Westminster Hall Sitting of 14 June 2000

Preamble
[SIR ALAN HASELHURST in the Chair]

Christians in Egypt
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Betts.]
9.30 am
Mr. Edward Leigh: Last week, the first pedestrian bridge across the Thames in more than 100 years was opened. The new crossing is one of countless initiatives to mark the new millennium. While most people throughout our country continue to celebrate the start of the Christian calendar, I want to focus on pressures on the Coptic Church—the remnant of believers from the first days of Christianity. I am sad to report that while we celebrated the start of the millennium with fireworks, laughter and parties, in Egypt the new year was ushered in with a massacre of 21 Coptic believers. It was the worst episode of violence against Christians in decades.
It is easy to forget that, although Christianity started in the middle east, Christians in that region face persecution and possible extinction. While mass genocide in places such as Rwanda rightly grabs our attention, the plight of the people we are considering is important and relevant. I heard disturbing details of the persecution of the Coptic Church at a meeting organised by the Jubilee Campaign, the British human rights group. I met a Coptic bishop and Dr. Helmy Guirguis, the president of the United Kingdom Coptic Association, when they came to my home. Those men gave deeply moving accounts of atrocities against the Coptic Church in Egypt. It was strange to sit in the comfort of a Westminster home listening to quiet, impressive men, and being shown photographs of beatings inflicted on their people.
I was concerned when the two gentlemen told me that, in their view, the Government seemed unwilling to lend their full support to help the Egyptian Copts. It appears that it was difficult for a Minister—not the Minister of State, Foreign and Commonwealth Office, the hon. Member for Leeds, West (Mr. Battle)—to find time in his admittedly busy schedule to meet those Church leaders and hear the report of the human rights violations. I hope that the debate might lead to a meeting.
The Government were clearly ready and willing to support the concept of human rights in Egypt, but there was no direct evidence that they were prepared to make representations to the Egyptian Government. It is therefore fortunate that I have a factual and detailed report of the millennium massacre directly from Alexandria. I shall relate it shortly. I hope that it will spur the Government into action and into representing our deep anxiety about that incident and others to the Egyptian authorities in London and Cairo.
Mr. Patrick Nicholls: I refer to my entry in the Register of Members' Interests and the fact
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that I visited Egypt recently as a guest of the Egyptian Government. When I was in Egypt, I spoke to the Grand Imam about the problem. He said that he believed that he and the Coptic Pope were close personal and spiritual friends. He said that whatever incidents had taken place did not reflect an aggressive attitude on the part of the Egyptian Government. He said that they were reprehensible incidents that had to be tackled. He believed that he and the Coptic Pope were as one spiritually and were personal friends. Does that give my hon. Friend any hope in the circumstances that he is about to relate?
Mr. Leigh: Yes. I am grateful for that intervention because it underlines the complexity of the matter. I am not talking about mass genocide, or the Egyptian Government overtly discriminating against Christians. We are not considering open disagreement between the Coptic Pope and the Muslim community. Enormous efforts are made to try to live together. However, we are considering a complex matter. The Coptic Church in Egypt is under great pressure. Disturbing recent incidents support the view that matters may be getting worse, despite efforts to make improvements. It is important that we do not remain silent. Silence strengthens the hand of those who persecute people from other churches.
I shall outline a little history. The Coptic Church is heir to a 2,000-year tradition of Christianity in Egypt. By tradition, it traces its origin to 42 AD and the formation of the first Church in Alexandria by St. Mark the evangelist and martyr. The Egyptian Church has an ancient heritage, and is the largest and one of the oldest Christian communities in the middle east.
Egypt was a province of the Byzantine empire. Before the Arab conquest of 640 AD, all Egyptians were known as Copts. Early Arabs called Egypt the land of the Copts. After the Arab conquest, Egyptians gradually converted to Islam, and Muslims became the majority population in Egypt. Coptic means "Egyptian" in the pre-Arabic language of the country. While opinions differ on the origins of the word "Copt", most agree that it is a derivation of the Greek term "Aegyptos", which the Greeks called Egypt and the Nile. It currently denotes the original Christians of the country who retained their faith when the majority converted to Islam.
Today, Copts comprise more than 6 million inhabitants—more than 15 per cent. of Egypt's population of 65 million. The Church in Egypt, including Protestants, Catholics, Anglicans and Orthodox denominations such as Syriac, is the largest Christian community in the Arab world. The Coptic Church has survived more than 1,000 years of petty oppression and sometimes outright persecution. Recently, it has been the target of systematic and brutal attack by extremists who try to influence the authorities to exercise their religious privilege. It has also witnessed the quiet erosion of its status in society.
Christians in Egypt are bystanders in the conflict between the Government and Islamic fundamentalists. They are frequently caught in the crossfire. They believe that the authorities do not give them adequate protection from such aggression. The difficulties that the Christian community in Egypt faces are varied, and I shall detail them. I am grateful to several sources for the

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information. They include the United Kingdom Coptic Association, the Jubilee Campaign, the Egyptian Centre for Human Rights for National Unity, Just Law International, Compass Direct, Open Doors, the office of Congressman Joseph Pitts, the head of the religious liberty taskforce of the United States Congress and Christian Solidarity Worldwide.
For years, the Government in Egypt have strictly enforced laws that date back to the Ottoman empire. They forbid the construction of new churches or the repair of existing churches. Christian churches can be built only with express permission of the President. The Hamayouni edict of 1856 requires the Head of State's approval for repairs, even mending a church toilet. In the past 10 years, few churches have been constructed. Some communities have been working for a church for 30 years.
I recently read "From the Holy Mountain" by William Dalrymple. It states:
According to the Government's own statistics, mosque building had accelerated—some 125,000 unauthorised masjids had been erected in the last decade alone—but in the same period, the Hamaynoic Laws had been used to deny permission for the building of more than a handful of churches.
In December 1999, the decree was relaxed and permission must now be sought from a local authority. The change requires mosques as well as churches to obtain permits for repairs, but mosques receive permission far more easily.
A report published by the Committee for Fact Finding in Sectarian Incidents recorded in the People's Assembly on 28 November 1972, identified the following:
Total of existing churches in Egypt: 1,442
Total churches that are licensed by royal or presidential decree: 286
Total of churches without permits: 1,156.
Those 1,156 churches function illegally and face the wrath of the authorities. Permits that are sanctioned are frequently for churches that were built approximately 100 years ago. More recently, surveys have been undertaken by the Egyptian Centre of Human Rights for National Unity, which, among others, has sent documentation to the Jubilee Campaign. I have many examples of locations without in Egypt without a church, but shall cite only a few. An application for one was made in Mamoura district in 1967, but the presidential permit has not yet been granted. In Luxor, no building permit has been granted by the local authorities since 1979. There is no church on the northern coast—375 km from Alexandria to Marsar-Matrouh—nor in the towns of Sixth of October, Al-Rehab, Al-Sherouk, Al-Nanda, Badr, Al-Salam, and so the list continues.
I also have many examples, which I can send to the Minister, of locations where churches have had difficulties, but I shall mention just two or three. The Church of the Virgin Mary in Ashmonein in Malawi has been closed. The Church of the Virgin Mary and Mar Girgis in Al-Ayat and the Church of Shaheed Abu-Seifein, Governorate of Al-Fayoum were burned down, and so the list goes on.
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I shall refer to some of the problems and difficulties faced by Copts in Egypt. Under Islamic Sharia law, conversion from Islam to any other faith is punishable by death. Converts to Christianity face harassment from not only the state, but their own families. In fairness, Sharia law is not strictly enforced in Egypt, but it has been recognised as the foundation of Egyptian law. The Egyptian Government do not allow people to change their religion or the names on their identity cards and other personal pipers if they convert. That regulation does not apply in the case of converts from Christianity to Islam. That difficulty is constantly faced in Egypt. Such discrimination is not overt, but it makes life very difficult, especially when it involves changes to identity cards.
The Egyptian Government have done too little to control those who provoke hatred against Christians. For example, an Egyptian newspaper reported that the nationally famous late Sheikh Muhammad Mitwalli Al-Sharawi referred to Christians as "infidels". He was also accused by a Christian leader of making extremely derogatory remarks about Christians and Christianity. On one occasion, he allegedly stated that "the Sons of Dogs call the Torah the Old Testament." His implication was that Christians are sons of dogs.
There are reported cases—I shall not read out the list—of the use of rape as a means of forced conversion. Admittedly, those events are rare and, of course, abhorrent and intolerable, but they have taken place and should be dealt with firmly. Forced conversion is illegal according to Egyptian law. Egyptian civil law number 31, 1948 sets a legal age of 21, and Egyptian child law sets the age of consent at 18 years. The Grand Sheikh, Dr. Tantawi, issued a decree in 1997, stating that no Christian girl should be forced to marry a Muslim and that Christian girls younger than 21 cannot convert to Islam without the consent of their legal guardians.
There have been complaints of inaction by Egyptian authorities in the face of such practices and of refusals to act on behalf of victims and their families. Again, under Egyptian law, a Christian must speak to a priest or pastor before converting to Islam, but that law is rarely applied and a clergyman is usually informed only after the conversion takes place.
A major reason for conversion is economic. Conversion to Islam improves Christians' economic prospects because of the widespread discrimination against employing and promoting them. Pressure to convert is also applied to Copts, with offers of material reward, money, jobs, accommodation and even a spouse.
All that is serious enough, but I shall now deal with reports of violence. In the past five years, extremists have killed more than 100 Christians. In that period, not more than one or two of the killers have been arrested, tried and convicted. In the past two decades, more than 700 Coptic Christians have been wounded in attacks; more than 700 properties and businesses of Christians have been targeted by militants; more than 120 churches have been burned or ransacked; and about 100 homes have been destroyed. On 4 May 1992, armed members of the Islamic group, Al-Gamma Al-Islamyia, conducted a co-ordinated attack that resulted in the

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killing by gunfire of 13 Christians. I have a long list of many such incidents, which I can send to the Minister, but I shall not read it out.
In August and September 1998, more than 1,000 Christians were detained in Sohag province in upper Egypt, many of whom were tortured, including 13 and 15-year-old girls. That was the incident that prompted the Coptic delegation to visit me. Bishop Wissa of Baliana and his co-priests were targeted for their part in exposing police brutality and reporting it to non-governmental organisations outside Egypt. They were interrogated and charged, but released, pending trial, after posting bail of 100 Egyptian pounds each.
One of the worst incidents was the millennium massacre. Five predominantly Christian villages in upper Egypt's Sohag province were ravaged over the new year weekend. At least 21 Christians were killed and another 34 hospitalised with injuries. More than 80 Coptic homes and businesses were destroyed, along with a village church. That was the worst sectarian violence for years and the largest massacre of Egyptian Christians for decades. Significantly, El-Koshesh is the same village where, 22 months ago, police were charged with brutality when more than 1,000 Christians were arrested.
I could go on relating such completely up-to-date information. For example, on 5 June this year, the Sohag criminal court convicted a Coptic Christian of murder and sentenced him to a maximum term of 15 years. Shaiboub William Arsal was convicted of murdering his cousin and a friend following a gambling dispute in August 1998. His defence lawyers are convinced that the verdict was a political decision and that the prosecution case was based on forced confessions extracted from two army conscripts from the same village after they were tortured. The Egyptian Organisation of Human Rights accused the police of detaining more than 1,000 Christians after the double murder at Al Kosheh and treating many of them brutally in an effort to pin the crime on a Christian to prevent tension with Muslims from occurring.
To reveal the horror of that incident, I quote a little passage from The Glastonbury Review—a journal of the British Orthodox Church within the Coptic Orthodox Patriarchate of Alexandria. It states:
On New Year's Eve, Friday 31 December … an argument broke out between a merchant and a customer. The situation could have been brought under control but the local security forces failed to intervene and before long a mob was on the rampage whilst all night long Christian-owned homes and shops were looted, destroyed and finally burned Unchecked by the authorities, assaults against property now turned to persons and the killings began. Copts were living in fear and stayed in their homes, not even able to open their windows. They did not feel safe at all. Some congregated far from the attack areas but were able to hear shots being fired.
The violence soon spread from El Kosheh to surrounding villages, including Awlad Touq East and Awlad Touq West, Naga Moussa as well as other areas. St. George's Church in Alwad Touq was destroyed and all of its contents were looted. Fear was spreading among Copts as they witnesses these uninterrupted acts of vandalism and killings. All of these acts occurred without any intervention on the part of local authorities.
Pope Shenouda has tried to take a moderate line, which is why he kept quiet after the first incident. Perhaps that prompted the intervention of my hon. Friend the Member for Teignbridge (Mr. Nicholls).
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Pope Shenouda waited three months after the first incident before issuing any public statement. I continue to quote the review, which states that
when he did so it was with the intention of bringing the polarisation resulting from this first incident to an end and preventing further escalation. Having worked for so long and so assiduously to foster good relations between Christians and Muslims and in support of national unity as the surest antidote to Islamic extremism, he rejected foreign interference and counselled quiet resolution for discussions with the authorities.
For their part the authorities assured him that complaints would be properly investigated, grievances righted and those who were responsible brought to justice. Unfortunately, not only were these promises not fulfilled but the principal perpetrators appeared to be rewarded whilst the innocent suffered.
His Holiness felt that this failure to address matters was the cause of the further problems, "In all honesty attempting to cover-up the previous events in El Kosheh approximately one and a half years ago, by means of acquitting individuals responsible for the incident and accusing the victims, has led to the escalation of the problem in a horrific manner. Physical attacks have turned into killings".
The Egyptian Government are aware of our concerns and they acknowledge that the constitution guarantees religious freedom. However, they often say that those terrible incidents are not sectarian clashes, but personal feuds. I understand the problems that they face with extremists. For example, the ruthless murder of the leading secular dissident, Farag Foda, has escalated the problem in Egypt, but Christians are dangerously exposed.
What do the Christians and Copts want? The answer is simple and can be summarised in one word—equality. The president of the United Kingdom Coptic Association has told me that they seek nothing less than equality. That is all. At the start of the 21st century, when the world considers equality and human rights as birthrights to be taken for granted, we cannot ignore such injustice. I call on the Government to place the plight of the Coptic Church at the head of the agenda in discussions with the Egyptian authorities.
Copts are not asking for special treatment or compensation for centuries of discrimination and persecution. They want to feel that Mr. Mubarak is President for Muslims and for Copts. They want him to care for them and to address their concerns. They want him to meet their religious leadership regularly and perhaps visit their churches, which other Presidents did. That would no doubt break down walls of mistrust and build bridges of tolerance and harmony between Muslims and Christians.
Copts want the abolition of the antiquated 19th century Hamayouni decree, which restricts the construction of new churches and the repair of existing ones. Copts want all Church trust lands returned to the Copts. The income generated by those lands was used to provide for needy Copts. Copts want all Egyptian citizens to have freedom of belief, including the freedom to change one's religion. Copts want religious affiliation removed from national identity cards, job applications and so on. Christians must not be identified and discriminated against.
Copts want the education curriculum to be revised to guarantee that it contains no denigrating references to Christians and Christianity. Copts want the Government to control the media to ensure that they refrain from conducting attacks against Christians.

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Copts want an end to discrimination in job appointments and promotions. Few Christians are appointed to key jobs, such as Ministers or other Government officials. At present, there are no Christian governors, mayors, chiefs of police, presidents of city council or deans of college.
Copts want the Egyptian Government to be serious about apprehending those who murder Copts, to punish them to the fullest extent of the law, and adequately to compensate the victims of such crimes. Copts want to be allowed to enrol in all schools that are publicly funded, such as the Al-Azhar university. Copts want to be treated with honour and dignity within police departments. Copts want an end to religious discrimination that prevails at all levels of the Egyptian education system. Copts want an end to the enforced conversion of Christian girls.
I hope that our Government will raise the matter of the new year massacre of 21 Christians with the Egyptian authorities in London and in Cairo, and seek assurances that it will be thoroughly investigated. I also hope that Ministers visiting Egypt will raise these matters and apply and encourage concern in international forums. When I wrote to the Minister of State, Foreign and Commonwealth Office, the hon. Member for Neath (Mr. Hain) about the Al-Kosheh massacre, he replied:
We shall encourage the authorities to take appropriate action against anyone found to have committed a crime or to have violated international human rights standards.
That is encouraging, but what does it mean exactly? The Minister also said that the Foreign Secretary had
discussed interfaith issues with members of the Government, including President Mubarak.—[Official Report, 14 March 2000; Vol. 346, c. 163.]
However, there is no indication that the Government have made direct representations on behalf of the Copts. I hope that the Minister of State, Foreign and Commonwealth Office, the hon. Member for Leeds, West, will tell us that Her Majesty's Government are now prepared to do so.
In a written answer to my hon. Friend the Member for Meriden (Mrs. Spelman), the Minister of State, Foreign and Commonwealth Office, the hon. Member for Neath, said:
Our embassy in Cairo has been following the events and has discussed them with the Egyptian authorities.—[Official Report, 2 February 2000; Vol. 343. c. 624W.]
That could mean anything. It could just mean a polite request for information.
On 3 February 2000, the Minister of State said in reply to my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan):
When my right hon. Friend the Foreign Secretary visited Cairo … this year, he met the Sheikh Al Azar and Bishop Daniel as well as members of the Government … Interfaith issues were part of the discussion.—[Official Report, 3 February 2000; Vol. 343, c. 737W.]
Again, what does that mean? Did the Foreign Secretary make direct representations on the part of the Copts?
It is important to ensure fundamental rights of political representation, to end educational apartheid, to allow the building of new churches, and to prevent massacres and killings. I hope that the Government will make strong representation on all those matters.
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The Copts are a brave and quiet people. They are used to discretion. Indeed, they often have to deny in public what they say in private. They do not overstate their case in any way. William Dalrymple quotes a Copt as saying, "We Copts have always been attacked for our faith. Compared to some of those attacks these troubles are nothing." "So what sort of attacks are you thinking of?" said Dalrymple "Oh, the massacres of Emperor Diocletian, for instance," was the reply. These matters have been going on for a long time, but that does not mean that they are not serious.
The old Ottoman empire was relatively tolerant of Christian minorities. Up to recent times, our record in Christendom was far worse than theirs. The result is that, whereas at the beginning of the 20th century there was a thriving Christian community all over the middle east, today only 14 million Christians are left out of a population of 180 million in the middle east. Istanbul is virtually cleared of Greeks, and the Syrian Orthodox Church is a dying ember in Turkey. Only in Syria has the Church survived relatively in tact, but, with the death of Assad, that may change. In Lebanon, the Maronites are in retreat. In Jerusalem, a commentator said that the last Christians could be flown out in nine jumbo jets. In Egypt, the Copts are fearful, knowing that if Mubarak falls things would probably only get worse.
I am not opposed to the Egyptian Government. I know the difficulties that they face in resisting fundamentalism. I can also understand the reticence of our Foreign Office, which is rightly anxious not to criticise a Government who are moderate by middle east standards and vital to the peace process. However, as a friend of Egypt, we have the right and duty to speak up. Christianity is, by origin, a middle eastern religion. If we remain silent, by the end of this century it will no longer be a religion practised widely in the middle east.
It is estimated that more Christians were massacred worldwide in the 20th century than in any other century of the two millenniums. The world is becoming less, not more, tolerant. We should proclaim the values of tolerance in our own society and praise Muslim values. By speaking out, we will discourage intolerance everywhere and ensure that religion unites people rather than dividing them.
9.56 am
Mr. Nigel Evans: I congratulate my hon. Friend the Member for Gainsborough (Mr. Leigh) on gaining this Adjournment debate and raising a vital issue. I am vice-chairman of the all-party friends of Egypt group. As my hon. Friend stated, this country is a friend of Egypt, and it is vital that such issues are raised openly and freely.
To be true friends of Egypt, it is vital to ensure that problems and crises such as those facing the Copts in Egypt are eradicated, and to encourage a feeling of toleration and understanding in that country. It is an important country: it has a population of 63 million and sits between the middle east and Africa, both of which are strategically important regions. We have interests in both those areas, and a number of British people live in Egypt.
I recently went to Egypt with the all-party group, and we visited Cairo among other places. Last year, we managed to set up meetings with a number of Egyptian

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Ministers, including the Chairman of the Foreign Affairs Select Committee. There have also been visits by Egyptian Ministers to this country, and I and other members of the all-party group met them and raised issues, including the situation of the Copts.
We went to a factory in Sixth of October, which is an amazing, vast and growing city. We visited Unilever, which had a number of British workers. We spoke with a Copt who felt that there was no impediment to her job acceleration. She had reached quite a high position in Unilever. The issue that we are discussing and some of the events that my hon. Friend has mentioned, although ghastly and appalling atrocities and human rights violations, including violence and death, are exceptional in Egypt.
Ministers have made a number of visits to Egypt in the past three years. I hope that this issue has been paramount in their thoughts when they have spoken with their opposite numbers in Cairo. It is vital that they take every opportunity to have a constructive dialogue with Egypt.
I am involved in a number of all-party groups, including those on China and Turkey. Human rights violations not only occur, but some seem to be promoted by the Governments of those countries. Where we look to influence them, it is right to do so through constructive dialogue where possible, although, in certain examples such as Zimbabwe, constructive dialogue seems to be a complete no-no. It does not matter what we say to Mugabe—he will just carry on with his campaign of terror against the people of that country—but the Egyptian Government have not systematically carried out atrocities such as those referred to by my hon. Friend.
On our previous visit, we met the Grand Imam and spoke about the Copts and the death penalty. We had a free and frank discussion. As my hon. Friend said, the Egyptian constitution guarantees religious freedoms. We must do what we can, even when personal feuds exist, and I believe that the Government and Islam, the Muslim religion, have a role to play in ensuring that atrocities are stamped out. Egypt wants to maintain good relations with this country and although we know of the tourism atrocities in Luxor and a number of other places, the Government seem to have taken speedy action to stamp them out. I hope that they treat the atrocities in other parts of Egypt equally seriously.
My hon. Friend talked about what he wants for the Copts and spoke on behalf of us all when he mentioned tolerance, dignity and respecting the rights of people of minority religions. He also referred to churches and planning. To flip that on its head, there are planning issues for building mosques in this country. In certain areas, it is difficult for planning permission to be given and building a mosque never seems to be popular among the local population. Although they show great tolerance, their area never seems to be the right place to put a mosque. I have one in my own constituency and do not believe that it is in the right place, so perhaps similar issues are being discussed in Egypt and various other countries.
Over and above simple planning procedures, my hon. Friend mentioned a number of atrocities that give us great cause for concern. I, too, ask for those issues to be raised time and again through the British embassy in
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Cairo, when the Minister meets his opposite number and when other Ministers visit Egypt. We must work with the Egyptian Government and should perhaps suggest where we can help to ensure that the minority who perpetrate atrocities show greater tolerance and understanding. The all-party group also has a role to play in raising those issues whenever possible. My hon. Friend might think it helpful if we tried to arrange a meeting with someone from the Egyptian embassy, perhaps even the ambassador himself, to enter dialogue and discuss what progress can be made. I have met the ambassador a number of times and he has been very helpful in all sorts of areas. I am sure that this is an issue on which the all-party group may be able to facilitate progress.
I conclude as I began: we are friends of Egypt, and I believe this country to be a friend of Egypt. Being real friends means having the honesty to say where things are going wrong. When there are problems, it is only right for us, as friends, to point them out. I hope that initiating the debate will enable more progress to be made. Sweeping those issues under the carpet would only make things worse. I congratulate my hon. Friend again and hope that, through the Minister, progress can be made.
10.5 am
Mr. David Amess: I congratulate my hon. Friend the Member for Gainsborough (Mr. Leigh) on initiating the debate and endorse everything that my hon. Friend the Member for Ribble Valley (Mr. Evans) said.
When politicians talk about Christianity, there is an audience that automatically turns off. That is well understood, but if being a politician in today's Parliament has any value, and given the significance of this particular year, we should applaud any Member who is prepared to take the time and trouble to raise the atrocities carried out against Christians throughout the world. In particular, I pay tribute to Christian Solidarity Worldwide and the Jubilee Campaign, which do marvellous work to alert people to all sorts of issues throughout the world. We should applaud the way in which those organisations conduct their lobbying, which contrasts with that of one or two other groups that tend to antagonise rather than encourage hon. Members to support their view.
Two years ago, I was privileged to be a member of the United Kingdom delegation to the Inter-Parliamentary Union annual conference in Egypt, which I had never visited, although I was only too well aware of pyramids and the Nile. However, other matters were brought to my attention that week and after, one quite graphically: the day after the UK delegation had returned home, terrorists planted a bomb by a museum. They were a day late in their activities. That incident brought all the difficulties home to us. Perhaps I should not speak for all colleagues, but the UK delegation was slightly irritated by the protection we were given throughout. We thought, "This is a lot of old nonsense; everyone seems pleased to welcome us." Of course that was not the case at all.
During that week, I saw poverty the like of which I had not seen before, whether it be in the Philippines, Pakistan or elsewhere. I was gripped by the scale of

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Problems in Egypt and at a loss as to the solutions. I know that the Minister is a devout Christian and I do not want to over-criticise the Government's role and their response to the questions of hon. Members, a long list of which I have asked. However, I feel in my heart of hearts that these matters are not at the top of their agenda, although I could be completely wrong. [Interruption.] The Minister says, from a sedentary position, that that is not the case. However, although this is 2000, I feel that Christianity and trying to help people who wish to practise it—not only in this country, but throughout the world—is not the focal point of the Government's agenda.
The Government seem to think that Christians form a diminishing number of the population, so perhaps there are other priorities. That may or may not be the case and no doubt the Minister will mount a robust defence, but a number of opportunities have been missed. Hon. Members have already touched on Church property, conversion, the incitement of hatred against Christians, use of rape as a means of forcing conversion, pressure on Christians to convert to Islam and violence against Christians.
I want to focus briefly on two of those, beginning with the use of rape as a means of forcing conversion. Some people would immediately say, "That is absolute rubbish. Where is the proof?" I hope that hon. Members keep raising the issue long after the debate is forgotten and put it to the test, but the Jubilee Campaign has received reports from Christian sources in Egypt of the use of rape by Islamic extremists to coerce Christian women to convert to Islam. In Egyptian society, a girl's virginity is highly valued. Its loss through rape is often viewed by her family members as a loss of honour. That leads to their ostracising the victim, or even killing her.
It is difficult for a rape victim to find a marriage partner. Extremists use rape to pressurise Christian girls to convert. After the girl has been raped, the extremists promise that they will arrange for her to be married to a Muslim if she will convert to Islam, guaranteeing that they will provide her with a husband. Conversion offers marriage to a member of the group and "security" to the victim, whereas returning to the family after the rape would result in potentially fatal consequences. That practice is reportedly becoming more widespread.
I know that many people will be cynical and say, "That cannot happen in this day and age," just as it is completely dismissed that baby girls are culled in China. I believe the Jubilee Campaign. I believe that those atrocities are happening. It is beholden on this the mother of all Parliaments to continue to disregard the smirkers and doubters and to speak up on the issue, so that world leaders will raise the point when they meet. Let other world leaders smile at them when they do so.
There have been complaints of inaction on the part of the Egyptian authorities in the face of such practices: complaints that they refuse to act on behalf of the victims and their families. That has undoubtedly led to a change in life style among Christians in the upper part of Egypt. There is a growing reluctance to allow girls to attend schools. When girls are allowed out of the house, they are usually accompanied by a male member of the family.
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What is going on in Egypt as regards the property of the Church is of great concern. The legal foundation for the Egyptian state's control of Church property is the Ottoman decree of 1856, which was amplified by the Interior Ministry in 1934 as the Alazabi decree. That decree severely restricted the construction and repair of Christian churches by requiring Christian congregations to submit petitions for building and repairs to the head of state. The decree completely contradicts the 1971 constitution.
Regarding repairs to Church property, progress has been made over the past two years. In January 1998, an amendment was made that delegated presidential authority to issue permits for church renovation to the country's 26 provincial governors. On December 28 1999, President Mubarak decreed that church repairs no longer required presidential, a governor's or federal ministry permit. Only planning permission from the local council was required. However, the need for presidential assent in order to build a new church is still required. That is ridiculous. There can be no justification for such nonsense.
No such permission is necessary for the building of mosques. In addition, churches may not be built in an Islamic locality. It is absolutely crazy. That criterion creates a loophole for the refusal of any application to build a church, as any locality may be considered Islamic. It theoretically promotes the persecution of Christians. A church may not be built within 100 m of a mosque.
In practice, the state systematically obstructs the construction of new Christian churches, halls, offices and parsonages, leaving many parishes without adequate facilities for worship and other congregational activity. The Coptic Orthodox Church has particularly suffered in that regard. Few of its applications for building permission have been accepted. Even the successful applications can take up to 30 years before presidential approval is granted.
Although the current Egyptian Government boast that, since President Mubarak has been in power, he has not denied permission for a single church to be constructed, the fact remains that many applications have never reached him. Even if an application receives presidential approval, in practice, it will often be blocked at the level of the Interior Ministry. In some cases, after permission had been given by the president for construction, Muslims quickly built a small mosque within the 100 m limit, thereby preventing the church's construction.
I am sure that my hon. Friend the Member for Gainsborough would not wish the debate to damage our relationship with the Egyptian Government. I do not think that we are particularly bothered about our relationship with Her Majesty's Government, but we certainly would not want to damage our relationship with the Egyptian Government. As I know my hon. Friend the Member for West Suffolk (Mr. Spring), our Front-Bench spokesman, will say, the Conservative party understands all the issues involved in trade; we understand those only too well.
We recognise that people will say, "What did the Conservative Government do for 18 years with their relationship with the Egyptian Government?" No doubt all those matters will be raised, but we have come into a

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new dawn since May 1997. Her Majesty's Government has had more than three years to deliver on all their promises. Given their style, I should have thought that they would have been delighted to put Christianity at the heart of government.
The celebrations of the year 2000 have not been entirely joyous. There were many people who thought, "Never mind the hype about the dome, the millennium eye, the new bridge and all that; it should all be about Christianity". Therefore, what could be a finer tribute to the United Kingdom celebrations of the 2,000 years after the birth of Christ than the mother of all Parliaments, in raising issues concerning Christianity in this country and throughout the world, but in Egypt in particular, making a difference and stopping the persecution of those people in Egypt, who have devout beliefs in their Christianity and should be allowed to worship without any interference whatever from the Egyptian state?
10.17 am
Dr. Jenny Tonge (RichmondPark): I, too, congratulate the hon. Member for Gainsborough (Mr. Leigh) on raising the issue in debate. I am pleased to reply on behalf of the Liberal Democrats.
We have all heard about what went on in Egypt over the millennium. I say at the beginning—I have got more and more stirred to say this while listening to hon. Members—that I was raised as a Christian, I love God, but I loathe religion. I think that it is dangerous and causes immense suffering throughout the world. We need to play it down in the modern world, not up.
I have read the reports from the non-governmental organisations; we have been well briefed. The Jubilee Campaign and Christian Solidarity Worldwide have sent us briefings. We heard about those briefings in detail from the hon. Gentleman. There are sickening reports of torture; I entirely agree. There is abuse of human rights and the introduction of Sharia law by stealth, it is alleged. The hon. Member for Southend, West (Mr. Amess) has talked about rape as a means of converting Christians to Islam. Referring to my previous remarks about religion, I remind him that, in Kosovo, the Christians were raping the Muslims to destroy their lives and to ensure that they could not be proper Muslims any more. It happens on both sides all the time. That is why I loathe religion so much.
My right hon. and learned Friend the Member for North—East Fife (Mr. Campbell) wrote to the Egyptian embassy and, indeed, to the Foreign Secretary after the incidents over the millennium in Al Kosheh, and was assured that the Egyptian Government had taken the matter seriously. For what it is worth, I shall quote the embassy response:
The incidents which occurred on the 2nd January 2000 at the city of Dar El Salam were a reaction to false information and rumours about events in Al Kosheh.
A large number of the Christian inhabitants of Al Kosheh … took refuge and were hiding in the houses of their Moslem neighbours.
Such friendship between religions is common. People who feel as I do can often be quite friendly across the board.
The embassy response continues
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That reflects the sudden nature of the event and the deep rooted cordial relations between the two communities.
The incidents that occurred in Al Kosheh and the events that followed started with a quarrel between a shop owner and one of his customers.
I have no idea whether that is true.
The investigations establish that these incidents do not reflect a bias towards any religion.
That is what is claimed by the Egyptian Government. I agree that it is difficult to believe when one takes word for word what is said by the Jubilee Campaign and Christian Solidarity Worldwide. I therefore looked up the Amnesty International reports on what was going on in Egypt. I have four pages of them here, three of which are entirely occupied by accounts of abuses of Muslim groups.
The Egyptian Government come down very hard on religious groups, it would appear. We read of torture, imprisonment without trial, the imposition of the death penalty—what I must call the usual pornography of violence which takes place in countries all over the world. The treatment of people by their own police force, and their treatment when in prison, is pornography, and is perpetrated against both Christians and Muslims.
Mr. Leigh: To be fair to the Egyptian Government, they are engaged in a vicious war against an Islamic fundamentalist terrorist group. It is an ugly war, and the hon. Lady should be careful about what she says. The Egyptian Government are not persecuting Muslims in any way; they can be accused of acting very strongly, perhaps too strongly, against terrorist groups, but there is no persecution of ordinary Muslims in Egypt.
Dr. Tonge: What I am trying to illustrate is the fact that Egypt's human rights record is by no means good, as far as I can tell from the Amnesty International reports. Even if those arrested are terrorists, there is no need for the treatment that they are receiving. I am saying that there is a good deal of equality in the treatment of the groups involved. I think that the hon. Gentleman made a very biased speech.
I congratulate the hon. Member for Ribble Valley (Mr. Evans) on his point about planning applications. It was fair to point out that planning applications for mosques are sometimes difficult to get through in this country. I am pleased to say that there is a mosque in my constituency, which provides a useful centre for Muslims in the constituencies of Richmond Park and Kingston and Surbiton. I hold a surgery there every two months; I am always well received, and always have a good afternoon. I pay tribute to those who go to the mosque and foster such good relations in my community.
I look forward to hearing the Minister's reply. I contend that there is some brutality and abuse of human rights in Egypt, but that it is being dished out to all sections of the population, not just to Christians. There is a good deal of doubt about the way that the Egyptian police are behaving.
I must confess a love for Egypt and Egyptians, which I share with the hon. Member for Ribble Valley. I have been to Egypt twice, and I had a dear neighbour—a constituent—who was Egyptian. I sprinkled his ashes in

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Kew Gardens a few weeks ago. He loved his country, but he loved the United Kingdom equally, and I think he would be horrified if he were able to listen to this debate. Perhaps he is listening.
We need to reassure Egypt of our support. We want it to be part of the international community. However, I appeal to Government representatives from the Egyptian embassy—I am sure that they are here—to listen carefully to the debate, and to improve human rights for all their people.
10.25 am
Mr. Richard Spring: I congratulate my hon. Friend the Member for Gainsborough (Mr. Leigh) on introducing the debate. We all recognise and applaud the fact that he genuinely tries, as a Member of Parliament, to consider some of the key moral issues of our times and the practices in our society in the light of Christian ethics, and I believe that all Members respond to his sentiments. The same can be said of my hon. Friend the Member for Southend, West (Mr. Amess).
Although there are no clear figures relating to the size of the Christian minority in Egypt, it is undoubtedly significant, and 90 per cent. of the Christian community belongs to the Coptic Orthodox tradition. Many years ago, I stumbled into a church in Luxor where a mass was taking place, and was very moved by the ceremony.
In our country, we believe in religious diversity, and think that it should be accommodated in any pluralistic society. There is no doubt that Christians in Egypt have suffered significant difficulties, especially at the hands of Islamic groups, in a number of ways.
The jizya tax originated in the seventh century, and involved the defeated Jews of Khaybar paying a tribute to their Muslim conquerors. Some Islamic groups are trying to revive the tax, claiming that Christians and Jews accorded a separate and subordinate status under Sharia law must pay a special tribute to secure their own protection. The Egyptian human rights lawyer Moris Sadek says that the tax is nothing more than
a form of extortion used by Islamic militants to fund their campaign of intimidation and terror against Christians, tourists and the government.
The extent to which some Islamic groups are prepared to go to reinstate the tax is of considerable concern. In an interview with Al Ahram Weekly in 1997, Mustafa Mashhour, head of the Islamic group Muslim Brotherhood, publicly called on Muslims to impose the tax, saying:
Christians must pay jizya … it is part of Sharia.
Human rights groups in Egypt estimate that up to 2,000 Christians are being forced to pay; the actual figure may be considerably higher.
Coptic Orthodox leaders describe the practice as akin to a "religious mafia". It is reported that at least 40 Copts have been killed for refusing to pay the tax in recent years. Some Christians are too afraid to inform the police of the pressures. There is a widespread belief among Christians that pressure is being put on the Christian minority, either directly or indirectly, to convert to Islam.
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The hon. Member for Richmond Park (Dr. Tonge) spoke of her loathing of religion. She talked of the violence of rape, but she was really talking about human failings and human weaknesses, however detestable. That is the antithesis of what religion is about. To equate feelings about those terrible human failings and weaknesses with a loathing of religion is a quantum leap that I would not wish to make.
The Christian community is vulnerable to many kinds of pressure because of its economic situation. There is a widespread belief that there is discrimination against Christians in terms of employment and promotion, and that conversion to Islam is the only way of improving their economic position. There are reports of constant intimidation and persecution, to which my hon. Friends have alluded. Let me describe the problem affecting one family.
In March 1997, 13-year-old Teresa Shakir, a Coptic Christian in the eighth grade at school, was taken by her teacher—believed to be an Islamic extremist—to a police station. The police and the teacher tried to force her to convert to Islam, it has been alleged. Her family were able to obtain a form from the chief of police, instructing that the young girl be returned to her father, but it is reported that the local police refused to release her. Only after the family had contacted human rights organisations, Pope Shenouda and the office of the President was the girl finally released. The police had held her incommunicado for nine days.
In November 1997, Teresa's older brother returned home late one night to discover that his parents and younger brother had been shot to death, and another sister wounded. Teresa was also dead. Her brother ran to the police station to report the incident, and was arrested and accused of murder. To cut a long story short, a retrial is due to take place, at which I hope that justice will be done.
The case that I have described has been a major source of anxiety in the Christian community, whose members do not consider the Shakirs' family history to be unique. Egyptian Christians feel threatened by Islamic groups. Rightly or wrongly, they do not feel adequately protected by the police.
I hope that the Minister will say what recent representations he and the Foreign Secretary have made to the Egyptian Government about the problems of the Christian community and their human rights. What measures can he take to seek to improve the human rights of Egyptian Christians?
Egypt is, of course, the jewel in the crown of Islam. Its unique history, beauty, and intellectual and spiritual life have exerted an influence on the whole Islamic family of nations. Britain has close and friendly relations with Egypt, and it is also worth noting that the Egyptian Government have had their own significant problems with Islamic fundamentalists. They have reacted vigorously against such violence and extremism, as my hon. Friend the Member for Ribble Valley (Mr. Evans) noted.
Mr. John Bercow: I declare an interest in that I recently took part in a visit to Egypt, courtesy of the Gulf Centre for Strategic Studies. In the course of it, I raised the subject of the death penalty. Does my hon. Friend agree that the existence on the Egyptian

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parliamentary statute book of the death penalty is undesirable, as is the fact that conversion from Islam to any other faith is punishable by death? Do not those factors effectively act as a spur to private citizens in Egypt, who think that it is both legitimate and desirable to mete out violence to people who are Christians or who are in the process of converting from Islam to Christianity?
Mr. Spring: I am grateful to my hon. Friend for making that point. I hope that the Minister will take it on board, and that he will consider it in the light of Egypt's human rights obligations.
No one is suggesting that the Egyptian Government promote any calculated persecution of the country's Christian citizens. Traditionally, there has been greater religious tolerance in Egypt than in many other parts of the world. However, I urge the Minister to bring to the attention of the Egyptian Government the important questions of religious freedom and human rights set out so graphically by my hon. Friend the Member for Gainsborough.
Egypt is a member of the United Nations. It is a signatory to the international covenants on civil and political rights and on economic, social and cultural rights. The attempts by Islamic groups to reinstate the tax that I described, the planning difficulties alluded to so powerfully by my hon. Friends, and the ordeal of the Shakir family that I set out illustrate the pressures on Egypt's Christian minority. These concerns have been raised frequently by Egyptian Christians, most recently after the tragic incident in January described by my hon. Friend the Member for Gainsborough, when 21 Christians were killed. I therefore urge the Government to raise the issues of justice and equality for all Egyptian citizens, in practice as well as in the law.
10.35 am
The Minister of State, Foreign and Commonwealth Office (Mr. John Battle): It is routine to congratulate hon. Members on securing a debate such as this, but I shall go further and say that the Government are grateful to the hon. Member for Gainsborough (Mr. Leigh) for introducing this topic.
The hon. Gentleman has a track record in such matters, and his interest in the welfare of Christians worldwide is well known, in this Chamber and beyond. He has led several delegations on behalf of Christians to my office in recent months, the last time on behalf of Christians in Burma, and he is respected for the consistent rigour with which he campaigns. Raising this important subject in the Chamber, as other hon. Members have noted, helps maintain a spotlight on it, as our deliberations go far beyond this quiet Westminster Hall.
I also welcome the tolerant tone of the debate, which has been well balanced. The hon. Member for Ribble Valley (Mr. Evans) called for constructive dialogue, and t hat has been evident in the spirit of the debate. I agree that what the hon. Member for Gainsborough called the plight of people is important and relevant, and that we should regularly discuss such matters. Violence and abuse are unacceptable, and the House's opposition to them should present a seamless robe.
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Freedom of religious worship is a basic human right, and must be respected. All hon. Members should work together to ensure that it is respected fully, and we have a duty and responsibility to raise such matters in debate.
I know that many hon. Members have read troubling reports in the press and have received direct accounts about violence between Christians and Muslims in Egypt. They have also come across allegations of police brutality and of other harm to members of the Christian Churches in Egypt. The hon. Members who have contributed to the debate have presented a detailed and worrying catalogue of charges this morning. I shall try to respond to the points that have been raised, and to set out what the Government have done. I shall be happy to receive more details from hon. Members who want to take matters further, and to act on them. I assure hon. Members that the Jubilee Campaign's representations continue to be welcome and respected, and that the Government take them seriously.
I shall begin with the incidents in upper Egypt to which some hon. Members have referred. The first Al Kosheh incident in August-September 1998 resulted in the murder of two Christian villagers. That was followed by numerous arrests and there were allegations that many of those arrested were tortured in police custody.
The Government have made clear to the Egyptian authorities our concern that the allegations—in particular those of police brutality—must be fully and effectively investigated. Soon after his appointment last year, the new Egyptian prosecutor general reopened the investigation. It remains open, due to the number of matters under investigation. The Government will keep a close eye on developments.
The hon. Member for Teignbridge (Mr. Nicholls) is no longer present, but I can say, in response to his intervention earlier, that people do not believe that the Egyptian Government are systematically persecuting people. Independent human rights organisations have stated that more than 80 per cent. of the Al Kosheh villagers are Copts. They point out that it is, therefore, not surprising that, when arrests are made after an incident, some or most of those arrested will be Copts.
However, that inevitable effect of the numbers involved in no way excuses any torture that may have taken place—one case of the torture of a human being is one too many. Although what has happened does not necessarily add up to organised religious persecution, that does not mean that the Government do not take the matter seriously.
The hon. Member for Gainsborough drew attention to the case of William Shaiboob, the Copt who has now been found guilty of the two murders and sentenced to 15 years hard labour. We are following his case with close attention, as two of the main witnesses at his trial withdrew their evidence and claimed to have been tortured.
I understand that, on Monday, Mr. Shaiboob's defence lawyers put a request for an appeal to the Court of Cassation, Egypt's highest appeal court. That case is now being heard. It is, therefore, technically sub judice so we cannot comment further as that would prejudice it. However, our embassy in Cairo is following the case closely, and will keep Ministers informed. I shall be

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happy to keep right hon. and hon. Members who have raised these points and others informed as we receive information.
The second incident took place in and around Al Kosheh in January this year, when violence and rioting left some 20 Christians and one Muslim dead, and 19 Muslims and 14 Christians injured. As with the first Al Kosheh incident, our embassy in Cairo has been keeping us up to date with regular reports. We have discussed the incident on several occasions with the Egyptian authorities; we are not afraid to raise these difficult issues with Egypt, because our strong relationship enables us to have a tough conversation occasionally, and that is as it should be. We have a good, open and free dialogue with the Egyptian Government on these matters. We have discussed them on several occasions, and have stressed the need to investigate them fully and bring wrongdoers who commit crimes to trial. That is exactly what we are monitoring now.
Given the intense interest that there has been, and in order to hear from the villagers first hand, a member of our embassy staff in Cairo visited Al Kosheh in May. He was the first and only embassy official from any country to visit so far. He talked to members of the village council as well as to individual Muslim and Christian villagers, including some of those whose relatives had been killed. He found that the atmosphere in the village was stable—there is now a strong security presence to ensure law and order and calm.
It was clear that the authorities had also made some real efforts to encourage reconciliation between the communities. Whether those efforts are successful will become clear only with time. Obviously, given the feelings of animosity and mistrust in that poor, traditional and divided rural community, in which more than 80 per cent. of the population is Christian, it remains to be seen whether reconciliation and tolerance work at a local level, but it is a project to work at.
We understand that when the Egyptian authorities set up their investigation into the second Al Kosheh incident, they consulted religious leaders and coordinated their efforts closely with them. On 11 March, the public prosecutor announced that he had completed his investigation into the events, and that 97 Muslims and 38 Copts would be charged in connection with the murders and the events leading up to them. I understand that five Copts have been charged with attempted murder, and that the rest have been charged with illegal assembly, damage to property and ownership of firearms without licence. No religious leaders, it might be noted, have been charged.
Two trials opened on 3 and 4 June, in a normal criminal court. One was for those accused from Al Kosheh and the other was for those accused from a nearby village. Both trials were adjourned until 7 August and 3 July respectively. Our embassy in Cairo will continue to monitor both trials. In other words, where there is criminal activity, the due course of law and order in bringing people to trial should take place. We like to insist that it does, and we are monitoring the fact that it is. That should be on the record, and part of the account of these events.
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Other questions have been raised, of a rather wider nature. The hon. Member for Gainsborough listed a number of tragic attacks on Christians by Muslims, including acts of terrorism. All people should deplore murder, and terrorism in particular, wherever it occurs. The hon. Gentleman spoke of a systematic and brutal attack by extremists. I would simply add that systematic and brutal attacks by extremists are extremely difficult for any society to defend itself against, as we have seen recently in other countries, without the state taking an over-secure approach, as it were, to tackle the possibility of problems.
Sadly, the problem of terrorist attacks is not confined to Egypt and nor, within Egypt, has it been confined to Copts. Foreign tourists, including British citizens, have also suffered at the hands of fundamentalist terrorists. The Egyptian authorities have expressed their determination to prevent such attacks and to increase security for all. We fully support their attempts to increase security for all. The difficulty, as the hon. Member for Southend, West (Mr. Amess) pointed out, is that that can lead to a kind of over-protection to defend people against possible terrorist attacks. Getting the balance right is extremely difficult in individual circumstances.
Acts of fundamentalist terrorism must be the most difficult threat that any society can face. It does not necessarily mean that there is something wrong or corrupt at the heart of a state if there are terrorist activities within it.
Some hon. Members have claimed that there is systematic state discrimination against Copts that amounts to persecution. We maintain a regular dialogue with many Coptic Christians, from the Coptic Pope, to bishops and clergy, and to ordinary members of local communities in Egypt and elsewhere. We listen to their views and opinions—we take readings of their interpretation of the situation. Not surprisingly, as in all human situations, we hear a range of different opinions, not least on discrimination. While some Copts do indeed talk of persecution, other leading Copts tell us that they do not believe that there is a general Egyptian Government policy of discrimination against Christians; nor do they talk of persecution. We need to take that range of views into account in working towards that agenda. Building an atmosphere of tolerance and respect has been mentioned in this debate.
The Copts are deeply concerned, as are we, about any cases of violence, allegations of police brutality and other reports that raise human rights concerns. Such matters are always of concern, regardless of the ethnic or religious background of the person or group concerned. However, that does not necessarily mean that there is active state persecution in Egypt.
The Egyptian constitution provides for equal public rights and duties without discrimination due to religion or creed. Forced conversion, to which hon. Members have referred, is illegal under the constitution. The President has been very clear on such issues, stating publicly that he wants to see more Christians in the next People's Assembly after the elections this autumn. Ensuring that assemblies, Parliaments and Governments are properly balanced according to the population is not always easy, as we know from our experience in this place when it comes to getting the

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balance right between the genders. However, that is on the agenda of the Egyptian President, which is encouraging.
We have also seen positive changes on another issue that the hon. Gentleman raised—the difficulties that Christian communities in Egypt have faced in building and maintaining their places of worship. It is just a few years since William Dalrymple's book came out. I suggest that matters have improved slightly since then. The difficulty that Christian communities face in this respect is on the agenda.
In 1998, authority for granting permission for church repairs was devolved from the President to the regional governors. I am not opposed to that. The hon. Member for Ribble Valley—I nearly said upper Ribble, but it is more like the valley of the Ribble—made a telling intervention about linking that to events here, as did the hon. Member for Richmond Park (Dr. Tonge). When planning permission is sought in this country, reconciling local communities of Christians, non-Christians and Muslims in not easy. I know that from my own constituency.
Negotiations for a community centre to have a minaret on it so that it can become a mosque can turn into an enormous argument and conflict about religious histories and traditions. I am waiting to see what happens when the application is made for the call to prayer five times a day to begin at sunrise, not at 7 am every morning, given that sunrise is currently at 4.28 am. I am simply saying that we have not reconciled those conflicts in our society either, so we need to work together internationally on the agendas of tolerance.
I prefer such decisions to be taken locally, rather than that the Prime Minister should decide whether a mosque should be sited in my constituency. To devolve such decisions to local areas is not a bad thing. It should be a stimulus for people to work together to build communities, instead of being antagonistic and oppositional, and not seeking reconciliation.
Mr. Bercow rose—
Mr. Battle: The hon. Gentleman is itching to intervene, so I gladly give way.
Mr. Bercow: Notwithstanding the Minister's remarks about the Egyptian constitution, will he comment on the fact, about which the Jubilee Campaign—among others—is most concerned, that, under Sharia law, conversion from Islam to another faith is punishable by death? There seems to be something of a tension between the constitution and the practice of the Islamic faith.
Mr. Battle: There appears to be a tension, but I made it clear that forced conversion is illegal. The question remains: does it happen? The practice in local communities may not always comply with the law and then the state has to act to ensure that the local community conforms. I accept that there is tension—just as there are tensions in this country over similar issues. However, we do not have time to spell them out, and this may not be an appropriate debate in which to do so.
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I welcome the hon. Gentleman's use of the word "tension", as that suggests that we should address the matter. There is conflict, but it does not need to degenerate into violence and personal abuse; we should look for ways to reconcile such conflict locally, so that people can live together, tolerating each other's activities, behaviour and practices—respecting one another as human beings. That should be the challenge for all religious traditions; it should be at the heart of their theological practice. I make that point because there is no easy reconciliation between the law and practice in any context.
As I pointed out, the authority for granting permission for church repairs was devolved, in 1998, from the President to the regional governors, but, in December 1999, it was decreed that all places of worship would be subject to the 1976 civil construction code—putting mosques and churches on an equal footing. Permission for new church buildings remained in the hands of the President, but, as hon. Members will be aware—from correspondence with my Department and with the Minister of State, Foreign and Commonwealth Office, my hon. Friend the Member for Neath (Mr. Hain)—President Mubarak has agreed all applications put to him since he came into office in 1981. When such matters were referred nationally, there was agreement; that brought about reconciliation locally, including over planning permission. If we consider planning permission in our own country, there are also some question marks; we can understand the tensions involved in that process.
We shall continue to follow these matters closely; we take them seriously. We raise them regularly—not merely through nods and hints in passing conversations, but to point out that they are important matters. We have strong back-up evidence and research, and we need to act on them. We discuss them with the Egyptian Government and religious leaders.
When my right hon. Friend the Foreign Secretary visited Cairo in January, he met a wide range of people from many communities, including Sheikh Al Azhar, the leading Egyptian Muslim cleric, and Bishop Daniel, a Coptic bishop, as well as President Mubarak and other members of the Government. He discussed inter-faith issues and the importance of dialogue and tolerance. He pointed out that, even though all our societies have not resolved such matters, we could none the less work together on a common agenda.
That conversation and those representations were not a one-off. We shall maintain our dialogue with the Egyptian Government; we shall welcome positive change when we see it; we shall encourage the authorities to bring to justice anyone who has committed a crime or violated international human rights standards; but we shall not be afraid to raise human rights concerns. At the same time, we need to try to remain in touch with a wide range of Egyptian Christians so that we receive first-hand reports of matters that affect Christian communities in Egypt—cases of discrimination, for example.
While balancing the evidence, we must continue to raise such matters and to campaign for an increase in tolerance. The way in which we do so can either contribute to the spirit of tolerance or can undermine it.

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This morning's debate could help, in a small way, towards generating a stronger atmosphere of tolerance—the tone of the debate is to be welcomed.
The debate will not be confined to this Chamber; these matters will be taken further—by the Government and by the Egyptian authorities. We thank the hon. Member for Gainsborough again for raising the issue, as well as for his introduction and presentation of the debate—it was a model to all of us.

Health Services (London)
10.55 am
Dr. Jenny Tongs: This debate was requested by some Liberal Democrats from south-west London; it was not initiated solely by me. We hope that the Government will treat it as part of their consultation exercise. I cannot mention everything, but I want to raise one or two matters in the context of the future of the national health service and the next tranche of money that the Government will allocate to it. I do not speak as a Liberal Democrat spokesperson; this is a Back-Bench debate, so for its purposes I am a Back-Bencher, expressing my Back-Bench views.
The Prime Minister often says that the NHS must get used to change. However, at present, the health service is definitely sick and one of the causes of its sickness is change—unfortunately. Although I accept that much change is needed this time—this year—the Government must get it right. We cannot go on reorganising the health service, because the energy of everyone—managers, doctors and nurses—is going into the process of change and reorganisation, instead of into the improvement of patient care. As someone who has worked in the health service for many years and who has undergone many changes and reorganisations, I plead with the Government to try to get it right this time.
The health of Londoners has always been at issue. I have been practising for long enough to remember when the Black report on the health of Londoners was published. I do not know what happened to that report. It stressed the importance of the link between poverty and deprivation and ill health. It made exactly the same points as eight subsequent reports. I do not know why we have to keep producing reports that say the same thing.
London has some incredible centres of excellence. Some of the best medicine and surgery in the world is practised in this city, but, at the other end of the scale, we have inner-city areas where medical facilities are appalling and where there is squalor, poverty and ill health.
I was considering the health services in the Tottenham area, as a by-election will be held there soon. They are patchy. I compared some of the statistics for Tottenham with those for Richmond, which is in Surrey but is also a part of London. In Tottenham, the infant mortality rate is three times higher, and the rates for tuberculosis are five times higher than those in Richmond.
Long ago, as a medical student, I was taught that a key indicator of poverty and deprivation is TB. It occurs where there is poor housing, poor health and poor nutrition. We have that in areas of London. I obtained the figures for TB from the Library; they clearly show a frightening rise in the number of cases in London over recent years.
I have spoken to people who work in the national health service who have had to contend with, among other things, the recent scandalous shortages of TB vaccine. I must draw the matter to the Minister's attention. It is no excuse to say that the manufacturer does not want to manufacture the vaccine any more because the patents have run out and it is not making enough money from it. Someone must get on with

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manufacturing that vaccine, so that a generation of children does not grow up unprotected against TB. TB is on the march and it is resistant, and it is an indicator of what needs to be done in this city.
Let us consider the modernisation funds that were recently given by the Government and gratefully received by the health service. I understand that the first tranche was intended for primary care development, but in the London area 90 per cent. of it was used to address the deficits of the trusts; it did not go into primary care at all. The London region had allowed St. Mary's hospital and the Chelsea and Westminster hospital—large, famous teaching hospitals—to run up huge deficits. The new money was used to pay off the debt.
The remaining 10 per cent. of the first tranche was used to pay off the overspend on drugs in primary care. I know that the Government are addressing that problem, so I shall not go into it in detail; I simply ask how will the Government ensure that the second tranche of money, which we are all looking forward to, will be used for patients, not to cover the debt that has built up over years of mismanagement of the health service. In attributing responsibility for that mismanagement, I would cite previous Governments more than the current Government.
General practitioners are very enthusiastic about primary care groups and trusts. After initial reservations, all the GPs in my area whom I talk to now express enthusiasm. Particularly in the London area, we desperately need computerised records, but they must link up with those of hospitals. I understand that my local health authority, the Kingston and Richmond health authority, will run a pilot scheme for computerised patient records. I hope that the hospitals will be as enthusiastic about it as the general practices are, because it seems to me that the consultants and some of the people working in the hospitals are less enthusiastic about the switch to computerised records than the GPs.
Before I leave the subject of GPs, I repeat my plea on behalf of those in the London area who have had to wrestle with the problem of asylum seekers in the past two years. It has been a great problem for them. One of the greatest difficulties has been the lack of translators and language facilities. Everyone knows that there is a telephone line that one can ring to obtain a translation of almost any language, but it is very difficult—as I have found—to conduct a consultation with a patient in a consulting room when a telephone is in the way.
Mr. Philip Hammond: Does that remark indicate a lack of confidence in NHS Direct, where there is a telephone in the way of the consultation?
Dr. Tonge: No. The patient telephones NHS Direct and receives advice. As a doctor, I have reservations about that service, but I was referring to the language service that doctors can use when they have a patient with whom they cannot communicate. I have had to use it myself. One rings the language service and speaks to someone who can speak Serbo-Croat or whatever language one needs, and then one has to interview the patient via the telephone, which is terribly difficult—almost impossible. I hope that the Government will acknowledge that GPs in the London area have been wrestling with those problems.
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Although it is not a feature of London alone, a problem remains in co-ordination between health services and social services. I have worked on both sides of the pale: I have been chair of a social services department and I have worked as a manager in community health. The two sides must be brought together. The Liberal Democrats would like to see them brought together under the auspices of local government. I do not mind any more how they are brought together, but they must be brought together. In the interests of patients, the buck-passing cannot continue.
I shall briefly discuss beds and NHS facilities. Over the past 10 years, there has been a 35 per cent. reduction in acute beds in the health service in the London area. I have failed—someone else in the Chamber might be able to help me—to find the figure for the percentage reduction in mental health beds, but I know that too many have been closed and that even the Government admit that.
The enthusiasm for competition and the internal market led hospital to fight hospital against closures. In my area, two hospitals were competing for supremacy. To show their hospital in a better light than the competitor, managers made extravagant claims and projections about how they would cope with patient flows, where patients would go and how facilities in their hospital would be able to cope—claims that did not materialise.
I plead with the Government: if there are to be any more closures in the London area, for heaven's sake let us have the extra facilities in place before a hospital is closed. In my area, the closure of facilities at Queen Mary's hospital in Roehampton created chaos at Kingston hospital. I pay tribute to the staff and managers at Kingston hospital who dealt with that, but the casualty department was woefully inadequate. Now, thankfully, the money has come through and a new casualty department will be ready at the end of next year, but that should have been in existence before Queen Mary's hospital closed; likewise the beds to replace those in Queen Mary's hospital. What I describe as a portakabin ward had to be put up to accommodate the extra patients. Funding has only just come through to create a proper ward block to look after our patients adequately.
If my hon. Friend the Member for Kingston and Surbiton (Mr. Davey) had been here—I pass on his apologies—he would have told hon. Members that in our area we also urgently need better diagnostic facilities. Patients from a huge area depend on Kingston hospital, and the facilities at Queen Mary's hospital are sadly out of date. For example, we have no magnetic resonance imaging in the area. In the United States, every hospital has an MRI scanner—it is standard diagnostic equipment nowadays. We must have proper facilities. Likewise, for radiotherapy we have old cobalt machines instead of linear accelerators. There is so much to be done.
The bed closures have caused a phenomenon that horrifies me. Bed occupancy rates are often touted. If we visit hospital managers—I do so regularly—we are told that bed occupancy rates are 95 or 96 per cent. My response is that that is a disgrace. It is impossible to run an acute hospital if 95 per cent. of its beds are occupied all the time. The result is that sick people must wait on

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trolleys and chairs for empty beds. In the mental health sector in London, the bed occupancy rates are 130 per cent. That does not mean that there is one patient at the top of the bed and another at the bottom; it means that while a patient goes out for treatment for a day, another patient occupies their bed while they are away. It is appalling.
High bed occupancy also causes poor hygiene. Recently, I initiated a debate about the rise in methicillin resistant staphylococcus aureus infection and the lack of hygiene in NHS hospitals. High bed occupancy is the cause. There is not enough time even to wash one's hands between patients, to clean down drips caked with blood or to ensure that the ward is tidy.
We cannot continue with such occupancy rates. They cause bad practice and corner cutting, and if there is an influenza epidemic or a disaster—such as a serious crash—they cause mayhem. I have experienced it. We must tackle the problem. We need more empty beds in the national health service, and we need more low-tech beds for the so-called bed blockers—those poor and mainly elderly patients who cannot be sent home and must be kept in hospital while social services and the health service pass the buck between themselves to decide whose responsibility they are.
I urge the Government, before they close any more small hospitals and cottage hospitals, to think very seriously about improving those hospitals in the London area in the context of low-tech beds, GP beds and nursing beds where elderly patients can receive the sort of care that they expected to receive for the rest of their life from the health service.
Other issues that affect London disproportionately are pay and accommodation. I saw a student nurse in my surgery last week. She is a mature student with two children, but her husband walked out on her three years ago, so she is on her own. She had managed to find a house that was just about big enough for herself and her two children and the rent was £10,500 a year. That is a bargain and good going in the Kingston and Richmond area, so she is not complaining about that. However, her bursary—it takes into account the fact that she has two small children—to be a student nurse at Kingston university and at St. George's hospital in Tooting is £8,500. Because she is a student nurse, she cannot claim income support and, because she is not on income support, she cannot receive housing benefit.
There is no way that my constituent could manage unless she did care assistant work at night. She thought she might be able to claim the working families tax credit if she carried out her studies during the day, picked up her children and worked at night. However, she then faced the problem of finding someone to look after her children at night, and that costs money. Will the Government please examine this problem, which does not affect only student nurses? I have been lobbied by other nurses. One of them said, "I'm really lucky that I have a council house, but my pay and conditions are so awful. I am so busy, tired and stressed that I think that I am going to have to leave nursing."
The price of accommodation is a big problem in London. I do not know whether it can be addressed through London weighting. It affects not only nurses
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but pathology laboratory technicians. We have all heard about the cytology technicians—they are university graduates—who earn £12,000 or £13,000 a year. There is a huge need for better pay and conditions for staff in London.
I take a deep breath before I mention hospital consultants. I shall qualify my remarks by saying that the vast majority of hospital consultants—I am married to one and I know many of them—are decent people who do an amazing job and work extremely hard. The British Medical Association will tell us that independent research carried out for the doctors and dentists review body by MORI in February 1999 showed that hospital consultants worked on average 50 hours a week in the health service, and that is not bad. Surgeons and anaesthetists work between 40 and 70 hours per week in the health service.
The research does not break down the figures for London and it does not go into much detail on them. I have had experience of the health service for 30 years and I know exactly what is involved. In the London area, consultants have a huge opportunity for private practice and their contracts are arranged in a rather odd way. One can be a full-time consultant and work eleven elevenths of one's time, because the contracts normally include Saturday morning. That still enables consultants to practise privately, provided that they do not earn more than 10 per cent. of their health service salary. I would not accuse consultants of fiddling their tax; I am sure that they do not do that. We must accept that they work their eleven elevenths in the health service, put in many hours and earn only 10 per cent. extra.
However, many consultants opt for another contract. It is a nine-elevenths contract which gives them two free sessions a week in which they can practise privately. Some say, "Okay. On Wednesdays and Thursdays, I work in the private sector, but I work for the NHS for the rest of the week." Many consultants work that way and it is absolutely fair and above board. However, there are a number—I know because I have worked in the NHS—who spread the two sessions over lunchtimes, early mornings, evenings and any other time when they get a senior registrar to cover for them. I could tell all sorts of anecdotes and tales of consultants who are not in NHS hospitals as much as they should be, but who can always be found in private hospitals. The problem of consultant contracts must be addressed for the sake of the future of the medical profession and the reputation of consultants.
Mr. Hammond: Obviously, no one condones anyone who seeks to cheat the system. However, for the sake of balance. Will the hon. Lady tell us whether she is aware from her personal experience of the surgeons and anaesthetists who would like to carry out more NHS work, but who are unable to do so because of the rigidities relating to support staffing and operating theatres?
Dr. Tonge: I entirely accept that point and I am glad that the hon. Gentleman has raised it. Consultant contracts are not the only problem. Many consultants are forced not to work for the health service because of the non-availability of an operating theatre owing to the closure of hospitals and the lack of provision in the

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hospitals that remain, or to the lack of staff or beds. I shall return to that point later, which, if not the only reason, is one of the reasons for the problem that has been described.
I represent a well-heeled constituency and when my constituents see a consultant, they are disturbed when they are invariably asked whether they want to be seen privately. If they do, they are told that they can be seen tomorrow or the next week. If they do not, they have to spend 12 to 18 months on the waiting list. That makes people suspicious and upset. If the same consultant can operate on them next week, why cannot they be operated on under the health service next week? Why do they have to wait 18 months for the same man to carry out the operation?
Even more ridiculous things happen in specialisms such as diagnostic radiology. I know of a consultant in a hospital not far from here who sees all the private patients and carries out all the investigations on the private patients that are referred to his department. The patients are referred by general practitioners and other doctors from all over the region and the managers love that because it brings revenue into the hospital. The consultant takes his fee from the patient and then returns a little whack to the hospital for the use of its facilities. Consultants who see private patients who have jumped the queue in the health service cause health service patients to wait much longer for their investigations.
In the hospital that I have mentioned, there is not a particularly long wait for the investigations; it has plenty of capacity. However, a young woman in my constituency has had to wait nine months for a pelvic ultrasound examination. That is ridiculous when private patients can be seen in an NHS hospital just five or six miles away and have the same investigation carried out within a week. That cannot be right, so I urge the Government to tackle that problem.
I suspect that I shall not have any friends or colleagues left if they get to hear about what I have said this morning, but—to be really nasty—the consultants who carry out the most work in private practice are, sadly, the consultants who receive the biggest merit awards. The more doctors and surgeons one knows and the more one is a member of the private practice referral club, the more likely one is to be nominated by one's colleagues for a merit award. That fact must be aired publicly, so I put my head on the block by airing the issue this morning. The Government must take that problem on board.
There is no shortage of consultants in London and there is certainly no shortage of beds and facilities; there is loads of spare capacity in the private sector. If the Government are serious about reducing waiting times and waiting lists, they have two clear options. They can use the private sector for NHS patients and let Sir Lancelot Spratt take his patient for a hip replacement down the road to a private hospital if he cannot do the operation in an NHS hospital—and why not? Alternatively, we should tell consultants that if they work exclusively in the health service where they will be given more beds and better facilities, they will receive much greater rewards than they currently earn.
Most NHS consultants receive consultant pay, not consultant. Pay plus merit awards. Therefore, their pay is not comparable to that of lawyers, who probably earn
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two or three times as much they do. In addition, lawyers do not suffer from the angst and are not subject to the flak that consultants have experienced in recent years.
Mr. Hammond: Does the hon. Lady not see a potential danger in inviting the most eminent surgeons to make the choice that she has described? There is the risk that they will be lost to the health service altogether. I have always found it a rather attractive feature of the health service that a surgeon who charges a high fee to see a wealthy patient from overseas in the morning will work in the afternoon seeing patients free at the point of use in the health system. Is that not a strength of our system?
Dr. Tonge: It is a strength of the system, provided that it is not abused. My contention is that the majority of consultants probably do not abuse it. However, those of us who have worked in the medical profession know that it is abused. Often, when an eminent person is seeing a patient in his private rooms, his senior registrar and junior staff may be coping like Trojans in his out-patient clinic in an NHS hospital. That needs to be examined carefully and tactfully. The Government must recognise that consultants need better rewards than they currently receive in the NHS if they are to compare with other specialties and are to continue to take the risk of doing complicated procedures that may sometimes lead to a patient's death. However, both options cost money.
I am sorry to have taken so long, but I shall conclude with a point about funding, which relates not just to the health service in London, although it affects us acutely. The health service cannot go on without secure guaranteed funding every year, and funding must not depend on the whims of the Government, focus groups or whatever we think will give us enough political kudos. The health service needs far more funding than the Liberal Democrats have ever proposed and more than the Government are planning to give it. Indeed, it needs more money than any political party is prepared to take out of direct taxation. That is the problem: no one is honest enough to tell the British people that if they really want the sort of health service to which they aspire, it will cost them money. It would actually be much cheaper to pay far more in taxes than to take out private health insurance, perish the thought. The problem is never declared openly and we desperately need a debate about how we will fund the health service in future.
Mr. Deputy Speaker (Mr. Frank Cook): There are seven speakers to get in if everyone who wishes to make a contribution to our debate is to be satisfied. I must therefore alert the Chamber to the fact that I shall be looking for concise, pertinent and clear statements that do not take an awfully long time.
11.22 am
Mr. Gareth R. Thomas: As is traditional, I congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing the debate. I agree with her concerns about mental health beds in the capital and think that her point about them was particularly important, although I suspect that the thrust of her other remarks will get the most attention. I share the general view that the amount of private work done by a small number of consultants needs to be

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examined by the Government. I understand that that is happening, but the Minister may be able to comment further.
I welcome the debate as it is almost a year since we last debated London's health services, on a Government motion in an Adjournment debate. Today's debate gives us an opportunity to see how London's health services have progressed in implementing the Government's health reforms. This time last year, the key strategic issue facing London was how to inculcate the principle of partnership. The hon. Lady's experience of two local hospitals battling for supremacy is one with which my constituents would have considerable sympathy. In our debate last year, I said that, at times, there seemed to be a sense of bureaucratic imperialism in the health service, with the chief executive of an acute hospital battling with the chief executive of another hospital over services that they wanted.
How have matters developed in the past year? I shall give local examples and discuss the atmosphere now prevailing in Harrow's health care services, which have embraced the Government's national priorities with enthusiasm. In relation to national priorities on heart disease and strokes, the Harrow West primary care group has agreed local development schemes and incentive targets with all GPs and practices in the group. The GPs have identified all the patients on their lists at risk of heart disease, strokes and diabetes. There are now proper records and monitoring of the treatment of those patients. There is new investment by the primary care group in clinics, and staffing levels to meet concerns about heart disease, strokes and diabetes.
Another positive development in health prevention is the recent launch of the Harrow Heartbeat health campaign, which is a multi-agency primary prevention exercise aimed at raising public awareness of how to avoid heart disease and diabetes. The primary care group has worked to develop better access to care and has been successful in extending psychological counselling, for example. There used to be only 13 practices with access to such counselling; now all 27 practices in the primary care group have access to such services.
Practice-based mobile ultrasound services have been extended from two primary care teams to 22 practices in the primary care group, and local waiting times have come down from 11 weeks to two weeks, easing considerably the pressure on hospital ultrasound services, especially at Northwick Park hospital. All practices are now able to carry out cryosurgery—surgery on bumps and lumps—which, again, eases the pressure on hospital out-patient referrals. There have therefore been positive local developments on better access to care for patients.
Most significantly, £2 million is being invested in Northwick Park hospital's accident and emergency unit. That investment has been needed for at least 10 years and is only taking place thanks to this Government. The newly refurbished unit should be open in September. Furthermore, £5.8 million is due to be invested in two linear accelerators at the Mount Vernon cancer unit, which will substantially improve the quality of cancer care available to my constituents and others in the
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region who benefit from the hospital. It will also give my constituents much-needed reassurance about the future of Mount Vernon hospital.
There is considerable concern nationally about quality of care, not least in the light of what is taking place on the issue at the General Medical Council this week. In my constituency, the primary care group has delivered a clinical audit covering all GP practices, and a second audit is due to take place. Proper peer review visits are being made to all the primary care practices. There have therefore been good and positive developments in both primary and secondary care in my constituency.
We have done a lot, but I want to highlight one or two matters on which further work must be done. I spoke in the Easter Adjournment debate to highlight the need to expand the provision of intensive care beds at Northwick Park hospital. There is an urgent need for significant investment in intensive care in outer London, so that my constituents and their relatives do not have to travel into central London to benefit from the intensive care services there.
Northwick Park hospital is ideally placed to benefit from additional investment in intensive care. It is a fully staffed unit. Northwick Park is probably one of the most successful hospitals in London in maintaining a full staffing complement for its intensive care needs. However, the existing facilities are not adequate to meet the local demand. I hope that the Minister will convey as a matter of urgency to her colleagues the need to accept and recognise the business case for an expansion in intensive care beds at Northwick Park.
Another local issue in Brent and Harrow is a review of the capitation process and formula. Under the present formula, Brent and Harrow is considered to be above its target so we tend to receive less growth moneys than other districts. The skill of many of the people who work in the primary care group, the health authority and the local trusts has meant that we have been successful at winning new funds for the NHS locally, but a review of the capitation formula needs to take place. I, for one, do not accept that the formula properly reflects the needs for health care in Harrow.
Recruitment and retention of nurses have received substantial attention in other debates both in this Chamber and in the main Chamber, but recruitment and retention of support workers are equally crucial to the quality of care. I am thinking of cardiac technicians and technicians who work in the delivery of pathology services. The pay and conditions of those professionals need attention.
I suggest that we need some more investment in the assistance that we offer to patients who think that they have not received good service from the NHS. In my constituency, the son of a woman who died had some genuine concerns about the quality of care that she received from one of my local hospitals, but he had and still has problems in obtaining access to medical expertise to advise him and help him read the medical records available to him and judge whether there was significant substance to his concerns. We have done a great deal to improve London's health service and health care for my constituents, but there are other things that we need to do, and I hope that the Minister will take those concerns forward.
11.33 am
Mr. John Randall: I congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing this debate. The attendance shows how popular the subject is and the need for the debate. Perhaps I can make a plea to the Minister. The hon. Member for Harrow, West (Mr. Thomas) said that a year ago we had an Adjournment debate in Government time on health services in London. I suggest that a proper debate on the Floor of the House is about due. We do not want to have any more waiting for that.
The hon. Member for Richmond Park raised one issue about which I have a genuine question. I am not too up on it and perhaps she can give me an answer. I understand that if a GP holds only computerised records and not hard copies, he or she is in breach of some regulation, and that that deters many GPs from computerising records.
In Hillingdon, we have recently had the arrival of the primary care trust—one of the few in London. It is early days, but it has been greeted by most of the people in the health agencies with open arms. It seems that, although it is early days, the enthusiasm and optimism shows that PCTs might well be appropriate in certain areas, certainly in suburban and urban areas.
I and the two other Members of Parliament for the London borough of Hillingdon had a meeting last Friday with all the health agencies, including the community health council, to find out whether there was a cunning plan for Hillingdon. We feel that we are just drifting. We were slightly reassured. We are having a further meeting, but there is a great willingness to work together. We were told by someone from outside the area that Hillingdon is a good example of an area in which everyone is working towards a common goal. The social services department is working closely with the health agency to try to resolve some of the problems that we know exist.
We are not entirely sure what the big plan is for Hillingdon. We have our own vision and ideas of what we want and expect for NHS patients in three or four years' time. Although many matters teed to be dealt with for the time being, we also want to look to the future. We are worried that once we have our own plan, regional and perhaps national plans will be changed.
If the hon. Member for Hayes and Harlington (Mr. McDonnell) were here, I am sure that he would raise the problem that he has and that I share in the Uxbridge constituency—the problem of GP practices. As time is short, I will make passing reference to the work that my hon. Friend the Member for Ruislip—Northwood (Mr. Wilkinson) has done in promoting the problems facing Mount Vernon and Harefield hospitals, which were mentioned briefly by the hon. Member for Harrow, West.
There is a great deal of concern locally—when I say "locally" I mean over quite a wide area—about threats to close those two hospitals. I cannot single out either of them, but Harefield is regarded as a national asset, and I find strange the idea that it would improve people's health to take them into the inner city for their operations and recuperation. Anyone who has been to Harefield knows what a tranquil and idyllic spot it is. Even a layman such as I realises that being in a place like that aids recovery.
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As time is short, I shall not rehearse the points about Mount Vernon. I mention only the A and E unit, which has gone, and the burns unit and the cleft palate unit, which are under threat. There is a strong feeling locally that consultation with local interested parties is consultation for the sake of it. It seems that the decisions have already been made. Whether that is true remains to be seen, but there is a strong feeling that the consultation is just lip service.
I share many of the concerns expressed by the hon. Member for Richmond Park. I have many of the same problems, including recruitment and retention. The hon. Lady mentioned the TB vaccine. I have taken up the issue and found out that there has been no routine BCG vaccination of children under the schools programme in Hillingdon for the past two years. In a letter dated 21 January 2000, I was told that this was due to the non-availability of BCG vaccine. I should like to know from the Minister whether there has been any improvement and what the Government plan to do about the problem. Are there any plans to vaccinate people who missed out? In that case, there will surely be a huge backlog. In the light of increasing incidence of TB, what threat is there to those children who have not been vaccinated? Do the Government consider the vaccination to be as vital as do the parents of those children who have not been vaccinated? I hear little on the subject from the Government, and I hope that today we shall hear more.
As Members of Parliament, we hear only the complaints, sometimes serious complaints, that come to us, so it is easy for us to think that everything is doom and gloom. Many questions surround the NHS in London. I pay tribute to all those people who work in the health service in Hillingdon, who are doing their utmost, sometimes in difficult conditions. There are some good things going on; I particularly mention the diabetes unit at Hillingdon hospital, which is certainly first class.
I regret that, as a Member of Parliament, I have spent the past three years or so fighting closures in the local health service. I should like to be welcoming the arrival of new services. It is a great shame that most Members of Parliament have been fighting such causes for some while. I make a special plea for increased renal services in our area. There seems to be a dearth of such services in west London—particularly of dialysis, but in a range of other services, too.
I am sure that the Minister is aware of the great disappointment and frustration, not only in my area and in London generally but throughout the country, about what is happening in the NHS. If we are not careful to address those concerns quickly, there really will be a crisis. I do not want to talk up crisis for party political gain, but if she walks the streets, she will find that that is what everybody is saying.
11.41 am
Mr. Barry Gardiner: I, too, congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing this vital debate. It is vital in the true sense of that word because it concerns the life and death of our constituents here in London.
I must disagree with the hon. Lady on one specific point. Early in her speech, she made a plea for no more change in the health service. I want more change; I want

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the sort of changes that we are seeing at Northwick Park hospital accident and emergency department. It was originally designed 30 years ago to accommodate just 40,000 attendances a year, but in the past year, that A and E department saw 75,000 people through its doors.
Dr. Tonge: I must qualify the point. There is great difference between reorganisation of management structures and new facilities that will affect patients.
Mr. Gardiner: I understand very well the hon. Lady's point. Indeed, were there time, I would elaborate on it.
I am delighted that we have secured the £2.2 million from the Government modernisation fund to make the change that is needed. Work has already begun. It includes a new six-bed resuscitation unit, a dedicated child care service, 22 new major injury bays, new minor injury bays and accommodation in the new A and E department for 90,000 attendances—more than doubling that of the present design and allowing for a 25 per cent. increase on throughflow. That is the sort of change that I welcome, and I am sure that the hon. Lady would do so, too. It is the sort of change that I want more of.
As anyone in Brent will tell you, Mr. Deputy Speaker, the overcrowding of the A and E department at Northwick Park was desperately exacerbated by the scandalous closure of the emergency unit at Edgware hospital, which was rushed through by the Conservative Government just one month before the election. My greatest disappointment since becoming a Member of Parliament has been to find that we could not reverse that decision.
We had pledged to review the closure. It was only after the election that the true extent of the deviousness surrounding that closure became apparent. The Tories had not just closed the A and E department; without telling the public, they had let the contract to demolish the surgical block. Without surgical back-up, it is of course not safe to have an A and E department. The promised review therefore could not restore the emergency unit. That is the sort of change that I did not want.
Together with other local Members of Parliament, I spoke to colleagues in government—indeed, to the now Secretary of State for Health—and secured for the hospital another review of all the services that were to take place on the site. The full business case for the redevelopment of Edgware hospital has now been approved at a capital cost of £21.8 million. That is £22 million of new money going into services and provision for the local community in Edgware, Brent and Harrow.
A pilot of a primary care walk-in centre will open in August. The new hospital will include consultant-led out-patient services, children's services, day surgery and a birth centre. Those are all changes in the health service in the Brent and Harrow area that we want and on which we welcome the Government's initiative.
However, there are other aspects of the service in Brent and Harrow which the Government must address and change. I believe that the Minister knows of my concern, which is shared by my hon. Friends the Members for Harrow, West (Mr. Thomas) and for
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Harrow, East (Mr. McNulty), about the provision of breast screening by the Brent and Harrow health authority.
Women should receive reports of abnormal results from breast screening within two weeks. In fact, the results are reported within four weeks. The Government set a target for assessment of abnormal results within two to three weeks. The time span is up to six weeks. That is a desperate situation for women who are concerned about an abnormal scan and who want to find out what is going wrong and what treatment they might be able to receive. Mobile units in the Brent and Harrow health authority are clapped out. There is one left that is working. I challenge anyone to say that a screening unit that has for five months stood in a car park in Stanmore is truly mobile.
Those are the sorts of problems with which we are dealing, and they must be addressed by the Government. I know that ministerial colleagues are committed to providing good oncology services and that screening is one of the most fundamental parts that is subject to the review that the Department is undertaking, but I urge the Minister to respond to the concern of all local Members of Parliament and to ensure proper provision.
I shall finally pick up a point made by the hon. Member for Richmond Park on the curse of tuberculosis. She talked of it as one of the most fundamental indicators of poverty. She may or may not know that my constituency has the highest incidence of TB. I raise the point because, although otherwise correct, her remarks cannot apply to Brent, North.
Brent, North is a comparatively affluent constituency, but 40 per cent. of its population comes from the Indian subcontinent, and they return there frequently. The health authority—I have been in discussion with it—is convinced that the real problem is with the Indian community visiting family on the subcontinent, where conditions are as the hon. Lady described, contracting TB and returning with the infection. I share her deep concern about the matter, but incidence of the disease in my local community is not indicative of poverty.
If time permitted, I would comment on many other issues. In particular, I welcome the reduction in the waiting lists in the Brent and Harrow health authority at Northwick Park from 11,500 to 8,500—a 25 per cent. reduction during the past three years. However, I am conscious of the time, and I know that other hon. Members wish to speak.
11.50 am
Mr. Andrew Love: I add my congratulations to the hon. Member for Richmond Park (Dr. Tonge), and apologise for arriving late and missing the start of her contribution.
I shall focus my brief remarks on an issue of major importance to the health service in London—the balance of funding between primary care services and the acute sector. Hospitals have always been synonymous in the public mind with the health service, but most people look to primary care—in many ways the cinderella service—to deal with their health care needs.
The balance of funding has been a problem in London since the advent of the national health service in 1948. A major recommendation of the Tomlinson report in 1992

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was that there should be a shift of resources from the acute sector to primary care. It was suggested that that should be achieved through a reduction in bed numbers. I shall not elaborate on the problems that that has created in London, but the report recognised the difficulties of funding primary care and the provision of GP services in the Greater London area, which was identified as a major problem by the hon. Member for Uxbridge (Mr. Randall).
The Tomlinson report made a number of recommendations for improving the number of GPs, the associated services provided by health centres, and GPs' premises. However, it is clear from the Turnberg report of only two years ago that the problems of primary care in London continue and in many ways intensify. Since 1990, GP numbers in London have fallen by 1 per cent., during a period when they have risen by 6 per cent. in the rest of the country, and at a time when the population of London is increasing.
There is a particular problem with single-handed GP practices. Whereas they have reduced to 8.6 per cent. of all GP practices in the rest of the country, in London they represent 20 per cent. of practices—a major issue for London health services.
With regard to list sizes, the number of GP practices with lists of more than 2,500 is much greater than in the rest of the country. I recognise that there is far more population movement in Greater London, so some lists may well be inflated, but the pressure on GPs in London is significantly greater than on those in the rest of the country.
The problem of GP premises was supposed to have been addressed by the Tomlinson report in 1992, but in my district, Enfield and Haringey, 55 per cent. of GP premises remain below the minimum standard.
Taking all those difficulties together, we can understand why Leslie Turnberg stated in his report:
General practice lags behind the rest of the country and appears to be getting worse rather than better.
The problem is not just the failure to attract GPs into Greater London. There is a series of associated problems, often but not exclusively related to single-handed practices. I refer to the additional services that we have come to expect from health centres—the provision of practice nurses, chiropody and so on. Those are not provided in Greater London, as they are in other parts of the country. The training of staff to provide those services is not being achieved in Greater London, partly because of the number of single-handed practices, and partly because of a lack of commitment to maintaining staff of the highest standard.
The professional development of GPs is a further issue. Many single-handed GP practices in London are run by elderly general practitioners, many of whom have never had to update their skills and are still practising as though the health service was still in the 1950s and 1960s, rather than going into the 21st century.
The provision of proper primary care in the most deprived areas has been a particular problem. The difficulty of attracting GPs to deprived areas was partially addressed by the Government in 1998, when they made available £25 million for additional deprivation payments. I welcome that, but there are continuing doubts. It is clear in London and other parts of the country that deprived areas face significantly greater problems in attracting staff.
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I recognise that a salaried general practitioner scheme may overcome some of those problems, but we must find ways of attracting GPs to work in those areas. The way in which the payments scheme operates is not to the advantage of the service. There seems to be some confusion about whether the payment is for additional work load, for providing additional time for the patient, or to attract staff into less attractive areas.
I urge my hon. Friend the Minister to re-examine the deprivation payments scheme, to see whether there is anything further that the Government can do to ensure that our most deprived areas—those that have been the focus of the recent report entitled "A National Strategy for Neighbourhood Renewal"—will be able to offer a level of service comparable with that available in other parts of the country.
Finally, I hope that the spending review will address the balance of funding between primary care and the acute sector. Tomlinson got it entirely wrong by suggesting that resources should be shifted across the two. With the additional resources that are to be made available, there is an opportunity to provide an adequate level of funding for primary care. If we do that, we may create a health service in London that meets the real needs of its people.
11.58 am
Mr. Paul Burstow (Sutton andCheam): I congratulate my hon. Friend the Member for Richmond Park (Dr. Tonge) on securing the debate. It is a timely debate, following on, as others have pointed out, from a debate in Government time about a year ago. From the contributions that we have heard today, it is clear that it would be valuable if there were a further debate in Government time, so that more hon. Members—London Members in particular, but others, too—could contribute.
Speeches have reflected a range of constituents' experiences and the concerns of professionals in the health service. As the hon. Member for Uxbridge (Mr. Randall) rightly said, in our mail bags we receive and pass on many brick bats; we receive fewer bouquets. However, much of what the national health service does in London and elsewhere is excellent and needs encouragement, promotion and further development.
My hon. Friend the Member for Richmond Park has raised several important issues. I want to mention some, and develop a couple of other themes that emerged from the debate. She was right to mention the huge health inequalities that exist in London and the litany of reports that have identified the strong relationship between poverty, deprivation and poor health, and the need to do more.
My hon. Friend was right to highlight bad practice and corner cutting, as she put it, that is caused by an obsession with bed occupancy rates. The fixation with bed occupancy statistics, and efforts to concentrate on conditions rather than the person as whole, can lead to lack of attention to detail in the care of an individual, often at the expense of that person's dignity and overall care.
My hon. Friend identified another problem, which applies to my constituency. She spoke of change that is not about investment in services, which the hon. Member for Brent, North (Mr. Gardiner) rightly

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described and welcomed, but organisational change. The NHS appears to be in perpetual revolution. It perpetually changes its organisation and management structures, not always with the outcomes trumpeted by the Ministers who initiated them. The primary care groups and primary health teams in the latest review are useful to drive primary care, but I am worried about the lack of integration of health, especially primary care, with social care. In my constituency, there is a lack of coterminosity between primary care groups and social services departments. That could get worse.
My hon. Friend said that she was making a Back-Bench speech. She made a typically forthright speech and raised many issues that will continue to be debated in this place and outside for some time. She was especially right to consider staff vacancy rates. It is important to acknowledge that capacity is vital in dealing with many anxieties that are raised with us in our constituencies. We have only to consider the legacy of staffing in the NHS to appreciate that the problems with which the Government grapple did not necessarily begin on 1 May 1997. They were long in their manufacture under the previous Government's tenure. We have only to consider the age profile of many staff, especially nurses, to realise that the current problems are not likely to be solved for some time. Many staff are approaching the end of their time in nursing. We must acknowledge that when considering the resources for tackling vacancy problems.
London suffers from the most acute staff shortages in professions allied to medicine and in nursing. One in three of the 15,000 vacancies throughout England are in London. The three-month vacancy figures for nurses and midwives show 2.6 per cent. in England and 5.1 per cent. in London. The figure in my health authority is 4.9 per cent; in my local Epsom and St. Helier trust, it is 6 per cent. Managers are grappling with genuine problems. They have to go ever further afield. Reports in the Evening Standard show that they look not only further afield in this country, but abroad to try to find additional staff to plug the gaps.
The hon. Member for Harrow, West (Mr. Thomas) mentioned the need to invest in intensive care services. I agree, but we must acknowledge that there was intense pressure on intensive care beds in London last winter and that that was caused, at least partly, by staffing problems. There are 20 per cent. vacancies in intensive care units in London. The problem is therefore not simply one of beds and units. However, the hon. Gentleman was right to point to the need for investment in such services in outer London.
The problem of vacancies is caused partly by the fact that people are being priced out of London. That applies to public sector workers generally, and especially NHS staff. In the past year, house prices have increased in London by 23 per cent. It is a harsh reality that a newly qualified nurse, who earns approximately £17,000, cannot get on the property ladder. As my hon. Friend the Member for Richmond Park rightly said, our benefits system makes it difficult even to get into the rented sector.
I want to address two other issues briefly. First, I want to speak about neurology, another Cinderella service which needs some attention in London. I understand
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that a review is currently taking place. I hope that it will shed light on the way in which the services might be developed in future. Specialist services have suffered through reorganisation and fragmentation. It is therefore important to consider the way in which we can tackle that.
Probably more than one in 30 people in London are affected by neurological conditions. There is only one neurologist per 200,000 people in the United Kingdom. I suspect that the position may be worse in London. There are not enough neurologists to fulfil demand. I undertook a survey earlier this year and found that the average wait for a first appointment with a neurologist was 19 weeks. The longest waits were 23 weeks. That is unacceptable when trying to map out the necessary care pathways to provide support, care and attention. Indeed, in this country, patients who sustain a head injury or stroke have half as much chance of waking with a neurologist or a neurosurgeon at the bottom of the bed than anywhere else in the developed world. That is an unacceptable measure of our position as a country.
Many neurological conditions leave people feeling marginalised and left to navigate their own way through the care system. Early diagnosis is vital; it leads to a better prognosis. Clear care pathways and counselling are often the key to many neurological conditions. Greater co-ordination of service providers and a multidisciplinary approach are essential. I hope that the Government will consider developing not only the strategy that is being worked on in London, but the need to provide a national service framework to develop neurological services.
Secondly, I want to speak about communicable disease, to which the hon. Member for Brent, North and my hon. Friend the Member for Richmond Park referred. I shall concentrate on mumps, measles and rubella, and tuberculosis. There is a strong correlation—although the hon. Member for Brent, North cited some evidence to contradict it—between deprivation, low immunisation levels and outbreaks. That is not surprising when we take into account that 11 out of the 20 poorest boroughs in England are in London.
Let us consider TB first because mortality rates in London are a serious problem. Incidence of TB in London is 80 per cent. above the national average. Incidence is concentrated in some of the most deprived parts of London The hon. Member for Brent, North identified other reasons why it is a problem in Brent. There is also a serious problem in east London. The incidence in east London is six times the national average. The hon. Member for Uxbridge is right to draw attention to the backlog of BCG vaccinations and the potential problems that that could cause, for example, a future increase in TB.
The recommended level of immunisation to avoid outbreaks of mumps, measles and rubella is 95 per cent. In the United Kingdom, take-up is 88 per cent; in London, it is 80 per cent. However, like any average, that figure hides wide variations. In some parts of London, the figure is as low as 71 per cent. Outbreaks occurred in east London last year. They were not major or life threatening, but they are a serious cause for concern when we consider that serious outbreaks

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occurred in the Netherlands, where immunisation levels are too low. Consequently, the more fatal elements of the condition were reached.
We need a concerted campaign to increase immunisation. Even if poverty is not the cause of outbreaks, low immunisation is a major reason for the increase in outbreaks. We need to consider carefully what immunisation levels in London mean for outbreaks in the next five to 10 years and ensure that we put that right now.
This debate has been a useful taster of the fuller debate that I hope will be allowed in Government time because many issues need to be discussed, including high-tech investment, about which hon. Members have spoken, and the need to deal with the detailed care of individuals. As my hon. Friend the Member for Richmond Park has said, the statistics on health inequalities in London are striking. Those inequalities need to be acknowledged in allocating resources and using existing resources more effectively, which means considering how to improve capacity without losing sight of Cinderella services, such as neurology. We must ensure that we drive home the message about immunisation and the links with poverty and communicable diseases so that health in London is as good as anywhere else in the country.
12.10 pm
Mr. Philip Hammond: I apologise to hon. Members for my late arrival. I had not realised until today that debates in Westminster Hall could start before the allotted hour. I, too, congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing the debate. She seemed to be slightly torn between the temptation to attack the current Government and the temptation to attack the previous Government, so she had a go at both, safe in the knowledge that the party that she represents is unlikely to be burdened with that responsibility.
We have had a good debate, and hon. Members have made some important and interesting points, to which the Minister will want to respond. London is different. London's size, population density, ethnicity mix, social problems and environmental characteristics provide a specific backdrop to its health agenda. Many of the issues that hon. Members have raised reflect the more general problems of the NHS across London.
The hon. Member for Edmonton (Mr. Love) made the point, which I am fond of making, that we as politicians are guilty of a tendency to focus on hospitals and acute services, yet primary care and community services represent the routine point of contact with the NHS for the great majority of people. A health agenda that works for Londoners must address the inadequacies in those services and provide people in the heart of the capital with the same quality of primary and community services that those who live on its periphery and in the surrounding suburbs have come to expect. Until the primary care tier is right, the secondary sector will always struggle to do its job properly against a background of inappropriate referrals and self-referrals to hospitals.
The hon. Member for Richmond Park referred to the huge additional burdens that the influx of asylum seekers have put on health services in London. That is
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an example of the specific problems that London faces. The incidence of TB is soaring. One estimate suggests that TB could have increased by 80 per cent. in 1999 alone, which inevitably imposes a huge burden on the service. There are other pressures, including HIV. A third of all HIV suffers in the United Kingdom live in London. The number in south-east London alone has increased by a third in the past two years, yet, for example, the genito-urinary medicine clinics at Guy's and St. Thomas's are forced to shut their doors once they have seen 100 patients because of the lack of resources. Facilities are not being used to address the urgent problems that face the capital.
Substance misuse and mental illness are particular problems in London, as hon. Members have said. Those problems affect twice as many male London residents compared with the United Kingdom average. Health authorities in London are inadequately resourced to deal with those specific problems, often with the result that improvements in basic health services for Londoners are not taking place as fast as in other parts of the country or as fast as necessary.
I am very concerned that the consensus by which the NHS prospers and has worked for the past 50 years will start to break down if what I shall typify as the ordinary working Londoner finds that the health services cannot deliver for him and his family, that the accident and emergency department cannot respond when his child needs it and that the family health services are not there for him and his family when they need them because of the extraordinary burdens that face the health care system in London. In addressing the specific needs involved in mental illness, HIV, sexually transmitted diseases, TB and so on, it is important that we do not lose sight of the fact that we have to preserve that consensus by providing appropriate services across the board.
Outer London has some of the longest A and E waiting times and, on average, London as a whole has longer waiting times than the rest of the United Kingdom. That is linked to the problems of staff recruitment and retention. Some London trusts are 30 per cent. under establishment in nurses and are surviving only by using agency and bank staff.
The hon. Member for Richmond Park described the problems facing student nurses on bursaries. I have seen examples of such problems in my constituency, where house prices are almost as high as in hers. That urgent problem needs to be addressed. I do not pretend to have an instant or easy answer, but it is vital that it is resolved so that the health service in London has a future.
The hon. Lady also dealt with bed-occupancy rates—obviously, a critical issue given the rising number of hospital-acquired infections, yet the Government are still closing beds. According to The Sunday Times last Sunday, that has led to scenes of third-world chaos and squalor at a major teaching hospital in London.
On the eve of the election, the Government's slogan was "24 hours to save the NHS". Now that they are in office, they seem to be slightly less pressured by time. In response to the Turnberg report, the then Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson) said that it would take 10 years to improve London's health services, but, in the meantime, the NHS is still failing Londoners too often. Deficits are piling up in health authorities and trusts.

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The Government promised a moratorium on hospital closures, but, after their three years in office, the axe still hangs over several London hospitals and beds are whittled away in others. Other hospitals have gone. Bart's—which was supposedly saved for the community and which, we were told, would focus on cancer and cardiac services—will not be a general hospital serving the local population, but a specialist unit. To all intents and purposes, for local people, Bart's has closed—a triumph of spin over substance and another broken election pledge.
The Harold Wood hospital scheme has been scrapped. The Havering hospitals NHS trust has now conceded that the new Oldchurch hospital will not be completed before the autumn of 2005, and people close to that situation believe that 2007 is a more accurate estimate. A further 200 beds have been cut from the planned number at the Royal London hospital development and the split-site solution has been chosen. Senior consultants have condemned that decision as a "dangerous" political fix, which presents a "serious risk" to patients.
The hon. Member for Richmond Park has spoken about the situation at Queen Mary's hospital, Roehampton. Ambulance response times there were only 26 per cent. compliant with the Government's target, which had knock-on effects in maternity and A and E services across west London. Services at the Royal Free, Whittington and other hospitals are facing continued threats and uncertainty.
What of the future? The fact that London has an elected Assembly and an elected mayor has not been mentioned. They are bound to want to have a say in the health agenda for London. Across the country, political interference and attempts by politicians to micro-manage the health agenda have been part of the problem, not of the solution. I hope that the Minister will reassure us that the NHS in London will not be turned into even more of a political football when the clash of titans takes place as the mayor gets into his stride.
The Minister needs to tell us that the extra money that will be made available to London during the next three or four years will reach the health authorities and can be used to improve primary and secondary services so that ordinary, hard-working Londoners can be confident that the NHS in London will be there for them when they and their families need it. After all the other extraordinary pressures that are specific to London have been dealt with, the ordinary people of London must find that the services that they need exist so that the consensus that is essential for the NHS to survive and prosper in the 21st century can be rebuilt.
12.20 pm
The Parliamentary Under-Secretary of State for Health(Ms Gisela Stuart): I congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing this timely and useful debate. Up until the last 10 minutes, I thought that it was specific to London, and I wish that I had more time to respond to the points that she raised. I realise how busy she has been this morning, as I saw her taking part in the earlier debate on Christians in Egypt. Her concerns go well beyond her constituency.
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I shall deal with the specific points before coming to the more general aspects. Consultation is part of the national development plan. Some people have said please, no more change, and others have said that they want more change. I think that we need both. We need continual change, but it must be part of a much wider, strategic framework.
The hon. Lady referred to bed occupancy rates. I am aware that there have been problems with bed occupancy in hospitals in her constituency. However, I understand that they have now been alleviated. Kingston hospital has 30 more acute beds than it had last year, and the provision of mental health beds at Queen Mary's University hospital in Roehampton has improved because alternative provision and arrangements have been made at Tolworth hospital.
I was grateful that my hon. Friend the Member for Harrow, West (Mr. Thomas) recognised the improvements that have been made, but he highlighted the issue of intensive care beds, especially in Northwick Park hospital. I understand that he has a meeting tomorrow with the regional director of the NHS executive in London. I hope that he will have a successful exchange of ideas.
The hon. Member for Uxbridge (Mr. Randall) was concerned about whether consultations in this area are real consultations. I point out that the Mount. Vernon hospital accident and emergency department was closed under the previous Government. We must not lose sight of the past. Closing accident and emergency departments is not a significant characteristic of this Government: we are concerned with the provision of services. The consultation process can sometimes be unsettling for communities. We seek certainty, but the very process of consultation involves a period of uncertainty until decisions are made.
Many hon. Members raised the subject of tuberculosis and the TB vaccine. We are fully aware of the problems. The Government are in discussion with the manufacturers about the national shortage of vaccine. I assure hon. Members that the Government have made sure that the available vaccine goes to the children who are most at risk. In London, where this is a specific problem, the Thames regional directors of public health in 1998 published "A strategy for tuberculosis control in London: a need for change". As a result of that, a taskforce was set up in consultation with multidisciplinary agencies. We are piloting a TB register in London, and we shall soon have some of the results of that scheme.
My hon. Friend the Member for Brent, North (Mr. Gardiner) reminded us of the disgraceful manoeuvring in relation to Edgware hospital, which made a revision of the plan impossible when we came into government. He raised valid
concerns about breast screening in his constituency. I am fully aware of the number of parliamentary questions that he has tabled on that issue. If he would find it helpful, I should be happy to facilitate a meeting with Ministers to discuss the matter further.
My hon. Friend the Member for Edmonton (Mr. Love) expressed his concerns about funding for primary care. He explained the problems faced in many parts of the country, especially in big cities. As a Birmingham MP, I recognise some of the problems that

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he referred to, but not on quite the scale that people face in London. Considerable extra funding is going into the primary care sector, not least the £10 million additional funding in 2000–01 that has been targeted on improving primary care premises in London. I am sure that my hon. Friend welcomes the opening of the walk-in centre in Tottenham and Edmonton on 31 July.
The hon. Member for Sutton and Cheam (Mr. Burstow) referred to the problem of boundaries, which is almost insoluble. There will always be overlapping boundaries: there is no perfect solution. It is important in the establishment of primary care groups and subsequent primary care trusts that the configurations we end up with have a natural dynamic. Communities should have cohesion. Sometimes boundaries will be concurrent, but in other places they will not be. Where there are overlapping boundaries, especially between health authorities and social services, we want provisions to be put in place that will overcome the problem.
Like all of us, the hon. Member for Runnymede and Weybridge (Mr. Hammond) learned something new today. I hope that he welcomes that learning opportunity. We welcome such developments in the national health service. I must challenge his notion that the problems are due to inadequate resourcing. He rightly said that we need a national consensus for a national health service. If there is one party that is committed to a national consensus for a national health service out of taxation it is the Labour party. We do not think that private insurance is the way forward.
To come back to the overall problems, what the debate showed is that London contains an extremely diverse community. It does not have a static population: some 7 million people live in London, but 25 million tourists visit the city, some 670,000 commuters come into London to work and almost a million people travel into the city centre every day. It has great diversity, including some of the most deprived areas and some of the most affluent. It has extraordinary nationally and internationally recognised medical expertise, and some examples of the worst practice.
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That is why one of the first things we did when we came into government was to establish the Turnberg review, which was an independent investigation into the needs of London. We also set up the NHS executive's London office. The Turnberg review reported in seven months, and the Government accepted all its recommendations. It is important in the London context that all the agencies work together.
Hon. Members raised the issue of mental health. It is important to remember that on 11 April the Minister of State, Department of Health, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), launched "Mental Health in London: A Strategy for Action", which was developed jointly by the NHS executive and the social care regions. As the hon. Member for Richmond Park said, health and social care services must be delivered coherently.
These strategies are underpinned by increases in resources and the provision of new services. It is no accident that, of the 36 walk-in centres, a quarter are in London. The new services of NHS Direct will be available for the whole of London by 31 October. The Soho walk-in centre is important because it is a local health service centre that includes the Chinese national healthy living centre. That is a recognition of the ethnic diversity of London.
The funding that has gone into London has been unprecedented. There has been huge capital investment of £3.5 billion in a building programme, and there is year-on-year recurrent investment that is not used to pay off debts, as has been suggested. We expect any institution, whether it is a hospital or a trust, to finance its services coherently. In London, new moneys are certainly not being used to repay old debts. They are used to address the shortcomings in services, and to reconfigure services so as to provide a better service for everyone in London.
Focus is being put on health action zones working together with the new London mayor to provide a much healthier environment for people in London. We have recognised the need for strategic input, for extra money and for extra help for the training and retention of nurses. We are confident that we will put those policies in place.

Industrial Deafness
12.29 pm
Mr. Martin Salter: I welcome the opportunity to bring the case of my constituent, Mr. James Fryer, of Purley in Reading, to the attention of the Chamber. Sadly, due to ill health, Mr. Fryer cannot be here to witness the results of his four-year struggle to obtain industrial injuries disablement benefit. However, it is obvious to me that there is a clear case for the legislation surrounding the IIDB qualifying criteria to be reviewed by the Government.
I want briefly to outline the history of my constituent's case. As my hon. Friend the Minister and hon. Members will know, to qualify for IIDB the claimant must have worked in a prescribed occupation and the claim must be made within five years of having worked in that employment. For 34 years, Mr. Fryer worked with power presses at Waymaster Ltd. in Reading. However, unfortunately for him, and for some bizarre reason, power presses are not listed in the Department of Social Security guidelines and the occupation is not prescribed.
Mr. Fryer has suffered hearing loss as a result of his employment. That has been supported by subsequent medical reports. He made his claim for IIDB in 1996 and was refused in the same year in which the social security tribunal upheld the idea that the use of a power press did not constitute the use of a prescribed tool in a prescribed occupation. The nub of that argument is that power presses somehow make only background industrial noise. Anybody who has spent time on the shop floor and has seen such a press in operation will know that the very last thing that a power press makes is background industrial noise. It makes a considerable noise, and 34 years' work in the industry is likely to have some effect on a person's hearing. I should know; I was born right next to Heathrow airport, which is one reason why I have to shout a lot.
It is worth quoting the DSS tribunal hearing of 3 November 1996. Giving the grounds for his appeal, Mr. Fryer states:
If you read the first paragraph of NI 207 you will find that Industrial Injuries Disablement Benefit was introduced to help the very people like myself. That is the first and foremost reason of its existence.
Secondly I do not believe there are two kinds of industrial deafness and I don't think the members of a tribunal will either, but if you can prove me wrong would you please put it in writing so that I might forward your statement to Mr. Hayworth, the hearing consultant at the Royal Berkshire Hospital, so he does not unknowingly mislead other people into thinking that they are industrially deaf when in fact, according to your rules, they are not.
A senior consultant at a well-respected hospital is advising constituents of mine that they qualify for that benefit when, because of a vagary in the rules, they do not.
Although I could continue at length, I am aware of the time constraints. However, I must quote the adjudicating officer's statement:
Mr Fryer is claiming that his deafness has been caused by working with power presses. In his letter of 23/4/1996 Mr Fryer states his deafness has been caused by working for 34 years with power presses and "for the rules to exclude power presses is very wrong".
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As Mr Fryer has not worked with any of the prescribed tools or in any of the prescribed occupations in the five years prior to his date of claim the decision at box I was given.
Unfortunately, that decision was to deny Mr. Fryer IIDB. It is ridiculous that we have such time-limited criteria. Even though someone worked in an industry for 25 or 30 years—34 years in the case of my constituent—and because of the five-year gap before the hearing impediment became such that he felt able to lodge a claim, Mr. Fryer is somehow ineligible. Somehow, 34 years' work in heavy engineering counts for nothing under the rules.
In my three years as a Member, I have made a number of representations about Mr. Fryer to Ministers in both Houses. Although the responses have helpfully set out the legislation surrounding the qualifying criteria for IIDB, unfortunately the law offers my constituent little hope of obtaining a benefit that was established in 1974—in his eyes and mine and, I would suggest, in the eyes of Parliament at that time—to cater for people such as Mr. Fryer.
I have had copious correspondence with Ministers, which has been useful but not productive. A letter from Baroness Hollis of Heigham states:
You also expressed concern about the fact that Mr. Fryer's occupation is not on the list of prescribed occupations for which industrial injuries disablement benefit in respect of deafness can be paid. A disease may only be prescribed as an industrial disease if it can be treated as a risk of occupation and not as a risk common to all people and where, in particular cases, the occupational link can be established or presumed with reasonable certainty.
Apart from the fact that that statement makes absolutely no sense whatever, it defies logic to suggest that members of the general public wander in and out of engineering shops, exposing themselves to noise caused by power presses. That is the implication of what the Minister wrote.
My gripe is not with the treatment that my constituent has received from the Government, but with the inflexibility of the IIDB qualifying criteria. I call on the Government to relax the criteria for those who have suffered hearing loss or impairment as a result of their employment. I understand that the Industrial Injuries Advisory Council keeps under review literature that relates to hearing loss at work. That fine, independent body then reports to the Secretary of State for Social Security and advises him or her accordingly. I put it to my hon. Friend the Minister that there is a case for reviewing the way in which the scientific evidence is used in this area.
Perhaps my hon. Friend can advise me whether the Government have any plans to establish a group to look more deeply into the problem. I want to hear from him today whether there will be a full review of the criteria surrounding industrial deafness and the prescribed occupations. I am aware that being able accurately to assess the nature of a claimant's hearing loss after the statutory five-year period is a problem for Ministers, but I hope that they will look again at the nature of the employment that perhaps led to the hearing difficulties in the first place.
I draw to the Chamber's attention the results of "Indecent Exposure", a joint report on noise at work by the Royal National Institute for Deaf People and the Trades Union Congress that was published in March last year. I congratulate both bodies on their fine work

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in researching excessive noise in the workplace. I am sure that, like me, hon. Members will be concerned to learn that current Health and Safety Executive figures suggest that at least 1.3 million employees are exposed to noise levels above 85 decibels—the point at which noise affects hearing and can affect it in the long term.
The connection between hearing loss and excessive noise is certainly not one that any self-respecting scientist or doctor would dispute. Clearly, the Government have done much to improve working conditions for millions of employees throughout the country. However, it seems clear that improvement is still lacking in this area and, despite various regulations and Acts of Parliament, industrial deafness still is not treated as seriously in the workplace as its consequences demand.
The report "Indecent Exposure" discovered that nearly a quarter of all respondents to the RNIDP-TUC survey reported listening to uncomfortably loud sounds for more than four hours a day. Almost one in five construction workers, more than one in 10 workers in the manufacturing sector and those working on oil rigs reported being exposed to uncomfortably loud sound for more than eight hours a day. A third of respondents said that work tasks left them with dullness of hearing—in 16 per cent. of cases, the dullness was continuous—and 20 per cent. reported that work tasks left them with ringing or rushing noises in their ears or head lasting more than five minutes.
Just as worrying is the fact that nearly half the respondents said that they were concerned that noise levels at work were affecting their hearing. However, only a quarter had raised their concern with someone and only two thirds had approached their employer. I endorse the noise at work campaign, which called for a number of improvements in the regulatory regime, such as:
more research into the dangers of noise in industries where the risks are not understood, or acted on … employers to meet their legal obligations under the Noise at Work Regulations 1989, reducing the risk of noise damage in the workplace; employees to be aware of the potential risks to their hearing from working in noisy environments, to wear appropriate ear protectors when provided and to inform and work with the employers to reduce noise risk; and greater awareness of the cumulative effects of noise damage—both from the workplace and from leisure activities—which increase the risk of hearing damage and tinnitus.
Those are very worrying figures, which should concern us all, particularly those of us who represent the few places in the country where there is still heavy industry, and manufacturing industry at that. To that end, I urge the Minister to re-examine the law surrounding the criteria for prescribed occupations with a view to offering my constituent some recompense.
I urge the Government to commission a report into noise levels in the workplace and their health implications, and to do more to encourage enforcement of existing noise regulations. I ask them to encourage employers and employees to foster a more ear-friendly culture in the workplace, especially through enforcement of the Noise at Work Regulations 1989.
12.41 pm
The Parliamentary Under-Secretary of State for Social Security (Mr. Hugh Bayley): I congratulate my hon. Friend the Member for Reading, West (Mr. Salter)
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on raising the important issue of occupational deafness. I sympathise with the difficulties that his constituent has experienced. I pay tribute to my hon. Friend for the persistent way in which he has pursued Mr. Fryer's case. He has proved again that he is an exemplary Member of Parliament speaking up for his constituents.
Before I respond to my hon. Friend's points, it may be helpful if I give some background information about occupational deafness and the industrial injuries benefit scheme. Occupational deafness became one of the prescribed diseases for industrial injuries disablement benefit in 1974. To qualify for industrial injuries disablement benefit on the ground of occupational deafness, a person must have worked in one or more of the prescribed occupations for an aggregate period of at least 10 years. The person must then claim benefit within five years of leaving the occupation that caused the hearing loss.
The person will be tested to see if he has an average hearing loss of at least 50 decibels in both ears due to damage in the inner ear. In at least one ear, that must be owing to noise at work. To get benefit for occupational deafness, the person's disablement must be 20 per cent. or more.
As hon. Members may be aware, the Industrial Injuries Advisory Council is an independent statutory body which provides advice to the Secretary of State for Social Security. The advisory council consists of a chairman and 16 members. There is an equal number of representatives of employers, appointed by the Confederation of British Industry, and employed earners, appointed by the TUC. The remaining members come largely from medical backgrounds connected with occupational diseases.
The advisory council advises the Secretary of State on the prescription of industrial diseases, on legislation and on the industrial injuries benefit scheme itself. When the advisory council prescribed occupational deafness as a disease in 1974, it considered that the prescription should cover those most at risk of substantial, work-related hearing loss.
The advisory council recommended that there should be four qualifying conditions. Those related to, first, the level of hearing loss; secondly, the occupations; thirdly, the length of exposure to noise; and, fourthly, the time limit for claiming benefit. The advisory council can recommend prescription only where there is good scientific and epidemiological evidence of a link between the disease and the occupation. Since 1974, the provisions for occupational deafness have been extended in line with further recommendations from the advisory council in 1979, 1983 and 1994.
My hon. Friend asks whether there will be a full review of those issues. I confirm that a review of occupational deafness is taking place. I will return to that later. First, I should like to comment, as far as I can, on the issues raised in relation to Mr. Fryer's case.
As my hon. Friend will be aware, Ministers cannot become involved in individual claims for benefit. Claims for benefit are entirely a matter for Benefits Agency decision-makers or, before July last year, adjudication officers. When they are contested, the claimant has the right to ask a social security appeal tribunal to hear the case. The tribunal, which is independent of the DSS—

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tribunals are accountable to a judge, not to the Department or to Ministers—can overturn the adjudication officer's decision.
The tribunal has the status of a court of law and a Minister cannot ignore or overturn its decision. Therefore, it would not be right for me to enter into a detailed discussion of the decisions on Mr. Fryer's claim. However, in his case, I understand that there are two main issues of concern. The first issue relates to time limits and the second relates to the types of job listed as a prescribed occupation.
In 1983, the advisory council recommended that the time limit for claiming benefit should be extended from one year to five years. The Government agreed with that recommendation. The time limit was set at five years and not longer to ensure that occupational deafness is linked to a prescribed occupation and is not due to subsequent environmental or natural causes, or simply the ageing process.
Mr. Salter: Does the Minister accept that, although there may be a case for a time limit to avoid fraudulent claims, my constituent worked on the same piece of machinery for 34 years? Does that not indicate that his industrial deafness is unlikely to have been caused by anything in the five and a half years that passed between his leaving that employment and his registering a claim? It is the fact that he is out of time that caused the problem in the first place.
Mr. Bayley: Under the earlier rules, there was a one-year, rather than a five-year, time limit. A time limit is necessary because the longer a person waits before making a claim, the greater the probability that some factor other than noise at his former workplace injured his hearing.
I hope that my hon. Friend accepts that a time limit is needed, even if he feels that the five-year period is too short. However, if we have a time limit of any kind, there will always be the chance that someone will apply just beyond the time limit—just too late for his or her claim to succeed. The decision to extend the time limit from one year to five did, of course, improve the rights of a claimant.
The second issue, on which my hon. Friend dwelt most, related to the prescribed occupations for industrial deafness. More than 20 types of job are prescribed for occupational deafness. The jobs range from those using continuous glass-toughening furnaces, to work in ships' engine rooms, the use of band saws for cutting metal in the metal founding or forging industries and certain work on gas turbines.
Mr. Fryer argues that his deafness was caused by operating power presses, with which he worked five years before his claim for IIDB, and that his former occupation should be prescribed. Of course, his claim had to be determined on the basis of the law at the time. The tribunal has determined that, on the basis of the law at the time, he did not qualify for the benefit. However, I will try to respond to his argument.
The Government's decision on what to treat as a prescribed occupation is informed by the expert advice that we receive from the advisory council. As I have said, the advisory council is looking at the whole issue of occupational deafness.
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In August 1998, the advisory council issued a consultation paper entitled "Occupational Coverage For Occupational Deafness." The paper invited evidence and views about the occupations already listed and about those not listed but which evidence suggests should be considered for inclusion. The paper also invited evidence and views about whether the approach to occupational coverage should be reconsidered.
The advisory council set up a group called the occupational deafness working group, whose job is to take forward the examination of occupational deafness. The working group is examining all the evidence that it has received, and is preparing a draft report for consideration by the full advisory council later this year.
The advisory council would recommend prescribing an occupation that used certain tools and machinery only if there was strong and sound scientific evidence that that occupation carried a generally much higher risk of occupational deafness.
Mr. Salter: Are power presses being considered as an additional category in this welcome consultation?
Mr. Bayley: I am afraid that I cannot answer that question, because I have not reviewed the evidence. The working group is reviewing it, however, and when it reaches conclusions it will submit them to the advisory council. If my hon. Friend writes to me with full details of the type of power presses on which Mr. Fryer worked during the five years before he made his claim, I will pass them to the council. I should point out, however, that even if the council supported Mr. Fryer's view, that would not alter the decision in his case, which would still have to be based on the law as it stood at the time of his claim.
Mr. Salter: I must make it clear that I have explained to my constituent—as, I am sure, all hon. Members do in similar circumstances—that, however vigorously we pursue such cases, we cannot expect retrospective legislation, much as we would like it. It is extremely rare for a Parliament in any western democracy to countenance retrospective legislation.
What we want—what I want, certainly—is an assurance that there will be no repeat of the injustice that I believe Mr. Fryer has experienced. We must close any loopholes in the legislation and the regulations to ensure that such episodes do not occur again, and that other hon. Members are not here in five or 10 years presenting exactly the same arguments to my hon. Friend's successor.
Mr. Bayley: I thank my hon. Friend for explaining to his constituent why the rules of Parliament do not allow legislation to be made retrospectively. I accept that his constituent feels strongly that the type of tool with which he was working should be prescribed. As I said, if he gives me full details of the type of power press that was involved, I will pass them on to the advisory council.
When the council has fully examined the issues, it will produce a report setting out its conclusions and any recommendations for the Secretary of State to consider. I understand that it hopes to publish the report later this year or early next year, and I assure hon. Members that the Government will consider carefully any further advice that it may provide.

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Employees who suffer hearing damage as a result of exposure to excessive noise at work may be able to obtain compensation from their employers under common law, on the ground of the employers' negligence. The fact that someone does not qualify for industrial injuries disablement benefit does not prevent that person from pursuing a claim for compensation against his or her employer.
Mr. Salter: It would be difficult for my constituent to pursue Waymaster Ltd under common law, because it has gone out of business. What would my hon. Friend advise?
Mr. Bayley: I am afraid that I cannot advise on an individual case without knowing all the circumstances. I can only advise on the law.
The Government believe that noise induced hearing loss caused by work is a serious and significant occupational health problem. As my hon. Friend said, exposure levels for many workers remain considerable: the Health and Safety Executive estimates that more than 1.25 million people in nearly 90,000 workplaces continue to be exposed to noise levels that could damage their hearing. There is no excuse for anyone's hearing to be impaired owing to loud noise at work. There is long-standing legislation requiring employers and manufacturers to address the problem, and to make noisy machinery quieter. The Noise at Work Regulations 1989 are the mainstay of the regime. They require employers to reduce risks from noise to the lowest reasonably practicable level, and to take specific actions in the case of certain noise levels to protect employees' hearing.
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The Health and Safety Executive has produced a range of guidance to help employers and others to comply with their statutory duties. It has also developed a new long-term strategy on noise at work. It will promote more effective control of exposure to noise on the part of employers by encouraging the introduction of quieter machinery and processes. It will also promote the effective use of purchasing policies, the application of noise control measures and, when noise levels cannot be reduced, the correct use of ear protection. Employees have responsibilities to protect themselves by complying with notices and wearing ear protection.
The Government consider that wide-ranging provision is currently made for sufferers from deafness in the industrial injuries scheme when the disease has an occupational cause. There must be rules governing the payment of benefit, and inevitably there will be individual cases that are not covered by those rules. I am confident that there is a reliable and independent way for changes to be recommended to the Secretary of State, through the advisory council, when new scientific evidence about occupational deafness comes to light. As I have said, the council is currently conducting a review. I cannot predict its recommendations, but when its report is published I shall ensure that my hon. Friend receives a copy. I also assure him that, when the Government receive the report, we shall consider its recommendations carefully.
Mr. Deputy Speaker (Mr. John McWilliam): I know that a green light is flashing on the Annunciator, but as a Division could not be taking place anywhere other than here, and as a Division cannot take place here anyway, I suggest that hon. Members ignore it.

Drink Driving
12.57 pm
Mrs. Angela Browning: I am raising this subject because of the case of Charis Yeoman, who was a constituent of mine.
Charis was a 20-year-old student nurse. She was killed in 1997. While driving her car on a dual carriageway, she was hit by a driver who in the previous six hours had consumed six pints of beer and 10 measures of spirits, and then driven down the Tiverton link road to prove that he could do it in record time. For therapeutic medical purposes, a blood sample was taken from the driver after he had been taken unconscious to casualty, but it could not be used as evidence in court because the criminal concerned had not given permission, and would not give permission, for it to be so used.
In Charis's case, the police were fortunate in being able to track down the pub where the drinking had taken place. It was a busy bank holiday, and the publican did not volunteer to the police the fact that the individual concerned had drunk to such excess on his premises. Luckily, because it was a busy day, there were enough witnesses, including one who was able to specify to police the excessive amount that the man had drunk.
The point I am making is that, in bringing the prosecution, the police could not rely on the evidence provided by a blood test. That could also have happened when there were no key witnesses to bring a prosecution at all.
Charis Yeoman's case is not unique. We know that there are other such cases elsewhere in the country. In a letter written to me in 1998, Assistant Commissioner Paul Manning of the Association of Chief Police Officers referred me to the 1989 White Paper "The Road User and the Law". Although attitudes to drink driving have changed dramatically in recent years, the same problems still exist. The purpose of this debate is to seek Home Office Ministers' support for changing the law so that natural justice can prevail in such cases. Justice is not well served as the law now stands.
In 1998, I had a meeting with the Minister then responsible for these matters, the right hon. Member for Cardiff, South and Penarth (Mr. Michael). When the right hon. Gentleman changed Departments, his successor as Minister of State at the Home Office, the right hon. Member for Brent, South (Mr. Boateng), wrote to me, stating:
The Government is sympathetic to the principle that an offender should not evade conviction for the very serious offence of drink driving, and we would be willing to consider possible improvements to present legislation.
Much time has elapsed since I had those meetings with Ministers. That is because I had to do more research into the matter and, more pertinently, I discovered that the Kent constabulary was preparing a detailed paper on this and other issues to do with testing and breathalysing people. However, I wish to focus today on the law covering blood tests in drink-driving cases.
I have held meetings and corresponded with a range of people and bodies, including the Association of Chief Police Officers, the British Medical Association, the General Medical Council, police surgeons and biochemists. I have spoken also to other hon. Members who have had constituency cases resembling the one that I have described.
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Most importantly, the Kent constabulary report by Sergeant Tony Ramskill has now been published. I know that the Home Office has been able to study it, as have other interested parties. My presentation today is about more than that report, but it is an important piece of research which could help to clarify how we can improve the legislation.
The report mentions the Charis Yeoman case, and it discusses the difficult and vexed issue of whether blood samples should be taken when the driver is unconscious and unable to give permission. That matter has implications for the medical profession and for police surgeons. Sergeant Ramskill's study goes into some detail, and makes specific recommendations about the role of police surgeons, who in future may be given permission by a hospital's accident and emergency doctors to take from patients blood samples that could then be used as evidence in court.
That is a vexed issue. It has been addressed in other countries, and trials have already been held here. The Lothian and Borders force and the Fife constabulary currently use hospital staff to take blood samples. That system has also been trialled recently at a hospital in Cheshire.
Under the Road Traffic Act 1988, such samples have to be taken in a hospital. Two key issues therefore arise that need to be dealt with. First, the BMA has told me that it has concerns on behalf of its members, especially on behalf of admitting casualty doctors, about doctors' responsibility to their patients. That is a difficult problem, but it could be resolved by changing the way that the law is framed, so that admitting casualty doctors are not placed in a judgmental position. I must make it clear to the Minister that the proposal is not that doctors should be required to pick and choose whom they think the police might pursue for criminal prosecution.
I had a meeting some time ago with the BMA's ethical committee, which has responded to the Ramskill report, and continues to express concern. The BMA's response to me in a letter encapsulates the legitimate concern that must be addressed:
the role of a doctor is to treat people with a clinical need, whether they be a drink driver or the victim of a drink driver. The basis on which society permits doctors to help individuals who cannot consent themselves is that to do so is in their best therapeutic interests. Unless there is evidence to the contrary, consent can be assumed. Although there may be grounds for society to decide that it wishes to expand the scope of implied consent to include consent to taking and/or testing of samples for forensic purposes, the BMA considers that it would be inappropriate for doctors to press for such a change. A change in the law would have an inevitable impact upon the therapeutic relationship, and one which could undermine confidence in the doctors' role as patient advocate. Were such a change to be made, it would be important that the impetus came from society, not the medical profession.
The BMA clearly recognises that a problem exists. The association—rightly—represent the concerns of its members, but it acknowledges that the House represents and articulates the views of society in general. Society does not believe it right that the law allows someone who wilfully drinks to excess and takes another person's life to evade prosecution and an appropriate sentence. The challenge for hon. Members is to find solutions to the problems that I have described that allow doctors to carry out their duties without undermining the patient-doctor relationship.

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The Kent police study found that 94 per cent. of medical staff would be prepared to take blood samples if that would not make them subject to legal challenge by patients. The remaining 6 per cent., of course, would not be willing to do so. Now that the report is available, Home Office Ministers should seek solutions to the problems that have created the difficulty in the law.
The available choices need to examined and pursued. First, should the law be changed so that drivers in road traffic accidents are tested automatically, subject to medical consent and as long as such tests do not jeopardise medical treatment? That option should be considered carefully. Blood samples are always taken from unconscious drivers taken into casualty departments. The sample size could be increased, so that it could be divided and stored properly. In that way, drivers could give their consent, or otherwise, to their blood samples being tested later, when they were in full possession of their faculties. That extension of the current procedure would not require any new invasive technique, as needles are used anyway to secure the routine therapeutic sample.
The Ramskill report also suggests that police surgeons should be allowed to remove samples, with the consent of the casualty doctor or the doctor in charge of the unconscious driver. Once the driver was well enough, he or she would have the right to agree, or otherwise, to the analysis of the sample being made known to the prosecuting authority.
As I have mentioned, matters of law arise when samples are taken, and we must consider carefully the position of the doctor. It would be one way forward if we could ensure that the law was changed so that the legal position of the doctor was not undermined, and he or she would not be subject to legal challenge under the civil or criminal law on the grounds that the procedure they had carried out was invasive and constituted an assault. Once the legal problems that doctors fear were overcome, we could start to address the ethical issues that must also be considered.
The experience of other countries such as Belgium, Cyprus, Denmark, Australia and many others, where blood samples are taken, indicates that changes are needed now in this country. I make no specific recommendation to the Minister, other than to say that recent research must now open up that area of the law to change, so that justice can be done, and can be seen to be done.
On the issue of ethics, the GMC has outlined its agreement, subject to reservations, such as the need for trust between doctor and patient to be assured. I believe that that issue can be overcome without the doctor's position being undermined. In the matter of ethics, the wider issue of the safety and health of members of the public who may be maimed or killed if drink drivers are not successfully prosecuted should also be considered. I return to the point that the BMA made in its letter to me about society pressing for this change. If Members of Parliament are to represent the views of society—I speak generally, not only about my constituency case—we must recognise that society is concerned about the safety of the public in general, which can be served only by successful prosecutions and appropriate sentences.
I have considered carefully the rights of victim and killer. While I would not wish to undermine the important doctor-patient relationship, I question where
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the balance lies in ethical terms. Does it tip in favour of the person who has perpetrated a criminal offence, but has been lucky enough to escape with his or her life and is taken to hospital, conscious or unconscious, through the accident and emergency entrance? Or does the balance tip in favour of the rights of the victim, who—as society must recognise—still has rights even though he or she has died?
Unlike the perpetrator of the crime, the victim is taken through a different hospital entrance and immediately becomes the property of the coroner. If we are considering issues of ethics and morality, the rights of the victim in those circumstances have at least equal weight with the person who has perpetrated that crime. In such cases, the evidence that is critical to a prosecution and an appropriate sentence should not be denied to the victims and their families.
In recent years, we have seen a distinct change in public thinking about the whole issue of drink driving, and we sometimes have to make judgments that are not easy, but do at least put the victim first. Therefore, I ask the Minister to consider whether now is the time to make progress in this area. I know that he has received much extra information, and I have far more information than I have been able to share with him in the course of 15 minutes.
Much technical information was provided to me by the clinical biochemistry department of the Royal Berkshire hospital about the way in which blood samples should be kept and stored so that they can be used as evidence in court. That point will need to be addressed after consideration of the principle of changing the law. I do not doubt that we will need consultation on the issue, but the difficulties are not insurmountable.
I hope that when the Minister replies to the debate he will agree to a meeting with me before the recess, so that we can explore in more detail how the matter might be taken forward. In that way, for Charis Yeoman and others like her, people who drink and drive and wilfully claim the lives of others will know that they will be prosecuted under the law without being able to deny the judicial system the very evidence that proves their guilt.
1.16 pm
The Minister of State, Home Office (Mr. Charles Clarke): I genuinely congratulate the hon. Member for Tiverton and Honiton (Mrs. Browning) on securing the debate. To be frank, I was not personally aware of the details of the cases and histories involved in this important and vexed issue, until the hon. Lady secured the debate and I briefed myself for it. I am grateful to her and can immediately agree to her final point, because I am happy to meet her before the recess to discuss how we may make progress. It is a very important issue and it is right that she campaigns on it.
The hon. Lady was generous enough to say in her introductory remarks that the issue has concerned several hon. Members. For example, my hon. Friends the Members for Ellesmere Port and Neston (Mr. Miller) and for Luton, South (Ms Moran) have campaigned on it.
It is appropriate, as I begin, to comment on the case of Charis Yeoman, which the hon. Lady mentioned. It is right that we acknowledge the terrible tragedy that

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befell the family when Charis was killed in the road crash, and I wish to express condolences to the family on behalf of everyone concerned. Perhaps I may offer them the consolation that if we are able to change the law in the future, something constructive may come out of that terrible tragedy.
As the hon. Lady knows, the issue has been the source of debate for many years, and it is the difficulty and sensitivity of all the points involved—many of which she mentioned—that have made it such an intractable subject. I am pleased to have this opportunity to debate the matter because it is an area of law and medical ethics that we need to consider regularly to see whether any changes have occurred to justify taking a different overall view from that taken in the past. The hon. Lady cited several reasons why we should do so.
Of all of the road safety issues involving death and serious injuries on our roads, none has received greater support from the public than those concerning drink driving. We want to ensure that we continue to make progress and reduce the casualties still further. In consequence, any deficiencies in the current arrangements must be considered most carefully. That is especially true if practice, procedures and the existing law may lead to offenders escaping trial and a due sentence, because—for the reasons the hon. Lady mentioned—the necessary evidence cannot be collected in time. She may be interested to learn that we shall publish a consultation document on the whole question of penalties for road traffic law to take the debate still further forward.
When a patient is admitted to hospital as a result of a crash, the first concern must be for that patient's welfare, whatever the circumstances that led to the admission. That is right and we cannot resile from it in any way. In consequence, the road traffic legislation recognises that the normal procedures associated with breath testing cannot be applied to that patient unless the doctor treating him or her is satisfied that the necessary procedures would not be prejudicial to the proper care and treatment of the patient. That also raises the key ethical issue of whether the doctor involved in treating the patient would be acting contrary to medical ethics if he became part of the process of gathering evidence to prosecute his patient.
The duty of care to the patient, and indeed to patients in general, could conceivably be undermined if it was thought that doctors were somehow operating on behalf of the authorities rather than primarily caring for the patient. That is the issue that has informed much of the response from both the British Medical Association ethics committee and the General Medical Council.
As the hon. Lady said, there is also the issue of obtaining the patient's consent. Doctors can take blood samples without the patient's consent, because their primary duty is a therapeutic one that is designed to help the patient. The whole breath-testing procedure rests crucially on obtaining consent. I understand that, in law, any taking of blood without consent would constitute an assault and would have to be treated accordingly. The hon. Lady referred to that fact in her comments on intrusive forms of medical treatment.
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The law already provides that those who refuse to provide a sample commit an offence for which the penalty is not dissimilar from that for an ordinary drink-driving offence. However, often patients are not in a fit state to give their consent, even when the doctor is prepared to allow a sample to be taken.
Mrs. Browning: My understanding is that when a person is conscious after an accident but declines to give a sample, the penalties are pretty derisory. This point may be tangential to the specific subject of the debate, but I do not think that the current one-year maximum penalty is sufficient for those who refuse to give a blood sample. I was therefore pleased to hear the Minister say that the Government will consult on the way in which courts treat drink driving in sentencing.
Mr. Clarke: That is a perfectly fair point, and I am sure that the hon. Lady will make it in response to the consultation paper that we shall issue. That paper is based on a view that has been expressed in various ways on both sides of the House—that our penalties have not been updated sufficiently to take account of what she correctly described as the change in public attitude towards driving offences, particularly drink-driving offences, and then tragic consequences. Her point is well made, and I am sure that she will make it directly in response to the consultation.
The classic case in the sphere that we are discussing is that of the unconscious patient from whom blood has been taken for medical diagnostic purposes, but from whom a sample for drink-driving purposes cannot be taken. Indeed, that is exactly the example that the hon. Lady gave. It has been suggested that the use of any remaining part of a diagnostic sample might be used for forensic analysis, and that consent could be obtained from the patient at a later date. There is indeed a precedent for that in a previous case. Under current arrangements, however, that would be a very speculative process that would be open to substantial challenge in court proceedings. Nevertheless, that is exactly the argument that the hon. Lady is using.
Alcohol-impregnated swabs are usually used in the taking of diagnostic samples. It is already well established that that might be used to invalidate the blood sample. Usually, no preservative or anticoagulant is mixed with diagnostic samples. Therefore the sample starts to deteriorate in various ways, which could make further analysis difficult or easily open to challenge.
Mrs. Browning: Will the Minister give way?
Mr. Clarke: I shall in a moment.
There would be difficulty in establishing the chain of evidence—that is, incontrovertible evidence that the blood was taken from the patient to the point at which it was sampled and finally analysed, and that no errors in its handling or labelling had occurred in between. By the time that the diagnostic sample could be released, it could well have been degraded by bacteria.
I wanted to list those points. They all involve technical issues, but they show that the standard medical procedure used for diagnostic purposes raises problems in the context of drink-driving legislation. However, I

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acknowledge what the hon. Lady said about the technical evidence that she has acquired. I give way to her.
Mrs. Browning: Obviously, I would be happy to make available to the Minister the information that I have been given by the clinical biochemistry department. I believe that sample degradation could be overcome by the use of fluoride, which stops that process. I also agree that, for the purpose that we are discussing, changes would have to be made to the way in which samples are taken and stored. However, I think that the problems that the Minister described are technical ones which could be overcome.
Mr. Clarke: I acknowledge that the hon. Lady is right. It certainly seems right that overcoming such problems would require a change in medical procedures in cases involving suspected drink driving. The issue, however, is whether such changes in procedure, which perhaps could be achieved along the lines that she is suggesting, would be ethically acceptable to doctors in the framework that we are talking about. That is precisely the issue that we are debating.
As the hon. Lady said, the Home Office runs a scheme to fund individual police officers to undertake research projects that it is thought might throw light on operational policing issues. As part of that, the Home Office agreed to fund the recent report by the police officer in Kent constabulary to which she referred. He has produced recommendations on the matter following a study of the position in Australia. Of course the views that he has expressed are not those of the Home Office; as the report itself makes clear, they are the views of the author alone. Nevertheless, he has tried to address a very difficult subject and, within his remit, has significantly added to the sum of knowledge on the issue and moved it forward precisely as the hon. Lady has described.
I am also aware that the British Medical Association and the General Medical Council have seen the report and commented on it. I have copies of letters from them explaining their position. I shall place copies of those in the Library for hon. Members to refer to, and send a copy of them to the hon. Lady. I also have a very interesting annexe produced by my officials on the procedures and problems associated with testing hospitalised drivers for alcohol, which consists of a flow-chart showing the difficulties of the process. I shall also send a copy of that to the hon. Lady, for her information in taking the debate forward.
Although the General Medical Council has said that in principle it would be acceptable to take blood from a person who is not competent to give consent, its letter goes on to explain all the practical difficulties involved. Those difficulties match the concerns expressed by the chairman of the BMA's medical ethics committee.
My officials have talked to both the BMA and the GMC, and we believe that there is not a fundamental difference of view between the two organisations on the issue. We also believe that the different ways in which they have expressed their views are the result of their different functions, not of a basic difference of opinion. However, none of that undermines what the hon. Lady has rightly said—that we have to face the issue head on.
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In the context of the competing rights involved in the case that we are discussing—those of victim, doctor and driver—we have to find a resolution that is acceptable to the community as a whole, to ensure that people do not get away with illegal activity simply because of an evidential problem that could not be resolved differently.
I have thought it appropriate to make it clear that the ethical problems with which we have been struggling have not changed substantially since publication of the report by the officer in Kent county constabulary. None the less, I also want to tell the hon. Lady that we are happy to look again at all the issues involved in the light of the latest position, and of the points that she has made.
Following this debate, I shall talk to my colleagues in the Department of Health to determine whether there would be value in having a joint Home Office and Department of Health consultation on the subject, to discuss some of the issues. As a result of the way in which the hon. Lady has raised the issues, I think that it might be helpful to take forward the debate in a slightly more structured way. As I said, I shall talk to my colleagues in the Department of Health to see whether some process of that type might be appropriate.
As I also said, I shall be happy to meet the hon. Lady before the recess, as she requested, to discuss how we might take the whole debate forward. It is very much a cross-party issue, on which many hon. Members on both sides of the House are concerned to ensure that we make progress.
The Government have always made it clear that we should like to resolve any difficulties in drink driving enforcement. I know from the way in which she has dealt with this debate that the hon. Lady recognises that there are difficult and complicated problems involving medical ethics and procedure, and technical issues that need to be resolved. I am inclined to think that the type of consultative process that I described might be the best way forward. Therefore, as I said, before she and I meet before the recess, I shall talk to my colleagues at the Department of Health to determine whether a joint process to take the debate a bit further forward is possible.
I should perhaps take this opportunity to reassure doctors, and the GMC and the BMA, that we take their ethical questions extremely seriously. It is important for us to understand the exact basis of the position and to propose procedural or technical solutions that would accommodate those concerns and find a way through. However, as the hon. Lady said, at the same time we have to be clear that society and the community want us to ensure that there is genuine justice—so that the perpetrators of what are, after all, crimes can be properly brought to justice, in a manner that I hope will also inhibit future breaches of the law, and thus future tragedies.
I am very grateful to the hon. Lady for initiating this debate. I have responded to it as constructively as I can, to try to move us forward.
Mrs. Browning: I am grateful for the way in which the Minister has responded to the debate.
Mr. Clarke: I appreciate that comment. This is a cross-party issue, and I know that both sides of the House would like to see progress made on it.

Sheltered Housing
1.29 pm
Mr. David Drew: I am grateful to be able to present a debate on sheltered housing. It is an important issue, and I hope that, via my hon. Friend the Minister, we shall be able to take some elements of it forward.
As I am sure the Minister knows, 22 to 28 May was sheltered housing week. Like other Members of Parliament, I participated in some of the visits and activities that took place during that week. I intend to discuss what I see as the importance of sheltered housing, drawing on the experience of my local authority in Stroud to help me so do. I want to look at the issues related to sheltered housing, particularly the development of very sheltered housing. I will use evidence from my own constituency, but will also look at what is possible in the country as a whole. I hope to be able to draw some conclusions from that, and to ask my hon. Friend some questions, which I hope that he will be able to answer.
I am indebted to a number of people who have helped me put together the text for this debate—Wendy Wilson from the House of Commons Library, Steve Neale from Stroud district council, Christine Allen from the National Housing Federation, Eileen Short from the daylight robbery campaign and, last but not least, all those involved with the emerging role of sheltered housing campaign. All those people value sheltered housing and demonstrate why it is necessary to have a debate at this time.
There is no statutory definition of sheltered housing. However, most sheltered housing schemes share certain common features, including the provision of accommodation designed with the needs of elderly occupants in mind—although not exclusively so—and the provision of on-site wardens and emergency call systems.
Standards for sheltered housing were laid down in the 1969 Ministry of Housing and Local Government circular 82/69, which introduced the concepts of category 1 and category 2. In category 1 schemes, communal facilities and a resident warden are optional. Dwellings can be bungalows as well as flats. Lifts are not usually provided. The circular intended that category 1 provision should be for the relatively independent elderly. Category 2 schemes comprise flats under one roof, and there must be communal facilities, resident wardens and lifts. Such dwellings were intended in the circular for more dependent elderly people.
Circular 82/69 has not been mandatory since 1980, but its influence lives on. The labels—category 1 and category 2 schemes—attract difference housing allowances and adhere to different cost frameworks. Category 1 and 2 sheltered housing is more expensive than ordinary housing because of its features and facilities—specially designed housing, a resident warden service, a communications system and communal facilities over and above those found in ordinary housing.
Sheltered housing dates back to just after the second world war. It took some time to take off—in fact, only 28,000 people lived in such units as recently as 1960. However, as my hon. Friend knows, during the 1960s
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and 1970s, there was a considerable increase in the sheltered housing provision. I am grateful to Anchor and Hanover housing associations, which identified for me the importance of their role, as well as that of the local authority.
There are three key issues to identify at the outset. First, how appropriate is sheltered housing today, given some of the alternatives that are available, such as staying put, and care and repair? I declare an interest in that I am a director of Stroud care and repair, so I appreciate the importance of people being allowed to stay in their own home. However, I do not see that as conflicting with my support for sheltered housing.
Today, there are about 500,000 sheltered housing units. Some 300,000 of those are in the public sector and 200,000 are in the private sector, with registered social landlords. They are mainly, but not exclusively, for people over 65. Some of the units are not easy to let, leading to repercussions which I will dwell on later.
At a time when we have a gradually ageing population, it seems strange, after the peak in the growth of sheltered housing that occurred in the 1960s and 1970s, there has been a decline ever since. For example, only 402 units were developed in 1997, the last year for which I have figures, compared with 1989, when some 7,000 units were developed. Something is happening to the demand for, and the supply of, sheltered housing. That is a little worrying and we must get to grips with it.
Much of the debate is about what is suitable for older people, what they want and what they expect. There are other issues, however, such as finance—what people pay in rent and what help they have to pay it. In addition, schemes in the private sector have been linked to leasehold problems. I have dealt with one of them myself.
I should like to use my district council area for the constituency that I represent as a good exemplar of what is best about sheltered housing. Stroud has 29 sheltered housing schemes, of which two are very sheltered. It has been a forward-looking authority, providing accommodation for people in their later years. There is a good take-up of units, but there is not the same desire to move into them that there was in the 1970s and early 1980s.
There are many valued aspects of the various units in Stroud. All older people who need it are able to link up with a central control system, so that, even if there is no warden on call, they have a back-up. There are good communal facilities in each unit, and some of them are comparatively new. There are many other ways in which people can have the benefit of living communally.
What is the future for sheltered housing, which has an image problem? As I said, there has been a rapid decline in the number of units provided year on year, affecting the private and, more particularly, the public sector. There is a funding issue, which is linked to people feeling that what they pay for is good value for money. We always come back to the housing benefit debate, which I shall say more about later. There are also issues about service charges and the cost of warden help.
However, sheltered housing has some good aspects. All the evidence suggests that there is a high satisfaction rate among people living in sheltered accommodation. There is an attempt to reinvigorate—almost to

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reinvent—sheltered housing, led by the emerging role of the sheltered housing campaign, which I welcome. Other things are happening on the back of sheltered housing, the most important of which is the move towards very sheltered housing for the more fragile older person.
What is the Government's response to this? I wish to highlight two documents, one of which is the Green Paper on housing. I am a little disappointed that it does not make more of sheltered housing. The main point, to which I have alluded, is how to grapple with the difficult issue of housing benefit. I welcome the attempts to sort that out; it has an especially deleterious effect as one of the reasons that people do not want to go into sheltered accommodation.
I welcome the move towards transitional housing benefit that began in April, as well as the continuing consultations. There is evidence that people are beginning to take note of those matters; that may change some of the adverse perceptions of the high cost of living in sheltered accommodation. I lay my cards on the table by stating my support for the daylight robbery campaign—inasmuch as people feel Some anger that, because we have not yet sorted out housing benefit, there is some subsidisation of those who pay full rent either by those who do not, or through the housing revenue account. Until we deal with that difficult issue, the anger will remain. It has certainly been expressed to me—we need to do something about the problem.
The second document relates to the "Supporting People" programme, from which a series of papers was produced. The programme takes an holistic approach to dealing with the problems of older people. The original document identified the need to try overcome some of the complications caused by unco-ordinated and overlapping funding streams and to make more transparent who has responsibility for the support of vulnerable people. It examined structures and pointed to the need to make them easier to understand. It proposed the evolution of a more comprehensible strategy that would be more likely to be carried through. It also noted that the housing benefit problem should be sorted out.
As the document states, that will mean that we are
putting people first … addressing the needs of vulnerable groups—
and producing
high quality services
and
a logical and transparent approach—
to the planning of such housing.
A disappointing aspect of my research into this matter is that one of the strongest concerns expressed during the consultations was about where sheltered housing fits in. That point needs to be addressed and I hope that my hon. Friend the Minister will do so. There are many reasons for that concern, but the main one is that, in these times of change, sheltered accommodation does not fit neatly into any of the relevant categories. It is not genuinely supported housing—unless it falls under the very sheltered category. People want some explanation of that point.
During the debates on the Care Standards Bill, I expressed the concerns, raised by some of the organisations that run sheltered units, that the
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registration of such units might lead to a considerable loss in the benefits available to some residents. If that situation could be clarified and overcome, that would be welcome.
We are beginning to examine different ways of using our sheltered accommodation. The most obvious is the move towards very sheltered—or what my authority describes as extra sheltered—accommodation for older, frailer people or those who have special difficulties. Stroud was a pioneer in that form of housing. It started a scheme in July 1993, working closely with Gloucestershire social services and the health authority. The stated objective of the scheme is to provide
enhanced personal and social care of residents … Provision of emergency care, if required, 24 hours a day, 7 days a week … To provide a cost effective alternative to residential/institutional care. To provide additional domiciliary care co-ordinated by the Wardens promoting an ability for residents to live more independently in the community.
Last, but not least, it offers the possibility to enter into contracts with different care providers.
The beauty of such schemes is the opportunity for mixing—of ages, of people with different problems and of funding streams. Although it might be good to clarify and co-ordinate such schemes to make them more coherent, they have much to recommend them. They show that there is a strategic future for sheltered housing in such specialised forms.
How can we move towards those different uses for sheltered accommodation? I hope that the Minister will consider the need to get the accommodation right and the parallels between the ideas expressed in "Supporting People" and the royal commission on long-term care for the elderly. We are an ageing population; we need to provide different facilities for older people. The main demand is for people to stay in their own home for as long as possible. We need to develop and use resources in the best possible way.
I hope that we can develop centres of excellence that will serve the wider community, so that specialist facilities for vulnerable people can be produced in an innovative way, using—dare I say it?—joined-up thinking and action. However, some key issues must be addressed. We need to revisit the purpose of sheltered accommodation and how it is allocated.
We must consider the role of the warden. The increasing professionalisation of the warden service is good. Two of my friends—Diane Wyatt and Carol Snell—are the key wardens in the very sheltered schemes in the Stroud district; they demonstrate the high capabilities that result from training and support.
We need to examine how care is provided, how people gain access to it and who pays for it. We need to overcome the difficulties associated with some of the more difficult-to-let accommodation. That applies equally to the private and to the public sector.
Sheltered accommodation has a place and it has a future, although it is reasonable and right that its role should change. I hope that my hon. Friend the Minister will address four points.
First, what is the position of the transitional housing benefit scheme—especially in relation to sheltered accommodation? Secondly, can the Minister clarify the registration process proposed in the Care Standards Bill? Thirdly, what are the Government's views on the

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evolution of very sheltered accommodation? Finally, how do they envisage the relationship between the public and private sectors? Can they be pulled together through the best value initiative?
I have given my hon. Friend plenty to do, so I shall conclude my remarks and listen to his esponse.
1.47 pm
The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Mr. Chris Muffin): My hon. Friend the Member for Stroud (Mr. Drew) has raised a significant issue. As he says, more than 500,000 older people live in sheltered housing—more than in residential and nursing homes put together. My hon. Friend asked several questions and I shall do my best to address them. If I do not do justice to them, no doubt we can pursue the matter through correspondence.
The Government are in no doubt as to the potential benefits of sheltered accommodation in enabling older people to remain independent for as long as possible in their own homes. Residents speak enthusiastically of the benefits of such accommodation: having their own front door; having the options of company and of privacy; of feeling a real sense of security and peace of mind; and of the importance of being able to remain part of a community. Sheltered accommodation is clearly a positive housing choice for many older people.
My hon. Friend touched on several matters. The "Supporting People" programme aims to ensure that the highest quality services are provided to vulnerable older people. It will mean that a wide variety of options will be available to them—ranging from retirement housing, to traditional sheltered housing and to "floating" support services—designed to enable them to stay in their own homes. The programme will raise the priority of support services and encourage local authorities to take a more strategic approach to provision, integrating it with social and health services.
As my hon. Friend said, concern has been expressed about the impact of the new funding arrangements for sheltered housing under the "Supporting People" programme. First, regarding the impact of the transitional housing benefit scheme, which was introduced in April this year, concerns have been expressed about the need for private sector tenants, including owner-occupier leaseholders, to have a valid community care assessment in order to get help under the scheme.
We needed a statutory gateway to ensure both that the claimant requires support and that the landlord can provide the support needed. The community care assessment provides that gateway. Relatively few private sector tenants receive help with support charges through housing benefit. We appreciate that there are concerns, and we have worked closely with the Department of Health to issue comprehensive guidance to both social services and housing benefit sections to make processes as smooth and as simple as possible.
Looking at the long-term arrangements under "Supporting People", the Government recognise that, when many existing sheltered housing tenants moved into their accommodation, they regarded it as a home
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for life. They did not expect to be rendered insecure in their tenancies or to be facing different terms and conditions as a result of changes to the funding of their accommodation. I assure existing tenants that when "Supporting People" is introduced, in April 2003, they will not have to move out of their homes or see a change in services provided, simply as a result of the change in funding arrangements that will be introduced in three years' time.
As my hon. Friend mentioned, service providers have expressed concerns that the changes will be excessively bureaucratic. The Government are determined that the administrative arrangements that are put in place for "Supporting People" will be straightforward, cost-effective and transparent. My hon. Friend asked me for detail. There is still a great deal of work to be carried out before "Supporting People" is implemented in April 2003; indeed, we have some time in which to do that work. The Government will work closely with local authorities, service providers and service users to develop a programme that can deliver the kind of high-quality support services that vulnerable people, including older people, need and want.
My hon. Friend mentioned the daylight robbery campaign and campaigners' fears about Government proposals to introduce resource accounting into the housing revenue account from April 2001. I have received many representations on that issue and I must say that there is some misunderstanding around, which we have done our best to clear up, but without complete success. Assumed surpluses on local authorities' housing revenue accounts underlie daylight robbery campaigners' concerns.
As my hon. Friend knows, we are introducing a major repairs allowance, which will have an immediate and substantial impact on those assumed surpluses and will address many of the campaigners' concerns. Full details of the major repairs allowance will be included in the annual determination, which will be sent to local authorities in December.
I mentioned the growing popularity of sheltered housing. With more and more older people actively choosing that type of accommodation, concern has been raised that there is no statutory inspection regime. I am not sure whether my hon. Friend mentioned that, but it is probably worth mentioning anyway.
Local authorities are subject to best value performance reviews of their housing stock, which would include sheltered housing. The housing inspectorate also carries out audit and inspection of local authority housing services. Registered social landlords who provide sheltered accommodation are regulated by the Housing Corporation, which sets performance standards.
The Care Standards Bill, which is passing through Parliament, will introduce the regulation and inspection of all types of home care provision, including that provided in sheltered accommodation.
Mr. Drew: All the evidence that I have shows that these changes are greatly welcomed. The worry is purely about the benefit implication.
Mr. Mullin: I am grateful. I cannot immediately provide my hon. Friend with the details, but we are

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working on them and I have given a general assurance, which I hope that he will relay, that we do not intend to threaten in any way the existing arrangements for tenants. We still have some time to go in which to agree the precise details.
Concern has been expressed about the definitions used in the Care Standards Bill of "care home" and "personal care", and there are fears that those will require sheltered housing to register, the consequence being that older people might lose their entitlement to benefits. That is the issue that my hon. Friend is interested in. The vast majority of sheltered housing schemes involve care being provided to people in their own home. In those circumstances, whether they are an owner-occupier or a tenant, that home cannot and will not be registrable as a care home.
The Bill's definition of "personal care" is intended to clarify, rather than change, the definition in the Registered Homes Act 1984. The existing definition in the 1984 Act is care that
includes assistance with bodily functions.
The intention of the new definition is to ensure that advice and encouragement given in connection with such care would be included within the definition of personal care. Other forms of advice and encouragement not connected with assisting a person with their bodily functions will not be included, and the Department of Health intends to table an amendment to the Bill in due course to make that clear.
As I mentioned, the role of sheltered housing is changing. Demographic changes over the next 20 years will have a substantial impact on housing policy. The number of people over 60 is likely to rise from 6.5 million in 1996 to nearly 9 million by 2021. The number of frail older people is growing even faster.
Older people's aspirations are also rising. Individuals increasingly expect services to respond to their specific needs and preferences. Quite rightly, they are no longer prepared to put up with "one size fits all" services. Flexibility, choice, independence, information and involvement are the key issues raised by older people in relation to the accommodation arid services that they receive.
Very sheltered housing, which my hon. Friend mentioned, has been developed as a way of bringing social care and housing together. It is used as a base for
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support and care provision which can enable older people to remain in sheltered housing as they become frailer instead of having to move into residential care. That type of accommodation, which is being developed in Stroud and throughout the country, is helping to widen the spectrum of housing options for older people.
In response to that changing picture, the Government aim to ensure a better and wider choice of options, with access to quality services which enable older people to lead active, independent and secure lives. To that end, the Departments of the Environment, Transport and the Regions and of Health are working together to develop a housing strategy for older people, which aims to ensure that they are able to secure and sustain their independence in a home appropriate to their circumstances. It also aims to support older people to enable them to make active and informed choices about their accommodation by providing access to, and advice on, appropriate services and housing options, including sheltered housing and extra care or very sheltered housing.
The strategy will also recognise the important links between housing, health and social services for older people and the need for those services to be integrated locally. Effective housing, allied to the right care, support and wider services, can be the springboard that enables older people to live life to the full. The Government hope to publish the housing strategy for older people later this year.
The future of housing for older people, including sheltered housing, holds many challenges and opportunities. Taken together, the Government's own work and that being carried out in the sector itself will ensure that older people have more choice about where they live and the type of services that they receive. Sheltered accommodation certainly has an important role to play in the development of quality services for older people that are flexible, responsive and user-focused. I am sure that, in the years ahead, we shall see many improvements in this sector.
I am grateful to my hon. Friend for raising the issue. If he wishes to follow up any further concerns by correspondence, I shall be glad to reply.
Question put and agreed to.
Adjourned accordingly at one minute to Two o'clock.