care but they also have a responsibility to the public. That form of health care should, therefore, be subjected to the same rigorous evaluation and audit that is applied to conventional medical practice.
Radiotherapy has been used to treat cancer for nearly a century. In those early years treatment machines were completely unprotected and were dangerous to staff and could not be directed with any precision. By the outbreak of the First World War, a number of major radiotherapy centres had been established, including the Christie Hospital, the Holt Institute and the Royal Marsden.
I think that I can say with some confidence that we have moved on and we have learned from those early years; but we are still learning. Future advances are expected in biological techniques to identify those patients with increased normal tissue sensitivity. That will enable individual treatment to be tailored more precisely.
Your Lordships may be aware of the 1991 publication entitled Quality Assurance in Radiotherapy. That document sets out 18 requirements to be satisfied
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to ensure that quality in radiotherapy is maintained. Quality assurance is defined by the British Standards Institution as,
"all those planned and systematic actions necessary to provide adequate confidence that a … service will satisfy given requirements for quality".
In the light of that report, two clinical oncology centres were funded by the department to undertake pilot studies on how best to implement quality standards, and to prepare manuals which might serve as a model for use by other radiotherapy centres. The results are set out in a document drawn to our attention by my noble friend Lord Ironside entitled, Quality Assurance in Radiotherapy—A Quality Management System for Radiotherapy, which has been widely circulated. However, it is an advisory document—a tool which we hope the NHS will find helpful in providing services.
I agree with my noble friend that it is important for all radiotherapy centres to have good quality assurance systems for radiotherapy. That is to be encouraged. However, BS 5750 is only one such system and offers no guarantee of a quality service or improvements to clinical practice if the quality systems are themselves inadequate or if clinical protocols are not right.
The noble Lord, Lord Molloy, sought some reassurance about funds for research. In 1992–93, the Government spent over £3.8 million on breast cancer research, £3.1 million of which was commissioned through the Medical Research Council. Government expenditure of £3.8 million on research into breast cancer in 1992–93 does not include clinical research supported through local NHS research programmes or excess service costs for the NHS attributed to breast cancer research. It is estimated that in 1992–93 the major cancer research charities spent £8.7 million on breast cancer research, thus giving, with the Government's contribution, a total identified spend of £12.5 million.
My noble friends Lord Ironside and Lord Brookeborough asked why Scotland and Northern Ireland were not part of the review. First, perhaps I may reassure my noble friends that there is no evidence of a North-South divide, nor, so far as I am aware, any evidence of an East-West divide. My noble friends can take some comfort from the fact that the Quality Assurance in Radiotherapy treatment document sets standards and has been commended to centres in Scotland and Northern Ireland by their chief medical officers. I am sure that those two countries will also be interested in the framework document which we have just launched. However, your Lordships will be aware that both those countries have their own health Ministers, health officers and structures.
The noble Countess, Lady Mar, asked why it had taken us so long to produce the policy document that was launched last week. There are a number of reasons. First, we wanted to ensure that the screening systems were in place, because our priority had to be early detection. Secondly, we had a great deal of work to do to prepare the ground, not least in terms of clinical audit. That concept is now well established in the NHS and the preparatory work on quality assurance is complete, especially for radiotherapy. Thirdly, we wanted to ensure the co-operation of the professionals involved.

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We believe that we have that now and that they support in principle the proposals in the document which we launched last week.
The noble Baroness, Lady Robson, asked about other staffing levels. She referred to the incidents at Stoke and Exeter which occurred some years ago. I believe that in the case of Stoke the problems started in the early 1980s and in Exeter occurred in 1988. Since then there have been increases in the recruitment of medical physicists throughout the country, including in both those areas.
The noble Baroness also asked about funds for replacing worn out radiotherapy equipment. The Government have recognised the need to replace old radiotherapy equipment. To speed up that replacement, a three-year programme of £15 million a year was set up from 1992–93 to cover the purchase of expensive equipment, including linear accelerators for cancer treatment as well as diagnostic equipment such as mammography units.
The noble Lord, Lord Rea, asked why we had the highest incidence in the death rate for breast cancer in this country. It is true that we have a very high incidence, but it is not fully understood why that should be so. One of the reasons that has been suggested is that in this country we have a very good system of cancer registration. We believe that if we are doing this better than other countries then we may have an apparently poorer record in terms of the incidence of cancer.
In conclusion, there are many women alive and well today who owe their lives to the progress that has been made in the detection, diagnosis and treatment of breast cancer. The service in general is good, but we want to make it even better. To that end, we have drawn up a blueprint for the future which we want widely discussed and debated, not only among professionals in the health service but by all those who have an interest in the subject.
Finally, I should like to say to my noble friend Lord Ironside that we are very aware of his concern about
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radiotherapy treatment and his and his wife's involvement in the organisation RAGE. He has been kind enough this afternoon to mention my personal interest in those women who have suffered side effects following such treatment. I thank him for the detailed information which he and RAGE have submitted to the Department. I am conscious that our policies are for the future and that it is right that we must go forward, but I cannot ignore the past.
I have discussed this matter at length with the Chief Medical Officer for England and he has agreed to establish a small group of professionals and lay people who over the next few months will consider guidelines for care for the group of women who have suffered tissue damage following radiotherapy for breast cancer. I hope that that will go some way to reassure my noble friend as to the seriousness with which we address this issue. Once again, I pay tribute to him for his diligence in pursuing the matter and in seeking to take it forward.
Lord Ironside: My Lords, before my noble friend sits down, perhaps I may ask her a question in connection with the clustering of radiotherapy treatment injuries which have occurred. Can she go further and say to what degree she is prepared to look at the situation from the point of view of an audit to see what happened and where and why it happened, with a view to preventing it happening in the future?
Baroness Cumberlege: My Lords, that is a separate point. My noble friend is due to meet the. Chief Medical Officer for England and also the President of the Royal College of Radiologists to take the matter forward. I suggest that that is the forum in which he should raise the question and receive an answer. I am concerned with the women who have already suffered through radiotherapy treatment and how best we can look after their interests.
House adjourned for the Spring Bank Holiday at one minute before five o'clock.