Westminster Hall Sitting of 6 March 2001

Preamble
[SIR ALAN HASELHURST in the Chair]

Nursery Nurses
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Jamieson.]
9.30 am
Charlotte Atkins: I am absolutely delighted to be opening this important debate and I am indebted to my hon. Friend the Member for Brighton, Pavilion (Mr. Lepper) for suggesting it.
Nursery nurses have been the unsung heroes of early-years education and living proof of the need for trained specialists for children during their important, early, formative years when their personal, social and emotional development is so crucial. For too long, the early years have been seen as the province of the well-intentioned but untrained mother figure. In saying that, I do not wish to underestimate the fundamental role of mothers and fathers as children?s first teachers, protectors and play partners because their role is central and must never be eclipsed by carers or paid professionals. Indeed, I am pleased that early-years practitioners now accept the importance of involving parents at every stage. However, because the early years have always been seen as an extension of the home environment, early-years practitioners have been seen as the poor relations in the child development world. Nursery nurses have been living proof that young children need particular support and special skills to help them to progress positively through the early challenges faced by all children.
Children are starting school earlier and earlier and nursery nurses provide the bridge from home to school. Whether in school, nursery or other settings, nursery nurses have provided the essential understanding of early child development, which has sometimes been lacking. Primary school teachers may end up teaching reception classes or even nursery classes without specialist training and I am pleased that the Government intend to change that and to insist that all teachers have specialist training in crucial early-years education. Nursery nurses are invaluable as experts in their field.
Happily—and after a long time—we now have a Government who value early-years education and recognise its huge impact on the lifelong potential of children, particularly those from disadvantaged homes. Replacement of the previous Government's nursery voucher scheme was a welcome first step. It created damaging competition between schoo1s, playgroups and private nurseries for early-years pupils. Many pre-schools have closed since 1995 and only recently has the number of pre-school places increased under this Government.
Competition between the different providers led to schools hastily setting up nurseries and nursery classes to capitalise on vouchers when many were ill prepared to do so. I am concerned about the child-adult ratio that
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frequently exists in the school setting, which is often less favourable than in private settings. The establishment of a partnership between the voluntary, private and state sector through the early-years development partnerships is a welcome change. Some partnerships work better than others, which is to be expected at this early stage, so I welcome the Government's appointment of advisers to help these early-years development partnerships.
The boost that those partnerships will give to the training of early-years practitioners, be they in education or in child care, will be crucial. The national framework for qualifications, which was launched in September 1999, rationalised the existing 1,600 qualifications and gave individuals and employers clear information on the qualifications that are appropriate to different jobs. That is a good start, but in its recent report on early years, the Select Committee on Education and Employment, of which I am a member, went further. It recommended national targets for training, so that within 10 years all early-years practitioners will have appropriate specialist training, and all heads of centres and nurseries will be graduates or of an equivalent level. Moreover, all early childhood workers should be at national vocational qualification level 3 or equivalent.
That is not the entire story. Continual professional development is also a must. It is not easy to keep abreast of new developments, especially given that many child care workers have their own family and care commitments. Professional development should be a right and should be available flexibly. It should be available during the day in flexible training packages—including distance learning, workplace learning and modules—to allow qualifications to be built up progressively, and to increase access to training across all sectors of child care and early-years provision.
I welcome the Government's efforts to expand training in early years, and their commitment to provide appropriate training and development in early education for all qualified teachers and practitioners by 2004. Access to an average of four days relevant training for all early-years practitioners is crucial, but it is not enough and should be expanded further. For too long, early-years practitioners have been the poor relations of other education practitioners who get Baker days and associated training packages that help them to develop their professional expertise.
If we are to improve the quality of early-years provision, the dissemination of good practice is vital. I am excited at the prospect of helping to develop a rural sure start for pre-four-year-olds in my constituency, but we should not underestimate the difficulty of building such a project in areas where little infrastructure exists. Ensuring that rural villages and towns have the benefit of early education and health intervention will be a real challenge, especially in low-income areas. In practice, the so-called rural idyll can mean isolation and poverty. That is particularly true now of rural areas that face the devastation associated with foot and mouth disease.
I want to see a huge expansion in good-quality and affordable early-years provision. I am grateful to the Minister for supporting the expansion of nursery classes in Leek within the All Saints and Beresford schools, which are in my constituency, but we need to go further. Nursery nurses have blazed a trail for early-years education, and working as part of the early-years team

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they have played a vital role in its expansion. I should stress the need for teamwork. Nursery nurses must be involved in planning. monitoring and developing good practice, and in helping to develop the skills of colleagues, including classroom assistants. In my view, the role of classroom assistants is underdeveloped. Schools such as Kelvin Grove—of which I have been a governor for many years, and which was the most improved primary school in London last year—have used classroom assistants creatively. They should not be left out of the equation, but they are often an undervalued part of the team. They are usually paid on local government manual pay scales, so their pay is low and their training can be neglected.
Nursery nurses have a different role, but I believe that classroom assistants can complement them. We must have a proper strategy for developing the skills of classroom assistants and nursery nurses as part of a ladder of qualifications through to graduate status.
I should like to see more men in early-years education to teach young boys at an early stage that learning is for them too. Unusually, a private nursery in my constituency, Nursery Thymes in Craigside Biddulph, has helped to develop young men interested in entering early-years education. I am delighted that it is successfully developing that interest among young men. Of course, the boys who attend the nursery also benefit, so it should be congratulated on its initiative.
Nursery nurses have shown us the way in early-years care and learning; we owe them a great deal. However, we must ensure that that message is expanded. We must ensure that the important role played by nursery nurses and early-years practitioners is properly rewarded and recognised because they play a crucial role that complements parents in developing young children's early lives. I should be interested to hear how the Minister anticipates that qualifications in early-years education will be developed so as to improve pay for nursery nurses and other early-years practitioners.
9.42 am
Mr. David Lepper: I should begin by declaring an interest: my daughter is a qualified nursery nurse. Throughout her career she has worked in a private-sector nursery. I hope that that will not be seen as the only reason why I feel that it is important to debate the topic. I congratulate my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) on securing today's debate.
I echo my hon. Friend's remarks about the importance of the Government's national child care strategy. It has been welcomed by everyone in the education sector and by many parents in my constituency. Last week, the Minister had the opportunity to meet some of the people involved in early-years education in the Brighton and Hove local authority area, and I know that the comments that she made to our local press were valued by those people. I add my congratulations to those working in my local area.
The Brighton and Hove early-years development and child care partnership offers an example of good practice to other parts of the country. Its regular
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newsletter "Partners" informs those working in early-years education and parents about services. As my hon. Friend said, partners form the keynote of a strategy that involves a partnership between the state and private sectors. The Government's laudable ambitions for early-years education need a relationship with the private sector.
In Brighton and Hove, we have secured a free nursery place for every four-year-old and we are making progress on our commitment to provide places for threeyear-olds. Thanks to additional funding from the Government, we hope by April this year to be able to offer a place to all three-year olds from the term after their third birthday. We are making progress toward achieving our ambition—and the Government's—that a free place should be available to all three-year-olds by 2004.
My interest in early-years education was sparked not only by my daughter's job, but by the suggestion made last year that the name of the job done by nursery nurses be changed. Many people in the profession were surprised and dismayed by the suggestion that their job title should be "classroom assistant" or "teaching assistant". My hon. Friend talked about the important role of classroom assistants and teaching assistants and the way in which that role should be developed, expanded and given greater recognition. However, nursery nurses were hurt by the notion, which seemed to come from Government sources, that their role was merely to provide assistance, whether in a nursery classroom, reception class or private sector nursery.
I was interested in the wealth of correspondence published in Early Years Educator magazine from practising nursery nurses who were shocked and dismayed by what appeared to be undervaluing of their professional status. In the course of that correspondence, Dr. Vivian Robbins of De Montfort university described nursery nurses as the invisible profession, relied upon throughout early-years education, but often overlooked in terms of professional status and qualifications.
The role of nursery nurses is extremely wide ranging. I received a letter from a Brighton and Hove resident who works not in the Brighton and Hove education authority area, but under East Sussex county council. She said that, in the course of any one day, nursery nurses have to
"teach, care, comfort, change children, be first aiders, prepare activities, plan work, display work, clean up, set up equipment, have a detailed knowledge of early learning goals, have meetings, speak to parents/carers, carry out assessments of children, liaise with other professionals and carry out individual responsibilities relating to the job. We do not get paid for our one hour lunch break, during which we usually manage to sit down for half an hour."
That is an interesting summary of the range of educational and caring responsibilities that are common to any nursery nurse in whatever setting she works. As my hon. Friend suggested, the profession is largely female, and I echo her sentiments about the need to attract more men in to the profession.
More than merely the name of their job lay at the heart of the concertns expressed by many nursery nurses last year, but that issue was symptomatic of their feeling that their professional expertise, acquired during two or

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more years' training, is not properly recognised. That expertise is vital to the success of the Government's strategy, which I am sure all hon. Members support.
There are two related issues, the first of which is pay. The basic scale from 1 April last year for nursery nurses in schools ranged from £9,531 to £12,444. For most nursery nurses working outside London and its fringe areas, the second figure is the maximum that they could hope to earn, irrespective of their qualifications. Although there are higher pay scales for nursery nurses working in social services departments, the majority working in education feel that the main pay scale does not sufficiently recognise their training, expertise or experience.
We can understand that feeling if we examine the new earnings survey carried out in April 1999, which examined the average earnings of many related professions. At that time, the average earnings of nursery nurses were £10,777, whereas the average earnings of classroom assistants, who probably have far less training although, no doubt they bring other expertise to their work—were £10,385. The difference, which is just a couple of hundred pounds, does not recognise the qualifications of dedicated nursery nurses. The Professional Association of Nursery Nurses has recommended that a pay scale of between £11,628 to £18,000 would be reasonable recognition of the professional status of a nursery nurse.
I have been talking about pay in the state sector, but the picture is quite different in the private sector, where pay often depends on the whim of the manager or owner of the nursery. Often, nursery nurses working in the same nursery have no idea of differences in pay between colleagues because there is no clear pay structure. My daughter, who works in a private sector nursery, has had a different experience. Her nursery has developed a clear pay structure that recognises training undertaken since employment. It is a pity that many other private sector nurseries do not follow that example.
Career structure, like pay, is important. Many nursery nurses felt that the Government's suggestion that nurses who want to earn more or increase their professional status ought to train as teachers might appeal to some. However, the survey suggested that the majority of women and men in nursery nursing are doing that job because it is the job that they want. They do not want to be teachers, but prefer instead to concentrate on a particular age group and use the skills that they learned during training.
There is a need for a career structure. My hon. Friend outlined some of the proposals that Government agencies have made on the recognition of qualifications. That is a step forward, but I suggest that the Government take a leading role in that respect. I recognise that the Government car not intervene in the relationship between employer and employee in the private sector, because that is a matter for nursery staff and their employers, but they should indicate the direction that ought to be taken.
The emphasis must be on partnership. The Minister's letter to nursery nurses, which said that the role of nursery nurses was to support teachers in primary, secondary and special schools, suggested a lack of understanding of the professional role of the nursery nurse. Obviously, nursery nurses provide support, but they often take a lead role in their institution as well.
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My plea is that the Government play a clear and leading role in bringing together the public and private sectors to work on creating properly recognised career structures and pay scales across both sectors. I shall be interested to hear the Minister's comments. Nursery nurses are the valuable people on whom we will rely to deliver the child care strategy of which the Government can be justly proud.
9.56 am
Helen Jones: I congratulate my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) on securing the debate and my hon. Friend the Member for Brighton, Pavilion (Mr. Lepper) on the work that he has done to raise the profile of the subject. The child care workers whom we are discussing are an important but often neglected group who have an important role to play in the Government's agenda on raising standards. Nursery nurses work in a variety of settings, but I will concentrate on their role in the early years, when they can and do play a part in improving standards for our youngest children.
My hon. Friend the Member for Moorlands mentioned the Select Committee on Education and Employment report on early years. The Committee, of which I, too, am a member, emphasised clearly that the early years—from birth to five—plus are crucial in determining a child's life chances. That had been said before, and all the evidence that we received confirmed it. My experience as a secondary school teacher has led me to think that more money invested in the early years would lessen many of the problems that emerge at later stages of education. The Government, to their credit, have recognised that and, starting from a very low level of provision, they have done much to improve early-years provision. However, it must be recognised that, unless we can recruit and retain qualified and well-motivated staff, we will not be able to raise standards of provision. The Select Committee stated clearly its desire for integrated provision across health, education and social services.
We received much evidence regarding the importance of involving parents as partners in their children's education, especially in the early stages. However, that would require far more early-years staff than have previously been employed, they would need a range of skills to deal with the social, physical and intellectual development of children, and they would have to work proactively and constructively with parents, many of whom may have had a poor experience of the education system. In some settings, such as early excellence centres, parents are encouraged to learn and take courses themselves.
The job of working with young children, especially in disadvantaged areas, giving confidence to them and, in some cases, to their parents, is not one for a gifted amateur. There was much debate about that in the Select Committee, as my hon. Friend knows. The job requires staff who are highly skilled, take a broad view of education and recognise the importance of developing their own learning. We hear much about teachers in those settings, but not enough about the nursery nurses who work with them. Those who have worked in the education sector know that teachers and nursery nurses work as a team, and that the nursery

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nurse does not have merely a support role. They also know how much teachers value the nursery nurses who work alongside them.
In practice, nursery nurses are involved in planning, assessment and record keeping, as well as dealing with parents. They are increasingly involved in delivering the national literacy and numeracy strategy. We require a lot from them. Despite that, theirs remains a low-paid, low-status job, with the low pay deriving from that low status. As my hon. Friend the Member for Pavilion said, the average salary of a nursery nurse in education is just over £10,700, and the maximum that she can earn, whatever additional qualifications she may have, is just over £12,400.
It is no wonder that the Select Committee heard repeated evidence of the difficulties of attracting men to work in the sector. There is a gender issue, springing from the view that the job done by a nursery nurse is somehow an extension of women's natural role—that it is just a caring role. As a mother and a teacher with a higher degree in education, I have to say that I would not last five minutes in a nursery. I could not do the job.
Mr. Phil Willis: I would last even less time.
Helen Jones: Yes, so it is time that we valued properly the skills of those who do the job.
The Select Committee was adamant about the need to recruit a stable and highly qualified work force. We want to have a qualified teacher in every setting, but we also want a ladder of qualifications to ensure that nursery teachers can progress to a qualification equivalent to that of a qualified teacher. I am convinced that the key is not only to improve the qualifications of those staff who are currently poorly skilled, but to provide a proper career structure for the qualified nursery nurses that we have. At present, even if a nursery nurse obtains an additional qualification such as an advanced diploma in child care and education, it makes no difference to the sort of job that she can do or to the pay she receives. It is that lack of career structure that leads to a high turnover of staff and difficulties in recruiting men into the profession.
Members of the Select Committee were impressed with what we saw in Denmark. Pedagogues are a separate profession, trained to deal with children in the early years and in after-school activities, with a proper, recognised and valued qualification, and a pay scale that is almost on a par with that of qualified teachers. Unless we work towards a similar structure in this country, we shall neither achieve what we want to achieve in early years nor attract and keep the right staff. We should aim to put our best teachers and nursery nurses into the early-years sector, where they can do the most good.
I hope that the Government will consider that proposal seriously. Nothing will happen by telling nursery nurses that they can go on to become teachers. That approach does not value their existing job, nor does it recognise the different skills that they bring to a classroom or an early-years setting. I hope that the Minister will say something about improving the pay of nursery nurses. We need a proper job evaluation scheme
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to examine what nursery nurses do. I hope that other measures to provide an interim boost to pay will be considered. It says much about our priorities as a country—we are all involved—that when money was given to improve pay in higher and further education, it was given to all staff whether or not they were lecturers, whereas similar action was not taken in early-years education. Perhaps it is time that we lobbied my right hon. Friend the Chancellor for the money to do that.
I hope that my hon. Friend the Minister will comment on the problem of nursery nurses being replaced in some settings by classroom assistants. I valued the classroom assistants with whom I worked when I was a teacher—in fact, I valued them so much that one of them is my son's godmother. However, they are not the same as qualified nursery nurses and they do not do the same job. The current practice of many local authorities of replacing nursery nurses with unqualified classroom assistants or making nursery nurses take jobs as classroom assistants on lower pay cannot be allowed to continue because, in the long term, that is detrimental to good education.
I am not merely talking about the pay and conditions of one group of people, important though that is. It is crucial to raise standards and to deliver the Government's agenda on social exclusion and poverty. Unless we retain the right staff, we cannot deliver what we want to achieve. I hope that my hon. Friend will take that on board and that, in future, we can raise the profile and status of such key child care workers.
10.6 am
Mr. Phil Willis: It is a rare privilege for me, either here or in the House, to be able to agree with virtually every word that has been spoken. I, too, congratulate the hon. Member for Staffordshire, Moorlands (Charlotte Atkins) on introducing such an important debate. The quality of the contributions from the hon. Members for Brighton, Pavilion (Mr. Lepper) and for Warrington, North (Helen Jones) emphasised the seriousness and importance of early-years development. The only matter that I question is the title "nursery nurse". It is outmoded, as the hon. Member for Pavilion said. A more comprehensive title is "early-years learning assistant", but I urge the Government and their spin doctors to work out an appropriate title with the Department for Education and Employment.
As a member of an opposition party that has been committed over the years to early-years education, it is important to put on the record our support for the Government's actions. It would be churlish not to recognise the framework that has been put in place during the past four years. I am sure that the hon. Member for South Holland and The Deepings (Mr. Hayes) agrees that nursery vouchers were an abomination. They have now been abolished. We have got rid of the ludicrous idea of creating a market place within early-years education and turned rightly to a comprehensive framework for early years that brings together the voluntary and the state sectors into one organisation.
The early-years and child care partnerships in the North Yorkshire county council area, in which my constituency is situated, have provided opportunities, particularly in some of the remote rural areas, which

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until now often had only scant provision. We must recognise that. I am delighted that, during this Parliament, the Government have adopted Liberal Democrat policy on free places for a11 three and four-year-olds. It is always good to see the Government adopt ideas that we proposed in our manifesto. It shows great strength on the part of the Minister and her colleagues that they have done that.
The provision of places for three-year-olds by 2004, however, is a target that lacks vision. Given the resources at the Government's disposal, and the money that tomorrow the Chancellor will undoubtedly give to all who need it, delaying the introduction of free nursery places for three-year-olds until 2004 is a step that I hope that the Government will revisit. I am not making a cheap point, but I am sure that the Minister will recognise that a significant number of early-years settings are struggling desperately, given the resources that they receive. Despite what the hon. Member for Staffordshire, Moorlands said, there is still a drive by schools—particularly primary and i infant schools—to hoover four-year-olds into school settings.
I was especially interested in the Lady's comments about staff-child ratios. If I understood her correctly, she said that the Government were; committed to a uniform structure for such ratios. If the Minister will clarify that point, particularly with respect to four-year-olds in schools, it will be a remarkable achievement from this morning's debate. I strongly disagree with the Government that it is acceptable to set rigid ratios in early-years settings that are not schools, but that such ratios should not to apply to schools themselves. If the hon. Lady has advance information of the contents of her party's manifesto, I should be delighted if they could be revealed today. If the uniform structure is included, the Minister will have my wholehearted support.
We should move on from the subject of universality and, rather than simply looking at quantity, we should feel the quality. A satisfying aspect of the debate has been that all those who have spoken have mentioned raising the quality of the settings. Liberal Democrats support that. However, I ask the Minister to clarify what resources are being used to support quality and training. There is clearly confusion about the announcement on 27 February by the Minister and the Secretary of State about the £58 million that was allocated for additional training. Will the Minister confirm that £30 million of that money is coming from Europe, and that such resources have not yet been accessed? If she says that we have the money, that is great, but it is not Government money, it is money from Europe. Although I welcome the money and the fact that we are receiving resources from Europe, I hope that the Minister will clarify where the re sources are going.
Will the Minister also clarify how much of the £113.5 million, introduced as part of the comprehensive spending review for 2001 to 2004, will be used for training? [Interruption.] I believe that the Minister said that all of it would be used for training, but the press release clearly states that a lot of the money will be allocated for recruitment and advertising. That is a separate budget, and I do not regard it as training.
I understand that some £57.5 m Ilion of the £113.5 million announced in the comprehensive spending review is allocated specifically for training. Will the Minister make it clear that 47 per cent. of that—some
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£27 million—will have to be found from the budgets of local education authorities because of the match funding arrangement? That money is not Government money, but will require local authorities to pay more. The Government cannot claim to be spending such large sums of money when a significant amount—about £90 million—is coming from other sources.
The two press releases show confusion about the Government's training targets. I totally support the Government's ambitious targets to professionalise early-years settings. As hon. Members have said, for far too long it has been accepted that anybody can teach in such settings and that training does not matter. I reject that view, and I hope that we can clarify the matter.
On 27 February, a DFEE press release stated that new resources would provide enough
"to recruit a further 150,000 childcare and early years workers by 2004."
The Minister confirms—she nods from a sedentary position—that the resources referred to are for training, which is welcome. However, the press release that accompanied the comprehensive spending review stated that the Learning and Skills Council's target for training was 230,000 workers for child care and early-years education by 2004. Are those figures coterminous? Is the figure of 150,000 part of the 230,000, or is it 150,000 plus 230,000? If the latter is the case, I congratulate the Minister, because that ambitious target goes beyond my expectations.
I presume that the Learning and Skills Council will provide training for 230,000. Will the Minister put on record what additional resources have been given to the council for that purpose? My investigation reveals that its budget contains no additional resources for that element. If the Learning and Skills Council is to rob Peter to pay Paul, will the Minister be kind enough to let hon. Members know where the cuts will be—in the funding of sixth forms perhaps?
Will the Minister tell us to what standard the training will be done? If the figure is 230,000—we will keep with the Learning and Skills Council target for the moment—to what level will people be trained? Will they be trained to level 2, level 3 or, as many have hinted this morning, do the Government want to see more graduates in early-years settings? A breakdown of the figure would be useful because the level of training often determines the cost. Therefore, one cannot have one without the other.
On the same theme, how will the training costs of people in the voluntary sector be met? The voluntary sector felt enormously let down by the Select Committee's report. It was not that the report did not emphasise the need for training—the voluntary sector, especially the Pre-school Learning Alliance, supports the idea of training—but Government announcements make virtually no mention of resources to reflect the need to help the voluntary sector with training costs.
Staff in virtually every small voluntary sector early-years setting that I visit tell me that they cannot afford to let staff go on training courses because they do not have the wherewithal to cover supply costs. Indeed, there are often no supply teachers or nursery nurses available. I would be grateful if the Minister would tell us how the voluntary sector is to be supported.

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The Select Committee should be applauded for the emphasis that it rightly placed on training in its report. If the figures materialise at the levels that I mentioned earlier, the Government's response marks a turning point in the professionalisation and training of staff in early-years education. However, I need to explore that a little. There appear to be two level 3 NVQs for early-years training. There is the traditional National Nursery Examination Board route, which is tried and tested, and is recognised in the market place. The second principal route is the diploma in child care and education at level 3.
I disagree with some of the comments made earlier—especially those made by the hon. Member for Warrington, North—about the Government's agenda for growing professionals. It is an exciting agenda. People can leave the process at whichever stage they desire, but it creates a real opportunity to grow professionals from inner-city communities, not only in education but throughout the public sector. There will never be enough "middle class" people who want to work in inner-city areas, so we must encourage growth from within. I hope that that is not an either/or situation, but that both options are possible.
Does the Minister agree that, given the present structure, it is virtually impossible to move from level 3 to level 4? A level 4 NVQ in early-years education has been on the cards for some time, but one of the criteria for people moving from level 3 to level 4 in that course is that they must be in a management position. In reality, the vast majority of people who work as nursery nurses are in not management positions but support positions. I do not decry that, as it is right and proper that people should occupy such positions but, if they want to move on, we must remove artificial barriers rather than erect them. Will the Minister outline the Government's policy or vision for progression from level 3 to level 4?
Will the Minister respond to some joined-up thinking? I am sure that she has read the national skills taskforce reports word by word so that they are emblazoned on her heart, especially the significant piece of work by Chris Humphreys published last year. The final report stated that our major problem was with level 3 qualifications. One cannot disagree with that conclusion as, behind Greece and Mexico, this country has the fewest people qualified to that standard in the first world.
The report made two recommendations. The first was that people should have access to training at level 2 throughout their lives and the second was that 16 to 24year-olds should have access to free level 3 training. My party supports those recommendations and argued during consideration of the Learning and Skills Bill that the Government should support them. The Government rejected them at that time because the Chancellor had yet to unlock his war chest and provide additional resources. Does the Minister intend to press for that level of commitment for training at levels 2 and 3? Many people—certainly in my constituency and the others that I visit—find the costs of training prohibitive, especially in the private sector. Such a commitment
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from the Government would unlock an enormous amount of potential at the crossover to which I referred and give people free access to child care training.
Another question raised by the national skills task force and many of the national training organisations is how people may receive the right to time off for study. In the Teaching and Higher Education Act 1998, the Government committed themselves to giving 16 to 19year-olds without level 2 qualifications the right to time off for study. An extension of the right to time off for study, if it is paid for by the state, will be of enormous help to the voluntary sector, which desperately needs support in training its staff.
The hon. Member for Pavilion made a tremendous speech about pay. I applaud his critical comments about the Government's policy on pay. He was right. Pay cannot be ignored. We cannot talk about a high-quality early-years setting, valuing people and giving youngsters a flying start, while we pay people at appalling levels. we are not only talking about salaries in the state sector or local authority settings. Pay levels are extremely low in the voluntary sector. I visited two early-years settings, one on the Stockwell estate in Knaresborough, and one on the Knaresborough Road estate in Harrogate, both of which questioned the minimum wage because they could not afford to pay it to their staff. I said, "My goodness, you must afford it, and you must go beyond it." We must tackle that issue. How do the Government intend to ensure that people in the voluntary sector who receive training and develop their expertise are paid appropriately for the job and are not expected simply because they live in rural or poor areas to do the job for the love of it rather than as professionals?
10.26 am
Mr. John Hayes: I echo the welcome given to the debate. The hon. Member for Staffordshire, Moorlands (Charlotte Atkins) deserves our congratulations. She has achieved what few could. For some time I have been pressing the Government for a debate on early years on the Floor of the House, and I have written to the Secretary of State on the subject. He tells me that he is discussing the matter with the Leader of the House, and I hope that we shall have such a debate. I am delighted to see the Minister nod.
I should declare an interest in that I have an adorable three-month old son, who is a potential client for early-years education. Despite my enormous respect and affection for you, Mr. Jones, given the choice of being here with you or holding him in my arms, I would have him in my arms. Notwithstanding that, I turn to the job in hand.
There will be little debate or disagreement in the Chamber about the importance of early-years education. Since I became a member of a local education authority many years ago, I have held the view that early-years education is vital, and all hon. Members who have spoken in the debate have made that point. We understand and apreciate the importance of early-years education. The hon. Lady said that it has an impact on lifelong potential, which was an apposite phrase. We also know from Select Committee evidence that early-years education is important, and the hon.

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Lady and others are right to say so We know from academic work on child development and early learning that the first interface and experience of learning and socialisation has a significant impact on subsequent progress. We are all happy with that conclusion.
Provision is, however, patchy. Genuine problems are experienced in securing access to early-years education. The hon. Member for Harrogate and Knaresborough (Mr. Willis) rightly drew attention to the problem in rural areas, and mentioned north Yorkshire. The same would apply in many parts of Lincolnshire, including my constituency, where access to early-years education is difficult simply because of physical issues, such as travelling, especially from remote and sparsely populated areas, to sources of such education.
The problems of patchy provision are significant and also apply to some inner-city areas and social groups. Take-up of early-years education among some minority groups is much lower than for the majority population.
Parents have different expectations for their children and different requirements for early-years provision. That may be because they have a particular view of what is right for their child or because of their personal circumstances. All sorts of factors impact on people's opinions about what they want. There is no uniform demand; different parents have different demands in different parts of the country.
Parental involvement and the link between home and school are also vital. The hon. Member for Warrington, North (Helen Jones) referred to the select Committee's findings in that respect. My discussions with teachers have shown that that is a real problem n in many schools and communities. It is an important aspect of addressing the issue of early-years provision, and I shall deal with that in respect of the trends and changes that have taken place under the Government's stewardship.
We also understand that a child's experience should not be merely about learning. Play, for example, is an important feature of the early-years experience. Rigidity and formality in early-years education are not always desirable. The education provided requires a degree of flexibility and informality and, certainly, a high level of diversity. The hon. Member for Moorlands, in an unfortunate remark, talked about damaging competition. I am not entirely happy with the concept of damaging competition. I am not so arrogant as to believe that any single solution is the right one in every circumstance on every occasion. Diversity of provision is needed not only to allow for choice, but, more importantly, to allow for a variety of approaches to develop and prosper in order to identify best practice.
Charlotte Atkins: The damaging competition was drawn to the Select Committee's attention by the Pre-School Learning Alliance, which complained that school settings were taking potential pupils and making pre-schools unviable. That was the damaging competition in question, which the alliance felt was unfair.
Mr. Hayes: Now that the hon. Lady has made her position clearer, I endorse what she says. She is right to say that in many ways there is less choice than there was four years ago, which I shall illustrate later. That is because of the unfair and unreasonable competition
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from schools, as a result of which the number of alternative providers, especially playgroups and preschools, has shrunk dramatically during the past three or four years.
Flexibility and diversity in the sector, to which the hon. Lady alluded, are genuine concerns. It is true that parents want choice, and it is true that diversity has diminished. The facts are clear enough. The Minister will remember that, in November last year, I asked her what had happened to the number of pre-school and playgroup places under this Government. In a clear and frank answer, she told me that there were 30,000 fewer places than in 1997. She will also know—although it was not included in her answer—that the number of providers has reduced dramatically. According to one of the provider organisations, there are nearly 20,000 fewer providers. I would be interested to hear the Minister's precise interpretation of that.
There is a danger that we are producing uniform, vanilla flavoured provision. Perhaps that has been caused by the damaging competition that was mentioned by the hon. Member for Moorlands. The matter needs to be addressed, and I wonder whether the Government's current policy does that sufficiently, as there is no sign yet of that trend being reversed.
There are also issues concerning the diminishing level of parental involvement due to the reduction in community and volunteer provision of an informal nature. The great feature of the system of early-years provision that developed in part by accident—or, perhaps, by evolution—until 1997 was that it guaranteed a high level of self-help, community involvement and volunteering. Many parents, grandparents, and other members of the community became involved who would, perhaps, never have thought of becoming involved in a professional capacity had they not come through such informal routes. The hon. Member for Harrogate and Knaresborough talked about some of them becoming professionals as a consequence of their first involvement as volunteers, but the current policy puts that in jeopardy.
Volunteer and community involvement is diminishing, but there are also other problems, such as the difficulties of establishing private provision. The hon. Member for Brighton, Pavilion talked about the matter at length, but he did not, perhaps, have enough time to add that it is extremely difficult to set up a private nursery. A considerable amount of bureaucracy is involved. One has to be registered, secure planning permission and find suitable premises—and trying to find suitable premises in which to set up a private nursery in some London boroughs must be a nightmare. It is a lengthy and intimidating process, and many people who might wish to establish private provision are deterred from doing so.
Mr. Leppert: I hope that the hon. Gentleman is not suggesting that the highest standards of property, administration and management need not be insisted on for private sector nurseries. His remarks seem to suggest that.
I also hope that the hon. Gentleman will acknowledge the Government's introduction of the neighbourhood child care initiative, which is aimed at providing capital

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and revenue resources to help set up child care places, particularly in the 20 per cent. most deprived wards in England.
Mr. Hayes: The hon. Gentleman is correct that standards need to be guaranteed. However, I have received correspondence from someone who is very interested and committed to the private sector and who has no particular political prejudice. The letter tells of a group of people who offer early-years provision to small rural communities from a local church. They have been told that they are obliged to have low-level toilets, in other words, separate toilets for staff and children, and other health and safety facilities that are beyond the limits of many premises that are designed for general community use. Those early-years providers were using a building that was, perhaps, also satisfactorily being used for other community activities, but they have been asked to make changes that they cannot afford. That will prevent them from continuing to provide a popular and valuable service that displays good practice in an area where there is, perhaps, no alternative on offer.
A balance needs to be struck with regard to our expectations of voluntary and private sector providers between the hon. Gentleman's desire for regulation and my desire for self-help, entrepreneurship and the widest possible provision. I am sure that the Minister will want to address that.
A recent report by the National Early Years Network addressed the problem of the decline in the number of nursery schools. The Minister will be aware that that report also described the Government as opting for the "lowest common denominator" with regard to early-years provision. The report suggests that up to 100 of England's 513 state nursery schools will close because of damaging competition unless the Government recognise the service that they offer. The National Early Years Network believes that the Government's current policy is a further threat to diversity and choice in nursery schools, in addition to the threat to the voluntary and private sectors.
My next point concerns the complexity of the system. The Minister knows that there are more than 20 separate funding streams for early-years education. It is very difficult for those involved to comprehend the process and simplification is required.
The Parliamentary Under-Secretary of State for Education and Employment (Ms Margaret Hodge)indicated assent.
Mr. Hayes: I am delighted to see the Minister nodding in agreement.
The number of initiatives, new schemes and pet projects has led to a multiplicity of funding streams, which has created confusion and perhaps incoherence. We must examine that.
Perhaps the greatest indictment of the current regime, and I am angry about it, although I know that one should never become angry or animated in this Chamber, is that now, in 2000–01, more children are being taught in early-years classes of more than 30 than was the case in 1996. That information came from the
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Library, which stated clearly that, in 2000, 29 per cent. of pupils were taught in early-years classes of more than 30; in 1996 that figure was 27.3 per cent. and in 1997 it was 26.5 per cent. One result of more children being educated in reception classes and the unequal requirements for the pupil-teacher ratio, to which the hon. Member for Harrogate and Knaresborough drew attention, is the irony that the Government, who are determined to teach five to seven-year-olds in smaller classes, are teaching an increasing number of younger children in larger classes. We have heard the argument that the younger the child, the more important the direct contact with a teacher, but that is contradicted by the results of the Government's policy. I am entitled to be angry about that, not on my behalf but on behalf of the children, parents and others who feel cheated—
Helen Jones: Will the hon. Gentleman give way?
Mr. Hayes: I shall not give way because I have done so a couple of times and I want to conclude.
I am angry on behalf of those who feel cheated by that policy.
I welcome the helpful comments in the Green Paper on the Government's national accreditation scheme. I thought of that excellent idea at the same time as the Department for Education and Employment. I came up with it alone, working by candlelight, and the Department for Education and Employment matched me. I am proud of that very good idea and I welcome it. However, significant problems exist that are not addressed in the Green Paper or in anything that we have heard from the Government. They include lack of flexibility, diversity, choice, volunteering and involvement, over-regulation, bureaucracy, a multiplicity of funding streams and, as the hon. Member for Harrogate and Knaresborough said, difficulties in meeting recruitment targets.
Perhaps the Minister will refer to retention when she responds because I believe that there is an issue concerning not only graduate recruitment, but retention. How long do we retain people when they enter early-years teaching? Is that trend improving or worsening and what impact will it have on meeting targets, even with ambitious targets on recruitment? What is the balance between European money and other money? How much of the extra money targeted on the expansion is being taken from the standards fund? The hon. Member for Harrogate and Knaresborough asked whether it is new money or whether it is being taken from elsewhere, which is an important point that I want to amplify.
Can the Government assure us that they will address the issue of clarity in the funding of early-years education? We must ensure that people are not disincentivised from establishing voluntary and private nursery provision. Diversity must be allowed to continue to flower because that is the prerequisite for choice in a healthy sector.
I am delighted that we have had today's debate. I hope that the Minister will address some of my questions in her response and write to me about the remainder.
10.45 am
The Parliamentary Under-Secretary of State for Education and Employment (Ms Margaret Hodge): Like others, I congratulate my hon. Friend the Member for Staffordshire, Moorlands (Charlotte Atkins) on securing the debate. I also congratulate those hon. Members who have participated.
Two weeks ago, I had the good fortune to visit the local authority in the constituency of my hon. Friend the Member for Brighton, Pavilion (Mr. Lepper). I was impressed by the work that is being done by the partnership there and delighted that it has endeavoured to bring forward the introduction of free nursery education for three-year-olds as well as for four-year-olds in advance of national targets.
This is a period of massive expansion in services. I shall quote two relevant figures. First, we are doubling spending from £1 billion to £2 billion to secure free nursery education for all three and four-year-olds. Secondly, the Department for Education and Employment budget for child care has tripled. Furthermore, we are securing European resources and have secured a new budget of £155 m Ilion from the new opportunities fund, which will enable us to create 1 million places for 1.6 million children by 2004.
On the issue that was raised by the hon. Member for Harrogate and Knaresborough (Mr. Willis), we want to time the implementation of places for three-year-olds in a way that assures us of quality: I took that on board when we decided the timing. We could bring more resources to bear more quickly, but, if we went too fast, it would be difficult to train sufficient people to obtain the quality of nursery education that we want. Child care and early years is the second fastest growing sector in the labour market. We have added 122,000 jobs in the past three years, so we have more than 660,000 people working in it, which demonstrates the extent of the task. On top of that, we have the 150,000 additional jobs alluded to by the hon. Gentleman.
I say to the hon. Member for South Holland and The Deepings (Mr. Hayes) that competition damaged diversity. The legacy that we inherited from the previous Government led to many private and voluntary groups losing four-year-olds to the nursery sector as competition drove schools to grasp children. We have proved that competition damages diversity; cooperation through partnership enhances it.
I shall put to rest the charge that playgroups are experiencing a continuing decline. They were declining as a result of parents' changing demands and the damaging nursery vouchers scheme. It has taken time to turn that round, but, in the last year for which figures are available, nearly 6,000 extra place,, were available in playgroups. We addressed that through the way in which we distributed money for three-year-olds, the massive resources that we have given to the PLA and the money that we have set aside to help struggling playgroups. I hope that the pre-school of sector will play a role both in our new plans for neighbourhood nursery expansion and in our other initiatives.
I do not share the hon. Gentleman's negative and rather pessimistic attitude about the role of the private and voluntary sectors in the expansion of neighbourhood nurseries. I am in constant conversation with them. We are determined that they will play a
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proper and appropriate role in creating the 900 new or extended nurseries in deprived inner-city areas, giving for the first time high-quality early-years experiences to young children in need.
On the issue of nursery schools, the hon. Gentleman has missed some of what we have been doing. We woke up a long time ago to the threat that nursery schools were under, which is why we gave them specific money to look at new ways in which to extend their services and to remain part of the diverse provision that is on offer.
I have talked about expanding numbers and how we value everyone who works in the early-years sector: nursery nurses, teaching assistants and all others. Far from devaluing them, our policy is about enhancing their esteem and enabling them to participate in training and development. It is not our intention to abolish names. I say again to the hon. Member for Harrogate and Knaresborough that we are leaving that matter for people to decide locally. If he wants to change the name in Harrogate, he can do so, but the Department for Education and Employment is not taking a view on names. We are investing £350 million in the next three years not only in nursery nursing, but in teaching assistants. Many teaching assistants have the NNEB qualification, so there is some synergy between teaching assistants and nursery nurses.
Our overriding vision of the early years is about greater integration of care, education and health. Many of the traditional structures and jobs will be recreated over time to form a new early-years profession. As the early-years world becomes more integrated, nursery nurses, whom we value and whose contribution we recognise, will become part of a greater offer and fit into that greater structure. I do not want to hold on to past definitions and past professional jealousies and divisions. I want to bring the best of the worlds of care, early-years education and health together to create a new highly valued profession. That period of change has caused some tension in the teaching profession and in the nursery nurse sector.
We are tackling recruitment with energy. This year, we are spending £8 million on a recruitment campaign and we have had 60,000 calls to our telephone line since it started. We contacted the people who had telephoned six months later, so it was not a matter of hitting them when they first contacted us. Interestingly, 79 per cent. have taken action, such as looking for job vacancies, with a further 6 per cent. intending to do so; 32 per cent. have enrolled on training courses; 16 per cent. have found work in the sector; 39 per cent. have applied, attended an interview, or been successful in finding a job as an assistant in a day nursery; and 20 per cent. did the same for nursery nursing. I am proud of our efforts to bring more people into the sector.
On the issue of training, generous money is available. We are using some of the money that is available for learning and skills councils, which have traditionally trained people in early years and child care, but there is extra money from the Government and, I am happy to say, from Europe. I am delighted that we have been able to use that European money. A sum of money also comes through the standards fund—there will be a local authority contribution. The investment is massive. I shall write to the hon. Member for Harrogate and Knaresborough with the details. I assure him that included in that sum is £7 million from the Government

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and £15 million from the European social fund. It is all about unblocking the barriers to training, so it deals with issues such as supply cover and course costs. Training is across the private, voluntary and statutory sectors.
I accept entirely the point that was made by my hon. Friend the Member for Warrington, North (Helen Jones) about the importance of working with parents, and the additional skills and competences that are required in that regard. We are trying to build those factors into the core competence.
I am proud of the framework that we established in 1999, which recognises 16 qualifications, including the NNEB qualification. We have asked the Learning and Skills Council to train 230,000 people to NVQ levels 2 and 3. We must remember that, according to the 1998 work force survey, 44 per cent. of existing staff have no such qualifications. That is why a pot of money is being provided. It will include funds from the Department for Education and Employment and from elsewhere.
NVQ 4 is an exciting development that will provide a route—as my hon. Friend the Member for Moorlands will recall, we call it a climbing frame—to enable those with an NNEB qualification that is equivalent to NVQ 3 to progress. I do not accept that those with NVQ 3 cannot work in management. We have negotiated with a number of universities to ensure that, with a little underpinning knowledge, those with NVQ 4 can regard it as equivalent to 240 credit accumulation transfer points, which is two years off a degree. Our Green Paper makes it clear that, by 2004, we hope to be working with 1,000 people towards establishing a new senior early-years practitioner route that will be just below degree level and that will enable the desired careers progression for those who enter at NNEB level.
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On pay scales, which a number of hon. Members mentioned, there is the single status agreement, which presumably takes account of such issues, given that it was based on a job evaluation scheme. We have asked partnerships to report on pay in this year's plans and we will see what comes of that. Of course, pay is determined locally and we must work hard in the coming years to raise the status and pay of early-years workers.
We recognise that ratios in reception classes are an issue. We have said that we want a ratio of 1:15. We have invested money to ensure that, in this Parliament, the 60 most deprived IEAs can establish such a ratio and recruit more staff through the standards fund. We need to make further progress throughout the country, but there is nothing to prevent any LEA from making ratios a priority: all LEAs have plenty of additional resources to enable them to do so.
In terms of gender, we have a very distorted early-years work force. Much of that distortion relates to status and to equal pay for equal value. At the moment, only 2 per cent. of the work force consists of men. Our target is that, by 2004, 4 per cent. of those working in the early-years sector will be men. We have also set targets in respect of ethnicity, disability and age. The work force tends to be very young and we want to encourage older people.
There has never been a more exciting time in the world of early-years education and child care. We take to heart many of the issues t hat hon. Members have raised and I hope that they will accept that we are making progress. We want to work A with the private and voluntary sectors through the successful local partnerships that we have created to provide the best start for young children, which, as my hon. Friend the Member for Staffordshire, Moorlands said, makes all the difference to outcomes in their adult lives.

Neurology
10.59 am
Mr. Paul Burstow: I suspect that this is the first debate on neurology in the House for many years, and possibly ever. I have not double-checked that with the Library, but the House does not seem to have given much consideration to services provided to people with neurological conditions. On the day that I received notice from the Speaker's Office that I had secured the debate after several weeks of applications, I was delighted to hear that the Secretary of State for Health had declared the Government's intention to draw up a national service framework for long-term health conditions, with a special focus on neurological conditions.
Three million people in the United Kingdom suffer from neurological conditions—only heart disease and cancer affect more people—and one in five of all admissions to medical wards are accounted for by acute neurological cases. Despite those facts, neurology has been something of a Cinderella service in the national health service—in part because until recently little could be done beyond diagnosis and amelioration of symptoms. However, that is changing , so now is a good time to have a debate in this Chamber and to turn the spotlight on neurological services with the aim of raising them to the standard of the very best NHS services. We need to improve the standard of excellence in neurology across the whole country, so that everyone has access to good-quality services on a level playing field.
Neurological conditions result from damage caused by illness or accident to the brain, spinal column or nerves. They have many causes, many of which are not yet known, and they affect young and o1d, rich and poor, men and women and people from all cultures and ethnicities. Some neurological conditions, such as epilepsy, are lifelong and people can experience their onset at any time of life; some, such as cerebral palsy, are present from birth; some, such as muscular dystrophy, commonly appear in early childhood; and some, such as Alzheimer's disease and Parkinson's disease, affect mainly older people. Certain conditions have a sudden onset owing to accident or illness, such as head injury, stroke or cancers of the brain and spine. Neurodegenerative conditions, such as multiple sclerosis and motor neurone disease, can affect people at any age and often cause a slow deterioration of a person's quality of life and ability to live independently.
Of those conditions, some can be life threatening, most severely affect people's quality of life and many cause long-term disability. Their impact often extends far beyond the individual concerned. because they have knock-on effects on family members and others who have a caring role. Caring for someone with a debilitating illness is often such an onerous task that carers have to give up their own employment. That, added to the inability of the person with the condition to continue to be economically active, can have a devastating impact on a family's quality of life, financial circumstances and long-term being.
Today's debate is not about the needs of carers, but we should bear it in mind that they carry a massive burden, especially where neurological conditions are involved, and their role is often unstated, unrecognized
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and undervalued. It is important to say, however, that some of the Government's initiatives on carers' grants and respite care are making a difference to many of our constituents.
Neurological conditions are poorly understood. Public awareness is low, even of relatively common conditions such as epilepsy. Many rare conditions are largely unheard of and poorly understood, even by nonspecialist health professionals. That can lead to problems with the quality of initial diagnosis and the care pathways down which people are directed.
My interest in the topic has developed over the past three and a half years. It started with my constituency mailbag, through helping constituents who were battling to be prescribed beta interferon for their relapsing-remitting MS. I approach the debate from a Back Bencher's perspective, having been struck by the patchiness of the provision of services across the country. There are wide variations in access to services, not only for MS, but for the whole spectrum of neurological conditions.
That interest led me to undertake a survey of NHS trusts last year. I am grateful for the support given to me by the Neurological Alliance, especially Nikki Joule, and for the advice of the Association of British Neurologists in drafting the survey. Their support and advice ensured that the information gained was useful and could inform the debate about how neurological services might be better provided.
I found wide regional variations in access to neurological services—it is yet another postcode lottery. Two out of three patients wait for more than 13 weeks to see a neurologist and the average waiting time in non-urgent cases is 25 weeks. In 44 per cent. of hospitals, patients wait for as long as six months for an out-patient appointment; the worst waits to see a consultant neurologist lasted up to two years. My survey also found that six out of 10 hospitals could not offer a 24-hour response to a neurological emergency. Yet early diagnosis and treatment can make all the difference to a person's chances of recovery and a better quality of life.
The reason that access to services is so patchy is quite simple: there is a lack of capacity, with not enough neurologists to meet demand. I am sure that the Minister will acknowledge that a key bottleneck is the shortage of training places, which are needed to expand the work force and fill vacancies for neurologists throughout the country. My survey found that, on average across England and Wales, there is one neurologist for every 165,641 people. In Wales, the south-west, the north-west and the north-east, the number of neurologists is less than one per 200,000 people. Recently, a neurologist told me:
"If the UK was to have the same provision of neurologists for the population as the United State there would have to be 2,000 consultants; for the same provision as Europe (excluding the UK obviously) 1,000 would be required. In fact we have just over 200 (allowing for part time academic posts etc). Quite how this situation has been allowed to go on for decades is beyond me; we appear to be where the US and Europe were at the end of WW2. The shortage will take decades to correct."
It is hardly surprising that most patients' groups to which I spoke said that, if it does nothing else, the national service framework must address the serious shortage of neurological consultants. The Association of British Neurologists and the Neurological Alliance

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recommend that the number of neurologists must rise to a minimum of between 600 and 700—roughly double the current number—if the service is to start to improve.
Access to specialists can make an enormous difference to how an individual copes with diagnosis, especially as the specialist can explain the progression of the condition and the options for treatment. That shortage, however, masks a deeper problem: the shortage of sub-specialists. There are only 60 consultants in the whole country who have specific expertise in Parkinson's disease, and fewer than 40 who specialise in treating MS. The rarer the condition, the scarcer the expertise. I wonder, for example, how many neurologists specialise in progressive supranuclear palsy.
In neurology, access to specialist centres is, a key way to make effective use of NHS resources and give patients the chance to receive the best possible care. I hope that the national service framework will address that. The current out-of-area treatment scheme, OATS, is often an obstacle to appropriate treatment. Many trusts have suspended specialist procedures unless they are under contract or being paid for privately. Many patients who have been referred to specialists under OATS are put on waiting lists that continue to lengthen.
Some patients' home health authorities have offered to pay for operations, but trusts refuses to perform them because there is no mechanism for funds to be transferred to them. Occasionally, trusts agree to undertake an operation, but only after much correspondence and often when hon. Members and others have lobbied on the patient's behalf. Operations have been suspended not because of lack of funds, but because of bureaucracy. I hope that that problem can be resolved, because it has put services at risk, and they are being run down. Last April, the Department of Health announced a review of OATS. It will help if the Minister can shed some light on the timing of that review and the publication of its results, so that we can see what reforms are planned and what issues are to be addressed.
In anticipation of the national service framework, I should like to raise a few issues. First, the Department of Health has asked the Medical Research Council for trials to test the treatment of Parkinson's disease through deep brain stimulation therapy. Will the regional specialised commissioning groups have complete responsibility for commissioning specialised neurosurgery? Will that be governed or monitored nationally and will it be reflected in the national service framework in future? Is there a timetable for the trials and will they account for all deep brain stimulation therapy during the trial period? Will those who opt out of them still have access to deep brain stimulation therapy? People with Parkinson's disease and the Parkinson's Disease Society of the United Kingdom will appreciate clarity on those issues.
Secondly, a few years ago, Scope conducted research into the effects of ageing on people with cerebral palsy and found that few sufferers visited their doctors for regular check-ups. The majority had not seen a consultant since leaving school and had not seen a physiotherapist for at least five years. General practitioners, physiotherapists, social workers and occupational therapists are often insufficiently familiar with cerebral palsy and, in short, many sufferers simply
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give up on treatment in the belief that they cannot be helped. That underlines the fact that the national service framework must address social and primary care as much as secondary and tertiary services. Primary care begins from the time of the initial referral and, alongside social services, has a long-term role after diagnosis.
The third issue relates to multiple sclerosis, which originally drew my attention to neurology. The Minister will know that new and emerging treatments can slow the progress of neurological conditions and may pave the way for even more effective treatments. For most people with multiple sclerosis, the national service framework offers the prospect of improved multidisciplinary working and enforceable standards of service. However, it will not deliver the improvements that one group is looking for. It appears likely that the National Institute for Clinical Excellence will deny access to disease modifying drugs to all or most people with multiple sclerosis who would benefit. The national service framework holds out the promise of better services for such people once they are disabled, but does not offer the hope of a brake on the progression of their disease.
At 3 o'clock on the day before the Christmas holidays began last year, after most people had gone home to start celebrating, NICE smuggled out an announcement, 10 days before its pre-programmed date for the release of the decision from its appraisal committee, which effectively kicked into the long grass its decisions on beta interferon. We will not know now whether beta interferon and copaxon will be available on the NHS until July at the earliest, and a final resolution will probably not emerge until even later. That is not acceptable. I hope that the Minister will look closely at the conduct of NICE on that day in December and its behaviour in respect of assessment of treatments. It appears to have ignored the voice of the patients, who have not been allowed to come to the table and express an opinion.
Fourthly, the Minister will know of the value that patients and patients' groups place on access to specialist nurses. The Multiple Sclerosis Society and the Parkinson's Disease Society contribute to the funding of a growing network of specialist nurses. That network should force us to examine how such nurses are supported, trained and funded in the NHS. While it is welcome that charities make contributions to the funding of such posts—in many cases, they fund them fully—in the long run, the NHS, in the context of neurology, must properly support the service.
The Department is addressing the recruitment and training of specialist nurses and considering how to ensure that commissioning bodies take such matters into account. Will the Minister say what progress has been made in the review of specialist nurses? When is that review likely to be concluded? Will it be affected in any way—I hope that it will not—by the national service framework? Time is pressing and clarity is needed sooner rather than later. The national service framework, which will be published in 2005, is welcome, but too far in the future.
Fifthly, I have received strong representations from several groups in respect of pain management in the NHS, about which, as the Minister may recall, the House had a debate last year—although it was held late in the evening and was therefore almost as well attended

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as today's debate. The issue is important, but not often debated in the House. The point has been made to me forcefully that chronic pain should be included within the national service framework. Given the prevalence of chronic pain in the UK, it is surprising how poorly coordinated services remain. At best, a person can hope to be referred to a pain management course after a long wait; at worst, he can find himself being passed around the specialists and offered a range of different medications on a trial and error basis until something turns up that might alleviate the pain.
My final point relates to the prevalence of neurological conditions generally. I mentioned at the beginning of my contribution that 3 million people in this country suffer from neurological conditions, but the truth is that we do not know precisely how many there are, because no method exists for recording the diagnosis of neurological conditions. There is no disease register or systematic means of capturing such information, even though that information would be invaluable to effective research and deepening our understanding of such conditions, and must be central to effective commissioning of services at a local level. As a starting point, the national service framework must include better recording of prevalence in the population, so that we can allocate resources according to need.
Patients' groups have an important role to play in the development of all national service frameworks, not least in the context of the national service framework for long-term conditions. Umbrella organisations play a key role in that work by bringing together the disparate interests that a national service framework often covers. I suspect that that will be the case when the Government and the Department begin their detailed work on the national service framework. The Secretary of State has given a welcome indication of willingness to provide extra support for umbrella organisations, to facilitate their task of engaging in robust and real dialogue with Government, but it would be useful to know whether the Department and Secretary of State would be minded to provide additional resources to facilitate the involvement of non-governmental organisations in the preparation of national service frameworks. That would be helpful to the Neurological Alliance and other Nongovernmental organisations with interests in other national service frameworks.
As the national service framework under discussion is likely to cut across already existing national service frameworks—especially those covering older people—it will be important to have cross-sector interests represented in the process to deal with those concerns. We must make sure that there are no gaps between the various national service frameworks. It will be interesting to hear how the Government will ensure that such gaps are not created.
I understand that the national service framework is unlikely to be published until 2004, and that it is intended that it will be implemented from 2005. It is essential that the Government's commitment to producing that national service framework in no way derails existing work that will benefit people with neurological conditions. I shall cite three examples. First, in a debate a couple of years ago, the Minister of State, my hon. Friend the Member for Barrow and Furness (Mr. Hutton), referred to the production of a compendium of good practice for GPs and primary care
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groups on the commissioning of neurological services. Publication of that compendium is a year overdue; when will it be published? It will be an invaluable aid to primary care trusts and others who have a responsibility for commissioning, and the sooner it is being used, the better.
Secondly, the National Institute for Clinical Excellence is to begin work on clinical management guidelines for MS for publication in 2002. I have made some representations about the pace at which NICE intends to proceed. Given the range that must be covered, it is important that its work is not lost within the work on the national service framework. Thirdly, I have referred to the Department considering specialist nurses in neurology; it will be useful if the Minister can say when that work will be promulgated.
The national service framework and the other work that is in train within the Department are welcome. I introduced today's debate because the findings from surveys show that we have a long way to travel to reach the standard of service that the Government and all hon. Members want for people with neurological conditions. We need a people-centred approach that develops services around individuals and builds on the ideas in the national health service plan. We must ensure that an appropriate multi-disciplinary range of services follow people throughout their lives, and that services are at all times tailored to be appropriate to their needs and those of their carers.
11.21 am
Dr. Peter Brand: I congratulate my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) not only on securing the debate, but on setting out the reasons behind it so clearly and excellently. I am disappointed that there has not been an enormous Back-Bench contribution to the debate, but his speech makes up for that.
Mr. Desmond Swayne: It is quality that counts.
Dr. Brand: It is.
My hon. Friend has made many valuable points, but I shall concentrate on a few. The national service framework is welcome, but I hope that it is not an alibi for not proceeding with the planning and thinking surrounding the diagnosis and treatment of neurological conditions. Over the past few years, the world of neurology has moved on tremendously. Some 30 years ago, when I trained, cerebral doctors who seldom handled patients considered it to be an intellectual exercise. That was probably appropriate because there was little that they could do.
Neurologists tend to be people who wear extremely expensive suits and silk ties and spend much of their time in Harley street. In fact, the man who taught me the Babinsky reflex, which is the awful test where doctors tickle the sole of a person's foot to see which way the toe goes, said that the only implement that should be used to carry out such a test satisfactorily was a Bentley key. Since then, I have never aspired to neurology, or to a Bentley, given that I did not think that owning such a key was appropriate.

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My hon. Friend was right to point out that neurology covers a wide range of diagnoses. Neurological illness can result from catastrophic events, accidents, intercranial bleeds, nerve injuries during accidents and conditions that are either contracted in utero or around birth, such as cerebral palsy. Indeed, some conditions that appear in the first six to 12 months after birth are difficult to distinguish from the effects of immunisations going wrong. Many neurological diseases are neurodegenerative diseases, such as Parkinson's disease, MS, motor neurone disease and the big condition of Alzheimer's, which is not a uniform disease and requires diagnosis.
It is important to recognise that, although much more can now be done about neurological conditions, it is no good taking a scatter-gun approach to treatment. A precise diagnosis is required. In that sense, we have progressed tremendously over the past 10 to 20 years. It is no longer acceptable for a condition such as epilepsy to be treated by taking the approach that might be taken in cookery: trial and error, starting with a dollop of phenobarbitone, going on to a dollop of epilem, and over five years a suitable drug regime might be found. It is important to have precise diagnoses and not to rely solely on pharmaceutical intervention. Neurosurgery now has a significant place, but only an appropriately skilled neurophysician can establish which patients are suitable for treatment and the form that that treatment should take.
My hon. Friend is right to point out that we are woefully short of capacity in diagnosis and treatment. Liberal Democrat Members have highlighted not only neurologists but the role of nurse practitioners. I commend to the Minister the role of nurse practitioners, who should be funded more meaningfully. One of our practice nurses trained as a nurse practitioner in epilepsy services, but it is difficult to secure meaningful funding for her, so that she may use the expertise that she has acquired.
Much of the work that nurse practitioners might do can also be done by nurse assistants under supervision. I shall return to that matter when I deal with the long-term care proposals that are being considered in another place.
In addition to nurse practitioners, in providing treatment, we desperately need more speech therapists. Many neurological conditions have as sequelae significant communication problems. Speech therapy has moved a long way in targeting treatment for particular conditions. It now involves not only speech therapy in the traditional sense but access to modern communication aids. A lot of electronic equipment can now be extraordinarily helpful to people with degenerative neurological diseases, but it remains hard to get hold of. When I first became involved in the matter, we had regional funds for environmental aids. That budget has now been dispersed, and in dispersal seems to have been virtually lost. I am sure that all hon. Members encounter cases in which people are denied what should be standard equipment to help with communication.
In addition to speech therapists, it is important to have access to psychologists who understand degenerative neurological conditions. Some conditions
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can be difficult to diagnose, especially degenerative brain diseases such as Alzheimer's or Korsacov's encephalopathy. The different causes of the disease are not always clear except through expert assessment such as neuropsychology.
Once a diagnosis has been made, patients should have access to a physiotherapist with a special interest in neurology, which is especially important for children suffering from cerebral palsy. It is not good enough for a small child to be assessed once and to be referred again only three years later. Much of a physiotherapist's work could be carried out by physiotherapist assistants or other carers, but expert supervision is required to check that the correct treatment is given.
I am enormously concerned about the Government's definition of what treatment is allowable under the new long-term care regulations. The Government do not recognise how the world has moved on. Care is now delivered through therapeutic teams. They may be headed by a registered nurse, but much of the work may be carried out by another health professional. It is ridiculous that only time spent by the registered nurse qualifies for funding through the national health service, not work carried out by care assistants, whether with children or with those at the other end of the age spectrum. I hope that the Government will think again about their definition because it makes no intellectual or practical sense.
We have not yet mentioned the great strides forward in diagnostic imaging. In the past, my neurological colleague with his sharp suit and Bentley key was required to perform all sorts of magic—there was also a test involving gold coins, but I have forgotten what it was. We can now be somewhat more scientific and specific by using appropriate scanning techniques. However, we still rely too heavily on charities and voluntary organisations to equip communities and district general hospitals with the necessary imaging equipment. Throughout the country, many scanners that were bought with funds raised through an extraordinary amount of hard voluntary work are coming to the end of their useful lives.
I hope that the Government will conduct an audit of available equipment to determine whether it is available in the strategic places in which it is required. Access to good scanning equipment is just as important as access to good cancer services or cardiology; indeed, scanning equipment is necessary for those services. There is no evidence at present of a sensible national or even regional framework for ensuring that such facilities are available.
I present a good example of how things have moved forward. There used to be a rare treatment for a strange condition called to torticollis that gave one a wry neck. What I am now doing is difficult for the Hansard writers to report, but the condition gives one an uncontrollable twitch. It is treatable through injections of botulism. It is amazing that that treatment is carried out predominantly in the private sector for cosmetic reasons—to get rid of wrinkles—yet in the national health service, there is an enormous waiting list for operations for genuinely distressing conditions.
I hope that the Minister will consider what is available and what can be done within the national health service framework. We should ensure that people who rely on

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the national health service for treatment of real conditions have priority over those who simply opt for "botulism-injection tea parties", as I recently saw them described, attended for three months by middle-aged ladies who want to have their wrinkles controlled. Personally, I like wrinkles, as they suggest a degree of experience.
The abolition of extra-contractual referrals has had a dramatic effect. In the past, money would follow the patient and specialist centres would vie for that patient. The mechanism ensured that patients were referred and accepted. The out-of-area treatment scheme, which replaced ECRs, does not do the same job. Payments are often delayed. One may have to guess how many rare conditions are likely to occur in one?s district and place a contract that may be unnecessary.
When some years ago I challenged the Secretary of State on the effect of the introduction of the OATS arrangements, he assured me that doctors could still refer patients anywhere within the United Kingdom. Doctors can do that, of course, but the hospital to which a patient is referred is under no obligation to accept the referral. Hospitals are increasingly turning down patients because they are not sure that they will be funded for the work.
A process such as neurosurgery for epilepsy, for example, is complicated and expensive. The diagnosis must be firm, the lesion causing the epilepsy must be identified through specialist techniques and the patient must be prepared psychologically for such a dramatic operation. On the other hand, the results of such surgery can be dramatically good. Patients may be able to come off a complex drug regime and begin to function anew—they may, in a sense, wake up. Those operations are worth while, therefore, but the few centres that perform them are working to capacity and to unwilling to expand and to increase their work load, owing to the uncertainty over funding.
I pay tribute to carers and patients themselves. Doctors, like all other health professionals, are good at networking and learning about conditions in which they have an interest. That is positive and useful, but it is high time that patients and carers do more networking, so that they become aware of the treatment available and adjust their expectations. Patient with neurological conditions have for too long accepted that they are suffering from a Cinderella condition and that they cannot do much about it, apart from swallowing a few tablets. Much can be done, however, and through patient education and empowerment we can hope for a change in the present position, which is very much top down. Patients may begin to make reasonable and achievable demands, which are currently held back because of the restraint on resources.
11.39 am
Mr. Desmond Swayne: It is always a privilege to speak after my neighbour across the western Solent, the hon. Member for Isle of Wight (Dr. Brand). who brings his professional expertise, wisdom and plain common sense to debates.
I congratulate the hon. Member for Sutton and Cheam (Mr. Burstow) on securing this timely and important debate, which has produced speeches of high quality. I congratulate him, too, on the amount of work
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that he has done in bringing the matter to our attention. I secured from his website a copy of his report, dated 3 January, on the neurological service in England. It is a real achievement for an ordinary Back Bencher, who does not enjoy a great deal of administrative support, to provide such a high quality document, backed up by a significant amount of research.
I am glad that the debate so far has concentrated not only on neurologists, because the matter goes beyond their numbers. The hon. Members for Isle of Wight and for Sutton and Cheam referred at length.to the failure of the out-of-area treatment scheme. That system is log-jammed, so an increase in neurologists alone will not necessarily address the problem. The OATS arrangements deserve attention.
The hon. Member for Isle of Wight drew attention to speech therapists, thereby raising the question of rehabilitation in general and of strokes and similar conditions in particular. If patient outcomes are to improve, such specialist provision must be made. All the evidence suggests that establishing specific rehabilitation centres and facilities is the best way to achieve that.
As for the provision of drug treatments, I share the concern that was expressed by the hon. Member for Sutton and Cheam with respect to beta interferon. I entirely agree with his analysis of the history and the behaviour of the National Institute for Clinical Excellence. It is 19 months to the day since NICE was asked to investigate and appraise the situation as regards beta interferon. On 6 February, at Health questions, we were told that guidance was expected from NICE in November; by that date, it will be 26 months since the matter was referred to the organisation. In the announcement that foreshadowed the creation of NICE, we were told that it would provide a mechanism by which the arrival of new drugs in the health service could be speeded up. In that role, however, the body has not covered itself in glory.
We are told that more economic modelling is required by NICE. I am not against that, in principle; one of the things that we do badly in this country is clinical appraisal, which should be accompanied by economic modelling. Many clinicians agree with that. They sometimes take a cynical view of the media-to-market approach—as they term it—of some pharmaceutical companies, and would like there to be a much more robust means of testing and appraising the value of drugs. However, I question whether, when the process has already been going on for so long, we should consider yet more evidence for beta interferon, given that it is no longer a new drug. Prescribing habits in the United States and in continental Europe are much wider than they are here. It is legitimate to ask how many patients who would have benefited from beta interferon have lost their window of opportunity as a result of the delays.
Dr. Brand: Is it not essential that, when a decision is made about making a drug available, the economic modelling should include the effects outside the national health service, for instance on benefits and the provision of social services? Would the hon. Gentleman agree that that economic modelling should be done by the Government collectively rather than by NICE?
Mr. Barry Jones (in the Chair): Order. Both hon. Gentlemen are on the edge of being out of order on this issue.
Mr. Swayne: There is much force in what the hon. Member for Isle of Wight says.
To return to the subject of neurological conditions, will the Minister answer the question posed by my hon. Friend the Member for Buckingham (Mr. Bercow) on 6 February, which the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), failed to answer—why is copaxone being treated as an interferon when it is chemically and pharmacologically different? It has been tested for eight years and has reduced relapses by 70 per cent. In addition, what stage has been reached with respect to treatments for Alzheimer's disease, especially donepezil and rivastigmine. When will we know the outcome of an expensive trial that has been conducted in the west midlands with respect to donepezil?
I shall not dwell on Conservative policy in respect of NICE for fear of you bringing me sharply to order, Mr. Jones. However, we want a radically different approach to the problem. We want an exceptional medicines fund, with prescribing criteria laid down by a committee serving that fund. We want to remove from NICE's responsibility consideration of what we would regard as the availability of overall resources. We believe that that is not a decision for NICE. It is a political matter, and a Minister should decide what is available for the exceptional medicines fund.
I come now to another issue raised by the hon. Member for Sutton and Cheam concerning the provision of specialist nursing, and I want to illustrate a point that he made. Currently, one of the log-jams in the system is a significant shortage of specialist nurses. I have in my possession a letter from Mr. Palmer, the consultant neurosurgeon at Derriford hospital, dated 17 November. In the letter, he warns his colleagues about the effects of having to devote time and resources to train overseas nurses to fill the vacancies. He stresses that
"All elective admissions have been cancelled until probably at least February."
He wrote that in November. The letter continues:
"The neurosurgical unit can no longer provide a secondary referral service for Derriford Hospital. We will not accept direct emergency admissions from GP practices or receive referrals from the Accident and Emergency staff directly. Only tertiary referrals will be accepted i.e. from an admitting consultant team. We will provide 24 hours notice of return to secondary care but need the hospital's support to take these patients back into the admitting consultant's service without delay. When patients are not accepted back further emergency referrals will only be accepted on the agreement to swap with our blocked bed. If this is not possible the only option would be a transfer to another neurosurgical unit."
In respect of transfer to another unit, his letter states:
"We know that the neurological units in Bristol, Southampton and Oxford are in similar crisis precluding transfer of care."
If that is the situation in the acute neurological service, it requires urgent attention. Perhaps the Minister, in her response, will say what the Government have in mind.
If I were to summarise and simplify the report produced by the hon. Member for Sutton and Cheam, its key feature is that it draws attention to unacceptable waiting times for neurological disciplines. Its principle
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recommendation is that we must increase the number of neurologists by 60 per cent. That might by true, but I have a slightly different focus. We are increasingly moving toward evidence-based medicine and so my focus, along with that of many other commentators, is on patient outcomes rather than becoming fixated by our input into that process. Of course, inputs are important because they largely determine patient outcomes. Nevertheless, it is important to focus primarily on outcomes rather than on inputs.
An interesting fact that comes out of the hon. Gentleman's report is that in Denmark there are 100 neurologists for every 1 million of the population, in the United States there are 40, in Germany there are 12, but in the United Kingdom there are only six. The question that immediately occurs to me is: what about patient outcomes for the neurological conditions to which those figures relate? Why is there this extraordinary number of neurologists in Denmark? Are patient outcomes in Denmark much better than in the US or Germany, which has only 12 neurologists per 1 million of the population? With half their number of neurologists we do not compare too badly with Germany, which poses some interesting questions.
There is a nice line in the report when the hon. Gentleman refers to the British Brain and Spine Foundation stating hat UK patients are half as likely to wake up with a neurological condition and find that there is a neurosurgeon at the bottom of their bed than they are in the rest of the developed world. To my mind, the key question is not who is standing at the bottom of the bed, but whether one is likely to wake up. Patient outcome is the key issue, so the discipline of the consultant who is responsible for care does not matter to the patient, so long as he or she is capable of delivering the best care available. It may be that it is vital that a neurosurgeon or neurologist should be at the bottom of the bed, but that is an issue about which we must acquire more evidence.
My conversations with neurologists have revealed that we function differently in the United Kingdom. Traditionally, neurologists have avoided dealing with the commonest causes of brain failure, be they stroke, dementia or sequelae of head injury; geriatricians and other physicians have made up the shortfall. The conditions upon which neurologists have traditionally had a therapeutic impact are epilepsy, Parkinson's disease and other rare disorders such as myasthenia gravis and post-infectious demyelinating polyneuropathy. I read about an hon. Member who had an episode of myasthenia gravis, although I must say that he has subsequently functioned as an outstanding parliamentarian, so he is clearly over that.
The diagnostic skills of neurologists have been useful traditionally in the diagnosis of multiple sclerosis, motor neurone disease and peripheral neuropathies, spongiform encephalopathy and a host of rare and esoteric disorders. The hon. Member for Isle of Wight drew attention to the fact that there has been a great increase in our ability to deal with many of those conditions in the past 10 years and longer. I know that, for patients, those conditions are not esoteric at all. However, many neurologists say that, in dealing with some of those conditions, their impact is quite limited, and neurology is predominantly an out-patient discipline.

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One of the complaints made by neurologists performing that out-patient role is that many of the referrals that they receive from general practitioners arise because the GPs are themselves least comfortable with their own neurological diagnostic skills. Consequently, many neurologists find their case load taken up by people suffering from tension headaches and those who believe that their symptoms are indicative of a brain tumour or some other disease. Perhaps addressing the diagnostic skills of general practitioners would have an impact on at least some of the out-patient problem. I hope that, within primary care groups, there will be an exchange of patients, and a cross-referral between general practitioners who are becoming more specialist in particular conditions. That might relieve some of the pressure on secondary care referrals to hospitals.
Dr. Brand: The hon. Gentleman is confident that general practitioners can become more expert, but he must recognise that, if we are to meet the Government's own standards in accessing general practitioners, we need an extra 10,000. Giving them an extra job in this area will not solve the overall problems in the national health service.
Mr. Swayne: I acknowledge what the hon. Gentleman says and the difficulties facing general practitioners involved in primary care, and I recognise the need for more of them to meet the demands of the national plan. We are now talking about the huge shortage of neurologists, which raises the question of which issue to address first, or which should be given the greatest leverage for an improved patient outcome.
Most patients with serious conditions, for example, multiple sclerosis or motor neurone disease, are relatively easy to diagnose on clinical grounds alone. As the hon. Gentleman said, we now use a great deal of high-tech equipment to confirm such diagnoses. About 40 years ago, it might have cost just a few pounds to diagnose a multiple sclerosis sufferer. Given the Gentleman's remarks when describing his teachers, it might be more appropriate to say that it would have cost a few guineas all those years ago to diagnose someone suffering from multiple sclerosis. Now, it might cost as much as £1,000, using high-tech equipment. It is legitimate for us to ask by how much our skill and ability in diagnosing these conditions has improved.
I was particularly enthusiastic about paragraph 3.8 of the report in which the hon. Member for Sutton and Cheam drew attention to the importance of speed of diagnosis and stated:
"A large number of neurologists and stroke physicians … are now saying treating stroke as a medical emergency the way a heart attack is would improve survival after stroke, reduce post attack depression … and the risk of being institutionalised."
That bears out what my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond ) was told when he visited the Royal Hallamshire hospital on Friday last week.
We all understand that a heart attack is an emergency and requires rapid treatment. The public also understand that, as do ambulance men and hospitals, but does the same understanding exist, especially among the public, about strokes, which also require swift treatment? All district general hospitals have coronary
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care units and they are successful in terms of patient outcome, but not all district general hospitals have stroke units, although experience shows that they can also achieve successful results.
Whether stroke units need to be staffed by neurologists or geriatricians, as they largely are now, is not a matter on which I have the expertise to make a judgment. It may be right to encourage a greater supply of neurologists to take on that work, but I would want to see the clinical evidence of improved patient outcome before huge resources were diverted to such an end.
I come to the national service framework announced by the Government, which, significantly, the hon. Member for Sutton and Cheam called for on 3 January. It was a notable success for him to have secured such a swift response from the Government, and one that he deserves.
We favour a national service framework, but we have some reservations and want to ensure that it does not become over-prescriptive. However, we are confident that it will improve matters. Hon. Members are entirely right when they say that the national service framework, which may be in place in 2005, must not be allowed to delay development in the meantime. There is a tendency to produce a report, put a framework in place and believe that the problem has been dealt with. I remind the Chamber of Florence Nightingale's words when she drew a problem to the attention of a senior officer in the Crimea who assured her that it was unnecessary for her to trouble herself with it because there was already a report on it. Her response was that in her experience such reports were not necessarily self-implementing.
12.3 pm
The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I confess that I am too young to recall the words of Florence Nightingale, but I congratulate the hon. Member for New Forest, West (Mr. Swayne) on a polished close to his speech.
It is customary to congratulate an hon. Member on securing a debate, but the hon. Member for Sutton and Cheam (Mr. Burstow) should also be congratulated on the timing of his thoughtful debate. I agree that it is the quality and not the quantity of hon. Members in the Chamber that matters.
Hon. Members have raised a number of specific issues. If, inadvertently, I do not provide specific answers, I shall certainly return to them in more detail. However, I was somewhat surprised that the hon. Member for Sutton and Cheam referred to a national crisis in neurological services. I do not agree that there is such a crisis, but I accept that there are problems, which are more severe in some areas than in others. Our stated aim is that the worst services must make progress to deliver the best, but that will take time.
Hon. Members will be aware that the NHS was in survival mode for many years, but we are turning the corner and it is now in expansion mode. There is record investment and we are working towards shorter waiting lists. In many ways, the debate has illustrated why we need national frameworks and coherence in respect of the services that we deliver. It has also demonstrated that we need an expansion in staff. Virtually every hon. Member mentioned shortages in certain areas and the practical problems that arise when nurses are recruited and trained as specialists.

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The hon. Member for Sutton and Cheam has made a number of points about waiting times, and it is important that I clarify them for the record. He said in January that waiting times for appointments are horrendous—up to two years—but that is not the case. For in-patients, the maximum wait is 18 months. Since 1997, no patient in England has waited more than 18 months for neurology treatment. The average in-patient waiting time in England is 9.48 weeks. The vast majority of out-patients—about 95 per cent.—are seen within 26 weeks and the average waiting time in England is 10.6 weeks.
The hon. Gentleman also said in January that only 20 per cent. of hospitals are able to give waiting times of less than three months for an out-patient appointment to see a consultant and that 44 per cent. of hospitals make patients wait longer than 26 weeks. Again, that is not the case. More than 85 per cent. of hospitals are able to give appointments within 13 weeks.
Dr. Brand rose—
Mr. Burstow rose—
Ms Stuart: May I finish my point about waiting times before giving way?
According to the press release that was issued by the hon. Member for Sutton and Cheam, the number of neurologists in England and Wales would have to be increased by 60 per cent. to reduce waiting times to meet the Government's target of three months. However, it is not clear to which target the press release refers. There are two different targets in respect of the three-month maximum waiting time: one for in-patients and another for out-patients. The NHS plan refers to reducing the maximum waiting time for out-patient appointments to three months by the end of 2005, and reducing the maximum waiting time for in-patient treatment to three months by 2008. We are confident that those targets are achievable.
Mr. Burstow: I will look at the figures that the Minister has given today with some interest, but I hope that she will accept that the report is a faithful representation of the results of a survey of NHS trusts. The information was not converted or altered—we merely reported what we found.
Ms Stuart: I accept that the hon. Gentleman desires to do nothing other than act on the basis of his findings. I echo the comments of the hon. Member for New Forest, West by congratulating the hon. Gentleman on his efforts as a Back Bencher. I simply want to put on the record the findings of our survey, which is, I hope, more reliable and thorough. I hope that the hon. Gentleman is satisfied with that.
Dr. Brand: When the Minister conducts her surveys, does she ask each trust whether it defers putting people on the waiting list, especially in respect of out-patient appointments? In my experience, it is not uncommon for patients to be sent a letter stating, "We have received
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your referral, but we are not in a position to put you on our waiting list as yet. You will hear from us in about six months' time."
Mr. Nicholas Winterton (in the Chair): I call Dr. Gisela Stuart—
Ms Stuart: There are some doctors in the Stuart family, Mr. Winterton, but I am not one of them.
People should not be put on a waiting list for a waiting list, so I will take up the hon. Gentleman's point.
The hon. Member for Sutton and Cheam described the wide variations in waiting times throughout England and Wales as a postcode lottery for neurological services. As he knows, waiting times in Wales are a matter for the Welsh Assembly. Waiting times in England do vary. We recognise that patients can wait a long time for neurology treatment. The NHS plan says that all patients will have a maximum wait of three months for out-patient appointments and six months for in-patient appointments. We are confident that we will be able to meet those targets.
The hon. Gentleman said that the figures show that the non-urgent average waiting time to see a consultant neurologist is 25 weeks, with 44 per cent. of hospitals having to make patients wait longer than six months for an out-patient appointment. That is not the information that I have been given. The national average out-patient waiting time for neurology is 10.6 weeks. In December 2000, only 12 per cent. of neurology out-patients had waited as long as six months for an appointment.
We all accept, however, that that is not good enough. We need to make progress in a co-ordinated manner. Some hon. Members have expressed a fear that the national service framework would be a hindrance to further progress. It will not be—far from it—but the various initiatives must go hand in hand in dealing with the situation in the short term and in the long term. It is essential that they work in tandem.
I thank the hon. Member for Isle of Wight (Dr. Brand) for his enlightening anecdote about the Bentley key, and I am delighted to say that we have moved on from that. Funding for diagnostic imaging equipment was announced in the NHS plan, and 150 replacement computed tomography scanners, 50 additional CT scanners and 50 additional magnetic resonance imaging scanners will be funded by 2004. Those will be used in the diagnosis of cancer and other diseases, including neurological diseases. The hon. Gentleman said that we must consider strategic availability. Again, we must ensure that immediate and long-term strategies develop in tandem.
Reference was made to deep brain simulation therapy. The Medical Research Council is considering a trial of the effectiveness of such therapy. We are also working closely with the Parkinson's Disease Society and others. I understand that the trial would cost about £1.3 million over three years.
Hon. Members mentioned nurse practitioners and the availability of specialist nurses. The NHS has huge capacity problems. We simply do not have enough doctors and nurses of any specialisation. We must address long-term problems through more training and short-term problems through putting the available work force to best use.

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The hon. Member for Isle of Wight referred not only to nurse practitioners, but to speech therapists and physiotherapists. I am delighted that the Multiple Sclerosis Society is working with the NHS to provide more specialist nurses. The further development of a specialist nursing post is an integral part of neurological services. It will be addressed with NHS commissioners and providers. Specialist nurses will be important stakeholders in developing the national service framework.
Mr. Burstow: The Department is considering the recruitment and training of specialist nurses. Will that work be concluded before the implementation of the national service framework?
Ms Stuart: If there is information a bout precise dates, I will pass it on to the hon. Gentleman.
We must invest extra money. Hon. Members will acknowledge that we are dealing with that matter, not only through extra funding this year, but thereafter. I am pleased that the debate has not been a sterile discussion about solving the problem with pockets of money here and there. The problem is more fundamental than that.
The creation of national service frameworks to deal with the huge divergence of services is an important development. Hon. Members have lightly pointed out that there is a danger of creating various channels. We do not want that to happen. Other Government policy allows close working, for example with social services. The Bill to establish care trusts will facilitate such working together. I hope that hon. Members will be reassured that those are all parts of a jigsaw, which will be fitted together carefully.
Neurology covers a huge range of complex issues and conditions. Some neurological disorders are rare, but others are common, such as epilepsy, which affects more than 400,000 people in the Unitcd Kingdom, and multiple sclerosis, which affects a further 85,000 people. Most neurological disorders are chronic and disabling and have a profound impact on the lives of individuals and their families. One third of the British population lives with a long-term health condition. Therefore, our decision about the national service framework for such conditions, which was announced on 28 February, is important to people with neurological conditions and to their families and carers. Hon. Members have drawn attention, rightly, to the needs of carers and to the need to take their experiences into account in developing the national service framework.
The national service framework will focus on the needs of people with neurological diseases of the brain and with spinal injuries. It will include services for people with epilepsy, multiple sclerosis, Parkinson's disease or similar conditions. The question has been raised of whether the treatment of chronic pain will be included in the framework. What place that will have within the framework will be addressed during the consultation with stakeholders.
The aim of the national service, framework is to overcome the lottery in care and to ensure that health and social services work together in all parts of the country to provide the right level of care and treatment for people who live with long-term health conditions.
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Many such people are poor, or live in the poorest parts of the country. There is an especially strong correlation between social class and long-term health conditions such as diabetes and epilepsy, as well as a fundamental and consistent link between poverty and ill health. The Government have a responsibility to break that link.
The Government have been successful in developing and publishing national service frameworks for mental health, coronary heart disease and the national cancer plan. Those frameworks have helped our programme to deal with inequalities and raise standards and to reduce unacceptable variations in NHS services. Later this year, a national service framework will be introduced for older people and for diabetes. The illnesses covered by the five national service frameworks account for half total NHS spending. The frameworks are part of the Government's commitment to ensuring that patients have fair access to high standards of care, wherever they live. The NHS plans commit us to developing more of them.
Each national service framework is developed with the assistance of an external reference group that brings together health and social care professionals and managers, service users and carers, partner agencies and other advocates. That inclusive process ensures that a range of views is heard and can contribute to the development process. A decision on the chair of the national service framework for long-term health conditions and on its scope and membership will be announced in due course.
I pay tribute to the constructive and important work of voluntary organisations. The Neurological Alliance has given an unequivocal welcome to the national service framework for long-term health conditions and is looking forward to collaborating with the Department of Health to produce a framework that will benefit people in that neglected area. The hon. Member for Sutton and Cheam paid tribute to the support that he received in producing his report.
With long-term health conditions, patients are the specialists in how best they can receive care: whether it is best to receive it in the acute sector or at home. The Government recognise the important role of the voluntary sector and specialist patient representative bodies not just in being advocates for patients, but in bringing extraordinary expertise to the debate. That is why we work closely with the voluntary sector in other areas of neurology.
Mr. Burstow: That point provides the opportunity to seek clarification from the Minister, who rightly welcomes the important work and support provided by non-governmental organisations in supporting patients and so on. I specifically asked her about the Secretary of State's indication that the value of such work might be recognised with additional funding for umbrella organisations. Might that translate into additional support for the Neurological Alliance and, particularly, the work on the national service framework?
Ms Stuart: Of course, we are all optimists and everything is possible. If my brief is correct, the hon. Gentleman may be referring to applications by the Neurological Alliance under section 64 of the Health Services and Public Health Act 1968. We are

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considering those applications to allow services to be expanded. I am sure that his representations will be heard, but it would not be right and proper for me to make an announcement now and he would not expect me to.
I refer to our work with Epilepsy Bereaved and the comprehensive clinical audit to investigate the unexplained death of people with epilepsy. Tragically, some 1,000 people with epilepsy die every year. That audit should allow us to move forward in a more coordinated way. Hon. Members have recognised that some conditions are rare, but we must try to develop an understanding of them. We are working with the Human BSE Foundation to provide standards of care for people with new variant Creutzfeldt-Jakob disease. We are also working with the Parkinson's Disease Society, which has just received £36,000 for advice helplines. Only a couple of months ago, the society launched a fascinating CD-ROM, which took patients through the adaptations that they could ask for in their houses. We work with and support the voluntary sector. I put on the record that it is uniquely able to do something that neither the Government nor the NHS can do.
I turn to whether we have enough neurologists. I am grateful to the hon. Member for New Forest, West, who graphically illustrated that ultimate numbers do not necessarily show us the picture, or whether more specialists in an area will provide a better outcome for patients. We know that neurological disorders account for up to 17 per cent. of all general practice visits and almost 20 per cent. of all acute hospital admissions. Studies suggest that up to 2,000 people in a population of 100,000 will have a disabling neurological condition. More than one quarter of those will require daily help to remain living at home.
There have been difficulties in filling consultant neurologist posts in some areas. The Speciality Workforce Advisory Group has reviewed the number of consultants in neurology annually. The average length of training in the speciality is six years and past recommendations by SWAG take time to be felt on the ground. Current trainees in neurology will provide approximately 90 additional trained specialists by 2006: an increase of almost one third between 1999 and 2006. We shall continue to keep the specialty under review with the Royal College of Physicians and NHS management. In particular, we want to find ways of resolving local shortages that have been reported in some areas.
We are aware that most neurological conditions have no cure at present. Often, their causes are not fully understood and the diagnosis of individual conditions is difficult. That is why, in improving our understanding of how to treat and manage such conditions, it is important to consider research, too, hence the Government's support for the Medical Research Council, the NHS health technology assessment programme and other research streams that help us in our drive to understand the causes of neurological diseases. In England, the main Government agency for research is the Medical Research Council, which receives funding via the Department of Trade and Industry.
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The Government keep their priorities for research under review. NHS priorities are identified through widespread consultation with those using, delivering and managing services. Account is taken of the burden of disease, potential benefits and Government objectives as well as the responsibilities and work of other funders. It is a long-standing and important principle of successive Governments not to prescribe to individual research councils the detail of how they should distribute resources between competing priorities. That is best decided by researchers and research users. The MRC will take all such factors into account when it decides whether it wishes to fund research projects into neurological and other conditions. I remind hon. Members that, in 1999–2000, the MRC provided about £18.6 million for research into neurological conditions. That research will help to improve our understanding of such conditions and aid the development of treatments for them.
I was not surprised that hon. Members raised the issue of beta interferon and multiple sclerosis. Although we shall have divergent views about the language with which we described the action that NICE has taken, it is probably best to put on record why it has asked for more evidence. There seems to be genuine uncertainty about the appropriate use of beta interferon. That was reflected in the different prescribing patterns throughout the country. We therefore asked NICE to conduct an authoritative appraisal of the evidence on beta interferon as part of its first appraisal programme. To us, that is a high priority.
I stress that NICE has not yet issued guidance on the use of beta interferon for multiple sclerosis. As part of its appraisal process, NICE circulated its final appraisal determination to patient groups, professional groups and manufacturers. All were given 10 days to appeal. NICE rejected eight appeals against the FAD. An appeal panel considered the appeals on 22 and 23 September 2000. Part of the appeals were upheld and, as a result, NICE's appraisal committee reconsidered its guidance on 13 December 2000.
During its appraisal of beta interferon and a similar drug, glatiramer acetate, NICE considered evidence that included economic models supplied by manufacturers and independent researchers, including data not previously submitted. Those models are used to inform NICE's judgment on the cost-effectiveness of beta interferon. The evidence relating to the cost-effectiveness of those medicines is critical to NICE's appraisal of the drugs. NICE considered those models and concluded that such detailed examination raised several issues, which its appraisal committee, using the information available, has been unable to resolve.
After considering the deliberations of the appraisal committee, NICE commissioned further economic modelling. It advised that the commissioning, construction and evaluation of a further economic model will take some months. It is therefore extending the time scale of its appraisal of both beta interferon and glatiramer acetate to enable further research to be undertaken. It anticipates that the appraisal committee will reconsider the evidence, which will consist of a new model and any other new material available at the time, in July 2001. Unless there are further appeals, NICE expects to issue its guidance by November 2001. We shall have to wait for that final guidance. I do not wish to pre-empt what it might say.

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I hope that today's debate, which has been informed and welcome, has reassured hon. Members that we acknowledge the great importance of neurological services. The development of the national service framework will mean that good service will be available wherever in the country a patient must call upon it. However, sometimes long-term solutions will be needed to get that right and improvements may be made more quickly in other areas. That will happen, but, as ever, our biggest present constraint is the work force, the training of whom will take time.
Mr. Nicholas Winterton (in the Chair): I thank the Minister for her reply. We move to the next debate, initiated by the hon. Member for Clydebank and Milngavie (Mr. Worthington).

Asbestos Claims
12.30 pm
Mr. Tony Worthington: It is a joy to be under your tutelage, Mr. Winterton, although you mispronounced my constituency.
I thank the Minister for meeting me and my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) last week about this matter, which has caused immense anger and disgust among sufferers of asbestos-related diseases and their relatives, and in communities such as mine, where there has been a long record of abuse caused by the appalling poisoning of people due to the use of asbestos. Clydebank has had the highest rates of asbestos-related diseases in the United Kingdom, because we had shipbuilding and ship repair industries and an asbestos works. We also had employers who poisoned their workers long after the health hazards of asbestos were known.
Earlier this year, Chester Street Insurance Holdings Ltd went bankrupt. That company held the employers liability insurance for more than 2,000 firms—often long dead—many of which worked with asbestos. Therefore, its collapse threatened the prospects of compensation for many people who will die from asbestos-related diseases. Many such people will not currently know that they will contract a disease such as mesothelioma because its incubation period may be many decades.
Frank McGuire, the most prominent lawyer in Scotland dealing with such cases, calculates that about 5,000 people in Scotland are affected by the issue, and around 50,000 people affected in the UK. Thompsons solicitors, the largest legal firm in the field, has calculated that Chester Street held about two thirds of employers liability claims relating to asbestos in the country.
The appalling occurrence is that the solvent part of Iron Trades Holdings Employers Insurance Association Ltd. was sold to QBE International Insurance Ltd., an Australian firm. The loss-making element of that company, which included the mounting asbestos claims, was retained as Chester Street Holdings. I contend that that company was knowingly set up to fail and to deprive sufferers from the compensation to which they are entitled. I back up that contention with the 2000 annual report of Iron Trades Holdings' auditor, Ernst and Young, which, only two months after the deal had gone through stated:
"Considerable uncertainty exists as to whether the undertaking can continue as a going concern."
Sure enough, the company collapsed at the beginning of this year. The liquidators, PricewaterhouseCoopers, found that Chester Street's assets of £30 million were dwarfed by liabilities of £250 million.
Incredibly—I say that carefully—the Financial Services Authority, which was set up by the Government to safeguard the consumer, had approved that company restructuring. The deal went through in February 2000, following approval from the FSA. Two months later, Ernst and Young raised totally justified doubts about the viability of Chester Street. Why was the approval given? Why did the FSA not protect the interest of people who will inevitably die from asbestos-

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related diseases? Why did it act on the side of Robert Hardy, the former chief executive of Iron Trades, whose income rose from £204,000 in 1998 to £668,000 the following year? That is a difference of almost £450,000. A mesothelioma case might be expected to obtain between £50,000 and £100,000 in compensation. I hope that Mr. Hardy realises that he has taken the compensation of between six and 12 people who are dying from mesothelioma. He ought to be ashamed of himself. Those are immoral earnings, but his chairman congratulated him on his "outstanding achievement" as he pocketed the money and left the firm before the collapse that he had set up.
The FSA seems to be washing its hands of the matter. Thousands of seriously ill clients will lose out. The insurance industry must act to protect its name. The essence of insurance is that one wins on many occasions and loses on a few. We insure ourselves against things that we hope will not happen, but the insurance company has to pay out in the minority of cases in which the worst has occurred. Cases concerning asbestos-related diseases are the worst, so what kind of scurrilousness is involved when insurance companies renege on those policies?
Lawyers have written to me expressing concern about the domino effect with regard to other insurance businesses. Field, Fisher and Waterhouse suggested that regulations be put in place to prevent other insurance companies from dividing the profitable from the unprofitable parts of their businesses in the way that Iron Trades and Chester Street have done.
The insurance industry must give a lead and face up to its responsibilities. To its credit, the Insurance Times is forcefully pointing out the damage that such cases are causing to the industry. The Government must act to ensure that not a single victim loses out due to the appalling behaviour of Chester Street and Iron Trades. The Government acted to secure restitution for people who had been conned due to pensions mis-selling in the financial services industry. They must act again in this case.
The Government must give an immediate assurance that people who are dying from asbestos-related diseases will not suffer at all financially. That assurance must be extended to their relatives, because in many cases it is the dependants of the victims who receive the insurance money. There must be 100 per cent. restoration. Imagine what it must be like for someone who is dying from mesothelioma to hear that the chance of securing compensation for their relatives has been shattered by this deal.
I do not want a vague assurance from the Minister that there will be investigations. I want a commitment that those who are suffering from asbestos-related diseases will not lose out in any way. I also want an independent inquiry conducted by an independent person or body, rather than by the FSA, which is already tarnished by its approval of the deal.
The inquiry must focus primarily on the conduct of Iron Trades and Chester Street, but there is also a wider issue. Firms and insurance companies in the United States of America are being brought to their knees and bankrupted by the rising tide of asbestos-related cases.
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The inquiry must ensure that the interests of the victims of asbestos-related diseases are safeguarded. In particular, the interests of people who were in contact with asbestos before 1972 must be examined. There are many such people and they have been left without any protection. After 1972, victims receive some statutory protection from the Policyholders Protection Board, which has been backed by the insurance industry and is supervised by the Department of the Environment, Transport and the Regions. However, that has limitations; the figures are calculated on a percentage basis.
Can the Minister confirm that victims who contracted their illnesses while working at a publicly owned firm will be protected? I also need to know why Iron Trades was sold by Chester Street for £77 million less than the valuation of its accountants. The sale price of £175 million was £50 million less than the valuation of the company, and the Australian firm QBE held back £27 million in an escrow account. Why was it sold for less than its value, when that extra money could be used to pay claims? Is it true that Iron Trades Management Services is receiving money for helping in the winding-up of Chester Street Holdings? It is still receiving income, but not meeting its liabilities. There are so many questions to be asked about that shady deal.
The inquiry also needs to look at the confusing involvement of the Treasury, the Department of Trade and Industry and the Department of the Environment, Transport and the Regions. I and others have been trying to extract from the Government a coherent statement on the matter, but although Chester Street Holdings collapsed in January, not one word has come from the Government voluntarily. Two months ago, Chester Street Holdings announced that it was insolvent. I hope that the Minister's statement will show that the Government are on top of this issue.
I am trying to get through my speech as quickly as possible in the hope that my hon. Friend the Member for Barnsley, West and Penistone, the chair of the all-party asbestos group, may attract your eye, Mr. Winterton.
In urging that a statement be made on the matter, I am conscious that we should not have to rely on a Member's luck in winning a raffle for an Adjournment debate. Such issues are of serious concern to my constituents. There is much anger about what has been done by Chester Street Holdings. I hope that the Government will recognise that and ensure that no one loses out. We can afford it. We acted strongly on the pensions mis-selling and we must act strongly now. It is absolutely wrong for someone dying from mesothelioma to lose the compensation for his family because of the shady actions of Chester Street Holdings.
Mr. Michael Clapham: rose—
Mrs. Margaret Ewing:rose—
Mr. Nicholas Winterton (in the Chair): Order. Before I call the hon. Member for Barnsley, West and Penistone (Mr. Clapham), it is the usual custom that a Member who wishes to speak in a half-hour Adjournment debate receives the permission not only of the hon. Member

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who initiated the debate, but of the Minister and the occupant of the Chair. I am not sure whether the hon. Gentleman has the permission of the Minister to speak.
The Economic Secretary to the Treasury (Miss Melanie Johnson): I am happy for my hon. Friend to contribute to the debate. However, the more contributions that are made, the less time I shall have to respond.
Mr. Nicholas Winterton (in the Chair): Indeed. I hope that the hon. Member for Barnsley, West and Penistone heard what the Minister has said. I am happy to use my discretion in this case and call the hon. Gentleman, who happens to be the chairman of the all-party asbestos group.
12.42 pm
Mr. Michael Clapham: Thank you, Mr. Winterton. I will be brief.
My hon. Friend the Member for Clydebank and Milngavie (Mr. Worthington) clearly pointed out that this matter reflects the unacceptable face of the insurance industry. The decision in 1990 to hive off the liabilities between the two companies was taken in a calculated way. I regard such action as a dumping of the liabilities for asbestos-related diseases into Chester Street Holdings in 1990. To do so without ensuring that those liabilities were covered clearly shows that there was some callousness in the decision that was made at the time.
Will the Minister institute a Department of Trade and Industry inspectors' inquiry under section 432 of the Companies Act 1985? My hon. Friend suggested a completely independent inquiry, but I have legal advice that it is possible for a DTI inspectors' inquiry to be set up under that Act. Is it possible to call the insurance industry together to review the policy protection scheme to ensure that a better scheme could be instituted, which would cover the pre-1972 cases, so that we are not again likely to encounter a similar situation?
Mr. Nicholas Winterton (in the Chair): I call the hon. Member for Moray (Mrs. Ewing), who I hope will speak for no longer than about 60 seconds.
12.44 pm
Mrs. Margaret Ewing: I will literally take one minute. I shall check. The clock now shows 44 minutes past.
When I was first elected to this Parliament in 1974 to represent the adjoining constituency to that of the hon. Member for Clydebank and Milngavie (Mr. Worthington), the issue was raised with me. I have pursued the matter in the Scottish Parliament, too, because of health board responsibilities for diagnosis and treatment.
I fully support the points made so eloquently by the hon. Gentleman about Chester Street. The distress of the disease is enough without the additional distress caused by lack of compensation and insurance.
12.45 pm
The Economic Secretary to the Treasury (Miss Melanie Johnson): I congratulate my hon. Friend the Member for Clydebank and Milngavie (Mr. Worthington) on having secured the debate and on the energy with which he pursues the issues that he outlined. The Government understand the anxieties expressed in today's debate, which has been triggered by the news of the insolvency of Chester Street Insurance Holdings Ltd. In particular, the Government understand the anxieties, revealed by today's debate, of those suffering from asbestos-related diseases as a consequence of employment in firms whose employers' liability insurance is provided by Chester Street. It is for that reason that I welcome the opportunity to respond to today's debate.
It may help if I clarify several issues raised today. There are three main aspects—first, the company's history, secondly, employers' liability insurance policies, and, thirdly, arrangements for protecting policyholders of insolvent insurance companies.
The history of Chester Street is of much interest to people, judging from the letters that we recently received. Chester Street Insurance Holdings is an insurance company that is authorised to do business in the United Kingdom. As hon. Members will be aware, there is a general principle in law that employers are required to take out insurance policies to cover their liabilities towards their employees. That requirement is specified in the Employers' Liability (Compulsory Insurance) Act 1969.
Chester Street's main line of business was the provision of employers' liability cover. Its main customers were therefore in the business sector rather than individual retail customers. The history goes back much further than the 1969 Act, however. Indeed, Chester Street is the new name of an insurance company that had its origins at the end of the 19th century.
As a mutual, Iron Trades, which was founded in 1898, could write insurance business only for customers who were members of that mutual organisation. In the 1940s, that feature of the mutual status of the organisation was recognised as unhelpful and constraining business freedom by not allowing business to be written to nonmembers as well as members. The association therefore created a new subsidiary that it used to write business to non-members, and that subsidiary was called the Iron Trades Mutual Insurance Company Ltd.
In the late 1980s, association members agreed to restructure the Iron Trades group further. In view of rapid changes in the insurance market, it decided that all the group's insurance business, whether for members or non-members, should in future be written in the subsidiary company. The original association would no longer write new business itself but would remain the owner of the subsidiary and run off outstanding contracts. The changes took effect at the beginning of 1990, and the subsidiary was renamed Iron Trades Insurance Company Ltd. As the subsidiary was 100 per cent. owned by the association, all the benefits from its performance in writing new business accrued to the benefit of the association in run-off.

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Further restructuring took place in 1997, at which point all the association's assets and liabilities, including ownership of the subsidiary insurance company, were transferred from the association to a new company, Iron Trades Holdings. The transfer had no effect on the underlying position of either the run-off business or the continuing subsidiary.
In early 2000, Iron Trades Mutual Insurance Company was sold to QBE International Insurance Ltd. The sale converted the asset represented by the subsidiary into cash that could be invested and from which claims payments could be made. As part of the deal, the name Iron Trades was sold to QBE and that is how Iron Trades Holdings Ltd. became known as Chester Street Insurance Holdings Ltd.
Claims for asbestos-related diseases incurred before 1990 are likely to continue to rise for many years. The management of Chester Street received information on claims developments earlier this year that indicated that the company had become insolvent. That triggered the decision to appoint provisional liquidators on 9 January 2001. The scheme of arrangement was unanimously agreed on 5 February at the creditors meeting. The scheme ensures that the assets of Chester Street are protected for the benefit of all outstanding and future claims on Chester Street and it has been sanctioned by the court. The provisional liquidators are assessing the available information about existing and potential claims.
I will now deal with employers' liability insurance—the main type of business that Chester Street wrote—the impact of insolvency and, in particular, one key area of potential misunderstanding. The general position is that employers are required to take up such insurance under the Employers' Liability (Compulsory Insurance) Act 1969. The employer, rather than the employee, would have taken out a policy. That an employer has such a policy does not affect the fact that employers remain liable for any valid claim brought against them by a current or former employee. A claim might relate to an injury sustained or an illness contracted in the workplace, and an employer can turn to the policy in the event of a successful claim against them.
However, the insolvency of the insurer with which an employer has placed its employers' liability risk does not affect the liability of the employer to its employees or former employees. Therefore, despite the insolvency of Chester Street, employers who placed their risk with the company remain liable for claims made against them by employees or former employees. That is the case for all employers, whether they are in the private or public sector.
On the arrangements for ensuring the protection of policyholders when an insurance company becomes insolvent, as in other areas of financial services, specific statutory arrangements exist to protect the interests of financial services customers. The Policyholders Protection Act 1975 was established to protect the interests of policyholders of insolvent insurance companies. In the case of compulsory insurance policies, and to the extent that the insolvent insurer is unable to meet the claim, the Act provides for 100 per cent. protection for eligible claims. The cost of protection is
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met by levies on the insurance industry under a scheme administered by the Policyholders Protection Board, which was created under the 1975 Act. The Government expect the board to work closely with the provisional liquidators and others to ensure that eligible claims are processed promptly and that the provisions of the Act are fully implemented. To the extent that Chester Street is unable to meet the terms of the insurance contract in full it is for employers to establish whether any protection is due to them under the 1975 Act.
Today's debate has rightly raised the position of employees whose employer no longer exists. We are investigating their position carefully. It is not correct that no arrangements exist to protect workers suffering from asbestos-related diseases whose employers have gone out of business.
Initially, many sufferers will be eligible for industrial injuries disablement benefit and other related Department of Social Security benefits. Above and beyond that, the Government have recognised the case for making further compensation arrangements for workers unable to claim damages from their former employers. The Pneumoconiosis etc. (Workers' Compensation) Act 1979 exists to compensate those workers. Since 1980, the scheme has compensated around 8,500 workers and their families with approximately £10.5 million.
Several concerns have also been raised about the management of Chester Street, its predecessor organisations and the reorganisation of the Iron Trades Holdings Employers Insurance Association Ltd. Concerns about the management of Chester Street are a matter for the provisional liquidators, who are required to review the company's affairs and the actions of the directors and other parties. I understand that the issues that my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) raised in relation to company law could be a spin-off from the liquidators' investigation into the insolvency.
Finally, questions have been asked about the role of the regulator. As an insurance company authorised to do business in the UK, Chester Street has been supervised by insurance regulators to ensure that it meets the requirements of the Insurance Companies Act 1982. Since 1 January 1999, the FSA has been responsible for the prudential supervision of insurance companies. The Treasury is in touch with the FSA about both the reorganisation and the concerns that I mentioned earlier.
Mr. Worthington: I asked the Minister for two basic assurances. First, I asked that no sufferer from asbestos should suffer further by loss of compensation because of the actions of Chester Street. Will the Government give an assurance that the goal that they are pursuing is for no one to lose out, which would mean that the insurance industry would have to contribute? Secondly, I asked for an independent inquiry because the FSA has lost our trust by approving a failing firm.
Miss Johnson: On the latter question, I understand my hon. Friend's argument, but the liquidators are examining the issues surrounding the insolvency. When that information is publicly available we will be able to see which further issues emerge.

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On my hon. Friend's earlier question, I reiterate that the Government understand the concerns that have been expressed in debate. It is obviously desirable that people should receive the compensation that they seek. Treasury officials are in close contact with other Departments, the Policy Holders Protection Board, the FSA and the relevant parts of the remainder of the financial services industry to ensure that the concerns raised by the insolvency of Chester Street are dealt with as quickly as possible. I assure hon. Members that the Government are monitoring the situation carefully in the interests of those affected by the insolvency of this insurance company.
Mr. Nicholas Winterton (in the Chair): We can move on to the next debate, which has been initiated by the hon. Member for Runnymede and Weybridge (Mr. Hammond).

Central Railway
12.58 pm
Mr. Philip Hammond: I am grateful for the opportunity to raise this subject in debate. It has been raised on several previous occasions, but I make no apology for raising again a matter that is of importance to my constituents. A major threat has been posed to hundreds of households in my constituency and thousands of households along the length of the proposed route of a railway line. Since the subject was properly debated in the House, there have been considerable changes in the surrounding landscape and the company has announced that it intends to pursue a different route in seeking approval for the project.
The proposal for a freight line from the north of England to the channel tunnel goes back to the 1990s. In 1996, an application made under the Transport and Works Act 1992 for the proposed railway on an alignment that took it through south London was resoundingly defeated on a vote in the House of Commons. Many people thought that that would be the end of the matter, but in July 2000, the company resurrected the scheme with a revised alignment taking the route around the south-western quadrant of the M25 and off towards the channel tunnel. That would have a direct impact on my constituents, who—like everyone else, including the Government—assumed that the project would again proceed by means of a Transport and Works Act application: that is, it would be considered in accordance with the processes of that Act and voted on in the House. They were confident that if it were subjected to the proper processes, the scheme would ultimately be rejected on its merits. I shall address the scheme's merits and demerits later.
During the latter part of last year, my constituents concluded that the problem was the continuing blight that they were suffering as a direct result of the proposal, rather than concern about its eventual approval. Throughout that period, I asked Ministers several questions about the matter. The Government took the view that they could not comment because the Secretary of State might have to exercise a quasi-judicial function in respect of a future Transport and Works Act application. I acknowledged the legitimacy of their position. In the meantime, however, my constituents faced a potentially open-ended blight on their properties. As long ago as last summer, it was clear that the company had no intention of submitting a Transport and Works Act application until after the general election.
The whole process has highlighted the serious weaknesses in the Transport and Works Act procedure. It allows a company—which, as in this case, may be very thinly capitalised—to promote an extensive and expensive scheme without demonstrating its economic viability, producing any sound environmental impact assessments, or, most importantly, having to commit to any timetable for progress. Under the procedure, homes can be blighted for years without any obligation on the person or company causing that blight to make progress. I gave the Minister's predecessor some suggestions about how the law might be revised to deal with that problem. Although the Central Railway issue

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has moved on, my appetite for reforming the Transport and Works Act procedure has been whetted and I shall want to pursue my ideas further.
In January this year, the company raised the stakes considerably by publicly announcing that it would not make a Transport and Works Act application and that it was seeking the Government's backing for a hybrid Bill to enable the scheme to proceed by Act of Parliament, thus bypassing the proper processes of scrutiny that a Transport and Works Act application would have entailed. In a sense, the company moved the application from the planning process to the political arena, and it did so at a moment that was probably not of the Government's choosing. The Government's line that it would be inappropriate for Ministers to comment on what might become the subject of a quasi-judicial application under the Transport and Works Act procedure is no longer applicable—it has been shot out of the water. The purpose of today's debate is to try to elicit a clear statement of Government policy about the project now that it is clear that, if the Government give their backing to a hybrid Bill, it will not proceed by means of a Transport and Works Act application.
No doubt the Government thought that they were being rather clever in bouncing an awkward ball into the long grass by asking the Strategic Rail Authority to consider Central Railway's proposal. I hope that the Minister will give us a clear outline of the terms of reference given to the SRA, including the timetable for its report. Those of us of a slightly cynical disposition might guess that that report will not be completed until after the general election. The proposal for the freight railway, albeit on a different alignment, has been around for years so it is not credible for the Government to say that they have no position on the project. The Strategic Rail Authority may or may not be the right body to review the overall implications of the proposed scheme. The company claims that there will be a clear impact on road freight volumes if the railway is given the go-ahead, but it is not clear that the SRA is the best body to comment on or evaluate that effect.
Whatever rationalisation the Government may offer, neither it nor the scheme will not be acceptable to my constituents in Runnymede and Weybridge. They are suspicious of the Government's record on transport infrastructure in our area, for reasons that I shall explain. The people blighted by the current proposal are the same people—residents of communities alongside the M25 motorway—who were blighted by the previous Government's proposals to build the infamous M25 link roads. My predecessor, Sir Geoffrey Pattie, fought long and hard against his own Government and eventually persuaded them to drop that scheme. Some of the houses that are now blighted by the Central Railway proposal have only recently—since my election to Parliament—been sold by the Department of the Environment, Transport and the Regions, having been compulsorily purchased for the link roads scheme. My constituents have had enough of blight resulting from one project after another along the M25 corridor. The Government's refusal to come clean about where they stand on the Central Railway project perpetuates that blight.
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Before the previous general election, the Labour party clearly implied its hostility to the proposed widening of the M25 between junctions 12 and 15—a section of the motorway that will be affected directly by the Central Railway proposal. The current Secretary of State for the Environment, Transport and the Regions described the scheme as "lunacy". The then Opposition spokesman for the Department, the hon. Member for Nottingham, North (Mr. Allen), described it as £100-million motorway madness. The local Labour candidate in that general election went a little further in declaring specifically that a Labour Government would scrap the scheme on day one. A Labour Government were indeed returned, as history records, but once safely in office, after a series of reviews, the Government did a 180-degree U-turn. On 31 July 1998—the last day of the parliamentary Session they announced that the widening of the M25 to five and six lanes would go ahead after all. In so doing, they betrayed the many voters of all political persuasions in Egham, Thorpe and other communities along that stretch of the motorway who had voted Labour because of specific or implied pledges on motorway widening. The memory of that experience lingers.
Voters in my constituency want to know, and have a right to know before the general election, whether a Labour Government would support the Central Railway scheme proceeding via the mechanism of a hybrid Bill with no opportunity for proper local scrutiny. If the Government insist on postponing the moment of truth until after a general election, my constituents will draw their own conclusions, regardless of their broader political persuasions.
The backers of the scheme claim that it will take freight off the roads. The argument for moving freight from road to rail is essentially environmental, yet the scheme will be highly environmentally damaging. The railway will pass through built-up residential areas in my constituency, as well as areas to the north and south that are of great landscape value. Elsewhere, it will pass through areas of outstanding natural beauty.
Technical issues also arise. We are told that, due to design constraints, the railway will have a maximum gradient of 1 per cent., but it will have to pass over the top of major transport infrastructure such as the M25-M4 intersection, with which many hon. Members will be familiar. In effect, there will be an elevated railway for miles on either side of that and other intersections, which will have an enormous impact on visual amenity and generate huge amounts of noise. Nor will the railway carry cars of normal size: they will be wide-gauge and taller than normal cars of the shuttle freight type that is used to contain full-size freight vehicles on the channel tunnel line. There is even talk of using double-decker freight cars, and it is almost certain that overhead electric cables will be used. In sum, the railway will be elevated, with very high cars and exceptionally high electric pylons. The scheme simply is not environmentally acceptable—a view that is supported by many local authorities along the route. It appears that the environmental damage will far outweigh the environmental benefits.
The assumptions that are necessary to demonstrate the project's economic viability are open to question. So far, there is no sign from the company of anything resembling rigorous analysis to support its contention

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that the project will lead to a substantial reduction in road traffic; nor is there any sign of an environmental impact assessment. Without producing a shred of evidence in support of its claims, the company is inviting the Government to support a hybrid Bill process that will side-step the usual checks to which such a scheme should be subject. Indeed, it is clear to all who have met the company's representatives that the scheme has not been properly worked out—it is simply a line on a plan. Requests for information about the vertical alignment of the railway, which will be vitally important to measuring the impact on the communities through which it will pass, have remained unanswered.
Given its undoubtedly huge environmental impact, even those who tend to support the scheme acknowledge that it should not go ahead without a public inquiry. Given the broad agreement to the proposed reform of compulsory purchase procedures, it would surely be wrong for a scheme with major compulsory purchase implications to be fast-tracked ahead of any changes to such arrangements. My constituents, who are suffering from the continuing blight arising from the project, are horrified at the thought of the promoter trying to erode proper scrutiny of the scheme by seeking Government support for a hybrid Bill.
I do not believe that in the years that the scheme has been around, the Government have not considered and evaluated its merits. My constituents demand answers to very simple and straightforward questions this side of a general election, so that they can decide how to cast their votes when the election comes. The first question is: do the Government support the scheme? The second is: will a Labour Government support the proposed hybrid Bill and thus allow the scheme to go ahead without the usual scrutiny of a planning inquiry? I look forward to receiving two straight answers to those simple and straightforward questions.
1.15 pm
The Parliamentary Under-Secret try of State for the Environment, Transport and the Regions (Mr. Robert Ainsworth): In the traditional way, I congratulate the hon. Member for Runnymede and Weybridge (Mr. Hammond) on securing the debate. I am aware of his concerns about the scheme as he has raised the matter on several occasions, but I am surprised at his desire to turn this into a blatantly party political issue. As Members of Parliament, we all have to decide how best to represent our constituents' interests in any given situation. Along with the other decisions that his constituents have to make, they will perhaps have to consider how he has represented their problems on this occasion.
As has been confirmed to the House previously, Central Railway has informed the Government that it does not wish to pursue its application under the Transport and Works Act 1992, but instead has requested our support for a hybrid Bill. It must be for the company to decide whether to allow its proposals to be examined openly under the TWA procedure. That would not preclude the possibility of the Government promoting a hybrid Bill if we considered it to be an appropriate means of authorising the scheme. However, Central Railway has yet to provide more details of its scheme, so I cannot say now whether the Government will sponsor a Bill to support it. It is, of course, open to any Member to propose a Bill, but this should not be
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seen as a means of bypassing the due consultation process. As with any major TWA application, a hybrid Bill must be debated in both Houses, and individuals and businesses directly affected would be given the opportunity to put their case.
Central Railway maintains that its project is an entirely privately funded scheme and that it is economically viable, but for a proposal of such scale and complexity, it is vital that the technical and commercial aspects are examined carefully. To that end, the Strategic Rail Authority has initiated a review of Central Railway's proposals. Until we have seen the results of that, it is impossible for the Government to take a view on the scheme, and it would be inappropriate for me to comment, let alone to give the assurances that the hon. Member for Runnymede and Weybridge wants.
The hon. Gentleman asked for the terms of reference that had been given to the Strategic Rail Authority. The purpose of the review is to identify those factors that are critical to the success of the project and to give an indication of the level of risk attached to each. Consultants should examine, but not be limited to the following areas: volume and market share forecasts; revenue and operating cost forecasts; capital costs; technical feasibility of the construction and operation of the project; planning issues, especially on the southern section of the proposed route; commercial and regulatory issues surrounding the use of Railtrack infrastructure and interfaces with Eurotunnel and Société Nationale des Chemin de Fer Francais—SNCF; capacity issues on the route; interchange location and other assumptions regarding terminals; and assumptions on rolling stock and rolling gauge.
Mr. Hammond: I am grateful to the Minister for giving the House such detail on the terms of reference that have been given to the SRA. I did not hear him mention the environmental impact of the scheme, but I am sure that he will correct me if that was an oversight. Is he convinced that the SRA is the right body to evaluate the company's claims with regard to the potential of the project for removing traffic and freight from the roads?
Mr. Ainsworth: The SRA is the body set up by the Government to examine how we implement our desires to move a significant amount of freight from road to rail, which it is doing. I know of no other body that would be more appropriate to undertake such a study on behalf of the Government, into Central Railway's proposal. It is worth bearing in mind the Government's clearly stated policy with respect to rail freight. The Under-Secretary of State for the Environment, Transport and the Regions, my hon. Friend the Member for Streatham (Mr. Hill), restated that policy in the House during the recent debate on this issue. It is relevant to our consideration of Central Railway's request for support for a Bill, and it is important to reiterate it. He said:
"We are committed to more freight on rail as part of an integrated sustainable freight transport distribution system. We have set out in our 10-year plan for transport an unprecedented investment programme to enhance the capacity and capability of the network. Through the Transport Act 2000, we established the Strategic Rail Authority with a remit to promote rail freight. We have also revitalised the freight grant regime to encourage

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companies to transfer more freight off the roads. We have made it clear that we wish to see greater investment in the railways to cater for growth in both passenger and freight traffic over the next decade. We have asked the SRA to take forward the detailed plans for applying that investment. As a first step, it will shortly produce its strategic agenda."—[Official Report, 12 February 2001: Vol. 363. c. 135.]
As the hon. Gentleman said, and as you will recall, Mr. Winterton, the last time that Central Railway's proposal was put before the House, hon. Members rejected it overwhelmingly. If the Government are considering supporting a Bill now for a revised and expanded proposal, it is right that the SRA should seek to learn more about it. I have outlined the basis of the Government's commitment to rail freight and the SRA's role in helping to achieve the industry's objectives. I cannot anticipate the result of that review, but I am confident that the SRA will examine Central's proposals in the context of the 10-year plan and the authority's strategy for freight. We will follow the SRA's review with interest, and will be happy to make a further statement about Central Railway in due course, taking into account the SRA's findings.
The main constituency issue raised by the hon. Gentleman was the question of blight. That is of great concern to many other hon. Members whose constituencies lie along the proposed route. Blight is caused by the presence of any major proposal in the public domain, whether or not a formal submission is imminent. Regrettably, and to varying degrees, blight is inevitable in connection with major infrastructure proposals. One cannot consider a case such as Central Railway in isolation. The sort of problems arising from the proposal under discussion can arise from any major infrastructure project, regardless of the form of the statutory consent being pursued. Nor is blight merely an issue in relation to major projects. It might also arise on a smaller scale in relation to any bad neighbour development that has a long gestation period, regardless of whether compulsory purchase powers are required.
The hon. Gentleman suggested that legislation to regulate developers such as Central Railway would be appropriate. Realistically, one cannot impose a time scale on the period between the inception of a proposal and its formal submission, nor can one dictate how the promoters of a scheme should act in the meantime. We would not want to inhibit developers from making their proposals public. Prospective applicants must surely be free to develop a proposition as they see fit, and to apply for approval when they feel best placed to do so.
Mr. Hammond: Does the Minister agree that as the law stands, there is nothing to prevent a wholly spurious, even malicious, scheme being proposed? There is simply no test. Anyone could propose to build an airport in the middle of the Minister's constituency without any real intention of progressing that proposal. His constituents would be blighted by the local authority's obligation to reveal that proposal in local searches. Does that not offend against the principles of natural justice?
Mr. Ainsworth: I do not know how the hon. Member would propose to change that. How could we without, as I have already said, stifling development proposals and preventing schemes that may be important to the future of the country, not merely a particular
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neighbourhood? An over-regulatory approach to the pre-application planning stage would stifle legitimate development of schemes essential to the well-being of the country as a whole.
The best approach to consultation is through flexible non-statutory guidance. That is why, as part of the Department's fundamental review into the laws and procedures relating to compulsory purchase and compensation, we published a code of practice on the dissemination of information during major infrastructure developments in October 1999. That emanated from the recommendations of an interdepartmental Working group on blight. The code's approach is commended to private sector promoters of major infrastructure development, as its aim is to minimise blight.
A further recommendation arising from the blight review was for a property purchase guarantee and compensation scheme that would offer guarantees of future value for a property and thus help to maintain the stability of a local property market.
Mr. Hammond: I realise that the Minister has only a few minutes left, but as we seem to be straying from the main thrust of the debate, I want to put this point to him. He has explained that he does not want to commit the Government to supporting or refusing to support the scheme until he has heard the result of the SRAs review. What is the Government's position on the use of a hybrid Bill as a too1? My constituents believe it to be a transparent mechanism to avoid proper scrutiny of the proposals. Regardless of whether the Government, having heard the SRA's report, think that the proposals are good, should they not commit themselves now to asking the company to take the TWA route so that all the players have an opportunity to scrutinise the proposals?
Mr. Ainsworth: As the hon. Gentleman knows, we were expecting Central Railway to take the TWA route. We did not encourage it to propose a hybrid Bill. It was the company's decision to do so, and we are trying to deal with the proposition on the table. Before we take a definitive view on whether the proposition should be allowed to go forward, or given any support, we have decided to ask the SRA to undertake the review. I know that the hon. Gentleman does not like that, but it seems to be a sensible approach and it would be seen as such by anyone who, rather than playing politics with the issue, is attempting to get the proposition on the table dealt with appropriately.
As part of the same review, an independent advisory group into compulsory purchase and blight compensation was established. The group published its final report last July, and we are currently considering its recommendations and the comments that we have received on them. As soon as possible, we will publish for consultation a statement of future policy on compulsory purchase procedures and compensation arrangements that takes those issues and the recommendations of the working group on blight into account. I hope that the hon. Gentleman is now clear about what is happening and about how we propose to handle Central Railway's proposition.
Mr. Nicholas Winterton (in the Chair): We can move on a little early to the debate on coastal erosion and its impact on neighbouring communities, initiated by the hon. Member for Middlesbrough. South and Cleveland, East (Dr. Kumar).

Coastal Erosion
1.29 pm
Dr. Ashok Kumar: What a pleasure it is that you always preside in this Chamber whenever I speak, Mr. Winterton.
I am grateful for this opportunity for the debate and I thank my hon. Friend the Minister who is to reply, as I know that he has more difficult problems to deal with. He is familiar with my constituency and has visited it on several occasions. Only recently, he met a delegation from my constituency of Redcar and Cleveland councillors and residents about the floods in Skinningrove. I put on record my appreciation for that useful and productive meeting.
The basic thrust of my subject affects only a small number of my constituents, but that small number is faced with serious worries. Their fears are shared by others living in neighbouring areas that are represented by my hon. Friend the Member for Scarborough and Whitby (Mr. Quinn) and other hon. Members representing constituencies along the North sea coast. I refer to coastal erosion, coastal stability and the problems that they cause for people living on the edge of cliffs and shorelines—problems that threaten them as property or business owners.
Many of the seaside towns and villages in the region started as fishing villages or small ports and, save become residential holiday and retirement centres. Along the coast in my constituency, the ground is made up of what geologists call glacial till, clay shale resting on harder sub-surface rock. By its nature, this is an unstable geological formation. With little water penetration the clay can rapidly acquire a plasticity that makes it vulnerable to landslides. The local shale is by its nature oily and slippery. A combination of those surfaces, along with the pounding that cliffs and foreshores receive from the remorseless action of the sea, makes slippage inevitable.
The instability is exacerbated by the constant erosive removal of material by wave action from the base of our local cliffs, some of which are around 600 ft high—the highest in Britain. That erosion results in the undercutting of the cliff, leading to more cliff falls and steepening, setting up a cycle of erosion that is so pronounced that its progress can be measured year by year and, indeed, month by month. I do not intend to enter the debate about global warming as we do not have the time, but weather patterns have changed significantly in the past few years and heavy storms and prolonged rain happen more frequently. If we accept the basic premise of global warming, we must accept rising sea levels and rising levels of coastal erosion.
I am pleased that the Government take the problem seriously and thank my hon. Friend the Minister for overseeing the new shoreline management plan, which involves an examination of the North sea shoreline. The plan process is democratic, embracing the local councils, communities and local water and drainage companies. The study also involves scientific engineering, and outlines in scientific and technological terms where the process of erosion can be halted and checked, where the line can be held and where there can be only a managed retreat, as it is called. That is where the problems start for my constituents.

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I refer to the small village of Cowbar as an example of the problem. It is situated high on the cliffs overlooking the picturesque and much larger fishing village of Staithes, where Captain Cook learned his seafaring skills. It has about 50 residents. Most of them are local people, some of whom are employed at the Boulby potash mine, which is nearby. Among the other inhabitants of the village are fishermen, retired people, and also the owners of holiday homes who, although they are only occasional visitors, are residents none the less.
About a year ago, those responsible for the shoreline management plan visited Cowbar, where the problems caused by erosion are well known and thoroughly understood. The road that serves the village snakes along the cliff edge. It has had to be repaired and re-sited twice within living memory; the last occasion was very recently. It is well known that rocks sometimes fall on to the shoreline below; that has been recorded for a long time. Engineers and academics have studied the area, and they have reached some sombre conclusions. The evidence before them suggested that, although there were no immediate problems, the erosion was unstoppable and that, within the next few years, subsidence might threaten some houses in Cowbar.
The impact of that prediction must be understood. The fact that it was stated in a public document was enough to frighten the financial institutions. The value of many houses fell because what had to be said had been said. No surveyor could ignore the findings of engineering professionals and no estate agency or mortgage lender could disregard the possible financial consequences of negotiating a property sale that ignored those findings.
The family home of Mr. Colin Mann, the chairman of the local residents' association, is situated far away from the cliff top. However, his mortgage lender has sent him a letter stating that it considered his home to be "unsuitable security" and, therefore, that it could not proceed further with his application.
I emphasise that I am not saying that public agencies should keep such reports secret. That would be a hundred times worse and could lead to charges that central and local government were keeping people in the dark about potential threats to them and their communities.
Increases in coastal erosion are starting to have an impact on people as well as on the countryside and the Government have a moral duty to take action. Coastal erosion will also start to impose costs on the wider community. Those costs are often unexpected.
I want, briefly, to adduce another example from my community that also arose as a result of the shoreline management plan process. One of the highest and most prominent natural features in my constituency is called Hunt cliff. It towers over the seaside resort town of Saltburn. Indeed, the town's very successful secondary school is named after it. A single-track railway line runs along the cliff top. It was constructed by Victorian railway engineers who sought a direct route from Teesside to Whitby. The line was an outlet for the limestone that was mined in dozens of local pits to feed blast furnaces. Passengers are no longer able to
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appreciate the great views from the cliff, but freight trains still use the line, carrying steel blooms into the Skinningrove steelworks and finished steel out.
The line is also constantly used by heavy freight trains moving potash and salt from east Cleveland's biggest employer, the Bou by potash mine, to which I have already referred. Heavy and bulky loads are moved quickly, cleanly and efficiently by rail and are, therefore, kept off the local road network, to the great relief of local people. However, the line has been indirectly threatened by the shoreline management plan, which takes a pessimistic view of the long-term stability of the cliff edge on Hunt cliff. It is recognised that there is not an immediate problem, but I am worried that the seeds of doubt might now have been sown. If big investment decisions were to be made about infrastructure repairs or new job creation projects, the report could have an impact on such matters. Increased movement of goods by road may be considered—movements that would have an impact on the environment of the area and the quality of life of local people and which would impose a cost on road maintenance and repair. For those reasons, the Minister and his Department should carry out an investigation.
That investigation should include whether the scope of the coastal protection budget—a budget informed by the work of the shoreline management projection—could be extended to cover the impact of coastal erosion on homes, businesses and infrastructure. Such a budgetary extension could be catered for by the existing public finance provision that applies to, for example, the compulsory purchase of properties needed for new roads or civil works. It could, in effect, be ring-fenced by saying that in a 30-year period it would apply only to properties that party or wholly lie within 200 m of a coastline.
Such a scheme could operate on a basis similar to the compulsory purchase order where, if agreement cannot be reached between the Ministry of Agriculture, Fisheries and Food and the individual affected by erosion, the matter could be subject to a public examination. The scheme would have a marked effect on restoring confidence to home and property owners who have an interest in land adjoining the shoreline, and investors and lenders would know that they were not running a high risk. I am aware that legal and insurance remedies exist for people affected by coastal erosion.
Given the increasing importance of the issue and of climatic change, we must look to new remedies. Our response to climate changes must be more than merely ensuring that the pumps are operating or that enough sandbags are on hand. We must recognise that coastal erosion has a profound impact on our society—an impact that takes a financial and legal as well as an environmental form The adoption of such a scheme would make a start on recognising that impact, as well as giving much hope to a small number of householders in my constituency, who at present feel threatened by a combination of natural forces.
1.43 pm
The Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food (Mr. Elliot Morley): I congratulate my hon. Friend the Member for Middlesbrough South and Cleveland, East

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(Dr. Kumar) on so clearly expressing the problems that people face in respect of coastal erosion. He has been to see me several times about the problem and I have visited his constituency. I pay tribute to the energetic and effective way in which he has represented his constituents in taking such issues up with the Ministry. I fully understand that coastal erosion, with the associated loss of land and property, is a highly emotional subject. It puts great stress on people and not only in economic terms. I have the utmost sympathy for my hon. Friend's constituents who are facing such problems.
Although natural events such as coastal erosion can never be prevented entirely, it is right that maritime district councils should take measures to alleviate the risk when it is sustainable to do so. However, it is unrealistic to expect to maintain all the coastline as it is now. We cannot completely surround the country with a wall of concrete. That is not only unrealistic, but undesirable. It would have consequences, given that our coastline is dynamic and erosion is part of a natural process. In that respect, we should base defence measures on an understanding of such natural processes and work with the processes as far as possible, while keeping the impact on defences elsewhere on the coastline in mind, rather than work against them.
As my hon. Friend stated, that is the reason why the Ministry of Agriculture, Fisheries and Food has encouraged the setting-up of coastal defence groups to provide a forum for discussion and co-operation. That leads to the preparation of shoreline management plans. They provide a basis for a sustainable coastal defence policy and set objectives for future coastline management, while taking into account natural coastal processes, coastal defence needs, environmental considerations, planning issues and current and future land use. Shoreline management plans are in place for the whole English coastline and are intended to be living documents, which can adapt to changing circumstances and which will be reviewed regularly to ensure that they are relevant to the needs of the people whom they protect and the coastline that they manage.
I understand my hon. Friend's strong case about the financial consequences of planning blight on people whose homes are identified in shoreline management plans as being at risk from erosion. However, I am sorry to say that compensation is not payable to people who are affected by flooding or erosion except in limited circumstances. That includes cases where it has been decided not to defend a particular area or to undertake managed realignment. That is not the case in this instance, as it is natural erosion.
That approach, which has been adopted by successive Governments, is justified by current legislation, which provides operating authorities with permissive powers to undertake flood and coastal defence work. Apart from the requirements of the habitats directive, there is no general obligation to build or to maintain defences at all, or to a particular standard. Consistent with that approach, the legislation makes no provision for compensation payable from public funds for people whose property or land is affected by erosion or flooding.
That sounds harsh, but coastal erosion is not a new process. It has occurred for centuries and people who live in areas that experience coastal erosion are aware of
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the inherent risks. The use of funding for flood and coastal defence would be unsustainable, given the funds that are available, although such funds have been increased. MAFF does not have the framework to provide such compensation. We do not have assessors or people who can advise on compensation levels. Also, we cannot compete with insurance companies, which have a role in flood and coastal defence, and nor should we.
I understand that that is not of great comfort to people who face such blight. However, I can offer my hon. Friend words of comfort about the grant aid that is provided for capital for flood defence and coast protection schemes that meet the criteria of being technically sound, economically worth while and environmentally acceptable. The priority score arrangements that we use for that are under review and a formal consultation is under way.
Schemes that meet such criteria may receive grant and approvals from MAFF to allow local authorities to borrow the balance of the cost of the approval schemes, net of grant. That funding has been increased in the past two spending reviews. Further funding has been announced as a result of the severe floods that the country has experienced. MAFF funding for flood and coastal defence capital is set to increase by 50 per cent: from £76 million this year to £114 million in 2003-04.
In recent years, MAFF has given grant aid for emergency coast protection works that have been undertaken by Redcar and Cleveland council at Redcar and Skinningrove and has funded strategic studies. My hon. Friend brought representatives of the local council to see me. I was impressed with them because, in contrast to others I have met, they did not sit wringing their hands and expecting the Government to step in and do everything for them. The council allocated its own resources and got on with the job of dealing with the coastal erosion problems and severe flooding that Skinningrove has experienced. It did not wait: it recognised the needs of the people that it represents and tried to provide for them. The council put forward some of its own money and attracted MAFF grant money. As my hon. Friend knows, I have agreed to consider a retrospective grant application for the flood defence works at Skinningrove.
Redcar and Cleveland council is undertaking some works at Cowbar. I assure my hon. Friend that, if the works meet the normal criteria, grant funding will be available to help the local council to provide coastal defences. That is a far more appropriate way of using Government funds. Although we cannot take on compensation for any type of blight, we can remove the blight by contributing to properly costed and evaluated flood and coastal defence schemes. The local council, which is considering that, is welcome to submit any proposals to MAFF to establish whether they qualify for grant aid. That may deal with the problems that my hon. Friend's constituents currently face.
I stress that we have clear criteria for giving grant aid, as my hon. Friend is aware. The key objectives of our flood and coastal defence policy are, first, to encourage the provision of adequate and cost-effective flood warning systems. No Government can guarantee that floods will not happen. We can, however, reduce the risk of floods and coastal flooding by encouraging people to provide good advanced warning. Secondly, we will

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encourage the provision of adequate, economically, technically and environmentally sound and sustainable flood and coastal defence measures. Thirdly, we will discourage inappropriate development in areas at risk from flooding and coastal erosion—a policy that has not been given sufficient weight in years gone by. Lessons have been learned from planning policies in the past.
Authorities are being asked to report on the extent to which local authority development plans contain coastal erosion statements and on planning applications in which coastal erosion was a material consideration. That does not affect Cowbar, but it is part of a strategic approach for the future. We must try to consider the future as well as dealing with the present.
I can offer my hon. Friend some support on the question of research and development. We should investigate the forces behind flooding and coastal erosion; the knowledge that we acquire will help to shape the technical means of responding to them. Local authorities would naturally find it difficult to find the resources for such research and development and we would not expect them to do so. It is appropriate that the Government take on the considerable spending involved to find the information needed to understand the forces along the coastline represented by my hon.
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Friend. That will give us some ideas in predicting the rate of erosion and about the responses that we need to make.
We are increasingly aware that we should regard holistically such issues as coastal erosion and flood defences. If one considers only one particular spot on the coastline and installs defences, it may have implications for other parts of the coastline. That consideration is taken into account in the research that we have commissioned and the funds that we have made available to assist the schemes that I am sure my hon. Friend wants.
We cannot, unfortunately, help with compensation for the sort of blight that my hon. Friend outlined so well. He made a strong case, but there is no facility for the Government to do that. However, we can help with capital support for his local council to enable it to defend some areas where it is sustainable to do so. That must be a key condition. I have a lot of respect for my hon. Friend's local council, which has done a good job in looking after the people whom it represents. If it suggests a scheme in accordance with the criteria that I have outlined, I shall be sympathetic to its case for Government grant support.
Question put and, agreed to.
Adjourned accordingly at five minutes to Two o'clock.