Westminster Hall Sitting of 31 January 2001

Preamble
[MRS. SYLVIA HEAL in the Chair]

Bed Blocking (Wiltshire)
Motion made, and Question proposed, That the sitting be now adjourned.—[Mrs. McGuire.]
9.30 am
Mr. Michael Ancram: I am grateful for the chance to raise the subject of the deeply worrying bed blocking crisis in Wiltshire. As a phrase, bed blocking sounds dull, but its impact is anything but dull. Every bed blocked in a hospital means an operation postponed or a treatment delayed, and that is often multiplied many times during the period for which the bed is blocked. In human terms, bed blocking is a cause of fear, apprehension and often suffering. For the individuals affected, it makes nonsense of the Government's aspirations to cut hospital waiting lists. It would be a blot on the Government's record of health provision in Wiltshire even if it were unavoidable. The fact that it is avoidable means that there must be strong criticism and demands for urgent action to rectify it.
It is difficult to be certain of the total number of beds genuinely blocked in Wiltshire hospitals. Bed blocking can occur for various reasons, some easier to ascertain than others. Currently, 68 hospital beds are blocked in Wiltshire for lack of Wiltshire county council funding for residential or nursing home placements. That is a lot of beds, and the knock-on effect of 68 beds being blocked is exponentially serious.
Bed blocking is not a logistical or supply problem about beds; it is about people who cannot get into hospital when they need to, and people who are held in hospital when they do not need to be because there is nowhere else for them to go. Bed blocking is a major human problem. However, it comes at the end and as a consequence of a long row of other problems. If solutions are to be found, they have to be found right along that row.
The figure of 68 beds blocked follows hard on the heels of the county council's purchase of 54 additional residential placements with special funding made available by the Government through the Wiltshire health authority. Such is the nature of the problem that the much-needed assistance has proved a temporary sticking plaster rather than a cure.
The problem is not in the hospitals themselves, but in the Wiltshire county council social services budget. Its cause is simply that, in terms of Government financial support, Wiltshire is being underfunded and unfairly treated. The purpose of this debate is to seek from the Government short-term measures to meet the current crisis and long-term measures to prevent it from recurring.
All that my colleagues and I ask for is fairness, fair shares and an even playing field. The reason for raising the matter today is that the current situation in Wiltshire is totally unacceptable and is getting worse. Bed blocking in Wiltshire is a problem that need not occur,
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and it can be resolved if the Government funding provision to the county is fair and if the balance of funding between health and social services is right.
At the moment the funding is not fair, as I will seek to show, and the result is socially unacceptable, economically nonsensical and politically offensive. It is politically offensive because people in Wiltshire see Government resources apparently being skewed away from rural areas to more Government-friendly urban authorities. It is socially unacceptable because of the stress and pressure that it creates for people whose families are involved on both sides of the blocked bed—those awaiting hospital treatment and those awaiting placement elsewhere. It is economically nonsensical because the cost of blocked hospital beds is far greater than the cost of the placement beds that currently cannot be funded.
I shall give some examples. The cost of a hospital bed is about £1,100 a week, which contrasts with the net cost to the county council of less than £250 a week per nursing home bed and less than £150 a week for a residential care home bed. Delayed hospital discharges are therefore nonsensical economics. As well as being bad for disabled and older people, that is bad for the health service in meeting its Government targets and serving the local population.
The cost of placing 68 mainly older people in residential or nursing placements is £719,785 a year. The cost of 68 hospital beds for the same people at £1,100 a week is, by my calculation, almost £4 million. The chain of causation is relatively simple. Beds are blocked because the county cannot afford to fund placements for those currently occupying the beds. They cannot fund placements because the funds are not there, and the funds are not there because Wiltshire is underfunded by the Government. The solution is to get the funding right to meet the particular needs of Wiltshire, which exacerbate the problem. I shall set out in reasonably simple terms what is wrong, and then suggest what could be done to rectify the situation.
Wiltshire county council currently spends 18 per cent. more on social services than the Government, through their standard spending assessment calculations, think necessary. At the same time, the SSA allocated to Wiltshire for social services is the ninth lowest of all social services SSAs in England. Next year, Wiltshire social services SSA per head of population is only £128 compared with the shire counties average of £148, which is £20 more, and the national average of £178, which is £50 more. If Wiltshire had the same SSA as the shire counties average, it would have £8.4 million more for social services. On the figures that I have given, it is not difficult to see that that money would go a long way towards resolving the problem.
Wiltshire social services SSA for next year increased by only 2.4 per cent. With Wiltshire social services overspending by £1.5 million this year—that is 2.3 per cent.—and that overspend being rolled forward into next year, even with an increase of £1.5 million in social services specific grants for Wiltshire social services next year, the SSA specific grant total will only balance this year's overspend. That does not allow for inflation or for the increasing number of elderly and disabled people who will need its services next year. Rationing of services and delayed hospital discharges will increase next year under the current provision.

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A major difficulty for the county is that the Government take little or no account of the three cost factors that impinge on social services in Wiltshire. Those cost factors may have a separate impact on some other authorities, but in Wiltshire they cluster, so they to have a major and unique impact. First, Wiltshire is an area of high employment with high employment costs, which reflects its location along the high-tech M4 corridor and the outer London commuter employment belt. Neighbouring authorities, such as Hampshire and Oxfordshire, receive an area cost adjustment weighting of 6 per cent., which is denied to Wiltshire county council. Allocating more to other authorities through the area cost adjustment next year has cost Wiltshire social services £0.3 million against the SSA increase that it would otherwise have received. That adds insult to injury.
The Government are inconsistent in their stance on the area cost adjustment, as health services in Wiltshire are being allocated additional finance to take account of higher employment costs in Wiltshire. Perhaps the Minister will explain that inconsistency.
Secondly, Wiltshire serves a large, rural and sparsely populated area. The higher costs of providing services in large rural areas are not adequately recognised by the Government. For example, detailed calculations undertaken in the county council in 1997 showed that a team of social workers and occupational therapists assisting disabled and older people had higher costs than a team covering an urban area with the same population.
In sparsely populated rural areas, smaller service units must be established to ensure that services remain locally accessible to the local rural population, but smaller service units usually have higher costs. For example, the 31 beds in a residential care home in a village in a largely rural area had a cost per bed per week of £333 in 1999. A residential care home with 57 beds in a large town had a weekly bed cost of £232, which is more than £100 less per week. That pattern of differential unit costs was found to be consistent across 19 residential care homes of between 30 and 57 beds within the county council area. However, the higher costs of providing social services in rural areas are not recognised by the Government. Instead, it is the urban areas that get higher levels of funding.
Thirdly, Wiltshire is distinctive in having one of the largest military populations in the United Kingdom. The higher demand that that generates for social services for children and families was identified by the joint review undertaken by the Audit Commission and the Department of Health inspection of social services in Wiltshire. The report stated that
"the Army presence more or less accounted for the 'excess numbers' over and above those that might be anticipated on demographic grounds alone. The work in relation to looked-after children is particularly time-consuming, because many families have moved to other parts of the country".
The additional demand for services from the garrison towns is equivalent to the current overspend of £400,000 on social services for children and families in Wiltshire. Again, that additional cost for Wiltshire goes unrecognised in the Government's funding allocations.
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The growing town of Tidworth in my constituency exemplifies the problems better than most. An enormous amount has been done in Tidworth in recent years in conjunction with the Army to provide better amenities and a more attractive environment. However, Tidworth is destined to grow. One local estimate suggests an increase in its family population of about 30 per cent. over the next three to five years. On any view, that is a large increase. The frequently transient nature of the population brings its own problems in education and in the proper provision of care for children; those problems are greater than in other areas of the county, and their impact will grow with the population. It is a truism to say that it all costs money, but the money is not there because the Government's formula does not recognise the real problems that I have outlined.
The foregoing points to the nature of the problems that give rise to blocked beds. Ultimately, it all comes down to a lack of adequate or fair funding to enable Wiltshire to meet the genuine shortfall against need in its social services budget. It does not help for Wiltshire to raid other constrained budgets to try to meet some of the shortfall. That would merely shift the hardship, not solve the problem, and it would exacerbate the sense of unfairness. We need to look for genuine solutions. We believe that they could be available if only the Government would consider them favourably.
In the medium term, the Government's funding formulae should recognise the higher costs of providing services in rural areas, the applicability of the area cost adjustment to Wiltshire and Swindon, and the costs of providing civilian services to the garrison towns, especially with the further increase of military personnel in Wiltshire that is now envisaged. More immediately, the Government could make additional funding available to social services, either directly or through the NHS, to allow all delayed hospital discharges to be tackled. They could increase the specific grants for social services for community care next year to prevent hospital-delayed discharges continuing in 2001–02. They could make a specific grant available for social services for next year to cover the costs being passed to social services that will result from the Government's response to the royal commission on long-term care. It is estimated that those costs for Wiltshire will be more than £300,000. The Government should consider those suggestions carefully.
I began by criticising the Government over central funding. I have long suspected that they do not understand rural England or the special needs of a rural county such as Wiltshire. Thus, they do not understand the hardship that they are creating in such counties. I am happy to be proved wrong this morning. I have explained what the Government could do at once and in the medium term to prove me wrong. I live in hope that the Minister, who has my gratitude for listening so attentively, will understand the depth of feeling in the county about its cruelly unfair and inadequate funding. I hope that she will bring relief to my constituents and my Wiltshire colleagues by accepting our suggested solutions.
Today the Minister could signal the beginning of the end of bed blocking in Wiltshire. If she would recognise the crisis and the long-term dangers that could flow

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from it, that would be a start. Wiltshire deserves a fairer deal, and I look forward to learning this morning that the Minister will provide one.
9.45 am
Ms Julia Drown: I congratulate the right hon. Member for Devizes (Mr. Ancram) on securing the debate. The issue is important and I am glad of the opportunity to contribute, and to put the case from the Swindon end of Wiltshire.
The right hon. Gentleman claimed that the problem arises from a failure to understand rural areas and from the Government's focus on urban areas. That is not correct. The Public Accounts Committee has examined what is happening all over the country. Its report entitled "Inpatient Admission, Bed Management and Patient Discharge in NHS Acute Hospitals", which was published this month, showed that difficulties such as those we are considering happen throughout the country, and there is no distinction between urban or rural areas. The problem arises in both the urban and the rural parts of my constituency of South Swindon.
Mr. James Gray: I am interested to hear the hon. Lady accept that there is a health service crisis in this context in both urban and rural areas. That is our point. However, my right hon. Friend's argument was that it arises from the standard spending assessment—which is a social services matter and does not relate to the health service. Wiltshire county council is much worse funded than Swindon borough council, for example.
Ms Drown: First, I have not said that the NHS is in crisis across the country. A huge majority of people—I hope that that proportion is reflected in the hon. Gentleman's postbag as it is in mine—receive a fantastic service from the health service. Problems exist and no doubt every day very difficult decisions are taken. However, we should not unnecessarily raise the fears of our constituents, most of whom receive wonderful service.
The hon. Gentleman is right to point out that there are problems with the standard spending assessment. They have existed for many years, under Conservative Administrations as well as under the present Government, who inherited them. However, the present Administration is studying the problem, and I shall deal with that issue later.
It is always difficult for Labour Members to listen to Conservatives talking about insufficient funding of services, because it is those same Opposition Members who say that the Government's spending plans are reckless. We hear that the priority should not be public services but tax cuts. Those two sides of the coin are not consistent. Supporting public services and calling for increased funding—I agree with that for health and social services—means supporting the Chancellor of the Exchequer when he announces increased spending aimed at improving services for our constituents.
Mr. Robert Key: The problem with that argument is that the Government are not spending enough money on services in Wiltshire. That is precisely the point. They tell us in Parliament that they are
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spending all that money, but when it comes to my constituents, they are not spending it. The hon. Lady's argument is flawed.
Ms Drown: If the hon. Gentleman examines the figures, he will see that social services expenditure in the standard spending assessment has increased year on year. I support him in saying that we should spend more on social services across the country, but he cannot deny that, year on year, more money has been spent on the health service and on social services. Over the next three years, the health service will receive the biggest ever increase in investment from the Government.
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): My hon. Friend may be aware that Wiltshire county council's overall standard spending assessment has not just increased, it is above the national average. Similarly, the council's personal social services spending allocation is above the national average. That might support her case.
Ms Drown: I thank my hon. Friend for that information. I want to talk about the title of the debate. Language is important, and the term bed blocking is unfortunate, because it makes it sound as if the person occupying the bed is somehow responsible for the problem, when he or she is not. As the right hon. Member for Devizes said, that person wants to be somewhere else: either in a nursing home or cared for at home. It would be more helpful if we were to use the term "delayed discharges" instead. That term implies that the person in hospital is suffering from the problem just as much as the wider community.
The main hospital in Wiltshire is the Princess Margaret hospital, which is in my constituency. There are roughly 30 patients there and in intermediate care beds around the town who are waiting for social services funding from Swindon borough council. That is not a new phenomenon, but it is nevertheless important, and must be dealt with. I was pleased that the Public Accounts Committee report stated that the NHS was encouraging good practice on the issue, both through targeted funding and by pushing the Government's aim of reducing delays in discharge by 30 per cent. by 2003. Clearly, the Government are trying to ensure that there are improvements in that sector.
We need to recognise that much work on this issue is being done on the ground by hospitals, health authorities and social services departments. There has been an improvement in services and relations between those bodies, and I hope that the Minister and all hon. Members present will join me in congratulating the staff of those hospitals, health authorities and social services departments on the good work that they are doing to combat the problem. They are improving the way in which they collate information about patients, and they are having weekly or daily meetings, where necessary, to ensure that they are addressing the needs of individual patients. The trusts and the local health authorities have worked together to minimise delays and to find areas in which services could be improved.
Mr. Ancram: Is the hon. Lady telling us that there is no bed blocking problem in the Princess Margaret hospital in Swindon? If there is a problem, is it increasing or decreasing?
Ms Drown: I am certainly not saying that there is no such problem. I began by saying that there was a significant problem. At the moment, there are roughly 30 patients whose discharge has been delayed. However, it would be wrong not to recognise the huge amount of work that is going on locally to try to deal with the problem. For example, there have been particular pressures at winter time. I was delighted by the programme of work that the local hospital put together to tackle those difficulties. It was not simply a matter of trying to set up more beds and get more nurses and doctors, it involved all the skills of the wider NHS team. More therapists were brought in so that people could be rehabilitated more quickly and go home. Laboratory staff came in to work extra time so that tests could come through more quickly and people could be seen more quickly. A group of staff was charged with preventing unnecessary admissions. All that work is important and it is worth congratulating those concerned.
I am also pleased that Swindon borough council, with the health authority, has recently agreed to fund an additional 14 placements, which will relieve the pressure. That has not been easy because, despite an increase in the SSA and the budget in excess of inflation, which is much appreciated, both local authority and health authority funds are tight in Swindon and money has been taken out of reserves. Those reserves, which were already low, are even lower, but significant sums have been found to support people.
To return to the point about rural and urban areas, the right hon. Member for Devizes said that Wiltshire social services has already been given an additional grant this year to try to alleviate the problem. Wiltshire is more rural than Swindon, which has not received the same grant. There has been Government action in Wiltshire, and Swindon would appreciate a similar grant because of its particular difficulties.
Mr. Gray: I want to correct a slight misinterpretation which the Minister may have made of the figures for SSAs in Wiltshire. Social services SSA for the county of Wiltshire is £128 per head. The shire county average is £148 per head, and the national average is £178 per head. Wiltshire county council social services SSA is £50 per head less than the national average. The Minister's interpretation of the figures does not bear detailed examination.
Ms Drown: Those remarks may have been better addressed to the Minister, but I shall comment on them. There is an issue with SSAs. The existing formula could be improved, and I am pleased that the Government have agreed to examine that. As responsible Members of Parliament, we cannot say that every local authority in the country should receive the same amount per person because needs vary. Our own constituencies include areas of higher and lower need, and that should be reflected in the services provided in those areas. Such issues are written large throughout the country. We know that there is a link between health and poverty, and that poverty leads to poor health. Those of us in
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more prosperous areas must accept that we should receive slightly less per head, but we want the services that meet our people's needs—[Interruption.]
The hon. Member for North Wiltshire (Mr. Gray) is trying to make a political point from a sedentary position. He is being irresponsible in not recognising that we all have a responsibility for the wider country. Members of Parliament who represent relatively prosperous areas must accept that sometimes it is not fair to claim the same amount of Government money, pound for pound, as areas with five times more unemployment and five times more poverty. Where there is poverty and ill health, the problem must be addressed, and it would be wrong for responsible Members of Parliament selfishly to press for more and cause more ill health and poverty elsewhere. I hope that the hon. Gentleman, as a responsible member of a political party, accepts that.
Mr. Gray: I apologise, Madam Deputy Speaker, for making an intervention from a sedentary position, and I shall now make it standing up. My point was that I stand here as the Member of Parliament for North Wiltshire and I shall argue the case for North Wiltshire. I shall argue the case for Wiltshire to have the same funding as the rest of the country, and even to have more funding if possible. I do not stand here as a Minister. The hon. Lady is a Back Bencher and should be arguing for the same funding for the people of Swindon as for the rest of the country. I am amazed to hear her accept that Swindon should be less well-funded than elsewhere. That will be well noted by her constituents.
Ms Drown: I thank the hon. Gentleman for his statement. If I were him, I would question my conscience. If I were a member of the Conservative party, I would question whether he should ever be in a position of responsibility. We have a duty to consider the big issues. The logical conclusion of his argument is that no money should go to overseas aid, for example, because that would take away money from his constituents. Such an argument is. morally reprehensible. Of course, I will argue for the best for my constituents, but I will always take into account the wider needs of the country and of the world because that is what we, as responsible politicians, must do. I hope that the hon. Gentleman will share that aim.
Swindon has enjoyed relatively generous settlements under the Government—indeed, much more generous that under the previous Conservative Administration. Our social services standard spending assessment for 2000–01 has risen by 22 per cent. compared with 1997–98, and it is interesting to look at the figures for Wiltshire. Like Wiltshire, Swindon's spending is 18 per cent. above SSA, which demonstrates the pressure on services. However, although the settlements are generous they have not kept up with demographic changes. Swindon's population, including the number of elderly people, is growing rapidly, which puts extra pressure on services. Moreover, we start from a very low base. For the first two years, we had the lowest council tax of any unitary authority in England, which was due to our national inheritance from the previous Conservative Government. Moreover, Wiltshire county

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Council—of which we were once part, and which was usually controlled by Tories but sometimes by Liberal Democrats—did not invest money in services.
The same debate about rural and urban areas has taken place in respect of education, and an effective cross-party group—the F40 group—has considered SSAs. We recognise that the Government have tried to address the problems associated with SSAs. The most recent settlement introduced a policy of funding floors, which we should all welcome, because it will help authorities that are lagging behind by ensuring that they catch up with average funding levels. However, we must ask the Government to go further. In particular, we must consider partnership grants to support work on the ground in our constituencies. Reference was also made to the area cost adjustment, and it is true that that has not helped. As a result, Swindon has lost £655,000, while other authorities with similar costs have gained by such funding.
We should also reflect on the pressure on the Princess Margaret hospital, which has undoubtedly led to specific and occasionally severe problems. My constituents often tell me that there are not enough acute beds in the new hospital, which is being built thanks to this Administration. However, because of delayed discharges, as many as 16 per cent. of acute beds are not being used effectively. If we can overcome that problem and demonstrate that there are sufficient acute beds, we can concentrate instead on other services, such as home care and intermediate care, so that our constituents can have the best, most appropriate services. I am pleased to say that a recent planning application has been made for an additional 60 intermediate beds, which would greatly help in addressing this problem.
As the right hon. Member for Devizes pointed out, solving the problem of delayed discharges would mean better economics for the public purse and better health. Those who have been discharged from acute wards are less likely to get infections. Moreover, there would be a huge psychological impact on patients. In Swindon, an excellent scheme involving purchasing beds in one of our residential homes—Langton house in Wroughton—has had an amazing impact on the people who have been discharged. The doctors and nurses who discharged them from the acute hospital thought that they might not be ready to go home for eight to 12 weeks, but, simply because they moved from hospital to a less acute setting, they got better much more quickly than anyone expected. That is partly due to the psychological impact—people tend to think, "I'm out of hospital, so I must be getting better." Such schemes can really help people's health.
The Government may say that Wiltshire and Swindon have sufficient funding and should be delivering as well as the best across the country. I would respond that if that is so, in what specific respects can we do better? In some cases we can say, "X or Y should have been done," but that probably happens everywhere. I know that the Government are working on best practice across the country, but it would be helpful if we could pass such information back to the people who are working in our constituencies to try to deliver the best that they can for patients. I recognise the hard work that is being done in Swindon and congratulate those who are doing it.
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The Government are working to encourage partnerships and to spread best practice. When I was first elected in 1997, the trusts were not communicating and the health authority and social services were not talking the same language—both were defending their own budgets and territories. Now, when I meet them, it is clear that they recognise that they have a shared problem that they are tackling together. That is a huge step forward.
I want to see much more funding for social services, so that we can return to the old-fashioned home help service, which is a good, preventive service. At the moment, we have only the more intensive home care service.
I appeal to the Government to consider increasing partnership grants. That would reward the good partnership work that is taking place and recognise the fact that together the staff are doing all that they can to deliver the best possible care for local people.
10.7 am
Mr. James Gray: It is a pleasure, I think, to follow the hon. Member for South Swindon (Ms Drown), although I have to say that I am slightly puzzled by one or two elements of her speech. At one moment she argued that there was a crisis in her local hospital, Princess Margaret hospital in Swindon, and at the next that there was no such crisis and everything was fine. At one moment she argued that social services spending in Swindon and by Wiltshire county council was sufficient, and at the next moment that it should be more. At one moment she argued that it was reasonable that we should rank significantly below the national average for social services spending—because that allows us to spend money on overseas development, for example—but at the next that it is important that we should be spending the same. I fear that some of her speech gave out mixed messages.
Ms Drown: The hon. Gentleman is trying to make an interesting and exciting speech, but I fear that he is not succeeding.
Mr. Gray: I have not started yet—just wait.
Ms Drown: It is perfectly consistent to recognise the good work that has been done and the fact that progress has been made, while saying that much more needs to be done.
Mr. Gray: I am grateful to the hon. Lady for clarifying her position. I am sure that her constituents will take careful note.
I congratulate my right hon. Friend the Member for Devizes (Mr. Ancram) on securing the debate. We entitled it "The bed blocking crisis in Wiltshire" advisedly. This is not a small matter, to be discussed in passing, that might justify a quick local press release, but a significant crisis in our constituencies. That is why my right hon. Friend, who is chairman of the Conservative party and has several other duties to perform, has none the less chosen to give up an hour and a half of his time, plus the time spent in preparing his speech, to come to the Chamber—as have other hon. Friends from the county and, indeed, hon. Members from other parties.

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Of course, Wiltshire, with the exception of Swindon, is an entirely Conservative-represented county, and I am delighted that all three of my colleagues are here today.
I should like to touch on several aspects of the crisis. As my right hon. Friend said, about 68 beds in the county are blocked, and that has various consequences. It is only the tip of the iceberg, because we believe that about 60 more people are at home and awaiting assessment. They need to be admitted to Cameron ward in Chippenham hospital because, sadly, they have dementia or similar diseases associated with the elderly. They desperately need admission to the ward, but they cannot even obtain an assessment on whether they are suitable for that placement.
There is hidden bed blocking throughout the county and people from other counties, particularly Gloucestershire, are seeking places in Malmesbury and Chippenham hospitals in my constituency but cannot get them. The bed blocking crisis is in fact greater than the figure of 68 that we heard on 19 January, when the most recent census was taken, but I shall focus on that figure.
There is a crisis in local hospitals. It was interesting to hear the hon. Member for South Swindon refer to the Princess Margaret hospital. She referred to it as a Labour achievement, but it was a product of the private finance initiative, which was invented by the Conservatives. The hospital was created and planned by the Conservative Government, although she was right in as much as the new Secretary of State laid the foundation stone, turned up to open it and signed the deal for the PFI. The PFI itself, however, was a Thatcherite invention. The Labour party voted against the whole notion of the PFI for hospitals and was totally and utterly opposed to it for years. When it came to power, it decided to use that Thatcherite invention to build the Princess Margaret hospital in Swindon, among others. I do not accept that it is an achievement of this Government.
The hon. Lady seems to think that everything is fine and has stated that there is no crisis in the national health service. I fear that the Western Daily Press does not agree with her. It stated on 25 January, under the blaring headline "Hospital facing new beds crisis", that the hospital
"is once again having to use trolleys as beds as it struggles to cope and the crisis at Princess Margaret Hospital in Swindon is being made worse by a shortage of nursing home beds."
That may be wrong, and the Western Daily Press will no doubt look into it, but it certainly suggests that there is a crisis.
Ms Drown: I was trying to get across the point that there is no crisis throughout the national health service. The hon. Gentleman is wrong to raise unnecessary fears among his constituents, the vast majority of whom receive an excellent service from the NHS. I said then and I say now that that does not mean that there are not real pressures in the health service. We all recognise that.
Will the hon. Gentleman admit that, under the Conservative Administration, the health service was also regularly in crisis—to use his description? If he read the same reports on delayed discharges in hospitals
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under the previous Administration, he would find exactly the same problem. Statistics on the number of people who waited on trolleys under that Administration show that the problem was the same. I should be interested to know how many times, between 1994 and 1997, he wrote to his local Member of Parliament about those issues. The problems have existed for a long time.
Mr. Gray: I am grateful for the hon. Lady's clarification. She used the word "also" and said that the crisis under the previous Administration was as bad as the one today, thus admitting that there is a crisis today. Whether the crisis five years ago was the same, better or worse than today's is academic, and I was not a Member of Parliament at the time, but it is clear that she accepts the general point that there is indeed a crisis in local hospitals. To confirm that, on 25 January the excellent Western Daily Press printed another stark headline, "Surgery delayed for 3,000 people by bed blocking". There is indeed a crisis in the national health service in Wiltshire, and I am sorry that she will not openly accept that.
Mrs. Caroline Spelman: Does my hon. Friend accept that one of the principal causes of bed blocking is the uncertainty that has arisen as a result of the Government's "Fit for the Future?" regulations? They are a major contributory factor to the closure of nursing home beds.
Mr. Gray: My hon. Friend is right. "Fit for the Future?" may be the result of sensible aims, but it has created an even greater crisis in long-term care. I have mentioned the Princess Margaret hospital and the Cameron ward in Chippenham hospital in my constituency. I am worried about the number of people who are there unnecessarily. The same applies in Malmesbury hospital, where several of my constituents have been affected by the closure of the long-term care home in Minety, one of the three long-term care homes that have closed recently in Wiltshire. Those people are stuck in Malmesbury hospital and are costing the nation a fortune. It is a problem for the hospital, as it is for those who have to stay in a ward where they do not want to be. It is inappropriate that they are there, but they have to be because of the crisis.
My hon. Friend referred to private homes. It is extremely worrying that a large number of first-class private homes are in deep financial difficulties. Many are deregistering as nursing homes. For example, Ferfoot, a former nursing home in Chippenham in my constituency, has now deregistered to become a long-term care home. Many homes have been left with huge numbers of empty beds. The Conifers home in Minety closed recently with tragic consequences for its residents. They received a letter on 20 December by registered mail saying that Conifers was closing down and were asked to find alternative accommodation. Many of its residents are now going into hospital. We have many fine, first-class private homes in Wiltshire and what is happening to them is tragic.
In 1999, there were 295 private residential homes in Wiltshire. We now have only 287, and the number of beds has dropped significantly from 3,141 to 3,079. The position of nursing homes is even worse. The number of

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nursing homes has reduced from 71 to 65, and the number of beds from 2,296 to 2,049. That is in an area where the population is growing older and, because of its environmental advantages, people are moving in. If anything, long-term care homes, residential homes and nursing homes should be becoming larger. We need more beds, not fewer, but their number has declined significantly.
I read the excellent Chippenham Gazette and Herald and The Wiltshire Times, but the Western Daily Press provides more evidence than other newspapers. On 25 January 2001, it carried the blaring headline "Care homes at risk in funds crisis". People are stuck in hospital and care homes cannot continue. They are going out of business and the whole problem is becoming a self-fulfilling prophecy. It is a vicious spiral of the worst sort.
What is happening has particular consequences for the public purse to which my right hon. Friend the Member for Devizes referred. From the point of view of UK plc—the taxpayer—it is extraordinary that we are happy as a nation to pay £1,250 a week to keep 68 people in hospital who need not be there. They could be living in first-class private accommodation with, in many cases, their own bathrooms—one home in my constituency has a swimming pool—for only £250 a week or, if they need long-term care, for only £150 a week. The nation—the taxpayer—is wasting £1,000 per week for each of those 68 people. About £4 million a year is going straight down the drain for no reason other than that health service money comes from one pocket, while social services money comes from another. It is administrative nonsense and an absolute disgrace that taxpayers' money should be wasted in such a way.
Throughout the country, we are wasting hundreds of millions of pounds providing care that people do not need and that is not right for their circumstances. Such people are not in need of acute care. They need long-term care. We are spending hundreds of millions of pounds providing the wrong care. I hope that the Minister will deal with such matters in her response. I suspect that not only the people of Wiltshire but the nation will be interested to hear what she has to say about what the Government intend to do about the problem.
The problem has real consequences. We are discussing not merely numbers—£4 million a year being wasted in Wiltshire—but elderly people being kept in large wards and looked after incorrectly by the wrong sort of people and not enjoying their lives or having an armchair to sit in and look out of the window at the garden. Such people are experiencing deep difficulties, and even worse off than them, it seems, are those who stay at home, often in unsuitable circumstances, around Wiltshire. The home care side has had to be reduced because of the SSA system, which I shall discuss in a moment. Such people sit at home, and their carers, who often suffer in such ludicrous circumstances, are having genuine difficulty in looking after them.
I am keen to leave adequate time for the hon. Member for Exeter (Mr. Bradshaw), who I am sure has a fine speech ready. I see him nodding. We are looking forward to that speech, although it is perhaps not directly relevant to Wiltshire.
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I should like to touch on a matter that lies behind the problem. We must differentiate strictly and clearly between the rural Wiltshire county council and the urban Swindon borough council. One of the unfortunate asides in the speech of the hon. Member for South Swindon suggested that she thought it perfectly sensible that the SSA and the revenue support grant in Swindon should have increased while those in rural Wiltshire have decreased. She said that that was a result of Swindon having been part of Wiltshire county council at one time, that Swindon was dreadfully underfunded, which was rotten, especially as Swindon has poverty, single mothers and so on, and that that makes it perfectly reasonable that Swindon should have more money and Wiltshire less. That is clearly what she said, and that is certainly what is happening in the rest of the country, where £30 million pounds has been ripped out of rural SSAs and pumped into urban inner cities. The Labour Government have removed a substantial amount from rural counties—Conservative and Liberal-controlled areas—and pumped it into Labour areas in the inner cities. That was my understanding of what the hon. Lady said a moment ago, but she may want to correct me.
Ms Drown: I was simply saying that Swindon has needs, and I am pleased that the Government have recognised that. We needed the funds, and the Government are right to support us by increasing our SSA over three years by 22 per cent. I am not saying that Wiltshire should receive less support, although the hon. Gentleman's argument seems to be that all the money should go to Wiltshire and none to Swindon. I have a much more responsible attitude to the matter, and I suggest that Wiltshire, too, should get more funds—as, indeed, it has. In 1997–98, the SSA was £48.5 million, and in 2000–01, £53.8 million. That is an increase.
Mr. Gray: One moment the hon. Lady says that Swindon's money has increased, and that that is good, and the next she says that that has not affected Wiltshire's money. The truth is that Wiltshire's money has decreased significantly. The bed blocking crisis is simply the result of that. As I said, we spend £50 a head less in Wiltshire on social services than the national average.
Ms Stuart: Will the hon. Gentleman give way?
Mr. Gray: I am slightly anxious that I am using up my time, but of course I shall give way, as the Minister is so charming.
Ms Stuart: For my benefit, will the hon. Gentleman remind us whether he agrees with the right hon. Member for Devizes that we should provide solutions to the underlying problem, not shift hardship?
Mr. Gray: That useful and interesting piece of rhetoric ignores the nature of the SSA system. The SSA system involves only one cake. We are not discussing increasing the Government's overall spending on local government.
Mr. Ben Bradshaw: Yes we are.
Mr. Gray: That shows how little the hon. Gentleman knows about the SSA system. There is a large cake, and

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the system is the means by which it is divided and decisions are made about whether the money goes to inner cities, rural areas or poor people. It makes no comment about the overall size of the cake, merely about how it is divided. The Government have cut up the cake in a different way. They have pulled a comparatively large amount of money—yesterday the amount increased—out of rural areas such as Wiltshire, and pumped it into places such as Swindon. That seemed to be the point that the hon. Member for South Swindon was making.
To answer the hon. Lady's second point, I am not ashamed of the fact that I am not a Minister of the Crown or even a Front-Bench spokesman, although I am an Opposition Whip. I stand here as the Member of Parliament for North Wiltshire to argue the case for more funds for my constituency. I do not have a responsibility for the poor of the nation, or for overseas development, although we would all agree that as much as possible should be spent on that. The purpose of the debate is to talk about bed blocking in north Wiltshire, and I am delighted to have the opportunity to do that. It is not about how much money should go to overseas development. The hon. Lady seems less keen to talk about her constituents than I am.
We must question the Government on the issue. I am glad that the Minister is here, and I know that she has been fully briefed, because she received the same briefing as we did from the excellent Wiltshire health authority and Wiltshire county council social services department. I hope that she is ready to answer the detailed questions that my hon. Friends and I put to her this morning. We seek two things. First, she must speak on behalf of her colleagues in the Department of the Environment, Transport and the Regions with regard to the current review of the SSA system. We need to know whether she believes that the cost adjustment system should remain in place, and why Berkshire and Hampshire receive more than Wiltshire. How can SSAs be reformed to find long-term solutions to the problems that we have mentioned?
Secondly, is Wiltshire in the same position as Hampshire county council, which last year received specific grants to sort out its bed blocking crisis? We look forward to the Minister's announcing whether she will award us specific grants this year to sort out the crisis.
I would also like to hear some longer-term, philosophical thinking from the Minister. The crisis has come about because the money comes out of two pockets—one for the health service and the other for social services. As long as that method of funding is used, the crisis will continue. Will she give some thought about whether it would be possible to amalgamate those sources and take the money from only one pocket? Only then will a final solution come about.
We have heard this morning about a very real crisis in Wiltshire. It is a crisis for nursing homes and hospitals, but, more importantly, it is a crisis for people. I hope that we do not hear a lot of political badinage. I want to
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hear serious answers to the questions that we have raised, and real solutions for my constituents who are facing this extraordinary crisis.
Several hon. Members rose—
Mrs. Marion Roe (in the Chair): Order. Before I call the hon. Member for Salisbury (Mr. Key), I remind hon. Members that the wind-up speeches will begin at 10.30.
10.28 am
Mr. Robert Key: Thank you, Mrs. Roe. I am grateful to the Minister for her presence this morning, and to my right hon. Friend the Member for Devizes (Mr. Ancram) for initiating this important debate. I hope that the Minister, with her usual charm and courtesy, will find answers for us in her reply to the debate, but I remind her that the system of standard spending asssessments holds no fears for me. As a former Minister responsible for local government finance, I know the ins and outs of it. When I was a Minister, in a different Department from hers, anomalies cropped up and mistakes and statistical errors were made, but it was possible to put things right. I hope that she will be able to do so.
Until 18 months ago, the circumstances in Wiltshire were serious. We had to undergo the consultation on standards in care, and it was clear that that would lead to the closure of homes throughout Wiltshire. Expecting high standards of staffing and physical accommodation is one thing, but damaging over-regulation that leads to closures is quite another.
The Inwood house residential retirement home in my constituency is a fine example of a home that is under great pressure simply because someone decided on the minimum number of square metres required per person and whether that included a loo or a bathroom. Homes are being closed throughout the country on that basis. Assisi house in my constituency closes today, having been home to 20 people for 18 years.
Last year, 700 care homes closed throughout the country, with a loss of 15,000 beds for the elderly and vulnerable. Is it all the fault of the county council in Wiltshire? I think not. It would not be fair to say so. We have all argued for a proper appraisal of the situation, and I pay particular credit to Councillor Mrs. Judy Seager, the chairman of the social services committee, and the director of social services, Dr. Ray Jones, who have worked unceasingly to try to find a solution to this problem. My constituents suffered another body blow today, as we have been told that out of the £52 million announced by the Secretary of State for Education on Monday, Wiltshire will receive just £100,000, and Swindon will receive £460,000. We are among the biggest losers on the transfer of adult education, and have one of the fastest rising school rolls. That is another instance of our county missing out.
Of course there is no problem in Swindon. The hon. Member for South Swindon (Ms Drown) not only lives in another local authority area but on another planet as far as these matters are concerned. Once again, the Government are sucking the tax out of Wiltshire, and stuffing it into Swindon.
Ms Drown: I know that outside this Chamber the hon. Gentleman would be far more reasonable. The fact is

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that Swindon has needs, which the Government are right to address. I hope that he, as a reasonable politician, will also recognise those needs.
Mr. Key: The hon. Lady has only been in the House for five minutes. Indeed, she has only been in Wiltshire for five minutes. Some of us have lived in Wiltshire most of our lives, as well as representing it. She will know that there has been a problem in Wiltshire long before Swindon had its own local authority. I do not want to digress, however, as we are very short of time.
One or two further points need to be made. The county and the health authority are working hard together to find solutions. Let me outline the practical impact on my constituents. Total delayed discharges in Salisbury district hospital are 45, which means 45 bed blockers. Of those, Wiltshire is responsible for 35, Hampshire for five, Dorset for three and others for two. The total number of bed days used by those 45 people is 3,384. The average length of stay is 75 days. General medical average length of stay is four days. Out of those 45 patients, 42 are more than 75 years of age. The mean average age of admission in Salisbury of the over-75 age group is 84 years. We are therefore discussing very elderly and vulnerable people. The delayed discharge rate—the number of people delayed in hospital per 1,000 over 75 years of age, which is a standard health service method of measurement—is 2.5, against a rate of 1.52 for England as a whole. We received news this week that a local deal has been done for lifetime placements, and the local NHS trust and county council social services will find the money for another 10 out of those 45. Therefore, 35 people will still be where they should not be.
The opportunity cost is huge. During the past financial year, bed blockers in my local hospital have meant that 2,920 operations have not been performed. If the county council is forced to continue without any further help, next year there will be 5,840 cancelled operations in my district hospital. That is unacceptable. We must get to the bottom of this problem. My right hon. Friend the Member for Devizes has enumerated some of the available solutions.
I want to stress the impact that the military has on the area. At my end of the county, there is a serious problem. The military are funded by the national health service as well as through defence medical services, but an increasing burden is being put on local services, especially by project Allenby, which will make the local garrisons the biggest garrisons in the country. That has a huge impact on health provision. If accidents happen on the Salisbury plain training area, the casualties do not all go off to the military hospital in Haslar, but to the accident and emergency unit, spinal unit and burns unit at Salisbury district hospital. That is another significant factor.
The crisis is of the Government's own making. As my right hon. Friend so decisively argued, the facts are beyond dispute. There were never such problems under a Conservative Government. The Liberal Democrats in Salisbury have exercised their full intellectual rigour and political clout and suggested that people write to them to complain. A fat lot of use that will be. The issue requires real politics at Westminster.
Sir Humphrey and Bernard could not have produced a finer script than what we have been presented with in Wiltshire. It would run like this: "First, Minister, you
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must close the care homes. Then you must apply a funding formula for the county council which makes its job impossible and wastes millions of pounds of taxpayers' money. Next, you should set targets for the Salisbury district hospital that will force it into deficit, block beds and threaten the community with the loss of thousands of operations. Then, Minister, you must issue the threat of red lighting on 1 April. That will lead to direct rule from Whitehall, with a Minister directly in charge of what happens in Wiltshire. That is just a couple of months away. That, Minister, is Labour reality." What a flagship NHS policy that is. The Minister should be proud of it. I cannot wait for the next general election.
10. 35 am
Mr. Paul Burstow: The right hon. Member for Devizes (Mr. Ancram) is to be congratulated on securing the debate, which raises serious questions. Perhaps the issues that we have been discussing affecting Wiltshire are a microcosm of the problems confronted every day by directors of social services and the NHS all over the country.
The example that we have heard about shows us a social services department being pressured into overspending its community care budget—at present by £1.5 million, and possibly by up to £5 million by the end of the year. We know, from surveys undertaken by the Association of Directors of Social Services, that the problem of over-commitment is widespread. Seven out of 10 social services departments surveyed last year considered that their budgetary position was worse in the current than the previous financial year. They expected it to be as bad, if not worse, next year.
Wiltshire social services department spends about 18 per cent. more than its standard spending assessment, so talking about increases in the standard spending assessment is deliberately misleading. Until the standard spending assessment is brought up to the right level, increases disappear into existing provision. They do not buy extra services. That is why the hon. Member for South Swindon (Ms Drown) was right when she talked of a history of underfunding. The standard spending assessment locks historical underfunding in place and penalises councils that for one reason or another have been frugal or tight-fisted in the past.
Nationally, most councils spend about 11 per cent. more than their standard spending assessment on social services. As a result, as the Local Government Association found only last week, nearly every social services department in the country expects an outturn overspend this year, totalling £205 million. Those budget pressures—not just in Wiltshire—are causing care gridlock. In Wiltshire the numbers of people over 85 are increasing quite substantially. That is a cause for celebration. It is wonderful that people are living longer. However, that reality is not factored into the equation relating to the funding of long-term care. The consequence is that the number of places that Wiltshire can fund remains the same, while more people need them. That leads to bed blocking, and more people experiencing rationing and being unable to obtain the care that they need.
We have heard details of the collapse in confidence in the care home sector in Wiltshire, but that is a national problem. In the past couple of years 15,000 beds have

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been lost and many care homes have closed. Will the Minister tell us why, despite repeated requests, the Department of Health has refused to publish the information obtained from last year's survey to ascertain the number of beds lost from the care home sector between October 1999 and October 2000? I am told that the survey was intended to provide an idea of councils' preparedness to deal with winter pressures. Surely hon. Members should be able to see the figures, to judge for themselves how prepared councils would be. Perhaps the refusal to publish the figures is due to the accelerating rate of bed closures.
I hope that the Minister will not tell us that the problems that right hon. and hon. Members have described this morning will be fixed by intermediate care. That is a short-term rehabilitation package to bring about a patient's return home. It should not be somewhere to dump people who need permanent placements in residential nursing homes. If that is to be its function, it is a con that needs to be revealed. We need to make sure that the Government do not propose that. I hope that the Government will not hide behind standard spending assessment figures, but accept that those figures do not reflect true cost pressures on local authorities.
Finally, we need to take into account what might happen if there were a change of Government. We know that the Conservatives want to spend £8 billion less on services. That would reduce funding to social services in Wiltshire by £3 million. Under the proposals of the right hon. Member for Kensington and Chelsea (Mr. Portillo), the situation would become worse, not better. More people would be left in limbo waiting for beds in nursing homes and more nursing homes would close.
The Minister may put on her rose-tinted glasses when she makes her comments about standard spending assessments. I fear that the hon. Member for Salisbury (Mr. Key) was wearing the same pair.
10.40 am
Mrs. Caroline Spelman: I congratulate my right hon. Friend the Member for Devizes (Mr. Ancram) on securing this debate. He had the good fortune or foresight to realise that this was a good week to debate bed blocking, as at this time there is peak demand for beds in the national health service, so the problem is at its peak. The Minister and I visited City hospital in Birmingham on the same day last week, so she will have seen that accident and emergency departments are not currently coping, due in part to the number of blocked acute beds to which emergency cases need to be admitted.
The debate has shown that there have been three key causes of the bed blocking problem, some of which were avoidable. We have heard about Wiltshire, but it is important to say that its case is not unique. Kent suffers badly from bed blocking. Five nursing homes have closed there, with the loss of 243 beds, and there are 225 blocked beds for the same reasons as in Wiltshire. The picture is the same nearer to me in Worcestershire, so the problem is nationwide. The possible differences and their serious consequences within one county have been thrown sharply into relief by the Wiltshire Members who have spoken.
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The avoidable aspect of the bed blocking problem was the imposition of the proposals in the document "Fit for the Future?", which contains onerous regulations for the care home sector. There is some irony in that, as the regulations have resulted in the closure of many care homes and the industry being much less fit for its future. Unsurprisingly, last year the Independent Healthcare Association described them as a piece of "strident bossiness".
The introduction of standard room sizes, wheelchair access to rooms and the reduction of the number of shared rooms to 20 per cent. has had a serious impact on those who have to decide whether they can continue in business under such regulations. I accept that the Government are aware of the extreme concern that the regulations have caused the care home industry. They have climbed down on several issues: they have been prepared to reduce the standard room size for an existing care home from 10 sq m to 9.3 sq m, and have made a distinction between existing and new-build care homes, so that new-build homes will have a standard room size of 12 sq m.
It is not beyond the wit of man to realise that the care home industry is left wondering what the standards will ultimately be. That degree of uncertainty will cause problems.
Mr. Burstow: Will the hon. Lady give way?
Mrs. Spelman: I am sorry but time is tight and the hon. Gentleman has had the opportunity to make his key points.
The Government's approach has been ham-fisted, and has led to a huge loss of capacity in the system. I hope that the Government were embarrassed when the hon. Gentleman pointed out that they were unwilling to provide figures on the loss of care home beds. However, they will be aware of last year's Laing and Buisson study, which showed the loss of 25,000 beds in the care home sector. That is an enormous loss of capacity, and one of the key reasons why we are debating the bed blocking crisis today. It is quite separate from the standard spending assessment issue, which has been well elucidated.
The uncertainty caused to the home care industry by the imposition of the regulations is entirely inflicted by the Government. It cannot be attributed to the previous Administration. Moreover, the Government would be wrong to interpret that as meaning that the Conservative party is more worried about the providers of care home places than the users. That is untrue. My right hon. and hon. Friends have made it clear that the problems of those in blocked beds, those who need to go into hospital but cannot, and those in care homes that are being shut are of paramount concern to our party. The Minister will be aware that the mortality rate is exceptionally high among care home residents who have to move out of a home in which they had lived for a long time. Let it not be said that the Conservative party cares more for the providers than for the users.
Care homes throughout the country are underfunded by approximately £50 a week. In order to remain in business, some care homes are turning to the families for top-up funds. That could cause difficulties, because £50 may be a lot of money to people who are rather

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euphemistically called third parties. The third party may be a son or daughter, a carer or other relative. The Government should not have allowed that to happen; they have presided over a serious decline.
There are knock-on consequences of bed blocking. I make no apology for mentioning again my recent visit to the City hospital in Birmingham; I am sure that it is as fresh in the Minister's memory as it is in mine. What I have to say is directly relevant to the bed blocking problem. The Minister and I visited a busy accident and emergency department that is not coping, despite the extra money made available to deal with winter pressures—money that has been allocated also to Wiltshire hospitals. It is no good blaming someone else for the fact that the hospital cannot cope. The hard fact is that the nation's accident and emergency departments cannot cope with a flu epidemic in the middle of winter. That is the Government's responsibility. They said that they would do something about it.
In the middle of February last year, out popped the new term "intermediate care". I asked the City hospital in Birmingham about intermediate care and about step-down bed arrangements, and I was told that it was not a reality for that hospital because it was in the midst of a crisis. Birmingham social services are as overspent as the social services department in Wiltshire—Birmingham is overspent to the tune of £14 million. The overspend in social services departments is one of the main contributory factors to the crisis that faces the NHS. That was well summed up by my hon. Friend the Member for North Wiltshire (Mr. Gray), who graphically described the problem by referring to the two pockets.
The problem has not been solved because the two sources of funding are completely separate, largely because civil servants at the highest level have a silo mentality. They seem unable to talk to each other about how the problem could be solved. It is yet another example of the Government's failure to define the problem correctly and to find an answer. It was this Government who coined the phrase joined-up government, so where is it?
10.48 am
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I congratulate the right hon. Member for Devizes (Mr. Ancram) on securing this morning's debate. There has been considerable confusion among Opposition Members about what is needed. Do they not want us to shift hardship cases to solve the bed problem? The hon. Member for North Wiltshire (Mr. Gray) said that he did not want any political answers, whereas the hon. Member for Salisbury (Mr. Key) was looking forward to the next election. I make no apology for saying that hon. Members cannot have it both ways in such debates. If they want a detailed response from Ministers, they must allow them sufficient time. If the members of the Opposition Front Bench raise wider issues, I shall address them, even if I have to do so outside the Chamber.
The hon. Member for Meriden (Mrs. Spelman) mentioned her visits to Birmingham's City hospital, so she will know that Birmingham social services received an extra £1 million to solve its problems. An extra
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£1 million was given to its accident and emergency department, and the go ahead was given for a £22 million ambulatory care centre. The hon. Member for North Wiltshire said that the private finance initiative was a Conservative idea. It may have been a Tory idea, but they could not make it work. We are making it work.
The flaw in the Opposition's argument is that they cannot have it both ways. They cannot ask for more money and at the same time accuse us of being reckless. They should not go down the discredited route of saying that we need to do more of the same. There has been a deep recognition that we need to reconfigure the services and work together. Conservative Members complain that the funding streams come from two sources, but that is exactly why we are encouraging social services and the health service to work together.
Mr. Ancram: Will the hon. Lady give way?
Ms Stuart: No. I want to deal with the basic argument put by Opposition Members.
Mr. Ancram: Well answer my question.
Ms Stuart: The right hon. Gentleman should allow me to give him an answer. I still have a few minutes in which to do so, although he may not like what I have to say. It is important to recognise that the way forward is for the two services to work together. It is no good criticising and asking about what would happen if this or that were the case. We are changing the way of working. The hon. Member for Sutton and Cheam (Mr. Burstow) expressed doubts about intermediate care, suggesting that it is a quick fix. Far from it: it is part of a whole package.
I refute the hon. Gentleman's allegation that we refuse to publish figures on the loss of beds. The Prime Minister said in Prime Minister's questions on 29 November that although there had been a 15,000 gross loss, the net loss was 8,600. That must be seen in the context of the 20,000 home care packages.
Mr. Burstow: Will the hon. Lady give way?
Ms Stuart: No. I want to make a little progress.
We have made a total commitment to improving public services, which we have matched with funding. Opposition Members, with their talk of crisis everywhere, fail to recognise that we are changing the services and making improvements. I should like to know how they would make improvements in the services while cutting £16 billion under their tax guarantee.
Today we have the opportunity to discuss what happens in Wiltshire. We have a responsibility to put the position in Wiltshire in context. It is no good suggesting that we should not blame the previous Conservative Government. We inherited a system with too few doctors, too few nurses and not enough beds. The hon. Member for North Wiltshire said that he wants more beds. We will provide more beds, but to do so we require extra staff, who need training.
I shall make a brief point on the accusations about the "Fit for the Future?" proposals. It is extraordinary that Conservative Members want it both ways. We are

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consulting on the best way to implement the policy. That is not a major U-turn. If they are suggesting that under the "Fit for the Future?" proposals the only measure that private nursing homes have to put in place at the moment is a complaints procedure, they are either misrepresenting the facts or displaying a total lack of understanding of what is going on.
Wiltshire has to be seen in context. We are investing more money throughout the country. From April, Wiltshire health authority will receive £408 million, which is a cash increase of £29.4 million on the previous year, and a staggering increase of £167 million on the figure for April 1997. Hon. Members should remember that that contrasts with the meagre increases in real terms of 0.5 per cent. and 1.4 per cent. that Wiltshire received in the last years of the Tory Government. The allegation that we are ripping money out of Tory rural areas and giving it to Labour urban areas is unfounded and not substantiated by the figures. Bed blocking involves health and social services. [Interruption. ] Will the hon. Member for North Wiltshire please allow me to answer his question? I shall be unable to do so if he does not listen.
We are putting investment into not just health, but social services, which are receiving more money. Under the Conservative Government, spending on personal social services rose by an annual average of just 0.1 per cent. in real terms—that is not a misprint or a mispronunciation. Under the Labour Government, spending on personal social services will increase by an average annual rate of 3.4 per cent. in real terms. Conservative Members may not like to hear that, but I am afraid that those are the facts.
Just to make my earlier point clear, for 2001, Wiltshire county council's overall standard spending assessment increased by 5.6 per cent., while Swindon borough council's increased by 4.9 per cent. Both of those increases are above the national average increase of 4.4 per cent. Conservative Members cannot turn this into a debate about rural areas not getting extra money, because the figures do not stack up. In the same year, the personal social services standard spending assessment for Wiltshire increased by 5.8 per cent., and for Swindon by 5.5 per cent. Again, both those increases are greater than the national average. As hon. Members are so exercised about local government spending, I am sure that they will play their part and spend some of their valuable time contributing to this afternoon's debate on local government finance in England.
Investment in the partnership has already begun. The social services and the NHS are working together to support the winter planning preparations in Wiltshire. Additional funding of more than £3.2 million has been provided to the Wiltshire health community. From the £63 million announced in August of last year, Wiltshire received £636,000, which is being used in a wide variety of schemes across the county, such as providing 22 additional beds for discharge and rehabilitation support in Swindon and Ridgeway Downs primary care groups.
The Tories will not match that funding, whether it is the £63 million announced in the summer, the extra allocation in November, or the special grant made to Wiltshire over the past six months. They are committed
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to their tax guarantee. They should not come here and complain that services in their constituencies do not receive enough money. They do not recognise the extra money that goes into the service.
Mrs. Spelman: Will the Minister give way?
Ms Stuart: I shall give way to the hon. Lady to allow her to make just more one point.
Mrs. Spelman: I appreciate that, as I gave the Minister an additional two minutes to accommodate such interventions. I should like to place on the record that the £16 billion in cuts is a figure plucked from the air. She knows full well that we have pledged to match entirely the Government's spending on the NHS.
Ms Stuart: I am grateful for that intervention. Will the hon. Lady clarify whether her party is also committed to matching Labour's social services spending? I would be happy to give way again if she could give me an answer. The core of the debate has been that bed blocking is caused by the NHS and social services not pooling their funding. Unless the Tories match their commitment to NHS funding with a commitment to social services, their promises are empty and worthless.
Mr. Burstow: Will the Minister confirm that, in a parliamentary answer to me, the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), has refused to publish figures showing the number of bed closures in nursing homes? That is a fact, which is on the record. Will she confirm it?
Mr. Ancram: On a point of order, Mrs. Roe. Is it in order for the Minister to refuse to take an intervention from the person who led the debate, but then to take interventions from Conservative and Liberal Democrat Front-Bench Members?
Mrs. Marion Roe (in the Chair): The right hon. Gentleman will know that the Minister is entitled to do that.
Ms Stuart: I shall give way to the right hon. Gentleman.
Mr. Ancram: I put four sensible and moderate suggestions to the Minister. I am looking forward to hearing her response to them.
Ms Stuart: I was outlining the whole package, and I was also making the point that the standard spending assessment review is on-going. There is a debate about that this afternoon. However, this debate is about bed blocking, and I am talking about how the NHS and social services work together. The extra packages that have been put in place in Wiltshire have led to the Princess Margaret hospital receiving an additional £408,000 for its modernisation fund. Wiltshire and Swindon are increasing spending on personal social services.

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Hon. Members have singularly failed to recognise the progress that has been made. I am not saying that the system is perfect. However, the solutions we propose are extra funding in the short term and a restructuring of services in the long term, which, as the right hon. Gentleman said, is not a matter of shifting hardship, but of solving the underlying problems. It is a 10-year plan, and we are well on the way. Conservative Members have no solutions other than arguing over figures that simply do not add up.

Employee Rights
11 am
Mr. Tony Lloyd: Just before Christmas, as we approached the 21st century, Vauxhall workers woke up to hear on the radio that their jobs and way of life were threatened with destruction. Most of us outside the Vauxhall work force considered that an outrage, but those who worked there were entitled to go further and speak of devastation for their families, and of how such things should not happen in a civilised country that claims to have the rule of law and acceptable minimum labour standards.
I pay tribute to my hon. Friends the Members for Luton, North (Mr. Hopkins) and for Luton, South (Ms Moran), who have worked to ensure that Parliament faces this issue squarely. Although the blunt reality is that too many Vauxhall workers have no right to information and consultation, this debate extends beyond Vauxhall to the rights of employees in general. In the main, the right to know what is going on and what is likely to affect individual employees simply does not exist for most who work in British industry and commerce.
Vauxhall workers are not the only ones to have been treated with contempt. The same problem arose at Coats Viyella and Biwater, and other hon. Members will want to raise similar issues of local concern. Britain is simply out of step with the rest of the European Union. Last week, Vivendi, the French company, held its European works council meeting in Paris. Vivendi employs some 25,000 people throughout Europe. Its employee representatives examined detailed company proposals on employment structure, employment trends and a range of other issues. Interestingly, although they were able to identify the situation in France in minute detail, no such detail could be discerned for the United Kingdom.
The right to information and consultation is a simple trade union issue. It is morally right and proper that employees should know what is going on, and it is sensible that they should demand that right; but it is also in the interests of companies to ensure that employees are properly consulted. There is considerable evidence to suggest that firms that communicate do better. My hon. Friend the Minister will be aware of a study that was undertaken at the behest of the Department of Trade and Industry by the Industrial Society. As the DTI itself said, all firms included in the case study asserted
"that their adoption of a partnership-based approach has helped them achieve enhanced competitive performance."
Consultation is in the interests not simply of the rights of workers, but of companies. Although I am not sure that it meant what it said, even the CBI agreed with that view, stating:
"The CBI has long supported effective employee involvement as a key contributor to business performance."
Of course, good employers already support such involvement, but too many others simply do not. Some 52 per cent. of firms that employ between 25 and 50 people offer little or no consultation to their employees.

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Vauxhall was rightly condemned by the Prime Minister and the Secretary of State for Trade and Industry, but we lag a long way behind in the international stakes.
Mr. Michael Clapham: My hon. Friend will know that there is a further pressure—globalisation. The ferocious competition between the trading blocs is leading to restructuring, especially in Europe. Is it no essential that British workers should have the same consultation rights as workers in the rest of Europe?
Mr. Lloyd: My hon. Friend is right. One problem that we face—not only on information and consultation, but across the board—is the lag between the rights and protections that are available to British workers and those that are available to their European colleagues. That means that, in case after case, British workers are the first to be laid off. We are an easy country to invest in, but also an easy country to disinvest in.
Mr. Llew Smith: Would my hon. Friend care to comment on the situation facing steel workers in my community in Ebbw Vale? When Corus was set up some 18 months ago, I received a statement from the managing director, Tony Vickers, saying that the plant was safe and that there was no threat to jobs. Now, if we are to believe the serious press, the plant faces closure.
The sad thing is that the workers, public representatives and the Government are not being consulted and the meetings that have taken place have left the Government no clearer about what is happening. The people who work in the UK steel industry and who have built it up into one of the best in the world have the right to be consulted about the future of their plant. Not only have they not been consulted, but the management will not even tell them when the redundancies will be announced.
Mr. Lloyd: My hon. Friend is right. The Corus saga bears out everything that has been said this morning about the need to change the basis on which British employers operate. I was disappointed that Corus turned down flat the offer by the Iron and Steel Trades Confederation to discuss a buyout. I am not in a position to know whether that would have been the right way forward, but a company that treats its workers with contempt deserves little in the way of plaudits from the general public.
Since the furore over Vauxhall broke out, we have heard strong statements of condemnation from the Prime Minister and from the Secretary of State, who announced some weeks ago that he was contemplating a change in legislation, saying that more should be done to ensure effective consultation with employees. Welcome as his comments were, he did not go far enough; he was merely talking around the issues involved in collective redundancies legislation.
The simple fact is that, as in the case of Corus, the need for consultation goes far beyond the point at which redundancies are announced. It must take place during the periods when employees can make a difference to the
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decision making of management. I hope that my hon. Friend the Minister will consider carefully the possibility that the present review will be inadequate unless it is cast wider.
On the EU directive, the Government have made it clear that they do not want to take that route. Like many people, I am somewhat mystified by their resistance. Some critics, such as the CBI, argue that the directive would damage small and medium-sized enterprises and that although effective employee involvement is critical to business, it cannot be legislated for. That is not a very progressive view. The CBI has stated:
"Any legislation imposing a duty upon employers always to inform and consult employees in advance…would…undermine managerial prerogative."
Frankly, we have gone beyond the days of the feudal state and of managerial prerogative being the only right that exists in the corporate sphere.
Judy Mallaber: Before my hon. Friend moves away from the issue of redundancies, does he agree that it should not be a managerial prerogative to do what was done at Coats Viyella? The DTI was notified late one night of a decision that was announced to employees the following morning, the mater having been referred to the Stock Exchange first. That decision resulted in hundreds of redundancies in my constituency and contradictory press releases during a two-hour period. There was a 13-week gap from the initial announcement until it was said that part of the company would be sold off. We are still waiting for information on how some parts of the company will be disposed of. There has been confusion throughout and a lack of information for Government Departments, unions and representatives such as myself on what is happening in the company.
Mr. Lloyd: I hope that this Chamber will condemn that use of the so-called managerial prerogative because it was not an acceptable use of the power. It may have been legal, but it is immoral and, in the long term, disastrous for British industry.
I turn to the European directive. The Government said that British company law is radically different from European law and that the one-size-fits-all approach is inappropriate. I have looked carefully at what the directive would do and those arguments do not apply. The most up-to-date version of the directive provides minimum requirements on information and consultation, as is right and proper; it would be pointless without those minimum requirements. It specifies a floor of 50 employees, which is quite high. Only 2.8 per cent. of United Kingdom companies would be caught and it is arguable that the cut-off point is too high, not too low.
The directive would allow national Governments to determine what procedures were appropriate for individual nation states. It allows considerable freedom to the British Government to say that British company law is different from that in other countries. Finally, it provides considerable scope for local agreement between management and employees to be accepted as being consistent with the directive.
On all those counts, the arguments against the directive do not apply and I must tell the Minister that I am bemused that the British Government are now

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accused of blocking the directive. At the Employment and Social Affairs Council on 20 December, the British Government used obscure procedural devices to keep the matter off the agenda. I am sure that my hon. Friend will want to respond to that, but the real issue is that a qualified majority exists to implement the directive.
It would be a tragedy if Britain were the one country out of step with the European framework. It would be a tragedy if we turned our backs on the clear need for change that hon. Friends have described, following the terrible experiences of British workers in recent months. It would be crazy if we were accused of siding with extremists such as the CBI, whose view of the directive is so ridiculous as to put it beyond reasonable consideration.
The change is necessary—I hope that even the Opposition accept that following recent disastrous experiences—and should be introduced quickly.
Mr. Alan Duncan: Does the hon. Gentleman accept that in all trade and commerce, there is a need for some confidentiality when negotiations are taking place? Negotiations cannot, realistically, be conducted step by step in public. If he is saying that proper communication with the work force is necessary, what parameters of confidentiality can reasonably be imposed so that normal commercial negotiations are not blown out of the water by being played out in public?
Mr. Lloyd: Of course everybody accepts the need for confidentiality. The trade unions, for instance, know that their members have the same interest in confidentiality as management. I urge hon. Members not to construct the debate as if it were workers against the company.
I shall give an example that moves us into the absurd in terms of confidentiality. I know of a Europe-wide merchant bank—I will not give its name—one of whose non-union European works council representatives learned of threats to jobs in the bank across Europe. He could not have obtained that information within the United Kingdom set-up, and would not have done so without the European works council directive. That has nothing to do with confidentiality. It is about a basic right to know, which is provided under the European works council directive but not under British law. It is about time that British law caught up. There is no question of a managerial prerogative to refuse to give information; it is a basic human and employment right to know. I hope that the Opposition will concede that point.
Dr. Nick Palmer: Does my hon. Friend agree that the tradition of consulting the work force on major restructuring has worked well on the continent? The usual procedure is to consult the work force representatives, who are well schooled in the need for confidentiality. It is not a question of immediately informing 10,000 people, but of making sure that the representatives are involved from an early stage.
Mr. Lloyd: If one looks around this Chamber, there is probably several thousand years of trade union
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membership among those present. My experience is that trade unionists are well aware of the need to protect confidentiality when it affects the running and good management of individual operations and companies. My hon. Friend is right. We do not need lessons in the need to maintain secrecy when it is important. However, we do need to make sure that there is consultation, so that the workers know what is planned for them as individuals and are able to respond collectively in the best interests of the company.
I appeal to the Minister to tell us what is wrong with the directive. If the directive is adopted by qualified majority voting in June this year, as is now possible, those who stand out against it but have not advanced a strong case will look a little ridiculous, if nothing else. If we are to follow the route of national legislation, will the Minister tell us in clear-cut terms when that legislation will kick in? The current reality is spates of redundancies, such as those at Vauxhall and possibly at Corus and other big and small companies. We need to know when British workers will be given the protection that would be taken for granted in any other part of the European Union.
11.18 am
Mr. Andrew Miller: I congratulate my hon. Friend the Member for Manchester, Central (Mr. Lloyd) on securing this debate, which is well supported within the trade union group of the parliamentary Labour party. I also echo his words of congratulation to my hon. Friend the Member for Luton, South (Ms Moran) on the way in which she has conducted herself in this Chamber in the context of the appalling situation facing Vauxhall workers.
Many Labour Members will know that I was involved in creating some of the early European works councils, especially in the late 1980s when I had an international responsibility for the creation of the Unilever European works council, so I speak with some experience of the process.
It has been argued that consultation can have an adverse effect on markets, because of market confidentiality and so on. GM-Vauxhall told me, after the current situation was made public on Teletext, that it could not give me full details of what was going to be announced for two reasons. The first was that the workers must be told before anyone else; that was a bit sick, because the announcement was all over Teletext and the national news. The second, which was outrageous and untenable, was that the matter was sensitive in terms of the stock market. One can see that that is nonsensical if one examines the stock values of GM's traded stock over the last year. I refer to data available on GM-Vauxhall's web site, which I presume is accurate. Unfortunately, we cannot display graphics in the Chamber, so I must describe the information. A graph on the web site shows stock values for the past 12 months. Interestingly, a steady downward trend started in mid-May of 2000.
At that time—the markets are sensitive and traders knew that something was about to happen—the market started to trade heavily. In the period May-June last year, there was massive trading in GM stock, way ahead of the norm. The price continued to decline without a blip, until GM made its announcement just before

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Christmas, which shows that the argument about stock market confidentiality is nonsensical. The market knew that something was going to happen. The trend began in early summer 2000 and continued downward.
I have experienced pan-European and UK works councils, and they all have confidentiality clauses. Discussions with the work force and its representatives about sensitive issues are covered by such clauses. Last night, I examined every service sector European works council. I deliberately chose a sector outside manufacturing to illustrate my point, in case I was accused of being emotive about the problems facing Vauxhall workers, colleagues in Luton and my constituency, which are inextricably linked.
In the service sector, I could not find a single works council that did not have a confidentiality clause, but there was only one case of a company having triggered it. In that case, the company had asked the works council to exercise sensitivity because a takeover was imminent. It was accepted that it was perfectly proper to give the work force the facts. The argument that sharing information with employees is damaging to shareholders does not stand up to examination and, as far as I can ascertain, there has never been any evidence for it. Indeed, quite the opposite is true. The engagement of workers adds value to the decision-making process.
Consultation is a good management tool, and consultation bodies allow management to hear news direct from the work force—the horse's mouth. The bodies can obtain information about what is happening in the company. It is a two-way trade. As daft as it may seem, the European group of trade union representatives at Unilever knew more about the structure of the company, its representatives, its product lines, volumes and predicted outputs than individual site managers in the United Kingdom. One reason why Unilever eventually caved in and accepted that there should be a consultative process on a pan-European basis was that it recognised that the work force had better information than it had and that it might be a good idea to get in on the act. There are management reasons why companies should engage in such processes.
The process of receiving early warning of what is happening in a workplace is generally a two-way trade. I can provide doubters with several concrete examples of information from employees helping the business to develop. There are plenty of examples when strategic plans shared with employees have materially benefited the way in which companies operate.
Consultation creates stability. It creates a better understanding of the overriding issues that affect the business. Undoubtedly, a better-informed work force is a more productive work force. When confidence exists in a company and employees understand precisely what is happening inside the business, the co-operative nature of such a relationship maintains productivity, even in difficult times.
Stability also helps to smooth out the process of acquisitions. It stops the short-termist approach that applies in the human resource departments of some companies when it is only discovered the following day that the company has bought another business.
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Engaging the work force in such activities resolves problems. No one has a monopoly on what is good information; it must be shared openly within those forums that are represented by works councils.
Different views are being expressed regarding Vauxhall and information is bubbling around all over the place. I cannot say what will happen to the constituents of my hon. Friend the Member for Luton, South; or, indeed, to my constituents. The rumour-mongering through the inadequate management chain has left people in the dark.
One of my constituents, a national official of the Transport and General Workers Union, has given me a detailed view of his analysis, supported by information that he has collected from the trade union side. My hon. Friend the Member for Wirral, South (Mr. Chapman), with myself and others, met employees and, briefly, the management last Friday in Ellesmere Port. I still have not been told in any detail what the company wants to do. Why should I be? I am not an employee of the business. But those who have given their heart, their soul and their life to the company do have the right to be told.
Many members of the work force in my constituency have relied on that business for their employment for many years; in many cases, for a lifetime. It is not just a one-way street. They have relied on the business, but, let us be honest, the business has relied on them. Those employees have turned round what was a failing business less than a generation ago and made it into one of the most successful vehicle companies; yet they cannot be trusted to be given information about its medium-term strategy. That is an unacceptable state of play.
I welcome the statement of my right hon. Friend the Secretary of State for Trade and Industry last week that everyone shared my anger and that of the work force at the way in which the situation was handled. As my hon. Friend the Member for Manchester, Central described, we have an opportunity to address such matters. I ask my hon. Friend the Minister to put into context the situation that is facing us today in respect of Vauxhall when considering our responsibilities under the directive.
I echo the point made by my hon. Friend the Member for Blaenau Gwent (Mr. Smith). We are dealing not only with Vauxhall, as Corus, too, acted abysmally. Three years ago, a transfer of undertakings in my constituency closed the steelworks that had existed for 100 years. As a result, people lost their pensions because the pension fund was under-funded. At an employment appeals tribunal, the company said that the information that they provided to the work force at the time was false. It said that no transfer of undertakings took place, and it now acknowledges that the information that it gave to Her Majesty's Customs and Excise and to the European Union stated exactly the opposite. Had a proper dialogue taken place, such a mess would not have arisen. It is an appalling state of affairs and yet another solid argument in favour of more information-sharing with employees inside businesses in the United Kingdom.
Several hon. Members rose—
Mrs. Marion Roe (in the Chair): Order. I ask hon. Members to keep their comments brief, so that as many Members as possible can contribute to the debate.
11.32 am
Ms Margaret Moran: I congratulate my hon. Friend the Member for Manchester, Central (Mr. Lloyd) on securing this important debate. Two years ago, when Vauxhall's management announced that problems were emerging in the plant, they were fast off the mark to contact me and members of the Government to secure support for funding for General Motors. It wanted to ensure support from the work force for what was hailed as a flagship partnership agreement. That pay and productivity deal was acclaimed as an exemplar of partnership arrangements. In other words, the company consulted at that time and, as a result, we were able to save the plant. Its productivity and profitability increased, as is still the case today.
Let us contrast that with the situation up to Christmas eve, when workers heard via local radio that their jobs were going. They had not been involved in any consultation process. What modern business operates in such a way in the 21st century? General Motors believed that it could get away with it. That is why it is essential that the Government act now to ensure that legislation is effective, so that we never again hear on early morning radio details of redundancies such as those at Vauxhall in Luton.
The way in which General Motors announced its plans for Luton was a disgrace. It is the unacceptable face of modern business. People clearly have a right to know if they face redundancy before the media finds out. I hope that the Minister will assure us that, notwithstanding the CBI and some Opposition Members urging us not to legislate on the matter, he will ensure that there is strong and forceful legislation to guarantee workers' rights to consultation when redundancy is imminent.
It is clear that the announcement came out of the blue. I suggest that the company not only failed to consult its work force, but went to some lengths to conceal the fact that there were difficulties. My hon. Friend the Member for Ellesmere Port and Neston (Mr. Miller) referred to emerging trends, so the company could have consulted the work force much earlier. It is clear that the company discussed the issue with trade unions before the announcement, but it assured them that a package of measures would save the plant, saying that there would no job losses or any impact on jobs.
I contacted the company a few days before the announcement to ask the reason for the extended Christmas closure, and was assured that there were no problems in the plant. At that point, the company must have known of the prospect of imminent closure and the potential loss of 2,000 jobs. We were presented with a fait accompli, and a flagship agreement was simply thrown in the faces of the work force.
The situation could have been different. If there had been consultation in advance, we could have changed the company's mind. I congratulate the trade unions on their work to outline the financial implications of closure and the strong arguments for the plant's productivity and profitability. Such arguments could have made a difference. We must ensure that they are addressed by GM, and that it understands that it cannot present its workers with a fait accompli and expect to walk away from the consequences.
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I welcomed the statement of my right hon. Friend the Secretary of State for Trade and Industry at Question Time a few weeks ago, when he said that he intended to review the employment legislation affecting collective redundancies. Different legislation would have made a difference. As a Government, we could have suggested aid packages to GM. Ironically, money is available in the Luton area to secure such plants. European structural funds, objective 2 funding and assisted area status funding is available for precisely such circumstances, but GM did not approach the Government to ask for that money.
Had there been a right to consultation before the decision was made, the trade unions could have made their coherent case as to why the European market was not in sufficient difficulty to legitimise the closure of one plant in the United Kingdom. We could have all asked the fundamental questions that remain unanswered. Why is a profitable plant being closed down? Why are the so-called losses of the company—they seem to be a one-year write-off of funds rather than actual losses—being used to justify the closure? How much is it costing the company to tear up contracts with supply-chain companies, many of them signed only weeks or months earlier in expectation of a second Vauxhall line?
Legislation is urgently needed, but, more importantly, it should ensure on-going consultation rights for workers. I recently raised the matter with my right hon. Friend the Secretary of State at Trade and Industry questions. It is not good enough, although it would have helped in the circumstances with which I am concerned, simply to give notice of redundancy within a few months of the event.
Mr. Graham Brady: Is the hon. Lady aware that just before Christmas and the Prime Minister's departure for the European summit negotiations in Nice, he gave me a categorical assurance that the Government would not allow worker representation?
Ms Moran: I am interested in whether the hon. Gentleman's party would introduce any measures to safeguard workers' rights.
Mr. Alan Duncan: The answer is that we have no intention of doing so, but perhaps the hon. Lady would answer my hon. Friend the Member for Altrincham and Sale, West (Mr. Brady) and tell us whether she agrees with the Prime Minister, whose view is clearly the opposite of hers.
Ms Moran: The hon. Gentlemen doth protest too much, methinks. As we have heard, the Conservative party would not pass measures to protect workers with respect to redundancy; not only would the Tories fail to do as much as the Government are prepared to do, but they would rip up workers' rights introduced by the Government—the right to join a trade union, the right to paid holidays, and so on. Their free market would have told the Vauxhall workers, "Go hang; we will not help you." Will Conservative Members tell me when a Government of their party assisted workers as the present Government have done? I will not hear such hypocrisy.

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We need legislation and on-going consultation so that workers can participate in the business plans of their organisations and understand the imperatives for productivity and profitability. That partnership can work, and has worked in the past. Companies ignore that approach at their peril. There is a strong business reason for advocating such an extension of the legislation. The Industrial Society has concluded, as a result of research—some of it in partnership with the Department of Trade and Industry—that employees should have the right to make their views heard on major changes affecting the businesses in which they work
The Industrial Society also considers that consultation has proven business benefits. Before Conservative Members again protest that there should not be legislation, I remind them of the clear benefit that new measures would provide in reducing the bureaucratic burden imposed by the current piecemeal approach to consultation legislation—in addition to the benefit of recognising the stakeholder rights of employees.
Consultation is relatively widespread in the United Kingdom in comparison to the continent, but significant no-go areas exist, particularly among smaller companies. However, there is also a significant gap affecting the degree of influence that can be exercised after consultation. The evidence from the Industrial Society is that employees' motivation and productivity improve after the passing of measures such as those I advocate. A study by the Involvement and Participation Association shows that participation tends to be associated with a wide range of positive outcomes. Work done by the Industrial Society for the Department of Trade and Industry has shown that the adoption of a partnership-based approach helped all case study firms to achieve enhanced competitive performance. A 1997 European survey confirmed a positive correlation between the economic performance of a company and the scope for employees to contribute their views.
The Industrial Society has recommended measures creating an obligation to consult on major business decisions and an opportunity for the Advisory, Conciliation and Arbitration Service to be involved when necessary. It argues that if the Chancellor wants to increase United Kingdom productivity, he should persuade Ministers to widen consultation rights. If staff are consulted on major decisions that will affect them, it will pay off in better employee trust, commitment and performance. The Government can achieve those benefits by legislating to ensure that on-going consultation is introduced at the earliest opportunity.
I welcome the Secretary of State's statement that he will introduce legislation to prevent morning radio redundancies. We owe it to the Vauxhall workers to make sure that legislation ensures the widest possible consultation, so that no other workers have to endure what the Vauxhall workers went through. A strong Vauxhall workers Bill that gives employees the rights to proper consultation would be a great honour and a real tribute to the hard work and loyalty of the Vauxhall work force.
Several hon. Members rose—
Mrs. Marion Roe (in the Chair): Order. I remind hon. Members that there will be three winding-up
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speeches, starting at 12 noon. I ask hon. Members to keep their comments brief so that as many as possible can speak.
11.45 am
Mrs. Diana Organ: I congratulate my hon. Friend the Member for Manchester, Central (Mr. Lloyd) on securing this debate. Many hon. Members have strong feelings about the need to improve consultation and the way in which workers are kept informed, and I wish to mention a constituency matter. First, however, I want to speak on the essential subject raised by the debate.
The European Union directive that gives workers the right to be told by their employers about impending decisions and the right to have their views on such matters taken into account is not radical. It is wholly reasonable that workers should have that right. They should be entitled to be told about their employer's economic and financial status, about recent developments and possible changes in the company's activities, and about the prospects for job security. They should know about decisions that are likely to cause significant changes in the organisation or work that might affect employment contracts. Workers should have time to digest that information, to prepare their opinion on it and to meet with management to discuss it and take to matters forward.
Workers in the UK do not enjoy the same rights as those in other EU member states, which is wrong. The rights afforded by the directive are not only fair but necessary in modern industrial relations. As John Monks, the TUC general secretary, said:
"Today's industrial relations aim to be about partnership and problem solving."
That partnership can work only if both sides are fully informed about the operation for which they are employed. It is wrong for employees to be told about key decisions after they have been made. It is wrong for workers to learn on the radio or from the press what is about to happen to their jobs.
A situation similar to that at Vauxhall is now being played out at Mitcheldean in my constituency by Xerox. The past three years have seen two major changes at the local plant. The first, in 1999, resulted in the company being the subject of censure and criticism at European level, partly because of the lack of information and consultation. The company has a history of not sharing information and not consulting workers. Every time that there is a change, the workers reel in shock, because they do not learn until the last possible moment what is about to happen at the plant. They learn about such decisions after they have been made instead of taking part in them. They are unable fully to work with the company to ensure their job security.
Xerox is the largest employer in the Forest of Dean. In 1998, it employed 2,900 people on its business park site, of which 1,900 were involved in manufacture. In 1999, the company decided to transfer 1,700 jobs from Mitcheldean to a new plant in Dundalk, Ireland. The plant was set up with the advantage of a low level of corporation tax—a rate of 10 per cent. was offered by the Irish Government—and for each new employee in Dundalk the company received a substantial subsidy from the Irish Industrial Development Agency. The

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company stated that it was committed to the future and that Mitcheldean would be a manufacturing site well into the 21st century. Some compensation.
The company came in for considerable negative publicity within the European Parliament for the use of European Union money for job movement rather than for job creation. The company also failed adequately to consult with the work forces involved.
Xerox faces a massive problem, with financial difficulties on a global basis. A wholesale review of its operations and a radical re-structuring of its manufacturing in Europe are under way. Its three main plants are located at Venray in Holland, which employs 2,000 people; Dundalk, which—even after the transfer of 1,700 jobs—employs 1,000; and Mitcheldean, which employs 1,500, with another 300 employed in supply chain operations on the business park. Dramatic reductions in employment at Xerox could have a devastating impact on the local economy in the Forest of Dean, since many hundreds of other jobs are linked to that activity. More than 2,000 jobs are dependent on the viability of the Xerox plant in Mitcheldean.
Xerox issued a statement on 10 January, which was vague and gave no time scale for decisions or a review. It talked about everything being in and everything being out. As before, the work force was left not knowing what was happening with regard to jobs and job security. The company says the problems are economic, that its cost bases are too high and that costs must be cut to make the plant competitive. The review groups operating in Mitcheldean are considering all possible ways of cutting costs. In the past, the plant has attained all the targets set by the company.
Mitcheldean is the plant with the greatest experience of the digital products that the company aims to produce globally. It is recognised that it is cheaper to make parts at Mitcheldean than in other plants. It is working hard to improve its cost effectiveness and competitiveness to bring them up to the levels found in Korea. All of that obscures the fact that, on another continent, the company has made its decision. The company has effectively taken the decision in advance of the process of consultation and information. The company says that it is evaluating and reviewing the work. That is rubbish. It has made its decision, which is a clear breach of Community law. The MEP for the south-west, Glyn Ford, is taking up the matter in the European Parliament through written questions tabled yesterday.
One reason why I believe that the decision has already been made is that the Dundalk plant was set up with the advantage of grants and substantial subsidies. The company would have to make restorative payments—thousands of euros—for every job lost in Dundalk. It is easier for the company to shed jobs in the United Kingdom than in Ireland. However cost effective the jobs in Mitcheldean may be, the payments that will have to be made for any job losses in Dundalk will outweigh any savings.
Dundalk has been afforded protection. Joe Browne, the director and general manager of Xerox in Ireland, has said that around 2,500 jobs will be cut in the European operations, but the numbers in Ireland would not be affected. That begs the question of where the 2,500 jobs will be lost. Xerox has made its decision, and is just managing the release of the information. It has engaged a political public relations company, Grayling, to assist with that.
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Xerox does not want the criticism that it received when it was restructuring and moving jobs to Dundalk. The company will carefully time any major announcement on redundancies and closures so that it is not made when issues such as consultation and information are high on the agenda, either here or at the European Parliament; especially when the European Parliament maybe discussing the directive.
Over the years, trade unions and work forces have complained that they have not been given information or had real consultation. Consequently, in the present situation, it is impossible for them not to think the worst scenario. It is difficult to build an effective, trusting industrial partnership in that environment. The local management have tried to address that in recent years but, since the culture and attitude of the company globally is not so inclined, it is difficult for them to do so. A constructive relationship is difficult to develop.
The situation facing the workers, the management and the company at Xerox in Mitcheldean is serious. Securing as many jobs as possible for as long as possible on the site requires efforts from all concerned and the support of local agencies, such as the regional development agency, Gloucestershire development agencies, national and European Governments.
The Government must sign up to the employee information and consultation directive. That would not do much to assist the workers at Mitcheldean now, but if they had had those rights over the past few years, they and their representatives would be better prepared and would be able to work constructively to keep the plant competitive. They would have had the right to know what was happening to their employment and their job security. Although at a local level the plant management have recently made greater efforts to consult, it is difficult for them to do that when it runs counter to the ethos of the company, which involves making announcements to fit the company's time scale and to fit in with what it wants to do. It is important that we have rights for workers, so that the Mitcheldean workers—who I hope will remain workers there for a long time to come—are not treated in that way.
11.55 am
Mr. Kelvin Hopkins: I congratulate my hon. Friend the Member for Manchester, Central (Mr. Lloyd) on securing the debate. I also congratulate my other hon. Friends who have spoken, particularly my hon. Friend the Member for Luton, South (Ms Moran), who has played a strong role in the determined campaign by the work force and the whole town to stop the Vauxhall closure, and to keep motor car production in Luton.
I want to make some simple points to the Minister about rejecting the Tory mantra of burdens on business. It is evident from events at Vauxhall that removing all constraints from multinational companies does not help our economy. It does not persuade those companies to stay in Britain, and it does not help the work force, who have been sold down the river. Many countries that have much stronger worker protection have done just as well, if not better, in terms of attracting investment from multinational companies.
We should not get involved in a Dutch auction, where we try to reduce worker rights to the lowest-possible level in the vain hope that we can attract multinational

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companies to these shores. British workers must have the same rights as those elsewhere. Governments must work together to ensure that democratic government means something, and that they do not have to lie down and be walked over by multinational companies.
I worked at the TUC in the 1970s. At that time, there was a big change in the organisation's culture. We used to have the view that trade unions had negative rights, in the sense that we had the right to strike and to take industrial action against companies that had different interests and different views. That does not work when unemployment rises. In that situation, industrial action by trade unions is not as effective as it might be.
In the 1970s, workers and trade unions decided to promote the idea of industrial democracy. The Institute for Workers Control initially developed the idea, but the TUC published a major report on it, which included rights to consultation and information. That is the direction that we wanted to take 25 years ago. We continue to press for movement in that direction.
Two weeks ago, my right hon. Friend the Secretary of State for Trade and Industry moved some way towards considering consultation rights. I am pleased that the Government are moving in that direction and making a clear break with what the Tories have done over the past 20 years. I want to see the Government move a good deal further in promoting trade union and worker rights, including the right to consultation.
In the past fortnight, I have promoted a private Member's Bill on consultation rights. It is 17th on the list, and probably will not get very far. However, I hope that it will, at least, help to persuade the Government that we want full workers' rights to consultation and information, so that what happened to the workers at Vauxhall does not happen again.
11.58 am
Dr. Vincent Cable: I, too, congratulate the hon. Member for Manchester, Central (Mr. Lloyd). He has clearly struck a chord, and he has also talked a great deal of sense. For most of us, the starting point is that several companies, notably Vauxhall, behaved in a crass and insensitive way. The key point, which has been picked up in several interventions, is that they were also very short-sighted. If a big company is trying to sign up its work force for a productivity package or a new flexible work force arrangement, the work force will look around at the company's other operations and draw its own conclusions as to whether the management can be trusted. The kind of behaviour exhibited in Luton sends all the wrong signals.
It seems strange that the management did not sit down with its work force representatives and say, "We have a problem here. We cannot compete because of economic conditions, excess capacity in the industry and so on. Have a look at our books, at our costs—these are the difficulties that we share. Go and talk to your friends in the Government about it and we will do our best." The company should have treated the work force in an adult way, and tried to involve it in the decision-making process. That would be grown-up management, and I do not understand why it did not do that.
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There are two issues that can be summarised briefly. First, should there be compulsion and regulation? Secondly, should that be established at a national or European level? In an ideal world, good management practice should be voluntary. In Holland—which I know reasonably well—Denmark and Germany, prior consultation is spontaneous because it has been embedded in their culture for decades. It has deep roots, and is related to their political system and much else. In this country, we do not have that culture.
There are two arguments for introducing regulatory compulsion. First, if one does not regulate to reinforce good practice, bad practice will tend to dominate. Every company with 100 workers that is faced with difficult decisions will look at blue-chip companies and multinationals and say, "If such behaviour is standard practice, why shouldn't we do the same?" Secondly, there is something in the argument that one can gain a competitive advantage by adopting hire-and-fire labour practices, although unions tend to exaggerate the force of such practices. I doubt whether companies decide in which part of Europe to invest —100 million on the basis of a hire-and-fire labour policy. None the less, such considerations clearly play a part at the margin, so some element of regulation and compulsion seems justified in principle.
In respect of compulsion and regulation at a European level, the Government have applied the subsidiarity principle. They argue that certain matters should be dealt with at a European level but that others should be dealt with nationally, and that labour law is clearly the province of the nation state. I have some sympathy with the subsidiarity principle. In many ways, my party is the most pro-European, but we nevertheless accept that there is too much European standardisation. The test of the subsidiarity principle is right and should always be applied, but it is difficult to apply it to the issue before us. Many industries—for example, the car industry—operate on a European basis. European business planning is relevant not just to the Renault-Nissan arrangements, but to Ford in Europe, the German operations of General Motors and the Japanese companies. To that extent, the subsidiarity principle does not apply to those companies.
Mrs. Ray Michie: My hon. Friend talks about subsidiarity in European terms, but I would like him to consider the global aspect as well. I draw his attention to an issue that extends beyond Vauxhall, and which is set out in early-day motion 254. Merchant Navy officers have offshore contracts with Associated Bulk Carriers, which is being sold by P&O. They have given many years of loyal service to that company, and are entitled to information and consultation, rather than being kicked out with three months' half-salary in lieu of notice, on contracts that are now based in Bermuda. Incidents such as that say everything about what is happening to our once great Merchant Navy, and I hope that my hon. Friend will take them into consideration.
Dr. Cable: That is a helpful intervention, because it reminds us that the problems associated with redundancy are not confined to the traditional manufacturing industry or European enterprises, but occur throughout the economy.

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In conclusion, we should be open-minded about how to tackle this problem. I am not a labour lawyer, so I cannot comment definitively on the implications of labour law, but it would seem that are two approaches to the problem, the first of which is set out by the TUC. As the hon. Member for Luton, North (Mr. Hopkins) said, these days the TUC is a modern-minded institution that, in general, tries to help to create a positive business environment. The TUC's approach is to treat the EU directive as a broad framework of protection within which, at a national level, it can sit down with the CBI—and unions can sit down with employers—to work out arrangements that are relevant to this country. If that is not practical, perhaps the Minister can explain why not. As a framework for commonsense—argument, it has few obvious flaws.
Alternatively, the Government could adopt a similar approach to that which has evolved in relation to competition policy. A few years ago, strong European directives and laws governed monopolies, mergers and restrictive practices. Over the past five years, the view that Europe is becoming over-centralised has taken hold. Consequently, the subsidiarity principle has been increasingly applied and much competition law has been pushed down to the national level—except in cases where mergers and monopolies are clearly European in character. The European directive could be recast so as to apply its provisions to cases where a European element is involved—such as in the car industry—but in all other cases legislation should be national in character.
If the Government take that route, they will have to explain how the national approach will evolve. Workers are not asking for much. They are not asking to intervene in the running of the companies for which they work, but for prior consultation on key decisions that affect their livelihoods. I would be surprised if the Government cannot find their way through the thicket of European and British law to resolve the problem.
Mr. John Cummings (in the Chair): The hon. Member for Rutland and Melton (Mr. Duncan) has graciously offered to make his speech a little shorter to enable me to call Mr. Harry Barnes.
12.6 pm
Mr. Harry Barnes: There is no greater argument for the introduction of employee consultation than the case of Biwater—a pipe manufacturing company in Clay Cross in my constituency, which was mentioned by my hon. Friend the Member for Manchester, Central (Mr. Lloyd)—where, before Christmas, 700 jobs were lost with no prior consultation.
The attempted takeover of Biwater by St. Gobain was first known about in April last year. Discussions about what was to happen took place between the GMB, the shop stewards, the work force and Biwater's management. They were assured throughout that their future was guaranteed—although two of the managers involved went over to St. Gobain after the takeover. Within minutes of the takeover on 4 September, it was announced that the plant would be closed within 90 days. It closed on 22 December, although some people had already lost their jobs.
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Despite the fact that deputations had met the Secretary of State for Trade and Industry, and he had spoken to Jean-Louis Beffa, the managing director of St. Gobain, about consultations on any changes, the work force was not allowed to enter into any discussions other than those concerning how the redundancies were to take place. Of course, it sometimes overstepped the mark and tried to raise other matters, but, as far as the management were concerned, such discussions were not to take place.
The loss of 700 jobs had a devastating impact on the area—yet there was no need for it to happen. Biwater was a viable works, and 80 per cent. of its output went into exports. St. Gobain's interest in taking over the company was to knock out a competitor, take over its order book, asset-strip and sell off those assets. There should have been prior consultation and discussion. I am convinced that had the directive existed and there had been consultation, that plant could have been saved. The importance of the measure cannot be exaggerated and I hope that the bitter experience of workers in Clay Cross will lead to suitable legislation.
12.10 pm
Mr. Alan Duncan: The hon. Member for Manchester, Central (Mr. Lloyd) has done us all a favour in raising this matter and I hope that I shall not destroy the future career of the hon. Member for Luton, North (Mr. Hopkins) if I say that his contribution was particularly thoughtful. My ulterior motive in encouraging the hon. Member for North-East Derbyshire (Mr. Barnes) to speak was to continue my enjoyment of the great spat between old Labour and new Labour—the fissure in the party and the great project is now clear for all to see as the old trade union bloc asks for certain measures, which the Minister and perhaps the Prime Minister will pretend to give, but will never deliver. I hope that they will not be taken for suckers by their own Front Bench.
We should listen to the CBI, which was, amusingly, described as extremist today. I have never heard it so described in such a context. Digby Jones, the director-general, warned:
"A one-size-fits-all policy for every business employing more than 50 people is exactly the type of Brussels initiative that will hinder UK growth, investment and job creation. Companies need the freedom to communicate with staff in ways that reflect national and local customs and practice."
Many of those customs and practices are well established and work as every mature company wants them to work.
Mr. Brian H. Donohoe: Does the hon. Gentleman condemn or condone Vauxhall's actions?
Mr. Duncan: I shall come to that in a moment. It is a fair point, which has coloured all the contributions to this debate.
Before the general election, Labour promised business:
"We will not impose burdensome regulations on business."
However, the reality is that business is struggling to cope with the imposition of an extra £5 billion a year in regulatory costs. Since 1997, the United Kingdom has fallen from fourth to ninth position in the world competitiveness league.

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Perhaps the Minister will tell us the status of the blocking minority to the directive. As I understand it, his allies in opposing the measure were Germany, Denmark and Ireland. Can he confirm whether the Germans are still opposed, because there were reports before Christmas that their resolve was weakening? That is important, because the Swedish presidency has made clear its wish for progress on the matter. Sweden's Employment Minister stated:
"We are looking to take an important step towards achieving a directive on worker information and consultation."
The directive will be adopted by qualified majority voting, so the Government must ensure that they have sufficient allies to block it. We heard much at the Lisbon summit last summer about how the EU would be a powerful engine for economic advance. If that amounts to more than the empty rhetoric that we are used to from the Government, why has the Minister failed to persuade more of his EU counterparts that the directive is exactly the sort of measure that undermines business competitiveness and increases business costs? I hope that he will clarify the position.
It was disgraceful that the redundancies at Vauxhall were announced on the radio. That was appalling. It was also unprofessional on the part of the broadcaster and doubly devious on the part of the person who leaked the information. The problem was not so much the process of consultation as the fact that the announcement was leaked before it was given to the work force. It was a complete and utter disgrace on someone's part and if the culprit could be found, he would face universal national opprobrium.
Mr. Hopkins: Is the hon. Gentleman saying that the decision would have been more acceptable if we had known about it before it was announced?
Mr. Duncan: The problem with the directive is that it does not cover the fact that the openness of what is said to a series of people down a chain of information has to be consistent with the process of negotiation. If all aspects of negotiation, whether commercial or based on employment, are played out in public, there will be massive problems, which may militate against a successful conclusion and the achievement of the firm's objectives. All that would have happened had the works council been told, is that some kind of rumour or half-announcement would have been made public, half-baked and before matters had been concluded. The danger is that compulsion in law could work against the interests of a work force, because management would be compelled to reveal, step by step, every aspect of their negotiation process.
Mr. Miller: Where is the hon. Gentleman's evidence?
Mr. Duncan: It is self-evident. Every reputable company will involve the work force at the earliest possible stage of negotiations, in a way that is consistent with the best commercial interests of the firm and the work force. Such a one-size-fits-all legalistic prescription could end up working against the interests of a work force. Its supporters think that that will not
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happen, but in many cases, such regulations ultimately have that effect. The Opposition want firms to be able to build up proper partnerships with the work force, so that they are not denied the opportunity to do what is best for them by legislation that is too prescriptive and narrow, which might work against the interests of many people.
12.16 pm
The Minister for Competitiveness (Mr. Alan Johnson): This is an important and topical debate, and I congratulate my hon. Friend the. Member for Manchester, Central (Mr. Lloyd) on securing it.
I do not intend to spend long on the comments made by the Opposition. Suffice it to say that the hon. Member for Rutland and Melton (Mr. Duncan) has many attributes, but understanding social justice is not one of them. I once said that trying to explain social justice to the Conservative party was like trying to explain origami to a penguin. The hon. Gentleman's contribution should be left out of the debate.
First, I want to explain the Government's current approach to information and consultation generally, and then I shall talk about the European directive and high-profile recent events, which have largely prompted this debate.
Our approach must be seen within the context of our overall approach to employment relations, which were set out in the "Fairness at Work" proposals. If my colleagues and I are absolutely honest, when the Labour party was deciding its agenda on coming back into government after so many years in opposition—I was part of that process in a previous incarnation—the information and consultation issue was never really at the top of that agenda. That is one of the historic problems, on which my hon. Friend the. Member for Luton, North (Mr. Hopkins) touched, of the trade union movement in this country especially.
In a very short period, however, we implemented the minimum wage, the working time directive, the right to trade union recognition and the right to be accompanied at grievance and discipline hearings. Let us not have any suggestion that this Government are acting against workers' rights. The question is where to place the important issue of information and consultation in the context of future Government action.
We are committed to the promotion of partnership. We believe in information and consultation. Our argument in relation to Europe, which I shall discuss later, is about the ends, not the means. Central to everything that we have done in relation to "Fairness at Work" is the attempt to encourage a genuine spirit of partnership. One can set up all the mechanisms, structures and works councils in the world—my hon. Friend the Member for Ellesmere Port and Neston (Mr. Miller) is well aware of this, as he has studied the matter in great detail—but the important issue is how to ensure that the work force can have a genuine influence on and input into management decisions.
The solution is not having token workers on the board, as we had under the Bullock proposals. I experienced the industrial democracy experiment—as did my hon. Friend the Member for Derby, North (Mr. Laxton)—at first-hand level as a local shop steward. It did not work. The mechanisms were in place,

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but management moved the decision-making structure. When workers sat on the board, decisions started to be made in a sub-committee of the board. We had the right to approach any issue locally, regionally and nationally. On the trade union side, we were not over-enthusiastic about the experiment and did not put the major trade union players in to bat. In effect, the entire project disintegrated. Mrs. Thatcher—
Mr. Duncan: Will the Minister give way?
Mr. Johnson: I do not have time. I have only 10 minutes. A refusal often offends; I should have made it clear at the beginning that I would not have time to take interventions.
How do we arrive at a genuine—
Mr. Duncan: That is very shabby.
Mr. Johnson: The hon. Gentleman would know everything about shabbiness.
How do we genuinely influence decisions? Informing and consulting employees is an integral part of harnessing the energy and commitment of the work force. The debate has hinged on certain specific, well-defined circumstances, such as collective redundancies. My hon. Friend the. Member for Manchester, Central said that he hoped that our review would not concentrate on collective redundancies. However, almost every contribution has centred on what happened to workers at Vauxhall, and BMW and in Clay Cross. We must examine collective redundancies and transfers and investigate the legal underpinning of those processes when necessary and practicable. We have done that, and I want to have time to explain the rights that British workers have at the moment, so that we can record them.
Mr. Duncan: I am grateful to the Minister for giving way. He made some good points about legislation pushing decision making into other layers of secrecy. I have been absolutely upfront about my opposition to the directive. However, the Prime Minister has said that he opposed it and, in the past, the Minister has said that he opposes it. Is he in favour of the EU directive or not?
Mr. Johnson: I shall discuss the European directive in a moment. We have just wasted a couple of valuable minutes.
We believe that employee involvement mechanisms must reflect the requirements of individual organisations. Employee involvement goes to the heart of the way in which an organisation is managed. Organisations vary greatly in that respect. Some operate in a global context; others are national or regional. They have different ownership structures and patterns of employment, and some are subject to Stock Exchange rules. Structures imposed from above will not work as intended.
Labour Members, and the hon. Member for Twickenham (Dr. Cable), were as one in asking for genuine information and consultation mechanisms. The establishment of a constructive dialogue between employees and management cannot simply be decreed through legislation. That is why, until now, we preferred
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to pursue a voluntary approach. That approach included the partnership fund and the launch of the TUC partnership institute last year, which stemmed from the partnership fund. The comments of my hon. Friend the Member for Luton, South (Ms Moran) on the Industrial Society relate to that approach. We want genuine involvement and a culture change.
As I explained, the Government's policy has been to encourage information and consultation on matters to which no statutory requirement applies. Some people say that the voluntary approach is not working. I ask such people to read the work force employee relations survey, which I do not have time to detail. It is the most comprehensive survey carried out in this country, and it is well respected by the trade union movement; partly because it shows that trade union membership is a plus for the company and the work force. The survey showed a large extent of voluntary work force involvement throughout the country, which suggests a healthy pattern.
Recent high-profile cases have suggested that we cannot be complacent. The Luton closure is the latest example—like BMW-Rover and Ford recently—of the problems that British workers are experiencing. An interesting point that I do not believe was sufficiently covered in the debate is that the decisions in all three cases were made—
Judy Mallaber: Will my hon. Friend give way?
Mr. Johnson: I really do not have time.
All those decisions were made outside the United Kingdom, and they should all have been covered by the European measure that we wholeheartedly supported. I do not remember the position of Opposition Members, but it was probably against the measure; that is usually the case if a measure mentions workers. We supported it precisely because we agreed that in trans-national and pan-European companies—with decisions being made in Munich or Paris or elsewhere in Europe—we had to have a mechanism to ensure that British workers were informed and consulted.
Although it is recent, we must review that measure because it has not worked sufficiently in the three cases that I have mentioned. That is an important part of our review. We must take stock of what happened, particularly in relation to the disgraceful way that workers in Luton found out their fate from a radio broadcast. We must ensure that whatever we introduce—or if we change the arrangements—such issues will be dealt with. The three high profile cases concern Europe.
Judy Mallaber: What about Coats Viyella?
Mr. Johnson: Coats Viyella is a good example of something that happened in the United Kingdom. I am merely trying to put the matter into context. Even if we had accepted the information and consultation directive from Europe, and applied it domestically, we would have been going through a process in which there was only the appearance of consultation. The actual decisions would be made outside the UK. That is what the European works council was designed to put right.

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The review announced by my right hon. Friend the Secretary of State will not be restricted to consideration of the redundancy issue. It must also take into account the accusation that it is cheaper to sack workers in the UK than anywhere else. The review must be wider. The process will involve three or four months of review followed by a decision, because it is important that we do not repeat past mistakes, such as the Bullock report, which was an experiment in industrial democracy. We must ensure that the problem is resolved.
As far as the European Union directive is concerned, our position has not changed. We are not alone in believing that it breaches subsidiarity, and the countries that support us in that belief have a long history of trade union involvement. I draw attention to the European works council. The European company statute that we agreed on 21 December has a full section on industrial democracy information and consultation, and that is the right way to proceed in Europe. However, we must protect our domestic situation. The countries that oppose the directive, under qualified majority voting, feel the same way. They have sophisticated systems and they do not want a one-size-fits-all measure to interfere with them.
I say to my hon. Friend the Member for Manchester, Central that I did not use some obscure procedural device on 21 December. I know more about "ABC of chairmanship" by Citrine than I do about "Erskine May". Coming from a trade union background, I know that if something is not on the agenda, it is not discussed. My hon. Friend can call that a procedural point if he likes. The situation in Europe is the same, because it breaches subsidiarity. If we are to resolve the problem in the United Kingdom, we must, given our history of employment involvement and industrial relations, take account of our domestic situation.
The history of this subject is fascinating. A statue should have been built to honour Alan Flanders, a young trade unionist who worked for the TUC; I suppose that my hon. Friend the Member for Luton, North was a young trade unionist once. Alan Flanders was the man whom Ernie Bevin sent to Germany after the second world war to recreate the German trade union movement, which had been banned by Hitler since 1933. To a great degree, Alan Flanders developed co-determination. Although we exported that sort of model, those of us in the trade union movement were not exactly enthusiastic. We all grew up with free collective bargaining, civil rights only with a union card and no state interference. We have changed tack. We are not as well advanced as some countries in Europe, and we have had to take a different route.
I have not had time to mention all the important legislation, such as the Transfer of Undertakings (Protection of Employment) Regulations 1981 and the collective redundancies directive—which was amended and improved in 1999—and other issues in relation to workers' rights. We are determined to have a proper review to consider whether the important concerns highlighted so effectively by my hon. Friend the Member for Luton, South can be resolved domestically, as part of our overall approach to social justice and fairness at work.

Police (South Buckinghamshire)
12.30 pm
Mr. Dominic Grieve: It has been my privilege since 1997 to represent the Beaconsfield constituency, of which South Buckinghamshire district forms the core. Recent surveys have shown it to be one of the wealthiest and most economically successful areas in the country. It has low unemployment and is, above all, a pleasant place in which to live. Far from being cloistered by their wealth and success, local residents are active in charitable and community work.
It has become clear during the past 18 months, however, that there is a growing problem with crime. Of course, there is always public anxiety about crime. I once served on the Lambeth police community consultative group, and I have seen problems of crime at the sharp end. Sometimes, people's anxieties are misplaced, but my mailbag and the evidence of my surgery tell me that crime has been increasing along with local residents' anxiety.
Residents have complained about burglary and car crime in particular and, in Burnham, about disorder, which is centred around the presence of several antisocial families causing fear in their neighbourhood. There is also a major problem with travellers, some of whom live wholly outside the law, causing damage to property, degrading the sites on which they unlawfully settle, and using their bases for other criminality. That matter became so serious that I raised it with the Home Secretary last March. I am extremely grateful to him and the Home Office for taking the issue seriously and issuing new guidelines to try to deal with the problem.
This month, Home Office research conducted by the university of Leeds, and highlighted in a Channel 4 programme, "The Crime List", identified South Buckinghamshire as having a serious crime and policing problem. Taking into account the many economic and social factors that affect crime, on the basis of which the Home Office allocates resources to the police, the survey rated South Buckinghamshire bottom of the 376 districts in terms of police effectiveness in dealing with crime. The press promptly dubbed South Buckinghamshire the worst-policed area of England and Wales.
That description is a gross oversimplification and singularly unfair to the police. Some types of crime, such as violent crime and sexual offences, are very low in South Buckinghamshire. We are 29th out of 376 for violent crime, and 16th out of 376 in the league table for sexual offences. The district is covered by two police areas, one of which, Chiltern Vale, is based in Wycombe, and the other in Slough, both of which are outside the district itself. Both areas are commanded by relatively young officers, Chief Superintendents Setchell and Beckley, for whom I have a high regard. They are dynamic and proactive in trying to fight crime, and are approachable for the local community. A recent raid on a travellers' site by the Chiltern Vale police also involved customs officers and the RSPCA. They netted a haul of stolen cars, illegal shotguns, stolen property, red diesel where it should not be, and ill-treated animals.
Beat officers are good. Some of them are extremely good. Community-police liaison is superb. Currently, though, no police stations are open full-time in the

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district. The police station at Iver is manned and kept open part-time with the help of volunteers, which is a good reflection of local support and participation. The district council does its best to help.
None of that has stopped the rising trend in certain types of crime, which has reached levels that are too high for the local police to tackle effectively, and certainly not as they would wish, as they tell me. The problem is that, because of its relative affluence and advantage, the area acts as a magnet for criminals from adjacent areas that have historically had much higher crime rates and, in fairness, much greater indices of deprivation.
Mrs. Cheryl Gillan: I congratulate my hon. Friend on securing the debate, which obviously covers my area as well. I endorse his remarks about our police force. Does he agree that one of the problems that the force faces is in the recruitment and retention of officers, especially because of the high cost of living in the south-east? No matter how excellent our police officers are in executing their duties, if we cannot recruit and retain them, we have a serious problem.
Mr. Grieve: I agree entirely with my hon. Friend, and I am grateful to her for attending the debate, as we share the Chiltern Vale police district. I will move on in a moment to deal with her point—she has captured the issue in one sentence—but first, I shall illustrate to the Minister the sort of problems that we are having.
Property crime generally, including burglary, theft, handling, fraud and forgery, and criminal damage, is at 25.4 offences per 1,000 population, compared with a national average of 19.6. It is particularly telling that burglary from dwellings is at 28.3 offences per 1,000 households, placing the district 330th in the catalogue of 376. In the village of Hedgerley, the rate is a staggering 55 offences per 1,000 households.
Theft from vehicles is at 30.3 offences per 1,000, which puts us 373rd out of 376 in the table. That is three times the national average. In Dorney, another small village on the Thames near Slough, the rate is over 75 offences per 1,000. Those are horrific figures. Theft of vehicles is at 7.8 offences per 1,000 population. Vehicle crime generally, theft both from and of vehicles, is twice the national average in England and Wales, and the gap is growing. It is a feature of most of the crimes that I have just cited that the latest figures show increases. Burglary has risen by 29.3 per cent. since last year, vehicle crime by 7 per cent., and criminal damage by 23.9 per cent.
To put those figures in perspective, all crime is down by 4.4 per cent. over Thames Valley as a whole. Equally, I accept that those crime levels do not compare with very high-crime areas in the Thames Valley, such as Slough town centre or Reading. What I find worrying—the Minister should, too—is that robbery, which largely means ram raids and holding up shops, which was hitherto very low, is showing signs of increasing at a time when it seems to be decreasing in other places. It all points to a deteriorating situation.
It would be nice to say that all that was unexpected, but it is not. The cause is not an inefficient or lazy police but lies elsewhere, in how the resources have been allocated. As the Secretary of State confirmed to me in his answer of 20 January 2000, spending on policing
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on an average per capita basis in Thames Valley in 1999–2000 was £108.88, compared with a national average of £123.19. Yet Thames Valley is a large area with significant policing demands.
Historically, increases in establishment agreed with the Home Office failed to keep pace with the growth in population. As a result, when in April 1995 funding was introduced on a complex needs formula, removing Home Office controls, a number of damping mechanisms were introduced. Those were designed to prevent places such as Surrey from losing too many officers, but the damping mechanism in Thames Valley has left the authority without the resources necessary to raise its establishment to the level that it needs.
In the police's view, we are £10 million short in grant and standard spending assessment over the six years. Worse, extraordinary items of policing, such as the Newbury bypass and the problems at Hillgrove farm, Witney, have cost the authority £11 million. When there was a problem at Huntingdon Life Sciences in Cambridgeshire, the Government saw fit to offer £1 million to help. Thames Valley has not seen one penny of assistance in respect of those extraordinary policing costs.
Up until 1998, South Buckinghamshire escaped the worst aspects of the formula, because historically it had been policed with a larger establishment than some other Thames Valley areas. The rumour is that, historically, because of the number of police officers living in the area, there was no problem in attracting a high level of policing to protect their homes—I do not know whether that is apocryphal. In that year, it was determined—frankly, inevitably, in view of the pressures elsewhere in the Thames Valley area—to apply the total resource allocations formula, or TRAF, to determine police numbers, and South Buckinghamshire suffered in that process.
I still have the correspondence and briefings from when my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) and I made our representations. Chiltern Vale took a cut of 9 per cent. in budget, on top of a 2.5 per cent. cut that applied to the force as a whole. That was 30 police officers and 20 civilian staff. On top of that, another 20 probationary officers were lost at the same time, as the service was over establishment. That was a huge cut. It is interesting to note that we were told at that time that crime had been reduced by more than 10 per cent. over three years, and burglary was down by one third: the result of good policing and adequate resources.
The effect of the changes has been entirely negative for South Buckinghamshire. In April 1997, there were 316 police officers in Chiltern Vale. Today, despite enormously creative attempts by the chief superintendent to raise the number of officers by cutting in other areas, we are below 300. In Slough, cuts in numbers were never envisaged—it is, after all, a high-crime area—but even there there are 254, which is seriously under strength, with 18 vacancies.
It is not surprising that one of the principal complaints, with the rising crime rate, is the inability of the police sometimes to fulfil the basic response requirement of getting to the scene of a burglary, when it is not an emergency, within two hours. If staff are off sick, longer delays will inevitably occur, and the police

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cannot be in two places at once, but public confidence in police efficiency is thus eroded and the closure of the police stations in the district, with Gerrards Cross no longer operating 24 hours a day, adds to a sense of being abandoned.
Other recent examples include the removal of community officers from Burnham and Iver back to Slough police station to deal with more urgent issues there. The fact that, in truth, the police are still working very hard, and concentrating on priorities, is not noticed. The complaints, in turn, have an adverse effect on police morale, as they see their hard work no longer being appreciated or recognised.
On some evenings, there are only two patrol cars on the road in the whole of the Slough police district. Some of my constituents point out that the one police force in the country that has seen an increase recently is Durham, and suggest that there may be a link with the Prime Minister's constituency. I have not the slightest idea, but such comments will continue unless clear answers can be provided.
Part of the problem with the police establishment is that the high cost of living makes it difficult to recruit and retain officers, as my hon. Friend said. The ending of the housing allowance in 1994 meant that officers recruited after that date received £4,000 per annum less than those previously joining the force. I accept that the decision was taken under the previous Government, but the Metropolitan police at that time enjoyed an uplift of £2,000, and will now enjoy an uplift of £6,000, over Thames Valley officers. It is hardly surprising that, as quickly as Thames Valley officers are recruited, they haemorrhage either into London or out into the country, to enjoy a better standard of living. Last year Thames Valley recruited 244 officers and lost 245. The briefing prepared for the Minister by Thames Valley police specifically states:
"These difficulties are threatening to frustrate our attempts to take up the extra resources provided under the crime fighting fund, and are in danger of undermining our efforts to reduce crime levels and the fear of crime across the Thames Valley."
I hope that I have persuaded the Minister that something must be done about issues that are a real problem, and not just some politically motivated exaggeration. I am aware that, under the provisional funding settlement of 2001–02, Thames Valley will get an increase of 5.8 per cent., receiving over £4 million from the crime fighting fund and £1 million for rural policing. Frankly, however, that will have no beneficial impact unless the recruitment problem is solved. Thames Valley needs the ability to provide a substantial uplift in line with the Metropolitan police. If the problem is reluctance by the Police Federation to allow for differentials, all I can say to the Minister is that he is going to have bang some heads together pretty hard and pretty quickly.
Some thought should also be given to the problem of policing rural areas such as South Buckinghamshire. The area is sandwiched between urban centres with high crime and high police priorities. With those competing priorities, my constituents seem to lose out. That might not happen if there was a separate police district covering our area and possibly part of Chiltern Vale as well.
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When the issue first broke, a local journalist suggested to me that, being relatively wealthy, South Buckinghamshire might be better able to cope with higher levels of crime and ought to accept its fate. I pointed out to him, as I do now to the Minister, that it is the money from the enterprise and thrift of my constituents that pays for the policing successes in places such as Knowsley, North in Liverpool. My constituents are, of course, conscious that they have a better standard of living and greater opportunities than people do there, but they are still entitled to expect a police service that inspires confidence and can deal with crime adequately. The dedicated police officers are there, but not the resources. That is the issue that I hope the Minister will address today.
12.46 pm
The Minister of State, Home Office (Mr. Charles Clarke): I congratulate the hon. Member for Beaconsfield (Mr. Grieve) on securing this debate, and I am grateful for him giving me notice of the main points that he intended to raise, which will lead to a better-informed debate.
I also acknowledge the intervention of the hon. Member for Chesham and Amersham (Mrs. Gillan), whom I am particularly glad to see here, as she has a long-standing relationship with my constituency and it is always a pleasure to share a debate with her. She tries to keep quiet about the Norfolk connection, but we advertise it as widely as possible because she is such a credit to the Conservatives in a rather thin field.
I was grateful for the remarks of both hon. Members in praise of the police in their constituencies. I add my tribute to the police in their constituencies and to the Thames Valley force as a whole, which has such a good record.
This debate is timely, because of the concerns that have been raised about policing in South Buckinghamshire recently, and in particular since the transmission of the Channel 4 programme on policing and crime on 13 January 2001. That programme drew up a league table that compared police performance in each district or unitary local authority area in England and Wales. It used the results of some regression analysis carried out by the university of Leeds to equalise a range of socio-demographic factors so that each local authority district could, it claimed, be fairly compared regardless of the nature of its population and the level of deprivation that it faced.
The Home Office has not tried to devise a national league table in that way, because there are methodological issues that are of concern. However, we have gone down the route of devising families of crime and disorder reduction partnerships and basic command units of broadly similar socio-economic characteristics. From those, the public and BCU commanders can benchmark and compare like with like.
We published our most recent figures earlier this month, and the previous figures, published in July, were on the same basis—the first time that such data have been published in that form. That should enable people to have informed debates of the type that the hon. Gentleman is trying to stimulate today.
The Thames Valley police have made known to me their disappointment with the content of the Channel 4 programme. South Buckinghamshire is affluent, in

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comparison with many areas with high levels of social deprivation, and in terms of violent crime, it is indeed one of the safest parts of the Thames Valley. It is important to place that on the record, given the nature of the programme.
The league table constructed by Leeds university is an interesting approach and I look forward to receiving more details from its creators of how it has been produced. When setting up inter-authority comparisons, we have found it far more helpful to generate families of crime and disorder reduction partnership with similar characteristics. That allows more direct comparisons between similar areas and makes benchmarking more accessible to all concerned.
South Buckinghamshire, which is in the crime and disorder reduction partnership family 11—as seen in the published tables of Home Office documents earlier this month and last July—is in the first quartile, the safest, for crimes of violence against the person and for sexual offences. I emphasise that that is within the crime reduction partnership family. It is in the fourth quartile, the worst, for robbery, burglary from dwellings and theft of and from vehicles. It is performing poorly in those respects, but not in terms of crimes of violence.
Across England and Wales as a whole, South Buckinghamshire remains one of the safest areas in terms of violence against the person and sexual offences. It is in the third quartile for robbery, but remains in the bottom quartile for burglary and vehicle theft. A similar pattern emerges across the Thames Valley police authority area. The best approach to stimulating debate about these matters is through more specific analysis rather than through an overall table produced nationally and published in a Channel 4 programme.
Our assessment is that South Buckinghamshire's higher than average property and vehicle crime levels are due to a combination of factors. The area borders several large towns that suffer deprivation. It is also well served by the motorway network, so it can be targeted by travelling and opportunistic thieves. The Thames Valley force is working in partnership with various agencies to promote safer communities and to target prolific offenders, which can be difficult in areas of high mobility.
Thames Valley's own crime reports show that individuals who leave articles such as mobile phones and laptop computers on show, particularly in company cars, contribute significantly to the rise in property-related and vehicle crime. When I recently visited the police in Slough, that point was made forcefully to me. Despite their best efforts, the police cannot solve these problems alone. That is why we developed the partnership approach for attacking vehicle crime, one product of which was the Vehicles (Crime) Bill, which completed its final stages in the House yesterday. In a series of other measures, we are working jointly with the police, local government, motor manufacturers and the insurance industry to attack vehicle crime and achieve our targets.
The Thames Valley police authority has set five-year targets to reduce domestic burglary by 40 per cent. and vehicle crime by 30 per cent. As the published figures demonstrate, it is a challenging target and it amounts to a head-on confrontation with the problems illustrated in
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the tables. I want formally to congratulate the force on setting such challenging targets in conjunction with the other authorities in the crime reduction partnerships.
The hon. Gentleman asked about funding for the Thames Valley force. We shall debate the police funding settlement for England and Wales later this afternoon. Thames Valley police are set to receive funding support of £245.1 million next year—an increase of £13.4 million or 5.8 per cent. over 2000–01. The average increase for forces in England and Wales is 4.9 per cent. I skimmed lightly down the table of increases and found that only six of the 43 forces have received better overall increases than the Thames Valley force.
It is worth placing it on the record that the 1998–99 increase for the Thames Valley force was 5.3 per cent., compared with 3.2 per cent. nationally; in 1999–2000, it got 2.4 per cent., compared with 2.5 per cent. nationally; and in 2000–01, 3.2 per cent., compared with 2.8 per cent. I have already provided the figure for 2001–02. Over the years, the Thames Valley force has done better than the national average, but that is not to dispute the issues of funding that the hon. Gentleman raised. However, the national context should help him to make appropriate judgments.
In addition, the Thames Valley force has received £4.3 million from the crime fighting fund for recruiting police, about which I shall say more in a moment; £8.7 million for the costs of the Airwave police radio system; and £1.3 million from the rural policing fund, which was established in response to the campaign around the country for more resources for rural policing. Those are all significant amounts and the Thames Valley force will use them well. I hope that they will go some way towards dealing with the situation that the hon. Gentleman describes.
I have met the chief constable and the police authority to discuss the funding for the extraordinary costs to which the hon. Gentleman referred. We have established a clear rule for such funding. The decision on the Huntingdon laboratory in Cambridgeshire took account of the specific circumstances there. I acknowledge the case that has been made about having had to deal with the environmental and animal welfare protests.
We have consistently stated that police numbers are important as part of a comprehensive package of measures. Thames Valley police has 3,748 police officers, as at the end of September 2000, which is eight more than on 30 March 2000, six months earlier, and 53 more than on 30 March 1997. I am delighted that the ambitions of the Labour shadow Home Secretary to have more police officers than when we took power have, under the Government's outstanding leadership, been well overachieved in Thames Valley, and I hope that that fact will be acknowledged.
Mr. Grieve: I accept that, but I hope that the Minister will deal with the fact that it is a much slower take-up of numbers than the police would want, because of the problems with recruiting and maintaining their manpower.
Mr. Clarke: I will come to that legitimate point. Thames Valley has 177.1 officers per 100,000 population. Six forces have lower levels of officers per 100,000.

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Because time is limited, all that I shall say about the crime fighting fund is that the process is being moved forward and that, because of the problems to which the hon. Gentleman referred, we are prepared to be flexible on allocations. The police negotiating board is considering whether there should be an allowance for officers in forces outside London, including Thames Valley, and we await its recommendations on that or any other issues to do with police pay and allowances. It is not appropriate for me, as a Minister, to second-guess the position of the police negotiating board—an august body whose deliberations can never be tested by anybody.
The employers' side has made proposals in which the chief constable and the authority for Thames Valley have taken a full part. We shall await the outcome of the PNB deliberations. I cannot express optimism or pessimism about that, except to say that the employers would not have made their case unless they considered it well founded, as the hon. Gentleman has acknowledged. I hope that, on the issue of police housing—there has been substantial debate in the authority about its housing sales policy—the hon. Gentleman and the hon. Member for Chesham and Amersham will put their weight fully behind those who argue that the police should maximise the housing available to police in the Thames Valley area and not rashly dispose of housing more rapidly than they need to.
We accept the hon. Gentleman's fundamental point about the need to increase presence and reassurance in rural areas. Only yesterday, I was discussing how to do that with leaders of the national police service. We are making progress on various initiatives, including mobile police stations, rural parish special constables and targeted patrolling, to address issues of police presence and visibility. I know that he will join me in celebrating the fact that police numbers are higher in the Thames Valley area than when we took office. The same goes for police stations: in March 1997, there were 53 in Thames Valley; in March this year, 55.
None of that is meant to deny that there are major problems that need to be addressed, but we can say categorically that we are seeking to tackle precisely the issues that have been raised by the hon. Gentleman in what I have certainly found to be—as I hope that he has—an interesting and worthwhile discussion.

North Lakeland Healthcare NHS Trust
1 pm
Mr. Eric Martlew: I welcome the opportunity to debate the findings of the first report of the Commission for Health Improvement. However, I very much regret that it is a report into a serious case of patient abuse in my constituency at the former Garlands psychiatric hospital, which was run by North Lakeland Healthcare NHS trust. I am pleased to say that this weekend I visited the site of the hospital; it has been closed, the demolition has started and the patients and the staff have been transferred over to the new Carleton clinic—an excellent facility.
In order to appreciate fully the scale of the problem, I shall have to outline some of the background details of the events and abuse that took place. In December 1998, two bank nurses from another hospital were working in the Garlands hospital, in Kielder House ward. They were so appalled by the abuse that they saw that they reported it to the senior managers. I would like to thank those two members of staff for taking that brave decision. I understand that they were heavily criticised by some of their colleagues, but whistleblowing has to happen in the NHS and they did the right thing.
I will briefly outline the sort of abuse that was taking place in Kielder House ward. In December 1998, two elderly patients in their night attire—not wearing their dressing gowns—were locked outside on a veranda in the cold. The staff refused to let them back in for a considerable period of time. Other incidents included patients being tied to commodes—a great indignity and against all the rules—and fed their meals at the same time. Other patients were sworn at and told they were past their sell-by date, that they should be in their box—in fact that they should be dead. They were subjected to verbal and physical abuse. One patient was struck in the testicles by a male nurse who was a judo expert. That was the level of abuse.
An internal inquiry looked into the matter and in March 1999 it reported with 33 recommendations to improve the situation in Kielder House and in the new clinic. I saw a copy of the Kielder House internal review in April 1999 and was appalled. I have been in public service since 1972 and have dealt with many difficult situations, but I was very angry when I read about the abuse that was taking place and lost sleep that night.
I had a meeting with Mary Styth, who was the chair of the trust. She expressed concern about the abuse and called for an external inquiry into what had happened in Kielder House ward. The inquiry was set up by the regional health authority. In August 1999 it discovered a previous report into abuse in the hospital in 1996.
The catalogue of abuse was very similar and it was then in ward 21, which was merged with Kielder House ward later. The 1996 report, which included complaints by student nurses, had been ignored and no real action had been taken. In fact, there was a cover-up in 1996. The chief executive of the trust said that he had not read the report for three years. In August, it was decided that he should be suspended.
In March 2000, the external inquiry reported. It found that a range of unprofessional and cruel practices took place in Kielder House, and severely criticised the

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1996 investigation. Following the publication of the report, the chairman of the trust, Mary Styth, was summarily dismissed by the Secretary of State, and six members of staff were subject to disciplinary action.
I am sure that the 1996 and 1998 incidents were not isolated. Sadly, we must presume that abuse carried on throughout the period, if not longer. Later, I will mention the failure of various organisations to detect and stop the abuse, but I would like to make it clear now that none of the failures of the system absolves those who perpetrated that abuse. There was no excuse for it.
Following the external review and the large amount of publicity about the abuse and the sacking, the Government rightly called in the Commission for Health Improvement, and we are now considering its report. It said that the abuse was some of
"the worst involving elderly patients in recent years".
It was highly critical of the management that investigated ward 21 and Kielder House, saying that there was a complete failure of effective management and a "whole systems failure". The report accused the trust of failing to respond to the early warnings of whistleblowers. Despite the evidence, the commission found a culture of denial among some staff, who did not believe that the abuse had taken place.
I shall move on to lessons to be learned and problems that were created. North Cumbria health authority failed to act following the complaint from Carlisle MIND about abuse at the hospital. Although the health authority's headquarters were only 10 minutes' drive away from Garlands hospital, it worries me that there was a remoteness between the two, as though they were 100 miles apart. I also felt that the non-executive members of the health authority were not informed of the problems at Garlands.
We are lucky in Carlisle to have an excellent community health council, which has been ably led for many years by its chief officer, Peter Canham. However, due to the nature of its visits, the CHC failed, in that it did not pick up the abuse. I repeat my belief that the abuse was systematic in the hospital, not occasional. Although we have a good CHC, and although I am not totally convinced that I support the Government 100 per cent. on the alternative to CHCs, the fact that they have structural problems was shown in this situation.
The only organisation to come out of the affair with any credit was Carlisle MIND. I have to declare an interest, as I am its vice-president and my office shares a building with it. It flagged up the fact that abuse was taking place at Garlands hospital, and it told the trust and the health authority. Unfortunately, it was ignored. The director, Ann Dawson, should be praised for her diligence and persistence. I am rather annoyed that when Carlisle MIND wrote to the health authority asking for funding for another five years to allow it to continue with its work, the health authority agreed to fund it for only one year. Whether we like it or not, an organisation with money for one year only that rocks the boat too much may not receive money for following years. I shall return to that subject later.
What issues, national and local, have resulted from the report? First, it is obvious that the trust had structural problems when was it was set up in 1994. It was a community and mental health trust. The majority of the effort and resources went into the community, and
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the hospital probably came second. I do not want to say too much about the new structure of health care in Cumbria because the Minister already knows my views. However, from 1 April, Cumbria will have a single mental health trust. I was initially worried about its size, but I believe that it will allow the trust to concentrate on giving the community a good mental health service, which is timely.
Another important factor is funding. We can blame various causes, but mental health has been underfunded for generations. Although we tend to concentrate on acute cases, it is time to ensure sufficient funding, nationally and locally, for mental health trusts. I hope that the Minister will take that on board.
Another important aspect is the way in which the Government treat non-executive members of trusts. The chair of the trust, Mary Styth, was summarily dismissed by the Secretary of State. The chief executive of the trust was suspended for more than a year, and was given the opportunity to plead his case. He underwent a disciplinary procedure and was rightly dismissed. However, I believe that non-executive and executive members of trusts should be treated equally and that both should have a right of appeal. I accept that members are appointed for a fixed term, but if they are dismissed they should have the opportunity to plead their case.
Next, I wish to mention the police. I make no bones about it: I would like to have seen the perpetrators of the abuse brought before the courts. However, my impression is that when we have problems in our hospitals, whether in Cumbria or elsewhere, the police adopt the unofficial national policy that such matters are better dealt with through internal disciplinary procedure than through the courts.
I greatly admire Cumbria police; I am sure that the Minister would agree that it is one of the best police forces in the world. Crime in Cumbria has been reduced by 21 per cent. in the past year. However, I am worried that no prosecutions were brought. I know that it is difficult, and that mentally ill people do not make good witnesses, but I believe that the two nurses who made the allegations and those who were disciplined were not interviewed. I do not know that for definite, but I have corresponded about the case with the chief constable. If the Association of Chief Police Office has a national policy of not getting involved in cases in hospitals and institutions, I suspect that the Minister should attend to it.
The future of the external reviews also needs thought. Will the new system set up by the Commission for Health Improvement supersede the external reviews such as the one at the Garlands hospital? A major flaw in the review was exposed by the commission's report. The first external review gives the impression that no consultants or doctors were involved in any of what happened at the Garlands hospital. Those conducting the review failed to interview the consultant concerned. I understand that he was off sick with a broken leg, but that should not have precluded his giving evidence. It was only when the commission looked into the matter that some responsibility was laid upon the consultant. Are external reviews now in the past, with that function to be taken over by the commission, or will they run parallel?

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A general question that I want to raise is how organisations such as MIND in Carlisle can be funded so as to retain an independent voice when they want to criticise an authority. It is not fair for an institution to have to depend for money on an organisation that it monitors.
The report has highlighted several problems that, hopefully, will now be tackled by the agencies concerned, especially the trust. We must look in a positive way to the future and hope for the restoration of public confidence and the improvement of the hospital's reputation. The vast majority of staff who worked at Garlands and who now work at the Carleton clinic are professional and conscientious and look after their patients well. However, if the hospital is to have a clean bill of health, the commission should return to conduct an audit; I shudder to use the word Ofsted. I understand that improvements have already been made. The commission needs to establish that it is satisfied that the people of north Cumbria and Carlisle have the mental health service that they require.
1.17 pm
The Minister of State, Department of Health (Mr. John Hutton): I warmly congratulate my hon. Friend the Member for Carlisle (Mr. Martlew) on initiating the debate and on his presentation of the arguments. I pay tribute to the work that he has done and continues to do to improve NHS services in his constituency. Carlisle has a powerful champion for the national health service in my hon. Friend.
The North Lakeland Healthcare NHS trust provides a range of mental health and community health services for a mainly rural area from a number of sites across north Cumbria. Last year 63,500 patients were treated by the trust, which provides a wide range of services from paediatrics and community midwifery to mental health services for all ages. I know that my hon. Friend is particularly concerned about those services.
I share my hon. Friend's concern about the findings of the various inquiries into the events at the North Lakeland Healthcare NHS trust. I appreciate his efforts in bringing those matters to the attention of Ministers. A clearly unacceptable state of affairs was allowed to develop in the trust. Standards of patient care and treatment fell seriously short of what we expect from the national health service. In addition, the trust failed to deal properly and effectively with abuses, which had been taking place over several years, as my hon. Friend made clear.
Allegations of abuse were first brought to the trust's attention in May 1996 by student nurses working in Garlands hospital. Those allegations were investigated by the trust's patient services manager and training manager. At that time, the internal trust inquiry concluded that
"the type of patient in this ward leads to a marked difference between theory and practice"
and that
"some of the difficulties encountered may have been created by the students' understanding of the relationship between theory and practice".
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That is totally unacceptable. No disciplinary action was taken and no report was made to the police. It was the failure at that stage to take effective action to deal with obvious evidence of unacceptable practices in the trust that lay at the heart of the subsequent events.
In December 1998, as my hon. Friend made clear, two bank nurses made further complaints about the treatment of patients in Kielder House ward in the same hospital. The complaints investigation uncovered other aspects of care that gave cause for serious concern. One member of staff was dismissed, one resigned and three were given warnings. I would like to express my gratitude and admiration to those two nurses. It was their actions that finally began the process that led to measures being taken to deal with the appalling treatment of NHS patients in the hospital. Those two nurses acted in the best traditions of the nursing profession.
The former chief executive of the trust met the police in January 1999 to appraise them of the draft report into the allegations, which could lead to suspensions and disciplinary action against staff. As a result of that discussion, the police concluded that it was not an issue for them as there was insufficient information to justify further investigation into the actions of any individual. As my hon. Friend is aware, the trust initiated a further internal investigation.
I understand that the police have now been sent copies of both internal investigations and are currently reviewing the evidence.
My hon. Friend was concerned that there was a national policy not to prosecute cases of alleged criminal behaviour by people in hospitals. I can assure him that no such national policy exists. Anybody who works in the NHS is subject—just like all of us—to the full operation of the criminal law, and that will continue to be the case.
My hon. Friend is also aware that, following that internal investigation, an independent external review was instigated by the Northern and Yorkshire NHS Executive regional office. The report of the independent external review found, in particular, an unacceptable culture of care, which allowed
"unprofessional, counter-therapeutic and degrading, even cruel, practices"
to take place. It also found that the governance of the trust was at risk through a significant blurring of roles and responsibilities between the chair and the chief executive, and that the trust lacked an atmosphere of openness and had no effective arrangements in place to ensure proper clinical governance.
The responsibility for the continuation of such a regime in any NHS trust must lie squarely and properly with the chairman of that trust. That is why we did not hesitate in removing her from her position. Chairs in the NHS are directly appointed by Ministers with the clear remit to deliver health services of the highest possible quality, which was not happening in the North Lakeland trust. The abuse and mismanagement on the scale experienced in North Lakeland meant that the chairman's position was not sustainable. Although the former chair was responsible for the overall management of the trust and must take responsibility for its failings, it was clear that senior management were also at fault. A number of disciplinary actions against

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senior managers have followed. To date, the chief executive and the director of personnel have been dismissed, and a range of serious disciplinary actions have been taken against six other members of staff at the trust.
We took the decision to send in the Commission for Health Improvement. The commission reviewed the previous reports and examined the management, provision and quality of care provided across the trust. It found that there was
"an almost complete absence of effective corporate management and clinical governance processes—in effect, a whole systems failure."
The Government accept the commission's findings, and we expect the acting chief executive and chair to take on board the recommendations and to implement the action plan drawn up to address them. I have asked my Department's regional office to work closely with the trust and the health authority to ensure radical improvements to the management and the delivery of services at North Lakeland. It is important that the community served by the trust can draw a line under the appalling sequence of events to secure a future marked by the highest quality of care.
Action being taken now in the light of the CHI's report will be vital to achieving that. I am pleased that since publication of the commission's report a number of important developments have taken place. An action plan to address all the commission's recommendations has been implemented; a service staff skill mix review was started in December and a draft report is due to be produced by today; clinical governance training for all board members has taken place and further sessions have been held with senior managers and clinicians.
The trust is actively reviewing and re-defining its corporate values with patients, carers and staff. Discussions have been initiated with the local community health council and the local branch of MIND to establish a patients council, which will be useful. The Northern Centre for Mental Health is supporting the trust in reviewing the allocation and responsibilities for standards and quality across the trust.
A user-focused complaints policy was introduced in November. Complaints are now valued as opportunities to learn about and improve services. My hon. Friend will be aware that a comprehensive review of nursing standards across the trust is also being carried out.
We have reorganised management structures in the NHS in north Cumbria. The North Lakeland trust will be dissolved on 31 March, to be replaced by a districtwide dedicated mental health and learning disabilities trust. That will provide the opportunity to refashion a modern, efficient and effective mental health service appropriate to meeting the needs in my hon. Friend's constituency.
The action taken will help to ensure that these events do not happen again. I welcome the intention of the Commission for Health Improvement to review the new trusts in north Cumbria one year after its report on the North Lakeland trust. I hope that a very different picture will emerge. My hon. Friend asked me to ensure that we would revisit the trust, as it were, and I assure him that we will.
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My hon. Friend also raised important points about checks and balances in the system, and about how groups representing patients and users can be heard effectively. I should make it clear that the Commission for Health Improvement found a whole systems failure. The trust was responsible for the appalling circumstances about which we have spoken. I praise the contribution of the local branch of MIND, which raised its concerns with the trust and the health authority. I congratulate my hon. Friend on his comments on MIND, as it stood up for patients at Garlands hospital.
The Government's reforms are helping to renew public confidence in the NHS through greater involvement than in the past of patients, carers and the public in the planning and the development of health services. The Government are determined to ensure that the voice of the patient is heard loudly and clearly in the new NHS. The NHS cannot operate behind closed doors and keep patients in the dark. New ways need to be found to take patients into its confidence. The NHS plan sets out how we intend to do that.
This week, my right hon. Friend the Secretary of State gave further details of our plans. We intend that every local trust should have its own independent statutory patients forum, run by patients. The forums will have rights to inspect standards of care and cleanliness. A patient will be appointed to serve on the local trust board so that patients' interests are at the heart of local decision making. I hope that my hon. Friend will welcome those reforms. In turn, the trust will have to demonstrate that it has responded to the concerns of the patients forum.
Other changes that we are making include ensuring that patients are regularly asked for their views on their care, and requiring trusts to publish a prospectus to set out how they intend to address patients' concerns. A new patient advocacy and liaison service will be established in every trust to give patients on-the-spot help with care and treatment problems. A new complaints system, more independent than the old one, and a new, independently commissioned and independent advocacy service will be available in every area when a patient needs specialist help with a complaint.
At health authority level, independent local advisory forums that will include patients will scrutinise the whole local health service. There will be more patients' representatives at every level in the health service. That will include existing organisations such as the General Medical Council, the National Institute for Clinical Excellence and the Commission for Health Improvement, and new organisations such as the new independent appointments commission and the independent reconfiguration panel. Patients will have seats at the top table.
The issues in the North Lakeland trust should not be considered in isolation. The Government are committed to delivering significant improvements to the NHS across north Cumbria. Year on year, we have increased the resources to the NHS in my hon. Friend's constituency. This year has seen a cash increase of more than £19 million, which is 6.4 per cent. above inflation, or a 9 per cent. increase in cash terms. Next year, we shall ensure a real terms increase of 6 per cent., which is more than £17 million in cash terms.

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My hon. Friend was concerned about the financing of mental health services, and I agree with many of his comments about the inadequate funding that has dogged them for many years. That is why I hope that he shares our commitment to modernising, investing in and improving mental health services, as set out in the NHS plan published in the summer. I accept that much is to be done, but new, dedicated funding is coming on stream.
I am sure that my hon. Friend and I agree that the trust needs to move forward, and in so doing it must ensure that its patients and the whole community enjoy a relationship of full confidence and trust in the services that it provides. That is what every member of staff in the trust wants and is committed to achieving. It is what my hon. Friend and I both want to happen, and I look forward to working with him to ensure that it does.

Northern General Hospital, Sheffield
1.30 pm
Mr. Richard Allan: I am pleased to have been able to secure this debate, as it provides an opportunity for the Government to make a statement on the record about an issue of serious concern to all those involved with the transplant service at the Northern General hospital, Sheffield. That includes the hon. Member for Barnsley, Central (Mr. Illsley), and other local Members, all of whom have been concerned about the service, which covers quite a wide area.
I intend to cover three main areas in the debate, and I hope that the Minister will be able to respond to each of them at the appropriate time. First, I will examine the rationale behind any move to reduce the number of transplant centres in the UK as a whole. Secondly, I will talk about the service in Sheffield in particular, and the valuable role that it plays within the NHS. Thirdly, it is important to discuss how decisions about service changes in the NHS are made, as that has been a source of complaint from many of the people who have contacted me on the issue.
There has been an underlying assumption behind the review of cardiothoracic transplant surgery that the national specialist commissioning advisory group—NSCAG—has been carrying out for the Department of Health that there are too many cardiothoracic transplant centres, and some should be closed. I understand that that is the brief to which it has been working. However, I suggest to the Minister that to accept such a strategy of fewer units, which are by definition further apart, may be selling the NHS short.
My vision for the NHS, which I hope that the Government share, is that it should continue to be one of the best health services in the world. In my view, it would be disastrous for the NHS to end up as some kind of safety net service that withdraws from the more complex and expensive procedures that some people will always need. In that respect, I can see the need for the skills of transplant centres growing rather than reducing over the coming years.
Mr. Steve McCabe: Is it not the case that at the very time when we are trying to expand the number of organ donors, it makes no sense to reduce the number of centres? If anything, there may be a need for some rebalancing of the geographical areas for harvesting donors. We should concentrate on that, to get the best distribution throughout the country, rather than concentrating on resources in the south-east.
Mr. Allan: That intervention helps to move us on to the issue of the shortage of organ donors, which has been one of the driving forces behind the strategy that has been set out. My presumption is that the shortage of organ donors is a problem that we could overcome. We should be tackling that, rather than closing the centres that could actually do the operations if the donations were occurring. I agree that there is currently a shortage of organ donations. The answer is not to give up but to campaign actively to increase the number. The Northern General itself ran a successful campaign in Sheffield before Christmas, using the local media and getting thousands of people to sign up for donor cards.

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I am interested in schemes such as the credit card scheme, as it seems that the vast majority of people these days carry a credit card. If that were also a donor card, that would be an immediate and straightforward way of identifying someone as a donor. We are only beginning the process of expanding donation. It is true that the effort to expand the number of donors may be set back by current events surrounding organ removal without consent, but the Government could and should make a clear distinction between those unfortunate events and consensual organ donation to save lives. There are some good examples of how consensual organ donation works. I hope that the Government will be clear about not allowing that to be dragged into a debate about non-consensual removal of organs, which all of us would quite rightly condemn.
The Sheffield Heart and Lung Transplant Society has put it to me that a review of the donor zones mentioned by the hon. Member for Birmingham, Hall Green (Mr. McCabe), which decide which units receive which organs, would create a more efficient service and possibly make the existing transplant centres more effective. We are also witnessing the advance of new technologies that may expand the possibilities for medical intervention. We have recently debated the advances in stem cell research, which could create new ways to regenerate organs. There are advances in mechanical devices all the time. Those new techniques will require the skills necessary to prevent rejection, and to work with new tissue or implanted mechanical devices, that have been developed in transplant centres throughout the country.
What a travesty it would be if new technical solutions came on stream but there were no medical staff with the experience to use them. The present transplant staff have been trained all over the world for 15 years to achieve the skills necessary even to begin some of the procedures. They work in close-knit teams and achieve great successes. They, in turn, train future medical staff in these highly specialised skills.
The closure of units will disrupt that pattern and risk the NHS losing skilled people, and the global market for staff with transplant skills cannot be ignored. In any reconfiguration, there is the potential to lose people with vital skills who will train the next generation of staff in the new techniques. I ask the Minister to consider whether it is not incredibly short-sighted in the long run to risk the loss of skills when major medical advances are anticipated that will create a need for more, not fewer, staff with these specialisms.
Most importantly, a reduction in the network may have a damaging effect on patient care. The seriousness of the matter was underlined by a submission from members of the Sheffield patients group. They told me that the typical procedure for a patient undergoing a cardiothoracic transplant begins with an assessment of the suitability of the patient for a transplant, which involves a four-day stay in hospital. There is then a two-year wait, with various episodes of in-patient and out-patient treatment. The transplant surgery itself requires an in-patient stay of about three weeks. After being discharged, the patient must attend hospital for a minimum of four hours a week for the first four weeks, fortnightly for the next four weeks, monthly for the next six months, quarterly for the next year and every six months thereafter. In such an intensive period of
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attendance at the hospital, its geographical location is much more significant than it would be if a patient went in and out of hospital only once.
With such an intensive treatment schedule, any increase in the distance travelled is a major burden for the patient, not only in time, money and so on, but in health terms, as patients are very frail when their operations take place. At present, patients from areas such as Hull, Grantham and Nottingham have to travel for up to two hours each way to the Northern General hospital in Sheffield. If they had to go to Manchester or Newcastle—the alternatives if the unit were to close—that would increase to between three and five hours' travelling time each way. On present figures, that would mean that 100 post-operative patients in the area, including those in Barnsley, Sheffield, north Lincolnshire, Nottinghamshire and Derbyshire would have to travel for six to 10 hours a day. If closure goes ahead, a group of existing patients will have to start travelling those excessive distances immediately.
In addition to the problems for patients and their families who may wish to visit them, closure could significantly increase NHS costs, especially if out-patient appointments had to be changed to include overnight stays because the travelling distance was too burdensome for a two-way journey. That expensive option would, however, have to be considered.
I said that I would refer to the case for the Sheffield unit. In doing so, I am not trying to talk down the other transplant units, as this is not a beauty contest between them. However, I want to place on record comments about the qualities of the Sheffield unit that have been passed to me by patients and others.
The transplant programme started at the Northern General hospital more than 10 years ago, since when it has provided more than 230 patients with successful transplants. The facility was much improved recently with the opening two years ago of the £20 million Chesterman wing, which has some of the best facilities in the country. The team now operating at the Northern General has a tremendous reputation. A study carried out by the Royal College of Surgeons showed that it was one of the most successful in the country. There is an active support group for the unit.
Graham Earle, chairman of the Sheffield Heart and Lung Transplant Patients Society, told the local newspaper, The Star:
"Sheffield has the best records for post transplant survival, the shortest waiting time for pre-transplant assessment and an excellent after-care service. How they can think of shutting it is beyond belief."
We have a first-class unit in a modern building, opened in this Government's term of office, providing a service that is much valued by patients. I am sure that other units are similarly valued by their local groups. An additional factor is important in considering the Sheffield unit: need. There is an acknowledged link between high rates of coronary heart disease and areas of high social deprivation. Similarly, the incidence of lung diseases is higher in areas of certain industrial activities such as mining.
The area served by the Northern General has a very high level of such problems. In the former coalfields of Yorkshire, Derbyshire and Nottinghamshire, people have suffered from years of poor health caused by

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poverty and the legacy of the former industrial activities. Barnsley and South Yorkshire have the highest heart disease rate in England. Those local factors are reflected in the high demand for cardiothoracic transplants at the unit. That is reflected in an extensive waiting list, which already, sadly, means that some people die before they can be treated. The loss of the Northern General unit would be likely to worsen the situation and leave that high-need population travelling much longer distances for their treatment, increasing their stress, at further cost to their health.
I am worried about the lack of public consultation. I want to leave the Minister in no doubt about the unacceptable nature of the decision-making process in this case. The main source for information has been the local newspaper, The Star. It has done an effective job in putting information into the public domain and has acted as a responsible local watchdog, but it is unfortunate that the Department's process does not appear to have included any more formal system for making the public aware of what is being considered and seeking their views on possible changes. The perception is that the results of the review were to be presented as a fait accompli to the users of the service.
I accept that people making decisions about the reconfiguration of services will always be criticised for not consulting properly by those who feel that they are losing out. Where my political colleagues are in power in local government they have had to deal with exactly that situation. In this case, there does not even seem to have been an attempt at public consultation. That is particularly serious given the nature of the service in question.
Cardiothoracic transplant units, by their nature, create long-term on-going relationships with their patients. I referred to the typical schedule as set out by the patients group in Sheffield when I talked about the need for a good geographical spread of centres. There are already hundreds of patients in the Northern General catchment who are at various stages of treatment and have an expectation of working with the hospital over several years to come. As one of them put it to me, they are very much stakeholders in their own treatment. In that context, the failure to make clear, authoritative public statements about the reorganisation to date has been a serious failing. I hope that the Minister will be willing to do something to remedy that today.
I have one last general point about NHS openness. The Secretary of State was very forthright about that in another context this week. The situation is not exactly comparable to decisions about the treatment that someone has received, but there are similar questions to be answered about the relationship between the NHS and the citizens of this country. We feel a tremendous sense of ownership of our health service and pride in its achievements. I was very conscious of that during the five years that I spent working in the NHS. NHS staff will often go that extra mile because it is for the public benefit. However, the decision-making processes in the NHS have often been remote from the people it serves. I believe that ordinary people can understand the concepts surrounding decisions about NHS service
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delivery. Those who hold power should not be defensive and seek to restrict information but should go out and involve people in the decisions that affect their lives.
The Government came into power with a commitment to save the NHS. I am sure that we will have the partisan debates about how successful they have been ad nauseam over the coming months. I ask the Minister today to consider seriously one aspect of the NHS debate, which would not cost a lot of money: the democratisation of the service. The alternative is to continue to have the NHS damaged by the perception that its users are being treated simply as patients having things done to them and not as full participants who both use the service and have a say in how and where it is delivered.
Ordinary people such as the users of the Northern General transplant centre should be entrusted with the information that they need to be involved in the decision-making process. I hope that the Minister will be able to give a commitment to doing that, and to publishing a full range of information on this particular decision. I hope that she will be able to explain clearly how public consultation will take place, and to set out a detailed timetable for the decisions on the review that will have to be made. I hope that at the end of the process she will be able to announce that the centre of excellence that is the Northern General transplant centre will continue to provide its valuable service within the NHS.
1.45 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I congratulate the hon. Member for Sheffield, Hallam (Mr. Allan) on securing this debate. I do not disagree with any of his comments on what we expect of the NHS, its openness and its consultation with patients, but I hope that I can make clearer what has been happening in terms of organ transplants.
I would also like to make it clear that, as one of the transplant units under consideration is in Birmingham and is located in my constituency, it is important that I state publicly that, despite taking this debate here in Westminster Hall, I will play no part in the decision-making process to identify the units that will be consolidated. It is also a sign of the strong feelings of the hon. Members who represent the three constituencies in which the units are located that they are here. I am grateful to my hon. Friend the Member for Birmingham, Hall Green (Mr. McCabe) for his intervention, as he is correct when he says that we should do everything that we can to increase the number of organ donations. I went through the background briefing and was struck by the number of letters that we had received from various Members. This issue goes across all parties, and people feel very strongly about it.
In terms of organ transplants, we are in a good position in this country. Over the past 30 years, organ transplantation has become established as the best treatment for people suffering complete failure of vital organs. In the case of liver transplant and cardiothoracic transplant, that is heart, heart-lung and lung transplants, the procedure is literally life-saving. In the case of kidney failure, renal dialysis can sustain people while they wait for a suitable organ to become

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available, but to put that into context, currently we have approximately 3,000 transplant operations, with organs from 900 donors, and there are more than 6,000 people on the transplant waiting list. More than 8 million people have joined the NHS organ donor register, but one of the difficulties is that only a very small percentage of those dying are suitable as organ donors. The main source of organs is from people who have died from sudden brain injury such as a stroke or resulting from a road accident, and there was an assumption in the early 1990s that the numbers would continually increase, and while I of course welcome the reduction in road accidents, it does have some consequences.
Last February, there was a review in response to a number of important issues that had arisen concerning organ transplantation, including a report on the future of organ transplant services by the Royal College of Surgeons of England. My noble Friend Lord Hunt of Kings Heath announced measures that, taken together, provided a comprehensive strategy for the development and reorganisation of transplant services in this country. He accepted the RCS's recommendations on minimum levels of staffing for transplant units. The recommendation was that, because so much organ transplantation takes place at night or over the weekend, surgeons would work no more than a one in four on-call rota. That would require a minimum team of five surgeons. Currently, very few organ transplant units meet that requirement.
The hon. Member for Hallam raises the issue of training, but unless the unit and the programme itself are of a sufficient size, training cannot take place. He mentions future technologies, but those are very likely to require different skills that are already being developed in a number of the non-transplant units. While the renal transplant service is affected by these issues, work to address them is at a much earlier stage, so I will concentrate, as he has, on the cardiothoracic services.
Our national cardiothoracic transplant service is recognised as being among the best in the world, and we are rightly proud of it. Following its designation as a national service in 1986, it has been restricted to relatively few centres, preventing the proliferation of a large number of cardiac centres, as happened in some other countries, in the belief that the number of organs would continue to increase. Four new adult cardiothoracic transplant centres were designated, so that by 1991 there were seven adult centres in England.
I am worried that there may be confusion. Just because there is a greater concentration of cardiothoracic transplant services, would not in any way affect what we expect from the expansion of cardiac surgery, which would happen in many places. The hon. Gentleman correctly referred to the very high incidence of heart disease in his area. There will be a continued expansion of the service, so it is not "instead of" but "as well as".
Mr. Graham Brady: The Minister has quite rightly drawn attention to the importance of specialisation. I wonder whether she would care to pay tribute to the work of New Heart, New Start at Wythenshawe hospital, in Manchester, which has raised £1. 8 million for the construction of a
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dedicated heart transplant ward, which will give Wythenshawe the only fully comprehensive heart transplant unit in the whole of western Europe.
Ms Stuart: This is the kind of thing that could get me into trouble. I would not wish not to pay tribute to extraordinary local fundraising, but my paying tribute to those activities should not be seen as indication that I take sides in the very close race between Sheffield, Manchester and Birmingham. I welcome the fact that the hon. Gentleman has such an active local organisation, but the decision is still open.
I return to what has happened in the Northern General hospital in Sheffield, because it is one of the new centres. The others were St. George's hospital in London, the Queen Elizabeth hospital in Birmingham and Wythenshawe hospital in Manchester. The three original centres were Papworth hospital in Cambridge, the Freeman hospital in Newcastle and, perhaps the best-known of all, the Harefield hospital in Middlesex. Hon. Members may be aware that the programme at St. George's has now been suspended following an unusual run of poor results last year, and the Commission for Health Improvement will be investigating that.
The early promise of expansion of cardiothoracic transplantation has not been fulfilled. Our assumption, in the early 1990s, that the number of available organs would expand has proved wrong, as a result of improvements in road safety and the prevention of strokes in younger people. Those are important health gains, which of course we all welcome, but they have had consequential effects.
For example, between 1990 and 1999, deaths from road traffic accidents in people aged 16 to 59, the usual age for adult heart and lung donors, fell by nearly 40 per cent. from 2,893 to 1,820. That is clearly very good news, but it has had an inevitable effect on the supply of organ donors. In the past five years, the number of organ donors under 60 has fallen by 15 per cent. The fall could have been greater had it not been for the dedication of intensive care units and the efforts of transplant co-ordinators and transplant teams in identifying donors, alongside our continuing efforts to increase organ donation, such as running major campaigns with credit card companies, which the hon. Gentleman mentioned. There is also the Boots initiative to persuade people to join the register. I think that he is absolutely right when he refers to the mood of the time.
We are having this debate after Alder Hey, and we face a significant challenge in re-establishing trust. It was interesting that many of the Alder Hey parents said that they would have given permission if only they had been asked properly. We will drive the issue of informed consent throughout the NHS. I know that in some areas extremely valuable work is going on with ethnic minorities to improve rates of organ donation.
We recognise that, however successful we are in arranging organ procurement, the supply of hearts and lungs, which come only from younger donors, will remain severely limited. Despite all our efforts, the impact on the cardiothoracic transplant programme has been considerable. Adult cardiothoracic transplant operations—heart, heart-lung and lung transplants—performed by the centres fell from 423 in 1995 to only 290 last year. During the same period, heart transplants performed in the seven centres in England fell from 262 to only 172.

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We are committed to maintaining excellence, but a difficult decision must be made on the number of centres so that the coverage of the surgical teams can be maintained. We have accepted the advice of the Royal College of Surgeons in its 1999 report on minimum levels of staffing. It will be evident to hon. Members that, with such complex treatment, if the number of transplants falls below a certain level, the members of the transplant team will begin to lose their skills and standards may fall. We must ensure that each transplant team is well staffed with access to all the support that it needs. It must perform enough operations to maintain a high level of skill in all the members of the team, and it is essential to ensure that the service remains of the highest possible quality for the sake of patients.
The national specialist commissioning advisory group is responsible for advising on which services should be provided nationally. The group considered the impact of the various factors and recommended last year that the national programme should be delivered from four centres in England. That would allow each unit the optimum infrastructure to support a programme of at least 50 heart transplants, which would allow each surgeon to perform an average of 10 heart transplants a year. That size of programme would also maintain the skills of the whole multidisciplinary team and would ensure that properly resourced organ retrieval teams are available to retrieve and make use of all usable organs.
Those recommendations are fully supported by many organisations, including the Royal College of Surgeons and the cardiothoracic transplant advisory group of UK Transplant. Dr. Roger Boyle, director of coronary heart disease services, has been consulted and fully supports the proposals. The Government have agreed that the principles are right and that some reconfiguration of the service is necessary if we are to maintain the high quality of the best services.
I recognise what the hon. Gentleman said about the long-term relationship that patients build up with a particular team. They develop strong ties and loyalties and the prospect of any change is disturbing. The Government want to keep disruption of patients and
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transplant teams to a minimum. One way of achieving that is to maintain the larger programmes, as far as possible, but any changes to the service will affect some patients. I stress that if any reconfiguration of teams involves loss of cardiothoracic surgeons because we want to keep teams together, we would strive to replace them so that other cardiac surgery, particularly to fit in with the national service framework and expansion of services, also happens.
Most patients on the waiting list will be treated by the team that they know. However, in future, some new patients may have to travel further to a transplant unit. Many patients already travel long distances, as they would have to do for any highly specialised national service. In the case of most highly specialised services, there will always be tension between improving geographical access and maintaining clinical excellence.
The hon. Gentleman referred to patient involvement and the national service. The provision of the service has never been a question of money. The issue is not about making financial savings but about where the service should be provided to meet national demand.
On patient consultation, we hope that the conclusions of the current study will be available in the not-too-distant future so that people can comment on the discussion document. The important point is that we are totally committed to a first-class transplantation service in this country, and we shall continue to do our best, as part of our work on informed consent, to ensure that organ donors carry donor cards. No decision has been made on which hospital will be chosen, but it will be made in the best interests of ensuring that the facilities—
Mr. Eric Insley: When?
Ms Stuart: My hon. Friend is trying to tempt me. The discussion document will be issued soon and I cannot make an announcement today. However, I take on board what has been said about patient involvement. We all agree that we want a service that is in the best interests of patients. With a national service, patients may have to travel, but the reward is better care.
Question put and agreed to.
Adjourned accordingly at Two o'clock.