Westminster Hall Sitting of 4 July 2000

Preamble
[MR. MICHAEL LORD in the Chair]

Down's Syndrome
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Mike Hall.]
10 am
Dr. Brian Iddon: I am grateful for the opportunity to introduce this debate on Down's syndrome in the 30th anniversary year of the Down's Syndrome Association. I intend to highlight some of the difficulties facing the 60,000 people with Down's syndrome in the hope that we can change society's attitudes towards them. I congratulate the association on the work that it carries out on behalf of people with Down's syndrome.
My involvement with the DSA was catalysed by one of my Farnworth constituents, Mrs. Flo McBrien, the mother of Shelley, who was born with Down's syndrome. Flo had to campaign for vital surgery that has given Shelley a much better quality of life, and she now campaigns on behalf of other children with Down's syndrome, such as 18-year-old Joanne Harrison from Shrewsbury, who desperately needs a heart-lung transplant. If Joanne's heart defects had been detected by screening at birth and the necessary surgery carried out at that time or shortly afterwards, her physical condition would not be what it is today. I am grateful to Esther Rantzen, who highlighted Joanne's case and other similar cases in her television programme.
Down's syndrome is a genetic condition, linked to the presence of an extra chromosome that may manifest itself in learning disabilities of varying severity and in physical problems, especially cardiac abnormalities. Sadly, people with Down's syndrome experience discrimination throughout their lives due to ignorance and misunderstanding. In the previous parliamentary Session, I tabled an early-day motion requesting that the Government combat such ignorance and misunderstanding, especially as it affects the treatment of those with Down's syndrome under the national health service. It was the 12th most successful early-day motion in terms of the number of signatories.
I am rightly proud of the modernisation programme that the Government initiated and implemented for the national health service. Thousands of nurses are returning to the NHS and thousands more are in training. Many more doctors are coming through the process, and in a few years they will be able to practise. Thirty-seven new hospitals have been approved, many of which are under construction. Some, like the one in Carlisle, are already open.
The Government have produced two important documents about learning difficulties: "Once a Day" and "Signposts for Success". They highlight good practice for the commissioning and providing of high-quality health care for those with learning disabilities, who include adults and children with Down's syndrome. Many people receive excellent care under the national
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heath service, but some patients with Down's syndrome do not. That is unacceptable. Prejudice is encountered in two ways: by reduced access to clinically appropriate services and by the attitudes of staff who discriminate against Down's syndrome patients on the basis of disability alone.
Last year, the Down's Syndrome Association published a survey of parents of children with Down's syndrome, entitled "He'll never join the army". It showed that 28 per cent. of the 1,509 parents who were surveyed reported a high level of dissatisfaction with the standard of health care that their children receive. There have been cases of overt and covert discrimination, particularly by general practitioners, cardiologists and ear, nose and throat specialists, but also by other hospital doctors and health care workers.
Discrimination against people with Down's syndrome contravenes the Human Rights Act 1998 and the Disability Discrimination Act 1995. The rights of the disabled are exactly the same as those of any able-bodied person. Discrimination is illegal, and we must raise awareness to prevent further discrimination against people with Down's syndrome. Ignorance and misunderstanding must not be allowed to taint the image of one of the world's finest health services.
Every day in the United Kingdom, one baby in every thousand will be born with Down's syndrome, 50 per cent. of whom will be born with a heart defect that is detectable using simple, non-invasive diagnostic techniques. If such simple investigations are not conducted and the abnormality goes unnoticed, irreversible pulmonary complications can set in, resulting in a shortened life expectancy. Early diagnosis and surgery at an optimal time can save 80 to 90 per cent. of such children. Successful surgery can prevent problems that can severely compromise quality of life and life expectancy later in the child's life. The profound significance of such simple investigations and appropriate treatment must not be underestimated, because they can extend a baby's life expectancy by several decades.
Unfortunately, the existence of screening programmes is patchy, arbitrary and, where they do exist, variable in quality across health authorities. Even when screening is conducted, doctors do not always convey the diagnosis accurately or give appropriate advice, guidance and support. To illustrate the awful consequences of such inaction, I give the example of Katie, a nine-year-old with Down's syndrome. She received cardiac screening at four weeks of age, but was not strong enough to undergo surgery until she was four months old. That delay in treatment unfortunately resulted in irreversible pulmonary damage. Katie now requires a heart-lung transplant, but she is unlikely to be entered on the list for transplant surgery, simply because she has Down's syndrome. I urge Ministers to introduce a policy ensuring that all babies born with Down's syndrome routinely undergo cardiac screening to detect any abnormalities, and are referred for treatment if clinically necessary. No child should be discriminated against on the basis of disability: that is wrong, socially unjust and probably illegal.
The physical symptoms of Down's syndrome are unfortunately not confined to cardiac abnormalities. More than half the people with Down's syndrome experience difficulties with their hearing and have

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varying degrees of visual impairment. Given the nature of their disability, such sensory impairments should perhaps be corrected more speedily than for other patients so that the potential of people with Down's syndrome can be maximised at the earliest opportunity. It is therefore disturbing to learn of patients being denied access to NHS treatment on the basis of that primary disability.
The DSA has provided a catalogue of serious cases of discrimination within the NHS. For example, one mother of a three-year-old boy was told by an audiologist that if her son developed hearing problems for which grommets were the clinically appropriate treatment, he would not be offered them, simply because he had Down's syndrome. Another mother, of a 16-year-old boy, remarked:
I was asked by an ENT specialist how I thought my son's life could be improved by having his hearing increased.
Denial of treatment is denial of opportunity for those people.
From the moment of diagnosis, parents can be subjected to discrimination. Imparting the initial diagnosis of Down's syndrome is a crucial opportunity to convey positive, not negative, messages about the child's disability. One mother of a 17-year-old told the DSA:
When she was born we were told by a doctor that it would have been better if she had died at birth.
A mother of an 11-year-old stated:
Shortly after his birth a midwife told me that had she known she was carrying a child with Down's syndrome, she would have had an abortion.
A parent of a 10-year-old boy commented:
I was advised to have my son fostered or adopted when he was three months old as he wouldn't amount to anything and that it was best to try again for another baby.
Such anecdotes are profoundly shocking. Parents have recounted horrific tales to the DSA of derogatory value judgments being made about their beloved children. Other parents have met with comments that verge on racism. Imagine the gut-wrenching feeling when one's child is described as a Mongol. That is how 12 of the parents surveyed by the DSA felt. That fiercely insulting term was discarded by The Lancet in 1964, and banned in publications by the World Health Organisation in 1965. However, the term was used to parents, by staff in the national health service only two years ago. In a society that espouses equality as a virtue, such practice must be not only reviled but eliminated.
Prejudice is manifested not only by the use of insulting and derisory terms, but by implicitly and explicitly limiting the aspirations of people with Down's syndrome. One parent was told, "Well, he'll never be a brain surgeon." Another was told by an opthalmologist, "We won't bother with glasses, as he's not what you would call university material." The father of Rhian commented:
It has become apparent to us over the years that there is a general reluctance on the part of health care professionals to fully understand and treat with sympathy and interest the needs of our daughter aged 16. There has been far too much of the approach from them that, because she has Down's syndrome, this or that ailment is to be expected and not much can be done. This is almost always inherent and coupled with a patronising attitude.
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Thankfully, such comments and treatment are not typical of the modern national health service. If such treatment occurs just once, however, that is surely once too many. Even if the majority of staff do not behave in that way, the minority must be forced to change.
The Department of Health's documents "Once a Day" and "Signposts for Success" acknowledge that some people with learning disabilities do not get a fair deal in the national health service. It is estimated that, on an average list size of 2,000 patients, a GP may have approximately 40 patients with learning disabilities, some of whom may have Down's syndrome. Despite the existence of good practice and the large amount of guidance available, no national strategy currently exists to ensure that people with learning disabilities can access high-quality mainstream health services.
However, there are many examples of good practice within the NHS. Professor Tim Eden is a paediatric oncologist at the university of Manchester who works at both the Christie hospital and the Manchester children's hospital. He informed me recently that he and his colleague, Dr. Robert Wynn, a consultant paediatric haematologist, have overcome the difficulties inherent in treating Down's syndrome children who develop leukaemia. As a result, the prognosis for those children may be better than for other children with the same disease condition. Following chemotherapy, Down's syndrome children are noticeably more prone to contract infections than other children, which is the main problem. However, those medical practitioners have discovered that, by employing up-to-date nursing techniques, that difficulty can be overcome. That is good news for Down's syndrome children.
It is of paramount importance to ensure that doctors and health care workers are trained in the care of people with learning difficulties, and that any allegations of prejudice and discrimination are investigated and dealt with speedily and with due seriousness. Pressure needs to be exerted on the deans of medical schools—for example, through the General Medical Council—to ensure that training to deal with people with learning difficulties is taken seriously.
St. George's medical school in Tooting, London, is a beacon of good practice. The DSA is working with the school to develop a pioneering on-line learning package, which is funded, I am pleased to say, by a £25,000 Department of Health grant. That will allow doctors to diagnose correctly people who have learning difficulties and train them, and health care workers, to deal with that group of patients more sensitively.
Disgust at the apparent discrimination experienced by people with Down's syndrome is not confined to patients, their parents and other relatives. It extends into the health professions. Dr. Vivian Nathanson of the British Medical Association said:
Doctors are making blanket policies about treating patients. This is ethically dubious. They should all be treated as individuals, not on the basis of some classification.
Alexander Harris is a solicitor who represents a child with Down's syndrome. He contacted 180 parents of Down's syndrome children, five of whom claimed that doctors had failed to give access to vital surgery. Eight of them said that children had died or were expected to die shortly due to delays in diagnosis and surgery.
I call on the Department of Health to ensure that four steps are taken. First, cardiac screening must be compulsory for all babies born with Down's syndrome.

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Secondly, they must have faster access to all required health services and, in some instances, receive positive discrimination in order to maximise their potential. Thirdly, training has to be in place in all medical schools so that doctors and health care workers can better understand the needs of those born with Down's syndrome and other learning disabilities. Fourthly, the Department must send out a firm message to everyone that the national health service should be a model of good practice and that discrimination against those with Down's syndrome will not be tolerated.
The chief executive of the DSA and I recently met the Minister of State, Department of Health, my hon. Friend the Member for Southampton, lichen (Mr. Denham), and our proposals were given a good reception. I hope that they will be enacted. I look forward to listening to my colleagues and to the response of my hon. Friend the Minister for Public Health.
10.16 am
Mr. Mike Hancock: I am delighted to take part in the debate. I heartily congratulate the hon. Member for Bolton, South-East (Dr. Iddon) on his good fortune in having the debate chosen, and on the splendid way in which he presented the case on behalf of Down's syndrome sufferers in the United Kingdom.
For a long time, I worked for Mencap and encountered daily the problems about which he spoke so eloquently. I repeatedly came across examples similar to those that he described, although many were far worse. One thing that always arose was the long wait that parents and young Down's syndrome sufferers had for everything. Nothing was ever available when needed. The fact that the issue had to be dealt with was recognised, but there were always long periods before their needs were met and before the health service, education, respite care and housing requirements were in place. Carers, and especially parents, had infinite patience. They never asked for a great deal, but only for a fair deal, which was and is still sadly lacking in too many cases.
Down's syndrome and learning disability sufferers were forgotten after the war, 60 years ago, in the speedy process that brought our health service together for the first time. They were to be considered later, but time continued to pass. Forty years had passed before people had started to get to grips with many of the issues, which is a sad reflection on all of us. It reflects the way in which the ignorance associated with the syndrome and learning disabilities generally has been allowed to persist. For one reason or another, Governments, local health authorities and local councils have ignored the issues and decided to prioritise elsewhere. That is why debates such as this are fundamentally important.
If we are to give all individuals in our nation, whatever the skills, disabilities or intelligence they are born with, the right to fulfil their true potential at their own pace and their own level, we must make sure that we put an end to that ignorance and desire to ignore the problem. The Down's Syndrome Association, which has existed for 30 years, has made a remarkable achievement, as has Mencap, which has been in existence for 50 years. Those organisations have had to struggle to educate the public and professionals about the issues.
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It is a great shame that the Down Syndrome Educational Trust, whose national headquarters is in my constituency, failed in its recent lottery bid. That money would have given the trust an opportunity to develop the Sarah Duffen centre, which is named after a young lady with Down's syndrome who fought against all the odds to reach her true potential. She is a classic example of what can be achieved when people are prepared to give someone an opportunity. Very few people with Down's syndrome, and very few of their parents, who are given that opportunity refuse to take it. Had the lottery bid been granted, it would have enabled the trust's work to expand and develop. It would have helped the trust to make people more aware of the problems faced by those with Down's syndrome. More importantly, it would have enabled it to give expert training, which is vital if we are to help those with Down's syndrome to reach their true potential. That has been denied the trust by the lottery decision. Perhaps the Minister for Public Health might influence her colleagues elsewhere in Government to reconsider that application. No reasonable excuse has been given as to why it was not granted.
This Government and the previous one have done a lot to bring the debate further into the public domain and set things in motion. However, there are deficiencies in the ageing policy adopted in social services and health authorities, which tend to treat older people with Down's syndrome as if they were 17 or 18 years old. They have not adapted their policies to ageing people with Down's syndrome. In many day centres, those people have the same experience that they had 30 or 40 years ago when they first went there. People aged 60 with Down's syndrome are no different from other people. They do not want to sit in a room full of loud music; they want peace and quiet, and the space to develop in their own way. That space is denied to many people because of a lack of resources. Some day centres have changed, but others have not and need to do so. More needs to be done.
We must also consider the issue of respite care for the ageing population of mums and dads who have cared for their children all their lives. The needs of those parents have changed. For example, they need to be trained to let go of their children. I have spent a lot of my time, as a professional in the field, trying to educate parents to let their children take the risks that children normally take and allow them to go to mainstream schools or further education colleges. However, we had to arm wrestle people to get such children into colleges, because those children were not perceived as having the same rights as others to go into further education. Every case was a personal struggle for parents and people campaigning on their behalf. That cannot be right but, sadly, it continues to happen.
We must ensure that the benefit system is easily understandable and offers opportunities for people with Down's syndrome to do more than simply be cared for. It is important that housing is provided for those who want to be independent and are able to live alone without being a threat to themselves. However, that accommodation must be provided close to their friends and family, so that support is on hand, just as we prefer our families to live close to us so that we can support them. Housing for people with disabilities is often the

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last thing that is thought about. Often, such housing is situated in places that are out of the way and difficult to reach.
We must also provide work opportunities. I remember many examples of youngsters, who previously were given no chance, responding when they were offered proper opportunities. A classic example is that of a young lad who moved to Guernsey from his home in Glasgow when his father retired from the Glasgow police force. He had lived in a long-stay institution for 15 years, but he went to work, first on a day placement and then at Grow Limited, an organisation that was formed by Mencap and gave such youngsters in Guernsey an opportunity to work. Within two years, he had learnt to drive and had passed his driving test. Had he remained in Glasgow, he would not have had that opportunity. He was able to take it because people could explain to his parents nicely that their son was now a young man and deserved the right to be released from their care for long enough to take some of the risk that we all experience, to fulfil the potential that was always there and to gain some satisfaction in life. The boy's life changed completely, as did that of his parents. Many other examples show how much can be achieved when time is taken and the pressure is off.
This debate opens the door for a great deal of opportunity and I am delighted and proud to have taken part in it. Once again, I congratulate the hon. Member for Bolton, South-East on his contribution to the struggle to get a fair deal. People with Down's syndrome do not ask a lot; they want only to be treated in the same way as every other young person and adult in Britain—to be given a chance and an equal share of resources, to be taken seriously and to be treated with respect and dignity. In my opinion, that is not a great deal for people to ask. After a 50-year struggle, it is about time that we as a nation recognised their rights.
10.26 am
Mr. Ian Stewart: I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on having secured this important debate. I come to the issue as a constituency Member of Parliament. Although I had a general awareness of Down's syndrome as an individual, my attention was focused and heightened by my contact with the Bell family, who live in my constituency and about whom I shall say more later.
When my attention was drawn to Down's syndrome children and the problems that they face, I found out some statistics. Two babies with Down's syndrome are born every day. As my hon. Friend the Member for Bolton, South-East pointed out, half of those children will have some form of heart defect. Failure to detect such problems early in life can have serious consequences. If they are found early, they can be fixed through surgery, as has been pointed out. If screening does not occur until later in life, however, a degenerative heart condition can cause serious health problems and even death. Because of the stigma attached to Down's syndrome, many patients are not given the essential heart screenings that can avoid such grave health consequences. The Down's Syndrome Association
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recommends that every child born with Down's syndrome should be given an echocardiogram to screen for heart defects. That is the only test that can provide an accurate diagnosis. The majority of defects are surgically treatable with a good prognosis, but if they are left too late, there can be irreversible change from pulmonary vascular disease.
Last year, the Down's Syndrome Association conducted research among 1,500 families with a Down's syndrome child. It showed that 28 per cent. of its members had experienced discrimination. It was alleged that in some cases discrimination went as far as withholding treatment and that children had died as a result. Discrimination against Down's syndrome patients is rampant. It ranges from name calling to the denial of necessary medical treatments. I have been told that some Down's syndrome cases have been passed over for heart and lung transplants because it was felt that their lives were of less value. Article 2 of the Human Rights Act 1998 states:
Everyone's right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which the penalty
provided by law is death.
More than half of the people with Down's syndrome have significant hearing problems, and problems with vision are at least as common. Help for vision and hearing problems is available through surgical intervention or by providing glasses, hearing aids and other techniques, which are offered routinely to other groups of people. It is imperative that hearing and vision problems are recognised and treated so that they do not create further obstacles to full development. Those children have the right to develop as fully as other children.
To combat the mistreatment of Down's syndrome patients, the Down's Syndrome Association recommends that every medical student should receive longer training on learning disabilities. Improvements need to be made to many aspects of treatment, including the manner in which the medical staff first inform parents that their child has Down's syndrome, and the actual treatment of the child. Such programmes have been developed, but should be given a higher profile.
St. George's medical school in London has developed a successful course, which uses practical case studies of people with learning disabilities and their problems. It addresses not only the medical issues involved but the attitudes of the students. However, the class is optional. The Down's Syndrome Association is working with St. George's to develop a web-based learning tool on how to diagnose effectively, and treat sensitively, people with learning disabilities as well as those with Down's syndrome. The Department of Health has donated £25,000 to that cause. The money is welcome, but more needs to be done.
At the beginning of my speech, I referred to the Bell family in my constituency of Eccles. I am proud to have made the acquaintance of Ms Alex Bell, who fosters six Down's syndrome children. I have rarely met a more happy, secure and loving family, but I mention the Bell family only to highlight the problem. I am sure that there are many other loving families throughout my constituency and, indeed, the United Kingdom. They

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need understanding and support, but that demands a change of attitude in our society. I know that the Government will take steps to ensure that proper support is forthcoming and to engender such a positive change in attitudes. I support the four demands made by my hon. Friend the Member for Bolton, South-East and congratulate him again on securing this debate, which highlights such an important issue.
10.33 am
Sandra Gidley: I should like to congratulate the hon. Member for Bolton, South-East (Dr. Iddon) on bringing this matter to our attention. I also congratulate my hon. Friend the Member for Portsmouth, South (Mr. Hancock) on his contribution. It was heartening to hear him say that matters have improved in the past few years, although we have a long way to go.
We heard that 60,000 people in the United Kingdom have Down's syndrome. Every day two people are born with the condition. The key word in both those sentences is "people". Down's syndrome people look a little different, are more prone to a range of health problems and, yes, may act a little differently, but all people deserve to have the best health care possible so that they can lead happy and healthy lives. Who are we to decide that people with Down's syndrome do not deserve the very best—and believe me, they are being denied the best. I read the survey entitled "He'll never join the army", which I would recommend to anyone because it is a real eye opener. I defy anyone who reads it not to be shocked and horrified.
From the moment of their birth, comments about Down's syndrome babies are commonplace. The survey gives several examples. For instance,
When it was discovered that the baby I was carrying had duodenal atresia, one doctor suggested that we withhold permission for the operation that was essential to save her life.
Or,
An eye specialist recently told me that my daughter needed glasses 'but with her condition one would not be able to tell if there was any improvement in sight'.
Or again,
He was screaming and rolling around in agony. The doctor asked if he was in pain—as if he was an alien.
Finally,
Our son was described by a senior physician as 'an unacceptable burden on resources medically, socially and educationally'.
Those examples are indicative of an oft-prevailing attitude—but it gets worse. One in two children with Down's syndrome are born with a heart defect. Some are minor, but others are severe and require medication or surgery. It is essential that those problems are identified in the first few weeks of life, but although the possibility of heart problems is well known, all too frequently an echocardiogram is not carried out and the symptoms are ignored. It should be compulsory for testing to be conducted in the first couple of weeks of life. Again, the examples are heart wrenching:
I was told by our original paediatric consultant that it would cost at least £10,000 for heart surgery and that they would rather spend that sort of money on a 'normal' child…
and:
Our daughter's heart problem was not found until she was two years old, which we found strange as so many children with Down's Syndrome have some sort of heart defect. Then we were told it was too late to operate.
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Those attitudes are still prevalent, yet there is a body of evidence to show that an early operation is less of a financial burden on the health service, and is in the best interests of the patient. If the operation is not performed, the prognosis is poor. In their early 20s, sufferers will probably be wheelchair bound and in a great deal of pain and discomfort, not to mention the fact that that will cost the taxpayer a great deal more money than the original £10,000.
All that makes harrowing reading, but I do not believe that the majority of medical staff involved are deliberately cold and uncaring. Their comments often stem from ignorance and lack of sensitivity. A seemingly cold and callous remark at birth can make it difficult for parents to bond with their new baby, and I would go so far as to say that it can potentially cause long-term problems with the relationship.
We witness discrimination. The basic training need must be addressed, because health professionals must be able to see the person, not the disability. It will take a long time to change entrenched attitudes, but we can make a start by insisting that students in the health professions receive training in learning disability issues, as mentioned by the hon. Member for Bolton, South-East.
I have come across children with Down's syndrome ranging from the cheerful and happy to the downright disruptive—exactly the same range of behaviour found in so-called normal children. In any group of people there are a wide range of behaviours and abilities, and we typecast any group of people at our peril. Health professionals must learn to see the person, not the condition. People with Down's syndrome no longer regard themselves as sufferers.
It is more difficult to insist on on-going training as, in my experience, those who are most in need of training are least likely to seek it. Once that is in place, attitudes will begin to change. I would then hope that no person with Down's syndrome would be treated differently or would ever be denied treatment because of his or her condition. By that, I also mean that the appropriate medical tests should be undertaken. Those are some of the aims of the Down's Syndrome Association, as outlined by the hon. Member for Bolton, South-East. I wholeheartedly support those aims and urge the Government to do all they can to deal with those problems.
10.39 am
Mrs. Caroline Spelman: I add my congratulations to the hon. Member for Bolton, South-East (Dr. Iddon) on securing the debate. This is the first time that I have followed the hon. Member for Romsey (Sandra Gidley), so it is nice for me to be able to welcome her to Westminster Hall for an Adjournment debate.
The topic that we are considering is a classic subject for an Adjournment debate, because all political parties are trying to tackle fundamental prejudice in society. We have talked about health professionals, whose response has a key part to play in achieving what we want for people with Down's syndrome. The truth is that prejudice in the population at large is extensive. We are tackling a big problem in society, and that can be done effectively only by taking a cross-party approach.

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Probably the most anxious moment for any parent of a newborn baby is when the child is passed to the paediatrician for health checks. What the health professionals then say to the parents is paramount. I expect that there is not a parent in this place who would not recognise the worry of that moment. The words that doctors use often replay in the parent's mind for years to come, and if crass or insensitive language is used, the damage can be very real. We have heard examples of just the wrong kind of language being used.
Many women opt for tests for Down's syndrome during their pregnancy, but for many that is a difficult decision. The classic test of amniocentesis carries a risk of miscarriage, and women who have miscarried may fear such a test. Faced with the dilemma of what to do if it were established before birth that the child had Down's syndrome, many mothers decide not to cross that bridge at that stage and do not have the test. The birth is often the moment when the discovery is made. In a handful of cases—an example occurred recently—the test can be wrong. That, as we saw from the interview with the parents, causes real distress.
A cultural problem has arisen. With new technology, we are moving into an era when prospective parents think of having a perfect baby, a perfect birth and no problems. The truth is that human beings are born in different shapes and sizes, with a wide range of variations in ability and disability. That huge variation is part of our make-up. As the hon. Member for Portsmouth, South (Mr. Hancock) said, there is a huge variation in the severity of Down's syndrome. In some people with the condition, the symptoms are very mild and they are perfectly able to lead a virtually normal life. I wholeheartedly agree that they should be given every opportunity to do so. Set against that, the appalling statistic that more than a quarter of parents of Down's syndrome children have experienced discrimination at the hands of health professionals needs to be tackled.
Like the hon. Member for Romsey, I read with horror the results of the survey carried out by the Down's Syndrome Association, "He'll never join the army". I read the whole document, and was aware of the same telling phrases that several hon. Members have referred to, which show how damaging language can be, and of the fact that decisions made by health professionals have adversely affected the outcome for some Down's syndrome children. I was also shocked by the responses to the two questions in appendix 3, which show the scale of the problem. There were 1,509 responses to the survey, and beyond the 28 per cent. who were dissatisfied with the NHS help that they received, 126 respondents experienced specific difficulty in certain disciplines of medicine. It is important to dwell on that finding for a moment, because it may help the Government to focus their efforts on the relevant areas.
Interestingly enough, the greatest difficulty was experienced in cardiology. We should not be surprised by that: cardiac conditions in people with Down's syndrome need special attention. The survey showed that, for those parents, that discipline's response was inadequate. Next came general practitioners, which suggests that an extra effort needs to be made in training
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GPs, as they are often the gateway to specialist treatment. I suspect that that is the cause of some dissatisfaction.
In third position came ear, nose and throat specialists. We have already heard that prejudice may exist and that quite straightforward procedures such as the fitting of grommets are sometimes not thought to be worth while. That is clearly a long way from the guidance given to the profession on how to deal with such cases. Such instances highlight where the Government should focus their attention.
The view of those at the top of the medical profession is clear. Dr. Ian Bogle, chairman of the British Medical Association, said:
All patients are entitled to good standards of practice and care from their doctors. A person with Down's syndrome has the same rights as any other person.
That, however, contrasts with people's experience. We heard that St. George's teaching hospital has a special programme to help doctors to learn more about what might benefit patients who have learning disabilities. My immediate thought was that if St. George's hospital can do it, others can too. Distance learning packages, such as the one described by the hon. Member for Portsmouth, South, are a good answer. We often see best practice in the NHS, but it seems incredibly difficult to disseminate that throughout what should be a national service. I ask the Government to redouble their efforts to cross-fertilise those good ideas.
I want to talk a little about age management, mentioned by the hon. Member for Portsmouth, South. I have a residential care home for people with Down's syndrome in my constituency. By coincidence, I was there on Saturday. Some of the residents are over 60 years old. That is a long lifespan, especially for people who have different requirements at various stages of life. I am pleased to say that that residential home is much more a home than an institution for the residents, some of whom have lived there for more than 30 years.
I was struck by what the hon. Member for Portsmouth, South said about older people not enjoying beat music blaring out from a ghetto blaster in a corner of the room, because some of the rooms in that residential home had been made quieter and more suitable for those women who were getting on in years. As a result, activities were possible in those quieter rooms that would appeal to ladies at that stage of life, such as weaving and other crafts. We must be careful not to take a "one size fits all" blanket approach to the needs of people with Down's syndrome. As the hon. Gentleman said, the condition varies so much that provisions need to be tailored to bring out everyone's full potential.
What more does the Minister think could be done to enforce the existing guidelines for dealing with Down's syndrome? Those guidelines are clearly not respected by all health service practitioners. If the guidelines are not adhered to, sanctions must be available. No one with Down's syndrome should be refused treatment on the grounds of that condition alone. Such action cannot be right. If hospitals were aware that claims could be made against them for negligence, they would be much more careful about what they said and did to patients who have Down's syndrome.

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I agree that an echocardiogram should be carried out on all newborn babies to ensure that Down's syndrome children are not discriminated against. There is no good reason for denying them that procedure. Indeed, it is a cost-saving measure, as has been said. If it is carried out early, it can save considerable problems later. It is difficult to understand what the justification could be for failing to do that. If a hospital fails to carry out that procedure and it is decided that it should be policy to test all newborn babies with Down's syndrome, the hospital should be subject to negligence claims.
In reply to a question from Lord Robertson of Oakridge in the other place last October, Lord Hunt of Kings Heath said:
The current guidance on health services for people with a learning disability…which includes Down's Syndrome, makes clear that they have the same right of access to NHS services as everyone else and that special care should be taken to ensure that they are not denied health care because of their disability.—[Official Report, House of Lords, 11 October 1999; Vol. 604, c. WA35.]
That is a clear and unequivocal ministerial statement, but nevertheless the guidance is ignored. I should be interested to hear from the Minister how that guidance can be made effective. The good-practice programmes "Signposts for Success" and "Once a Day" have not got to the root of the prejudice against people with Down's syndrome. We must start training the health professionals involved much earlier in the process.
The sanctity of life is the principle that underlies our demand for an end to discrimination against people with Down's syndrome. I do not believe that there is party political division on this issue. The problem is how to achieve our aim.
10.51 am
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon) on securing this debate on an extremely important issue. His points and the statements that he and other hon. Members quoted from their constituents and the Down's Syndrome Association report "He'll never join the army" are extremely powerful testimony to the trouble and torment that discrimination and indifference can generate for people with Down's syndrome and their families. They highlight the problems that people with Down's syndrome can face in practice.
People with Down's syndrome have the same rights of access to health and social services as anyone else. They should not be discriminated against simply because they have a learning disability. I am proud that the Disability Discrimination Act 1995 and the Human Rights Act 1998 are on the statute book. Those measures are designed to stamp out unacceptable practices and to make people more aware of when they are discriminating against others or undermining or denying others' rights. The Acts apply as much to health services as to other spheres of our lives.
Guidance issued to the national health service in 1996 made it clear that it is against the law to offer a service that is not as good as that being offered to other people, purely on the grounds of an individual's disability. Discrimination on the grounds of learning disability in our health services is unacceptable. However, in
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practice, discrimination and prejudice continue. Some of that discrimination stems simply from ignorance, and I pay tribute to the valuable work of the Down's Syndrome Association and other organisations in raising awareness of the needs of children and adults with Down's syndrome. The Minister of State, my hon. Friend the Member for Southampton, Itchen (Mr. Denham), met representatives of the association and my hon. Friend the Member for Bolton, South-East to discuss their anxieties, especially about possible discrimination in the health services against people with Down's syndrome and about training medical staff and others.
The association also had the chance to give evidence to the second stage of the Brompton hospital inquiry, which is considering parents' anxieties about the matter. However, raising awareness and setting standards to prevent discrimination are not a matter simply for the law and voluntary organisations. The NHS also has a part to play.
Guidance issued in 1992 reminded authorities that people with learning disabilities have the same rights of access to NHS services as everyone else, and stated:
Special care must be taken to ensure that they are not denied health care because of their disability.
That guidance was followed up in 1998 by far more detailed guidance in "Signposts for Success", which was mentioned by my hon. Friend the Member for Bolton, South-East. That publication provided good practice guidance on commissioning and providing health services for people with learning disabilities, stating that commissioners of services should develop service specifications, standards and monitoring to ensure that there are guidelines for sensitive sharing of information with parents about their child's impairment—points that were raised this morning by hon. Members. It also recommended that commissioners should ensure a shared understanding of the needs of families and the specific needs of children with disabilities and, importantly, the provision of early intervention services and counselling, as well as access to the necessary specialist services, for families.
We continue to reinforce the guidance contained in "Signposts for Success" by publishing booklets aimed at specific groups of health service staff. "Once a Day", to which reference has been made, was aimed particularly at primary health care staff and stressed the need for the sensitive sharing of information about a child's disability. It also stated:
Particular conditions, such as Down's Syndrome, carry an increased risk of certain health complications such as cardiac disorders, respiratory problems, thyroid disorders and hearing impairment.
We are preparing guidance based on "Signposts for Success" for staff in in-patient and out-patient services. That guidance has received considerable support from professionals, from those responsible for commissioning and providing services and from family carers.
The big question is how far that guidance is implemented in practice. A recent survey commissioned by the Department of Health, entitled "Facing the Facts" shows that there is still considerable variation in the health and social services provided for people with Down's syndrome. In other words, provision is patchy.

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That situation has also been spelt out in the work of the DSA and by the contributions of hon. Members this morning.
Implementation is vital, as is ensuring that we spread to every area the best practice that we know occurs in some areas. It is unacceptable that the care received by people with learning disabilities and Down's syndrome should depend on where they live. That is why we announced last year a new national learning disability strategy, to be launched towards the end of this year. We do not envisage a radical departure from existing policies and guidance, although we need to build on them; the central task is to make sure that we eliminate inconsistencies in service delivery and that all services meet the level of the best.
Work on the strategy therefore seeks to identify ways in which current policies and good practices can be implemented across the NHS and social services. As part of that work, we will consider what monitoring arrangements need to be put in place to ensure the proper implementation of the strategy and the prevention of unfair and unacceptable discrimination against people with Down's syndrome. The work is being taken forward in several small sub-groups that address a range of issues on children, supporting independence, health and work force planning and training.
We are involving a wide range of interests, including people with learning disabilities, family carers, professional organisations, providers, the Association of Directors of Social Services, the Local Government Association, the NHS Confederation and voluntary organisations throughout the sub-groups, the Department's learning disability advisory group and focus groups. We have also commissioned work on such issues as access to primary and hospital care, research issues, cancer services and services for black and ethnic communities. Dr. Oliver Russell chairs the health subgroup and he, with other officials, met the DSA last year to discuss its concerns about cardiac screening, discrimination and medical and other staff training. The sub-group on children has also considered such issues as early intervention and family support and has involved a number of advisers, including the DSA. I hope that our debate will inform work on the development of the new learning disability strategy.
I shall now respond briefly to the points that have been made in the debate. As my hon. Friend the Member for Bolton, South-East said, children with Down's syndrome are known to have a much higher risk of congenital heart disease than the average population: 40 to 50 per cent. of such children will be born with a cardiac abnormality. Given the known predisposition of that group of children to such problems, it is clearly good clinical practice to assess such babies for cardiac abnormality at the earliest possible opportunity, using the full range of non-invasive diagnostic methods that are available. That is the best way to ensure that appropriate treatment can be offered at the optimum time to achieve the best possible outcome for the child. Obviously, it is a matter for individual clinical judgment to ensure that the assessment is undertaken at the most appropriate time, taking into account the condition of
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the baby and the state of mind of the parents. How we ensure that that best practice is followed up certainly needs to be part of the new strategy.
My hon. Friend referred to the need to speed up access to care for those with Down's syndrome. All children have access to child health surveillance programmes, but it is clear that those with known needs often require referral for assessment earlier than the usual developmental checks. For those children, earlier detection and intervention can be helpful in best achieving their full potential. The child development centre, working in conjunction with the child, parents and professionals in many agencies, should be well placed to draw up an appropriate plan for the child's health, skills, development and play.
My hon. Friend referred also to the training of medical undergraduates and health professionals. University medical schools determine the content of the curriculums in the light of the recommendations of the education committee of the General Medical Council. Furthermore, the medical curriculum development scheme was launched in April 1998 to encourage national health service bodies and partner medical schools to work together on curriculum development to meet NHS needs. The chief medical officer has made available funding for six projects, the purpose of which is to consider what permanent mechanisms can be put in place to review and address NHS needs in curriculum development.
One of those projects is based in Leicester and is called "Learning from Lives". It is aimed at third-year medical students and has two themes, one of which is a comprehensive understanding of the nature and consequences of chronic disability. Students undertaking the course explore the differing needs of elderly and younger mentally and physically disabled patients and investigate the range, roles and accessibility of the multi-disciplinary teams that are involved in the care. Organisations from the voluntary sector are also involved. Students will be expected to develop professional behaviour and adopt a positive regard towards disability.
The projects are now in their final year and the Department of Health intends to publicise as widely as possible the good practice that is emerging from them to encourage similar collaboration in curriculum development elsewhere. The NHS executive is currently looking at suitable ways in which to do that. In addition, as a result of a meeting between the Minister of State, my hon. Friend the Member for Southampton, Itchen, and the Down's Syndrome Association, we have provided support for new website work that is being developed by the association because we must ensure that all clinical staff involved in the care of babies with Down's syndrome are aware of the health problems commonly associated with the condition, so that they can be picked up at an early stage.
I have mentioned other measures that we are taking to improve the recognition of wider health needs, but the work being carried out by the Down's Syndrome Association, supported by the Department of Health, to develop interactive web-based training is aimed specifically at raising the awareness of the condition among medical students. That is an important step forward.

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The Hon Member for Portsmouth South (Mr. Hancock) spoke about the importance of promoting independence, opportunities for work and education and developing full potential. Clearly, that is vital for people with Down's syndrome and for all people with learning disabilities. Opportunities should exist for everyone, whatever their circumstances. He also raised the issue of supporting older people with Down's syndrome. I wholeheartedly agree with him on that; it is another of the issues being considered in relation to the learning disability strategy.
Mr. Hancock: The Minister has made great play of the part that the strategy will play. Many people outside this Chamber will be interested to know when it will be published, when and if any associated action plan will materialise, and whether it will be resourced in such a way that it will be deliverable.
Yvette Cooper: The approximate timetable for the plan, which was launched at the end of last year, is to conclude its work and publicise the new strategy towards the end of this year. Clearly, the strategy must be deliverable. I cannot, at this stage, provide details of the content and form that it will take, because work is still under way, including in the sub-groups.
The hon. Member for Meriden (Mrs. Spelman) asked about enforcement mechanisms, and how to ensure that guidance is properly followed. Clearly, we must consider how to monitor the implementation of the strategy. That raises a broader question of how to spread best practice across the NHS in many different fields, which has been given detailed consideration as part of the development of the national plan, not just in this area but across the board. It is important to spread best practice rapidly, rather than in isolated examples.
My hon. Friend the Member for Eccles (Mr. Stewart) and the hon. Member for Romsey (Sandra Gidley) referred to communications skills in relation to training for the medical profession. That is already part of the guidance in "Signposts for Success" and "Once a Day", and must be reinforced in the additional guidelines for in-patient and out-patient staff. More work will be necessary, as part of the strategy, to make that difference.
I shall touch briefly on some more general issues in relation to helping Down's syndrome children and their families. They will benefit from initiatives to improve the services available for those with learning disabilities. Following a baby's birth, all children with Down's syndrome and their families must have a named health visitor. They should receive support from that health
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visitor, who, along with the family's GP, will be the main source of support and referral to other agencies. The primary health care team should offer the child health surveillance and a screening programme as agreed locally, and should work closely with the local community child health service to ensure that a care plan for child and family is properly formulated. In some cases, the child and family will be referred to a child development centre for a fuller assessment of their needs. That will provide a single door for multi-agency assessments to be carried out by health, social services and education staff. Clearly, there are implications not only for health services but across the board.
The Department of Health guidance, "Welfare of Children and Young People in Hospital", recognises and promotes the cardinal principle behind treatment—to provide support for the child as a whole and not simply for the condition for which treatment or care is required. The guidance acknowledges that children with disabilities who need hospital admission are doubly disadvantaged. Health service providers are therefore advised to ensure that facilities, procedures and staff can cope with the special needs of children with a physical, intellectual, sensory or communication disability.
We also recognise the need to provide for specialist staff training and orientation, which is reflected in the use of the court budget funding. The purpose of that budget is to stimulate training initiatives for child care health professionals. That is the source of the support for the Down's Syndrome Association. Through that support, we produced a template for the correct approach to families with a disabled child. It provided standards against which services could judge their performance, and was included in the Department's guidance document for health services in the community.
Considerable work has been carried out on this important subject, but we know that there is much more still to do. I congratulate my hon. Friend the Member for Bolton, South-East on bringing the issue before Parliament, raising public awareness and working with the DSA to provide proper information about the difficulties often faced by Down's syndrome sufferers—adults and children—and their families. We are committed to supporting such action. We have much work to do across the NHS, with the voluntary associations, and with all those who believe that discrimination is completely unacceptable in our health services.
11.11 am
Sitting suspended.

Transport (South-West Norfolk)
11.30 am
On resuming—
Mrs. Gillian Shephard: First, may I say how grateful I am to be able to raise in the Chamber the issue of transport in south-west Norfolk and, by extension, in rural areas throughout the country? The Minister will be aware that petrol prices and, in particular, the Government's imposition of higher and higher levels of tax on road fuel are at the top of the public's agenda. The Sun today is full of advice for the Minister, which it couches in the immortal words "Get It Down Brown." It is supposed to be positive and constructive. More seriously, on 2 July The Sunday Times pointed out that, since the general election, motorists have been hit with an £8 billion hike in taxes, which is equivalent to a 4p in the pound rise in income tax. Annual excise duties on petrol have risen by more than £6 billion, value added tax receipts from petrol have risen by more than £1 billion and road tax has increased by £700 million, all of which adds up to nearly £8 billion.
I know that the Minister will avoid giving the impression that fuel price rises are due to more than increases in the price of crude oil, but the public know where much of the blame lies. It will help his credibility if he does not try to blame the previous Government, although he will probably do that. His Government have been in power for the past three years and the public hold them responsible for the tax increases that have made petrol—at £4; a gallon—the most expensive in Europe.
I want to raise the results of a survey that I recently conducted on transport in south-west Norfolk. To date, 500 people have responded, although I expect many more to add their views. The Minister will be interested to know that nearly 100 per cent. of respondents believe that the Government should pay more attention to transport issues, such as railways, road improvements and traffic. Some 90 per cent. support people who are protesting against the rise in petrol taxes and 80 per cent. believe that more should be done to encourage the use of public transport. Interestingly, 62 per cent. do not—because they cannot—use local bus services, which are inconvenient, do not exist or do not reach their villages. The Minister should note the significant statistic that only 31 per cent. of pensioners are able to use concessionary bus fares in Norfolk because of the lack of services.
The Minister will point out—justifiably—that Norfolk has received a substantial grant for the development of rural bus services. It certainly has. I welcomed the grant when it was announced, but I also explained that the rural economy is so diverse that no transport system could cope with all its needs. Moreover, the way in which the grant was established militated against the sensible deployment of the initial £1.5 million hat Norfolk received.
In a briefing note produced for me last week by the county council, Andrew Harding, the officer in charge of such matters, said:
The grant was set up, quite properly, with conditions to prevent local authorities being tempted to substitute grant for local funding of established bus services. This can lead, however, to the
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situation where, due to local authorities budgets being fully committed, an established and well-used bus service could be denied the full financial support it requires, whilst a new RBSG service carrying fewer passengers is maintained. In the interests of obtaining Best Value, overall more flexibility would be desirable.
The county council has done its best under the rather unsatisfactory conditions imposed on it by the Government for the use of this subsidy, but the results of those initial requirements have not gone unnoticed by the public. The secretary of the Watton and district chamber of commerce, Martin Anscombe, wrote to the director of planning and transportation at county hall last autumn. He said:
I have now been asked by this Chamber's Committee to express the view of members in the strongest possible terms. That is simply that the provision…as far as Watton is concerned, is a complete waste of public money. There are now some 130 additional buses per week through Watton…Informal observations indicate that the new services are so far very little used, with large single decker coaches arriving and departing empty or nearly so. The effect of the grant has been the setting up of new services on a somewhat scattergun approach with no time for consultation or a thorough examination of either need or effect.
I raised this matter in the House last autumn. I am dismayed to find that the county council is still asking for more flexibility, to enable it not to waste this publicly provided subsidy for the rural bus service. I hope that the Minister will respond to that point or undertake to consider it. The most acute anxiety about rural transport—it has now reached crisis point—is that no public transport system can provide for the diverse needs of a rural area in which there are several population centres to which people travel for services and work. Not only do some people in such areas have more than one job, but it is by no means uncommon for one family to need two or even three cars in order to get to work. The fact is that people in rural areas need cars. For them, cars are not a luxury. Whether they need to work, shop or to gain access to medical services or schools, they are being precisely and punitively targeted by the Government's fuel tax policy while at the same time being exhorted in the name of the environment not to use their cars.
The Minister might not want to take my word for it, so perhaps he would like to hear the comments of some constituents of mine who responded to my traffic survey. Mr. Green of Outwell said:
It is ridiculous to keep putting tax on fuel hoping to try to get people to use public transport. Living in Outwell, I need my van for work, and to get places, and also to pick up my 2½ year old son and to take him back. I could not do that using a bus. I am a self-employed plasterer and work on different jobs all over the place, eg. one day I might be at Emneth, the next day at Gedney Hill, then maybe Walton Highway.
The Minister may want to listen to the following point:
I do not think that taking my cement mixer, buckets, levels, straight edges board and stands and trowels on a bus and then walking four to ten miles to the house I am plastering is a practical idea… Remember this is not London where a bus or taxi comes past every two minutes. So putting tax on fuel is disgusting. Remember an increase in fuel means everything else has to go up.
Those are the words of a self-employed man.
Mr. Middleton of Bradenham describes a different problem. He says:
I am a disabled person. I have a motability car, which costs me just under £40 weekly. There are no buses in this area that will take a wheelchair. To go anywhere I must use the car. The nearest rail station is 20 miles away. My car still costs me £40 weekly even if I

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don't use it, so it is cheaper by far to use it all the time, rather than just to go to the station and pay fares on top of the £40. I am, as most people are, quite concerned about pollution, but I feel that the Government is treating us rural persons very unfairly. Putting more tax on fuel will not bring the train or bus closer to my home… I feel I am really being got at. I am an OAP with a non-elastic income.
Mr. Wilkinson of Watlington writes:
In rural areas such as South West Norfolk, public transport is not an effective mode of transport, especially when we live out of town… We need our own transport, so Mr. Prescott's idea that there is no need for more than one car per family is totally out of touch with what is going on in the real world… I live in Watlington near the railway station, and I work at the power station at King's Lynn, which is on the south side of the town. To use public transport, I would have to walk a quarter of a mile to the Angel pub to catch the bus, travel all round the houses for 3 quarters of an hour, reach King's Lynn, then what? How do I get to the power station when it is not on my bus route or any other? Ah yes walk again for another mile or so. Totally unacceptable and unreasonable, after over an hours journey I can't get to work, assuming they don't cancel the service that day without telling anybody.
Mr. Birt of Watton writes as follows:
I heard that the Deputy Prime Minister had spoken on the question of transport and suggested that drivers over the age of 70 should stop driving. I gave that great thought as I am 89 years of age (still a good driver). I decided to give up driving. Result, I am tied to Watton due to a bad bus service. Should I go to King's Lynn or Thetford I cannot return home after 6 o'clock.
Mr. Birt's letter speaks volumes for the life and vigour of people of 89.
Mrs. Gyll Bradley writes:
I am a single mum on an extremely low income, yet I have to run a car to get my daughter to school or to go shopping. The nearest town is Wisbech and we have no regular services at all. The nearest train service is 10 miles away, so I need a car to get to the station. When I lived in London I didn't need a car and used the transport system—cheaper I hear than most up here. The petrol is also cheaper in London—why? They need cars less and yet it costs them less to run one! Cycling is fine in Cambridge, but locally it can be very dangerous, the roads are narrow and bendy and people drive too fast and there's no one around to stop them doing so. There is an increase of folks driving without tax and insurance around here, can you wonder though, some weeks I have to go without important items just to make sure that the car is roadworthy and legal. I would love to ditch the thing and get a bus—but they are so rare we take photos of them and put them in our "Endangered Species" album!!
We should remind ourselves that, at the 1996 Labour conference, the Deputy Prime Minister promised
immediate benefits for the travelling public
as a result of the Government's transport policies. The result has been that people in rural areas, who have to use their cars because of the nature of the economy and because of the deficiencies of the public transport system, are being penalised because they live in rural areas. That cannot be fair. In particular, people at work, the self-employed, the disabled, elderly people and people with families have been accurately targeted for punitive and regressive tax treatment—not the picture of the inclusive Britain that we were promised before the general election.
The Minister will certainly say that there have been international increases in the price of crude oil, and that is true. He might also say that the previous Government introduced the fuel escalator, but he cannot deny that our petrol is the most expensive in Europe because we have the highest fuel tax in Europe. For every £20 spent
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at the petrol pump, £17 is taken in tax. Meanwhile, according to figures from the House of Commons Library, planned spending on transport will fall by 12 per cent. between 1997–98 and 2001–02. To add insult to injury, only 14 per cent. of the £36 billion being taken from road users every year is going back into road improvements.
In my constituency it is not uncommon for people to have to take a round trip of 14 miles to visit a general practitioner. They might have a round trip of 24 miles to go to the nearest supermarket, and to go to the nearest hospital might require a trip of 36 miles there and back. I give those figures because they are the distances travelled by people from the village where I live. Of course, older people must quite frequently make trips to the GP, to pick up medication. Trips to the hospital may be necessary, perhaps to visit older relatives. Although everyone tries to support local shops, they must from time to time visit the local supermarket.
The Government's tax policy on petrol, therefore, has an impact on all those people, who do not have a choice. They do not have a choice of sensible public transport that suits their needs, as my constituents have shown in their comments. Nor would it be possible for a public bus service, for example, to provide for every need. I accept that. However, the excuse that is given is that petrol tax increases are possible because we have a viable alternative in a bus or train system. I have tried to show that that alternative does not exist. My constituents must use their cars and, therefore, be taxed.
This tax policy has an impact on all people in rural parts of Britain. People are being unfairly and punishingly taxed off the roads, for no fault of their own—merely because of where they live. We shall have reached a pretty pass if older people on a fixed income must calculate whether they can afford to go to the supermarket or the doctor. The Minister is, I know, a sensible and reasonable man. He has the great good fortune to live in a splendid part of London—Streatham—but that will not necessarily put him in a position to empathise with my constituents, and other people in rural Britain, over the plight to which they have been reduced. I recognise that he cannot today, at a stroke, say, with The Sun, "Get It Down Brown", but I want him to say that he has heard the pleas, which are genuine. They are the voices of my constituents, who speak from the heart about a state of affairs that some of them are beginning to find frightening. The Government will allow that to continue at their peril. Believe me, people in rural areas have had enough.
11.48 am
The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Mr. Keith Hill): I congratulate the right hon. Member for South-West Norfolk (Mrs. Shephard) on securing the debate. She has raised several important transport issues and explained their impact on her rural constituency. I am pleased with this opportunity to demonstrate the Government's commitment to improving transport and the quality of life of rural communities such as the one that she represents.
We set out our policy framework for transport in the integrated transport White Paper. We are taking further powers in the current Transport Bill and our

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forthcoming 10-year transport plan will set the investment framework for providing a modern transport system that will be accessible to everyone. Of course, I cannot give details of the plan today, but I am confident that it will represent a step change improvement in the way we meet transport challenges. It will enable us to implement solutions identified through our programme of multimodal studies of problem corridors; it will enable new rail infrastructure to be installed, more innovative and flexible bus services to be introduced, and additional investment to be made in the road network, particularly by means of much-needed bypasses. It will also enable the transport problems of rural communities and the effects of social exclusion to be tackled, and it will help us to give everyone a better choice in transport.
The forthcoming White Paper will set out the Government's vision for rural England. We have launched a discussion document, and have received more than 800 responses, which have been summarised and posted on the Department of the Environment, Transport and the Regions website. We expect the White Paper to focus on sustainable economic growth and regeneration in rural areas, access to services in rural areas and social exclusion, all of which are linked to transport. We shall consider the recommendations made by the Select Committee on the Environment, Transport and Regional Affairs as we continue our preparation of the White Paper.
I sympathise with the anxieties about petrol prices and fuel duty that were expressed by the right hon. Lady's constituents, but it is essential to place those concerns in context. First, the Government are reversing the previous Government's legacy of under-investment in transport with the massive £280 million of extra spending that was announced in this year's Budget. The Government are also investing in the country's public transport and road network, yet the previous Administration planned to cut the transport budget by £1 billion. Secondly, world oil prices are at an all-time high. We have seen steep increases in petrol pump prices. They have risen by 18p during the past 16 months, but less than 2p of that increase is due to this year's rise in fuel duty.
Mrs. Shephard: Will the Minister give way?
Mr. Hill: If the right hon. Lady will forgive me, she has left me relatively little time. I have much to say and little time to say it, but if the opportunity arises—I want first to say more about petrol price rises—I shall give way. I want first to make some progress.
I was about to point out that, although fuel duties rose in line with inflation in this year's Budget, it was the lowest increase in 11 years. The previous Administration introduced the fuel duty escalator in 1993 at 3 per cent. and then increased it to 5 per cent. This Government have
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abolished the fuel duty escalator. The fact is that fuel prices are lower now than they would have been had the escalator not been abolished.
Mrs. Shephard: Does the Minister accept that, since the general election, taxation on motorists has increased by £8 billion, which is the equivalent of 4p in the pound on income tax?
Mr. Hill: In real terms, motoring costs in 2000 are identical to those in 1970. The Government have achieved that by various policies, including cutting fuel duty, which I propose to deal with if I am given time to do so.
The Government were elected on a pledge to stick to the previous Administration's spending plans for the first two years. In the third year, we scrapped the escalator. We have also played our part in meeting the legally binding environmental targets agreed at Kyoto. The precise answer to the right hon. Lady is that, under the previous Government, car tax increased by £45 between 1993 and 1996. We have cut it by £55 on 4 million fuel-efficient cars. At the time of this year's Budget, the Automobile Association said:
This is the first time drivers can take some heart from a Budget in over seven years.
That covers the time during which the preceding Administration was in power. It is worth drawing attention to the fact that the right hon. Member for Wells (Mr. Heathcoat-Amory), the shadow Chief Secretary to the Treasury, said in 1996 that the price of fuels is not set by Government. Any real-terms increase in fuel duties in the future will go directly towards transport spending in addition to the billions already invested in modernising Britain's infrastructure.
I shall give a practical example of the Government's commitment to transport infrastructure in dealing with developments on the A11 in the constituency of the right hon. Member for South-West Norfolk. The A11 is a significant interregional route into East Anglia, but piecemeal improvements in past road-building programmes have resulted in congestion and safety problems, especially in the section that runs through the right hon. Lady's constituency. The Government's trunk road review of 1998 was a thorough review of the national road programme. That review was not held behind closed doors, unlike reviews carried out by the previous Administration, but gave communities, local authorities, businesses and transport and environmental groups the chance to have an input into the shape of the network and the type of improvements that should be made.
Completing the dualling of the A11 to give better access to the north and east was a high priority for the region. We inherited a wish-list programme of 147 schemes, including three for the A11. In 1998, we identified a targeted programme of 37 schemes that could be started within five years. One of those schemes was the dualling of the A11 between Roudham Heath and Attleborough. On 3 February, my noble Friend the Lord Whitty was able to announce that the start of construction on the Roudham Heath-Attleborough scheme had been brought forward to the beginning of 2001. At long last, a scheme that entered the national roads programme in 1985, and for which a preferred

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route was announced in 1990, will be under way. That is a practical example of the Government's commitment to the motorist in the right hon. Lady's constituency.
In the brief time left to me, I shall deal with the rural bus network, which the right hon. Lady mentioned. Norfolk's allocation of £1.6 million per year of rural bus subsidy grant was the highest in the country. We have recently announced that the funding will be extended for another three years until 2004. In addition, we awarded Norfolk a further £1 million through the rural bus challenge initiative. The bus subsidy grant has enabled 49 new services to be introduced in addition to those that operated before May 1998, several of which have performed very well. In 1999–2000, more than 500,000 passenger journeys were made using services provided through the grant. I am sorry to hear that a small number of services have had to be withdrawn, even after allowing 12 months for patronage to build up.
The rural bus subsidy grant has allowed a substantial number of new and useful services to be introduced and maintained, increasing opportunities and choice for the rural traveller. Norfolk county council says that the services that have benefited tend to be those that supply new links to training and work opportunities as well as to shopping and health care. In most parishes in the right hon. Lady's constituency, bus service provision has improved since the grants were first awarded. Parishes that remain below the county council's preferred level of service are a priority for action, and the extension for the rural bus grant will decrease the number of poorly served parishes.
I acknowledge that successful directly subsidised services have sometimes been abandoned in favour of those funded through the rural bus subsidy grant. The point has been made several times that the rules are inflexible. We set up the fund specifically for new services because we did not want the money to leak into other areas. Nor did we want people deliberately to reduce services in the hope of gaining access to the new funding. However, the extension of the grant for an additional three years should enable councils and operators to plan ahead with more certainty and will provide greater incentive for potential bus users to leave their cars at home. We do not want the grant to be used to maintain the existing network, as that would diminish the purpose for which it was designed. We have shown flexibility by moving from 1 May 1998 to 1 May 1999 the cut-off date for deciding whether an existing service can be supported. However, the important principle remains that the grant will be continued for the commissioning of new services. I am afraid that I cannot promise that we shall change that.
The rural bus challenge funding won by Norfolk county council has enabled the purchase of four new and fully accessible vehicles, and has allowed for the development of flexible feeder services to improve connections between rural areas and rail and bus interchanges. Those initiatives are in line with our integrated transport policies, will help to improve access for disabled persons, increase social inclusion and facilitate modal shift from the car.
Mr. Deputy Speaker (Mr. John McWilliam)>: Order. Time is up.

Rail Services(Gloucestershire)
12 noon
Mr. David Drew: I am delighted to have the opportunity to talk about the rail system in Gloucestershire. I want to consider some specific points to which I hope my hon. Friend the Minister will be able to reply. They include the recently released London to south-west and south Wales multi-modal study, the possibilities of redoubling the line between Kemble and Swindon where it is currently single track, and what I deem to be the threat to the reopening of stations. I would then like to talk about more general issues, including hardware, especially stations, and how we can extend rail operations for passengers and freight.
My hon. Friends the Members for Gloucester (Ms Kingham) and for Forest of Dean (Mrs. Organ) would have been present, but they had other engagements. They will eagerly follow up some of my points, because I shall make general ones connected to the county, as well as drawing on the example of my constituency.
I have experience of using the train; I came here this morning by a train that was only slightly late. The underground seemed to have had a complete signal breakdown and there was a fire at London Bridge, but I gather that the system is running again properly. If it is not, I know that our Ken will chase after it and ensure that it is.
The issue is a big one for all people in Gloucestershire. From talking to the Confederation of British Industry in Gloucestershire and the Gloucestershire development agency, especially its chairman, Mr. John Hazelwood, I know that they prioritise the future of the county's rail network and see it as an important issue. I lost one of my close friends, Bob Cotton, in the tragedy at Paddington, and I hope that it soon results in our building the safest network possible.
I am grateful to Mike Obst, the senior transport planning officer of the county council, and his colleagues Barry King and Ken Kemp, who talked me through some of the issues from a strategic point of view. People I meet on trains regularly tell me what they think of services, and I thank them too.
Gloucestershire is imbued with rail history. It is part of Brunel's "God's Wonderful Railway". It still has the legacy of that; one of our historical problems is the breaking of the gauge, which means that all trains that come into Gloucester have to go out the same way. That obviously causes some limitations. I once wrote a thesis on the Gloucester carriage and wagon works, but I shall not bore hon. Members with the details of it. Gloucester was a rail centre and I hope that it can become one again. More interestingly, I shall mention the fact that, in socialist circles, we better know Richard Potter, a great rival of Daniel Gooch, as the father of Beatrice Potter. I do not mean the author, but the woman who later became Beatrice Webb. That is important to some of us.
I want to talk about the present state of Gloucestershire's rail system and also about what can be done with it in future. I have talked extensively to all the different interested parties, including Railtrack, the train operating companies, the local authorities and

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customers. I attended the rail users consultative committee summit at the end of last year and the county council rail summit, which considered the sort of issues that I shall raise.
I make no apology for starting by talking about the London to south-west and south Wales multi-modal study. That is rather a mouthful, but it is an important document. It was launched on 11 May and, although I welcome it, it is somewhat light in terms of what it offers Gloucestershire. It could have a major backwash in the sense that our rail system could be stymied by a lack of investment and strategic thinking. Will my hon. Friend the Minister look again via his civil servants at how we could at least enhance rail services in the county, because the study could have major implications for its economic development, its ability to link to other areas in the country and its scope to deal with the existing capacity problems?
Will my hon. Friend also consider how to deal with the dramatic increase in passenger transport—I am pleased that that has happened over the past couple of years—and, more particularly, how to enhance rail freight development, in which the county is lagging behind, and examine other opportunities, such as green tourism? Will he consider how better to evaluate the use of roads compared with the use of trains? A major study is being undertaken into the M4, A419 and A417 road network, which I hope will take that into account. Transport 2000 made some trenchant comments locally on how such an evaluation should be made.
The second issue that I wish to raise is most important. It concerns the bizarre situation, whereby our main line east and west from Cheltenham to Paddington has 10 miles of single track between Kemble and Swindon. That has major repercussions for the way in which the trains are organised. It was developed on the basis that a single track was probably better quality than the two tracks that it replaced, but it will cause many problems in the future. I have spoken to Railtrack several times and, initially, it was somewhat cool to the idea of redoubling the track.
However, having discussed matters with Andrew McNaughton, the Great Western zone manager, I am happy to say that there is now some movement. There will always be the matter of who will pay for the redoubling and how it will be managed, given the consequences that will have to be dealt with when, hopefully, the two tracks will be put back. Such an issue has implications not only for passenger travel but because it will reduce the possibilities for dramatically increasing freight use. My hon. Friend the Minister may have something to say about that in his response. It is a matter not only of laying another track but of improving signalling and the track overall and ensuring that the hardware along the line is improved to encourage people to use it.
My third point concerns the reopening of stations. There is a will to reopen stations in the county. We currently have nine stations and we obviously wish to increase that number. A site at Bristol road, Stonehouse—I declare an interest because I live in the town—which would probably be used for the station reopening was identified by Railtrack Property as a site for potential sale. Working with the county council, we
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extended the period during which arguments could be advanced against the sale, but we were faced with the prospect of having an open market auction, which we would have lost.
I am pleased to say that the shadow Strategic Rail Authority has now listened to our pleas and has removed the threat for two years. That is important because a working group is now looking at how to bring the station back into use. When such sites clearly have strategic value and feature in local transport plans, it seems daft that another authority—a public authority—should try to sell them. When I told my dear friend, Councillor Bob Eccles, the chairman of Stroud district council, about today's debate, he reminded me not to forget various halts. He is keen on reopening Ebley halt and I know that many people agree with him. There will always be conflict about the use of local and longer distance services.
I want to look at some more general issues that affect Gloucestershire but also relate to the operation of the rest of the network. I would identify three key themes: first, how to continue to increase passenger use; secondly, freight; and, thirdly, hardware, principally stations. I am aware that Gloucestershire county council has done a great deal of good work in drawing together some of the arguments. It has listed, in various documents, the ways in which various lines and services would be prioritised. A lot of room exists to improve the level of service, reliability, and the treatment of customers. Among the objectives is the development of fast, frequent, inter-city-quality through services from Cheltenham to Gloucester to London via Swindon, and the provision of local services, which I hope will at least be on an hourly basis. There are also objectives to develop fast, frequent services between Birmingham and Bristol, calling at Cheltenham and Gloucester, and to make sure that the system is as accessible as possible to people of all types, including those with mobility difficulties.
The strategy is clear: we want more, and we want it fairly quickly. However, there are problems as well as opportunities—as always, the question is: who will pay? In the case of the reopening of stations, most of the money, and sometimes all of it, seems to have to come from local authorities. Both private operators and those who oversee the wider public purse should consider more carefully what benefit they would derive from the reopening of those stations. Having talked to Railtrack at length, I am optimistic about the fact that it seems to want to exercise its responsibilities. However, it will argue that much depends on the current asset condition, its ability to cope with growth, the capacity of the network, franchise renegotiation—which I shall discuss shortly—and overall network development.
As much as I would not want to labour the point about the importance of improving services in Gloucestershire, a great deal depends on how the other end of the network functions. There are serious problems with regard to the capacity of trains serving Paddington and Reading, but I was pleased to receive, in the past couple of days, some notation on what might be planned for Paddington. I hope that that will release some of the pressure on the system.
Clearly, all those who have an interest in the railways should be encouraged to work together to make improvements. Whenever I use the train, which is

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regularly, I find that it is possibly the worst-kept secret of all—more and more people are using it, to their great benefit, but the system is beginning to creak in places.
On passenger operations, the franchise negotiations, which are in mid-cycle, are somewhat confusing. No one would want to pick up the mess left by the previous Government. Some services are up for review, and I am especially concerned about the decision of Wales and West to drop out of its obligations to Wessex from the middle of next year. Will my hon. Friend the Minister consider the ramifications of such action? Can it be done, and who might provide such services instead? If no one is keen to do so, what will happen? I have been contacted by an old friend, Clive Mowforth, of CoJAC—the Coaley Junction Action Committee—who regularly raises questions about problems on the north-south line passing through my constituency, in relation to the better integration of the service and rolling stock, among other factors. If the Wessex idea is genuinely to come into its own—a Wessex franchise has already been established, and we are building on that—when can we expect some answers about when it will lock into place, and what will be involved?
We need to improve dramatically services on the Cheltenham to Paddington line, although there will inevitably be conflict between longer-distance travellers and local services. Next year, for the first time, we face the possibility of trains not stopping at local stations. Is that the thin end of the wedge? My hon. Friend the Minister might consider how to get the balance right in future.
Although we welcome the fact that the Swindon-Gloucester-Cardiff line has been highlighted as offering potential for freight use, Gloucestershire does not have a freight terminal. Five areas are being considered—Ashchurch, at the Ministry of Defence site; the Gloucester triangle; Gloucester-Quedgeley-Hardwicke; Sharpness, in my constituency; and Lydney-Parkend, in the constituency of my hon. Friend the Member for Forest of Dean. I shall not speak in favour of any one of them; I merely hope that at least one becomes a centre for a freight terminal. The matter relates to the opportunities currently available there, and we must make a proper evaluation. I hope that public money will be available, whether from the regional development agency or another source, to help speed that along.
I mentioned the need to keep sites available for reopening stations, and we want to build on existing stations, too. In Stroud, the centre point of my constituency, the station is in the centre of the Cheapside redevelopment. Stations can do a great deal for the regeneration of their areas. Again, we have been fortunate to receive money through supplementary credit approval to enable us to examine how to improve our inter-modal transport. I hope that my hon. Friend the Minister will make some nice noises, and will follow up those noises, about how stations are key to development and to the revival of market towns in particular.
I realise that I have raised an awful lot of issues for consideration, and I am sure that my hon. Friend will not be able to respond to all of them today, but I am sure that dialogue continues. Like my hon. Friends, I am a great believer in the rail system. We believe that the system that we inherited needs to be substantially
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improved. I am sure that the Government intend to do that, and I am more than willing to do anything that I can to help.
12.17 pm
The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Mr. Keith Hill): I congratulate my hon. Friend the Member for Stroud (Mr. Drew) on securing the debate and providing an opportunity for the House to discuss rail services in Gloucestershire. I thank him for his courtesy in giving me advance notice of several of the issues that he wanted to raise. I was fascinated by the Potter-ed history of the railways in Gloucestershire with which he began his speech.
Gloucestershire is served by several train operators, including Wales and West, First Great Western, Virgin CrossCountry and Central Trains, to which I shall refer throughout my response. My hon. Friend the Member for Stroud asked why Gloucestershire was excluded from the south-west and south Wales multi-modal study. The transport corridors to be examined as part of the study do not include Gloucestershire's railway lines. However, in identifying problems on the transport corridors involved, we need to be aware of problems on the adjacent transport network, of which the Swindon-Cheltenham line is part.
It may be that problems on the transport corridors can be resolved only by taking action on the adjacent network. If that is so, subject to the approval of the steering group, it may be appropriate to select such lines for further analysis later in our study. As a minimum, we must be aware of the constraints on, and aspirations of, the adjacent networks, because they could influence the overall strategy for the study. I hope that my hon. Friend will find those remarks reassuring.
I turn now to the Cheltenham to Swindon line, to which my hon. Friend the Member for Stroud referred, and in particular to the single-line section between Swindon and Kemble. The route is served daily by several freight trains; a Wales and West passenger service, at approximately hourly intervals between Swindon and Gloucester; and First Great Western through services in peak hours between Cheltenham and London. I understand that Wales and West proposes to withdraw its services on this route. Instead, Great Western and Virgin CrossCountry will jointly provide the same level of service, but using the latest high-powered, air-conditioned rolling stock. Overall journey times between Swindon and Gloucester will be unaffected, though the higher acceleration potential of those trains will provide improved performance. If present commercial and contractual negotiations are fulfilled, the route will enjoy through services to London Paddington eastwards and new journey opportunities northwards to Birmingham and beyond.
I understand that the draft regional transport strategy for the south-west includes the need for
a study into improvements to the Cheltenham-Gloucester-Swindon rail line, linked to the road based study for the A419/A417 at Blunsdon, in order to facilitate enhanced services for passengers and freight.
The regional transport strategy forms part of the emerging regional planning guidance for the south-west. The panel's report on the public examination of draft

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regional planning guidance is awaited. Once it is received, the Secretary of State will consider what changes may be necessary in the light of the recommendation. I will ensure that my hon. Friend receives a copy of the report as soon as it is published.
My hon. Friend raised the issue of the reopening of stations and gave Stonehouse, Bristol road as an example. I appreciate the importance of that plot of land. My hon. Friend will know from the answer to his parliamentary question on 13 March that the property at Stonehouse was included in the 60-day notice of intention to market the site that was issued on 10 November 1999. The British Railways Board and the shadow Strategic Rail Authority will take account of the representations made in response to that notice when deciding how to sell the site. I can, however, be a little more precise and, I hope, helpful on the matter of the land at Stonehouse. I understand that Gloucestershire county council has been informed that there will be no rush to sell and that it will be given reasonable time to get its act together and bring a train operator on board.
The county council is considering a rail passenger partnership scheme for several local stations on the route and thought that it would take five years to organise the business plan and planning permission. However, it has been advised that that is too long and that a period of 18 months to two years would be a more realistic basis on which to decide whether the station should be built or the land redeveloped. There is no immediate threat to the site and time will be allowed to enable the county council to make progress. I hope that my hon. Friend will be reassured by those observations. I am gratified to see, from his sedentary expressions of approval, that he evidently is.
My hon. Friend mentioned the important issue of replacement franchise proposals. The existing franchise contracts were seen by many as a potential obstacle to improvement. In view of that, my right hon. Friend the Deputy Prime Minister issued new instructions and guidance to the franchising director, asking him to bring about improvements through renegotiation of replacement franchise agreements. On 20 June, Sir Alastair Morton, chairman of the shadow Strategic Rail Authority, set out the future map of passenger rail services.
The franchise map, which follows extensive consultation, is based on the creation of three distinct service groupings: long distance, high speed—expanded from current inter-city services—and London commuter and regional services. Of course, the final detailed shape of the franchises created within the groups will be set only once bidders' plans have been considered, and following consultation with key stakeholders. However, the guiding principle behind the map is to improve services, not to introduce change for change's sake. It is intended that the map will revitalise the network, with franchise areas designed to relate better to each other and to provide improved accessibility for passengers. I am pleased to say that people are now using rail in the largest numbers for 50 years. The changes being proposed are intended to ensure sufficient capacity and investment to ensure that the trend continues to provide for 50 per cent. growth in travel in the coming decade.
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My hon. Friend mentioned the issues of Wessex Rail and the Prism deal and I hope to have time to deal with them all. The creation of a future Wessex Rail franchise to serve the west of England was announced by Sir Alastair Morton on 20 June. The franchise could include the area bounded by Worcestershire, Bristol and the south coast, or services to and from Gloucester. It could also include the line between Exeter and Waterloo, local services around Bristol and services transferred from Wales and West, South West Trains and the longer distance Thames Trains services. A study will be undertaken to define the Wessex franchise more precisely. A final decision will be made after consulting local and regional authorities and local rail passengers' committees.
Earlier this year, the SSRA also announced a feasibility study into a dedicated Wales rail franchise to serve the interests of Wales and the border counties more effectively. The study will decide which services should be included and consider the likely effects on passengers and value for money. Wales is served by seven franchises. There is little coherence and they have no ability to work effectively with the National Assembly or to address the emerging needs of Wales after devolution. The study will broadly consider the core of services within Wales and the border counties, excluding long-distance high-speed services that are operated by First Great Western and Virgin Rail, which provide the southern and northern inter-city links to London. The SSRA is consulting closely with the main stakeholders and an announcement is expected shortly.
My hon. Friend the Member for Stroud mentioned the Prism deal. The franchising director reached an agreement on 15 June with Prism Rail plc on the restructuring of the group's portfolio of passenger rail franchises, which includes Wales and West, West Anglia Great Northern, Cardiff Railway and London, Tilbury and Southend Railway. As a result, the Wales and West and Cardiff Railway franchises will be surrendered on 31 March 2001 instead of early 2004, which will facilitate the SSRA's proposals to create a single franchise for Wales and the borders.
The new arrangements for the three shorter-term Prism franchises, which were originally let for seven years, will reflect the SSRA's goal in franchise negotiations to achieve the best possible outcome for passengers and the taxpayer while accelerating the national franchise replacement programme. The franchising director's objective is to replace the shorter franchises, which expire in 2004, within about two years. It is not known when the franchising director will be able to announce the outcome of any franchise replacement negotiations, but he is not committed to accepting any proposal and could allow existing franchises to run to their expiry date. If an application is to succeed, it will have to guarantee better performance, more investment and expansion of network capacity, improvements for passengers and value for money for the taxpayer.
My hon. Friend set out his concerns, which I share, about the performance and quality of service of train operators serving his constituency. Hon. Members will know that last year the rail industry made several commitments to improve rail services during the year. I am pleased that most of those have been met. However, more clearly needs to be done if passengers are to get the service they expect. We must continue to work with the

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industry to ensure that standards are raised. That means better safety, improved performance, new rolling stock and investment secured for the future.
Operators are being judged against a new public performance measure that gives a clearer and more meaningful idea of the actual performance of train operators. Initial data cover the second half of the last financial year, from mid-October to the end of March 2000. Compared with the same period in 1998–99, of the four operators that serve Gloucestershire, I am delighted to say that three have improved—Wales and West, Central Trains and Virgin CrossCountry. The new measure will also allow headline figures for each train operating company to be published every month, which is a clear improvement on the previous quarterly shadow Strategic Rail Authority reports. I am pleased to announce that the first monthly summary will be published this month.
Results from the second national passenger survey, which is a twice-yearly tracking study conducted by the Oxford Research Agency to measure levels of satisfaction across the entire franchised rail network, indicates that between 78 and 83 per cent. of passengers who use the four operators are satisfied with the overall service. However, there are still gaps between the best and worst performers. The worst performers must raise their game to match the best. The powers given to the shadow Strategic Rail Authority by the Transport Bill, which is now going through Parliament, will ensure that they do that or suffer the consequences.
I have described some of the measures that we are taking as part of the franchise replacement programme, as well as the other issues relevant to my hon. Friend's interests. I hope I have made it clear that, through such measures, we are determined to drive up the quality and performance of rail services and lever investment into the industry. I thank my hon. Friend for allowing us to discuss these important issues in this Adjournment debate.

Widening Access to Oxford University
12.29 pm
Dr. Evan Harris: I am pleased to have the opportunity to debate this important subject, which has been in the news recently. Access to Oxford university was supposed to be a theme of Government campaigning, and a recent outburst by the Chancellor received a great deal of publicity. This is the first opportunity that we have had to discuss the subject in detail in the House. I think that everyone in the House and, indeed, everyone in society recognises that there is a problem about access to universities for less well-represented groups, especially in relation to the so-called elite universities—I would use the term "top" universities or university departments. We need to do something about that. I am pleased to welcome an Education Minister to the debate: I am sure that he feels as passionately as my constituents and I do about the problem of groups under-represented in higher education generally.
It is unfortunate that the Chancellor of the Exchequer is not here to respond to the debate, because that would give him an opportunity directly to answer some of the concerns that have been raised by my constituents and others about the Government's handling of the matter. The Chancellor waded into the subject by making a statement that was factually incorrect, offensive to people involved in the admissions procedure at Oxford and, most importantly, counterproductive to the aims of my constituents, of Oxford university and of the Department for Education and Employment. I hope that the Minister will take this opportunity, however indirectly, to apologise on behalf of the Chancellor, not only for making factual errors, of which everyone is capable, and not only for the unjustifiable offence caused to people involved in the admissions process at Oxford university—it is a casualty of all politics that some offence is caused—but mainly for the fact that his remarks were counterproductive and will make our task in rectifying the problems much more difficult.
It is worth considering the Chancellor's motives for pronouncing that the decision by Magdalen college, Oxford not to offer a place to one student was a scandal. What could his motives have been? It is interesting to note that he made the remark—which he knew would receive press coverage, because it had already been covered earlier in the week—at a celebration of the 30th anniversary of the Equal Pay Act 1970. Was it that the Chancellor had little to say about any new legislative proposals to deal with the pay gap between men and women? Given the subject of this debate, it is interesting to note that a pay gap in higher education has been proved to exist. The Bett report clearly showed a discrepancy in the pay of men and women in higher education, regardless of their status, for which the Government have refused to accept responsibility and refused to provide funding to tackle the problem.
The Minister often says that there has been a real-terms increase of 11 per cent. in funding for higher education and that that is sufficient to tackle the problem. However, he knows that that increase is to fund expansion, which he and I both welcome, but involves a reduction in the unit cost per student. When unit funding per student increases in primary and secondary education, the Government rejoice. In their

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annual report, they announced that as a wonderful thing, but when the higher education unit of resource is cut year after year by this Government, as it was cut by the previous Government, either they have nothing to say or they say that it is a necessary efficiency. I do not believe that equal pay or access can be fully tackled until that reduction in the unit of resource is halted or, preferably, reversed.
It is appropriate for me to refer to an individual case in relation to access to Oxford university, not least because Ministers, including Cabinet Ministers, have already done so. Some years ago, a state school student with a string of As at GCSE, or the O-level equivalent, applied to Oxford university. The student was predicted to do well at A-level, but was rejected by the medical school at Oxford, and went on to America to study at Harvard. That student was me. However, I went to Harvard high school in Los Angeles—and only for a year. I then applied again to Oxford university and got in. It was right that I was rejected the first time, as my performance in the entrance exam was poor. As I understand it, my place was given to a young woman from an inner-city school. She was born on the Indian sub-continent and had done equally well in her education, although she had overcome many more hurdles, not least that of language. I made no complaint and I was pleased to enter the university a year later. The contrast between my approach and that of the Chancellor in the Laura Spence case is startling. I shall speak more about that later.
We should consider the figures, as they are the basis of the subject under discussion. We know that only 7 per cent. of people are educated in the private sector, but that 50 per cent. of places at Oxford university and some other top academic departments go to students from the independent sector. That huge discrepancy is very worrying. The corollary is that the 93 per cent. of our young people who are educated in the state sector form only 50 per cent. of entrants to some of our top academic institutions. The gap can be narrowed, and it is important to note where it is reduced, so that we can see where the problem lies. Information given by the Independent Schools Association to the Select Committee on Education and Employment during its recent inquiry suggests that 20 per cent. of A-level entrants are in the private sector, which, of course, leaves 80 per cent in the state sector. The figure narrows the gap significantly, although there is still a huge discrepancy between the 80 per cent. of A-level entrants and the 50 per cent. of acceptances to top universities.
The Parliamentary Under-Secretary of State, Department for Education and Employment (Mr. Malcolm Wicks)indicated assent.
Dr. Harris: I see the Minister nodding. The gap must be closed if we are to solve the problem, whose existence we both acknowledge. Approximately two thirds to 70 per cent. of pupils who gain the sort of qualifications—the Government consider A-levels the best measure—that are required for entry into the top institutions come from the state sector. The pool from which Oxford university and other top institutions can recruit is limited to that 70 per cent. Clearly, that
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percentage needs to be levered up, because it leaves a large discrepancy between the state sector pupils among those students eligible to be admitted and the proportion among those who are admitted.
The ratio of applications from the two sectors, which varies according to institution and subject of study, is approximately 50 per cent. each from the state sector and the private sector. That figure is approximate and varies year on year, but, crucially, it roughly matches the percentage of acceptances or offers made or entrants—the terms are analogous—into the top institutions. It gives at least prima facie evidence that the problem exists mainly in the proportion of the number of people with top A-level grades who are from the state sector and who actually apply to the top universities or, indeed, to higher education in general. It is that gap to which we should apply ourselves, and I hope that Government policy will be directed towards it as well as the others.
In any assessment of the relatively poor performance of young people in the state sector as compared with those in the private sector, we must first say that the poor performance is that of the sector and not of the young people themselves. It would be wrong to argue that there is anything to do with the students themselves that makes them on average less likely to do well in the state sector than students do in the private sector. Classes in the private sector are much smaller, which is what wealthier parents are paying for. We ask whether the Government are doing enough to ensure that funding in the state sector is equivalent to or is catching up with that in the private sector. That will help address the problems of morale in the teaching profession in the state sector.
In his latest Budget, the Chancellor of the Exchequer put nearly three times as much state money into reducing income tax, which will benefit the better-off, as he made available in additional funding to the state education sector. The Minister knows that the Liberal Democrat party and I oppose that. Our priority is yet more funding for the state sector, and we oppose those income tax cuts. It ill behoves a Chancellor who has such priorities to say that the problem lies not with inadequate resources in the state sector but in some sort of bias in our top universities.
The Chancellor who made those remarks is the same Chancellor who, although it was not mentioned in the election manifesto, cut at a stroke maintenance grants for the poorest students entering higher education and imposed tuition fees on most of the rest. Independent studies of the subject, not least the independent Cubie commission in Scotland, show that fear of debt is a significant deterrent to young people entering higher education, particularly for those from poorer backgrounds.
The Government are particularly keen on focus groups as a mode of gauging opinion. However, it is not surprising that the university partnership in East Anglia found that fear of debt among poorer families in areas with poor access to higher education is a major factor in deterring people from applying for higher education. That is also the view of the Independent Schools Association, which has no axe to grind on maintenance grants for poorer students. Indeed, the director of

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Sutton Trust told the Select Committee that he was aware of the work of the Cubie commission and could understand its point of view.
The Government may have increased access funds, which is welcome as far as it goes, but I wonder whether that is the way forward, because it is a post-application, post-acceptance, post-poverty solution. Once students get into poverty, they are encouraged to enter a beauty parade to decide who is the poorest and who can qualify for access funds.
The major component of the problem relates specifically to the number of applications being made to our top universities and to universities in general. The Minister will know that a huge amount of work is already being done, although it could be argued that more should have been done earlier. Next week, at Oxford university, I shall again attend one of a series of summer schools to encourage young people from comprehensive schools, from poorer backgrounds and from the state sector in general to apply to Oxford university. Such summer schools can be found at other universities. Indeed, the Department for Education and Employment, in its welcome excellence in cities initiative, is funding some of them.
I applaud the Government for that, but it rather defeats the purpose of funding schemes that encourage people to apply to universities when the person in charge of the purse strings says, "By the way, however much you are encouraged to apply, you may as well not bother. The admission scheme is stacked against you because the old school tie or old boys' network is at large." That unsubstantiated allegation has caused great damage.
Application statistics show little evidence of bias in the selection and admissions system at Oxford university. For example, of the students from UK schools selected to study biochemistry—the subject that Laura Spence eventually decided to study at Harvard university—62 per cent. of candidates were from the state sector, and 38 per cent. from private schools. That is similar to the distribution of students doing well at A-level, which is welcome; crucially, the success rate is almost identical for students from each background—a 69 per cent. success rate for state candidates and a 70 per cent. success rate for independent school candidates.
Success rates are similar in the medical school, to which Laura Spence applied. Just over 100 places are available for UK students, and about 500 applications are received. Approximately half those application come from the state sector—the proportion should be higher—and half are from the private sector. Almost every one of those students will have gained straight As at GCSE and will be predicted for straight As at A-level; there is no point in applying without such grades, because it is such a competitive subject. Even if every one of those just over 100 places had been allocated to state school students, 150 eminently qualified and highly able state school students would not get a place. That is 150 Laura Spences—an awful lot of speeches for the Chancellor to make. The allegation that the offers received by that capable student from other medical schools were somehow unworthy is of concern to those who work in the top universities.
One must ask what the Government seek to achieve, particularly when the Foreign Secretary says, on the one hand, that too much cachet is put on Oxbridge
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degrees—I would agree with that—while the Chancellor says, on the other, that it was a terrible crime that someone as able as Laura Spence could not get a place at Oxford and that she was therefore right to reject the other top universities. That was her decision, and I wish her well wherever she studies, but the biochemistry scholarship that she was awarded by Harvard—not the subject that she applied to study at Oxford—will not cover the fees that she will have to pay. Poorer students at Harvard have to take jobs to pay their way, perhaps by cooking meals for richer students.
The Chancellor and his colleagues would do best to consider their own country—Scotland has done away with some of the barriers that prevented people from poorer backgrounds from getting into higher education—rather than some American panacea. The number of applications in Scotland as a percentage of the population has increased this year by nearly 5 per cent. following the abolition of tuition fees and the reintroduction of maintenance grants in some form, whereas it is still falling in the rest of the country. That must give the Minister pause for thought.
Finally, it is important that we realise that a problem remains to be tackled. We must ensure that people with a state-education background apply for higher education generally, and particularly to our top universities. That process is not helped by Oxford and Cambridge and other top universities being portrayed as having a Brideshead image. I get extremely frustrated—the Minister, too, must feel this—at press and television coverage showing Oxford students wandering about in academic dress. The times when academic dress is worn at Oxford are much the same as at every other university.
We must change those prejudices. We must ensure that universities do more to get people to apply for higher education, including at Oxford. That process is not helped by the Government's ill-founded, factually incorrect, offensive and counter-productive attacks on individuals in the Oxford admissions process. I look forward to the Minister answering some of the points that I have raised about Government policy. I hope that he recognises the damage that was done by the Chancellor's intervention in the debate.
12.48 pm
The Parliamentary Under-Secretary of State for Education and Employment (Mr. Malcolm Wicks): The hon. Member for Oxford, West and Abingdon (Dr. Harris) said that he was sorry that the Chancellor of the Exchequer was not able to reply to the debate. My right hon. Friend is elsewhere, helping to maintain a stable and growing economy, which must be good news for future public spending on education and many of our other priorities. It therefore falls to me to undertake the task.
I start with a quotation from the report of the vice-chancellor of Oxford university's working party on access of May 1999. In it, he said:
Year by year, Oxford admits more applicants from the independent sector than from the maintained, although the latter group contains approximately two-thirds of those school leavers who obtain the highest A level grades. Fairness to applicants and fulfilment of the University's mission alike suggest that the

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proportion of applicants accepted should be closer to the ratio of high grades at A level, one-third independent school pupils to two-thirds maintained.
I am struck by the fact that, although the Oxford university working party was not complacent about social inequalities, the hon. Member for Oxford, West and Abingdon appeared to be so on at least one occasion. He saw faults all over the place, but they did not relate to admissions policies. I side with the university in recognising that there is a serious problem.
Obviously, there has been much discussion about the matter in recent weeks and I for one welcome that, especially because it will become a spur for action. Many universities are doing good work to improve their links with state schools and colleges. They include Oxford, which is why I referred to the Oxford document. They are also reaching out to parts of our country where participation in higher education is traditionally low. As Oxford's vice-chancellor acknowledged, much more needs to be done. Although opinions differ on what precisely should be done, there is no doubt that action to improve the position should be taken in partnership: Government, universities, colleges and schools need to work together.
For our part, the Government have been taking action on a number of fronts to ensure that people with talent and all those who can benefit get their chance in higher education. Given the limited time that remains for this debate, this is not the occasion to speak in detail about our policies. However, I should point out that we are spending more on education. We have taken significant action for early-years and nursery education, and measures such as the primary school literacy hour and the numeracy strategy are in some respects as important to tackling this issue as encouraging an 18-year-old to apply to a particular university. The strategy applies across the board.
The hon. Gentleman presented a critique of our student finance strategy. The system that we have put in place is not subject to the failures that the hon. Gentleman outlined, but the system that we inherited failed in many respects. In his important report, Lord Dearing recognised that universities were seriously underfunded during the previous Government's time in office, which saw a dramatic fall in unit funding from public resources. Between 1989 and 1997, there was a 36 per cent. drop, which is a drastic decline in standards. A further cut was planned for the subsequent two years. It is vital to get right the balance between quantity—with more of our young people going to university—and quality. Spending on higher education was also regressive, as the great majority of taxpayers who did not benefit from it paid for the minority of people who went to university and who came, predominantly, from the higher socio-economic groups. Until recently, the state spent almost twice as much on the education of graduates as on the education of people who left school at 16. Graduates benefit from higher earnings and are less likely to be unemployed.
The facts speak for themselves. In 1960, more than a quarter of the 18-plus group from the top three socio-economic groups went to university, but only one in 28 from the lower groups did so. Mandatory awards were introduced by the Education Act 1962, giving student
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support and paying tuition fees for most students. By 1990, however, participation by the top three socio-economic groups had risen to more than one in three. In the bottom three groups, however, barely one in 10 went to university. By the mid 1990s, the participation rate for the top three groups had risen to almost one in two, or 50 per cent., whereas for the other groups, it had risen to only one in six. Whatever was good about the old system, it did not crack the problem of socio-economic inequality.
The plain fact is that mandatory awards did not promote the increase in participation by the lower socio-economic groups for which many had hoped. We were determined to tackle that problem, which meant some tough choices about what was needed. Consequently, we accepted the Dearing recommendation that those who benefit from higher education should contribute towards its cost. The arrangements that we have put in place mean that we can provide the extra funds that universities and colleges need to widen access without damaging quality.
The income we receive from student contributions to fees has helped us to plan more than £1 billion of additional funding over the four years from April 1998, which is an 11 per cent. increase after allowing for inflation. The costs of higher education are now shared more fairly between students, their families and taxpayers generally. I was unsure whether the hon. Gentleman was suggesting that he would change that policy, but if he was, he did not say how that change would be funded. Not everything can be funded from that famous 1p on income tax. If the Liberal Democrats are to be taken seriously, they must spell out their funding and taxation priorities.
We have also ensured that students from less well-off families do not have to pay fees. Indeed, already more than 40 per cent. of all students are exempt from making any contribution. That will rise to 50 per cent. from next year because we shall raise the contribution threshold. I repeat—poor students do not pay fees.
We recognise that much more needs to be done on the issue of access. The recent data produced by the Sutton Trust and others are not new but are very worrying. We must do more to ensure that all our talented young people, whatever their background, get the chance they deserve in higher education. It is not satisfactory that only 17 per cent. of young people from lower socioeconomic groups go into higher education, or that someone from a private school is almost 30 times more likely to get into university than someone from a disadvantaged background, or that 65 per cent. of those with three A-levels at A grade are educated in the state sector, but only 52 per cent. of entrants to Oxford and Cambridge in 1999 were from state schools or colleges. Many people are angry about that lack of equal opportunity. I am surprised that Liberal Democrat Members do not share that anger, and that they could not suggest one or two ways in which to improve the situation.
I applaud the work that has been undertaken by Peter Lampl and the Sutton Trust. The trust is sponsoring six separate university summer schools at Oxford, Cambridge, Nottingham and Bristol. The schools will run this summer and will be open to able 16 and 17-year-olds throughout the United Kingdom who fulfil

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the necessary criteria. Quite rightly, the focus will be on inner-city secondary schools and colleges where participation is still too low. We support that work and are contributing to its cost.
In addition, as the hon. Gentleman recognised, we are contributing £4 million towards piloting our own summer schools, which will start this month as part of the excellence in cities package and will offer opportunities to children from disadvantaged backgrounds. More generally, through the Higher Education Funding Council for England, we are allocating £30 million this year for initiatives to widen participation. A 5 per cent. funding premium for universities was introduced last year to recognise the extra costs incurred in recruiting students from disadvantaged backgrounds. I know that at Oxford that money has been carefully focused on the recruitment of students who might not otherwise aspire to study there. We have also introduced premiums for students with special needs and are supporting networks of universities, further education colleges and schools to enhance progression into higher education. We have provided £10 million for "opportunity bursaries" of up to £1,000 from autumn 2001, which will be aimed at young students from disadvantaged backgrounds.
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We intend to build on that work to ensure that all universities have professional recruitment and selection systems that maximise applications from able students of all backgrounds. We will also ensure that schools and colleges not only raise the expectations of their students, but assist them in preparation for applications, interviews and selection examinations, which are crucial areas where there is much inequality within the different school systems.
I welcome this debate. The test for all of us will be how we move on. A great deal is being done to widen access, but a great deal still needs to be done. The Government and Oxford university recognise that. The issue is simple and has been debated in the House for more than 100 years. We are determined to offer every one of our citizens of high ability, whatever their social class, whether they are poor or rich, the opportunity to go to one of our top universities. This debate and that stimulated by the Chancellor's remarks have been useful, because they have provoked clashes between the forces of elitism and the values of equality. We know where we stand. I wonder whether the spokesman for the Liberal Democrats knows where he stands.
It being One o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.