Westminster Hall Sitting of 21 November 2001

Preamble
[SIR ALAN HASELITURST in the Chair]

Alder Hey Hospital
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Heppell.]
9.30 am
Derek Twigg: I am pleased that this important debate is taking place. A number of my colleagues have been contacted by their constituents, and 12 families have contacted me over the past few weeks. They have asked me to express their concerns about a terrible and emotional issue. Indeed, it is a scandal. They are concerned about the way in which matters have been dealt with after the publication of a report and following on from various recent events. Some of my hon. Friends are present, and others would like to be. I hope that I can express many of their views. Some of my colleagues will speak when I resume my place.
My constituents are determined that their views should be highlighted in Parliament. What happened at Alder Hey hospital was a shocking scandal and almost beyond belief. Equally appalling is the way in which families have been dealt with at times by people at the hospital and by some members of the medical profession. The chief executive has been found guilty of misconduct. I note this morning that she has accepted the disciplinary panel's decision. It found that there was no alternative but regretfully to terminate her employment summarily in accordance with the terms and conditions of her contract. Miss Rowland was advised of that decision. It will be welcomed by the families concerned, as I welcome it.
Much of the parents' criticism is based on the need for further legislation. I know that my hon. Friend the Minister will refer to that. The parents believe that disciplinary action has been avoided. A typical family in my constituency who have raised concerns are Mr. and Mrs. Jarvis of Runcorn, whose son, Matthew, died aged four. The loss of their child is an important human story. We can imagine the emotional upheaval when they learned of the retention of organs.
We hear of a whispering campaign in the medical profession to the effect that families have over-reacted. I do not know how I would have reacted in the circumstances. It is clear that families have faced emotional upheaval. Mr. and Mrs. Jarvis are typical of the families involved and wanted me to voice their concerns.
The families are upset and concerned that all the doctors referred to the General Medical Council, as mentioned in the Redfern report, have been cleared, except for Professor van Velzen and Dr. John Martin. As I understand it, their hearings have not been set. Parents are concerned also that doctors' actions before 1988 and after 1995 have not been considered. They want to know why the GMC has used the Redfern
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report as a stand-alone document without referring to individual cases. With thousands of pages of documentary evidence, why did the GMC not call upon that material when making its decisions or call parents and relatives as witnesses? Parents cannot understand why they were not called as witnesses.
I have referred to Alder Hey hospital, but some of my constituents want other hospitals to be mentioned. For example, there is Warrington hospital, where about 60 families have been contacted and a disciplinary case has caused concern. The problem is widespread and concern extends throughout the country beyond Alder Hey.
Families are concerned about legislation. A change in the law has been promised in respect of the procedures used to gain informed consent to carry out post mortems and permission to retain organs. Pity II, the organisation that represents the families, says that it has been told that a change in the law cannot be brought before Parliament before the Session that starts in October 2002. The parents say that that is too long to wait. They fear that legal change may be diluted or even forgotten about. They want to know why the date cannot be brought forward. The matter is causing significant concern to the parents' group and among parents in Halton. I hope that my hon. Friend the Minister can deal with it this morning.
Parents are concerned about the role of the GMC. Disciplinary action has been considered but it has not been taken in most instances. That raises the issues of transparency and fairness and the way in which disciplinary action is handled for doctors. I understand that the GMC can basically take two forms of action. One is to strike off a doctor to stop him or her practising. The second is for it to send a letter of advice. Such letters went to eight doctors in the case that I am raising.
To the general public and many hon. Members, a letter of advice may not seem to be particularly strong disciplinary action. I understand from a doctor's point of view that such a letter is quite an important event in his or her career, and they would be very worried about receiving one. I understand also that there is no halfway house, such as a final warning or a yellow card system—a term that I do not particularly like—which would mean, "Next time, you're out." That situation concerns constituents, my colleagues and me.
I understand that the GMC has asked the Government to legislate on fitness to practise. It also wants more regulation. I met the council yesterday to discuss some of the issues. I considered it important that I understood its side in respect of the events. I know that the council has been encouraged by the Government to review its procedures—which is long overdue.
It seems strange that the medical profession does not have provision for taking disciplinary action locally. A doctor will be referred to the central body in London. The profession has an unusual way of dealing with colleagues who may face disciplinary action. It may be asked why alleged offences that took place in Liverpool, for example, will be dealt with in London. Why not deal with them locally? Parents have raised the issue with me. The GMC seems to be under general attack. Even doctors are attacking it for its handling of this case. I shall refer to a specific example later.
It is important that disciplinary procedures for doctors are seen to be fair and applied in a transparent manner. Last year, about 4,470 complaints and

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inquiries were received by the GMC, an increase on the 3,001 received in 1999. Of the 4,470, some 753 were referred to various GMC committees. There are about 180,000 doctors, but the number of complaints is a significant proportion.
Disciplinary action must be seen to be transparent and fair. At present, the GMC is seen as a toothless tiger run by doctors who look after their own. That may not be a fair view but there is that perception in many parts of my constituency and among the public generally. That underlines my suggestion that something must be done to ensure that the GMC deals with cases fairly.
I know that there are lay members on the GMC, but I still feel that it is necessary to review how disciplinary action is taken against those in the medical profession. The present system is not seen as fair.
I said that I would refer to some of the criticism of the GMC. I believe that it is important to do that, although I do not want to take too much time because other hon. Members want to speak. David Hughes, a consultant paediatrician, who is chairman of Alder Hey's medical board, said that Professor Donaldson, the chief medical officer, was looking for someone to blame when he referred many senior medical staff to the GMC. That is a scandalous accusation. He said that Professor Donaldson asked the council to investigate doctors who were criticised in the report. I am glad that he did. It is incredible that he has been criticised for doing that.
Dr. Hughes writes:
"It was with great distress that we witnessed the indiscriminate referral of our colleagues to the GMC by Professor Donaldson".
That is an extraordinary accusation by a senior member of the medical profession against the chief medical officer. Dr. Hughes also writes that Professor Donaldson
"displayed poor judgement and political expediency."
He suggests that the chief medical officer is influenced politically. By whom? He continues:
"This action demonstrated the need to seek individuals to blame rather than acknowledge the culture that created the circumstances for 'scandals' that were manifestly widespread and an accepted part of the system."
He also criticises the GMC for the "demeaning" way in which it handled the cases and for telling solicitors who acted for the parents that charges against most doctors had been dropped.
Dr. Hughes talks about blaming the culture, not individuals. It is unbelievable that such a culture could appear out of thin air rather than being created by individuals and that it went unchallenged. It is incredible for such a senior man in the medical profession to suggest that no individual, but a culture that appeared out of thin air, is to blame. It is important to emphasise that the Alder Hey scandal revealed that no one challenged the culture, so it persisted. Even those who did not like what was happening do not appear to have challenged it.
I repeat that I find it extraordinary that a senior member of the medical profession can take Dr. Hughes's line of argument in this day and age. Arrogance exists in some parts of the medical profession and parts of the NHS bureaucracy and management. It
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should be challenged. It has been manifest in the treatment of the families of the children, and not least in the dismissal of the chief executive of Alder Hey. That arrogance has made matters 10 times worse. It is time not only for the medical profession to adopt more open procedures, but to accept openly that it must sometimes take the blame for mistakes. If it starts to do that, matters will improve.
I believe that several questions need answering. The medical profession should examine itself and consider the way in which problems are managed. Legislation should be introduced sooner rather than later.
9.43 am
Mr. George Howarth: Sir Alan, I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing an important debate and on his thoughtful and well informed presentation of the arguments. My hon. Friend the Member for Knowsley, South (Mr. O'Hara) is disappointed that he cannot attend, but he had longstanding engagements away from the House.
We need to distinguish between the horrendous events that my hon. Friend the Member for Halton described, especially their effect on the families—many are constituents of mine—and Alder Hey as a working hospital. As a local resident, never mind a political representative, I have many connections with the hospital through members of my family. The medical treatment and the nursing care there are exemplary. It is therefore important to distinguish between the deplorable saga of organ retention and the medical treatment that is available at Alder Hey. It is no exaggeration to say that, despite the difficulties of the past few years, Alder Hey continues to enjoy a good reputation as one of the foremost treatment centres for children in the our region and beyond.
The sorry saga that my hon. Friend outlined is an example of a wider problem in our communities. We have no clear set of routines and procedures for dealing with horrendous events. Let us consider the Hillsborough disaster. I am not trying to make a direct parallel between that and events at Alder Hey, but there seem to be no adequate procedures for dealing with large-scale, emotionally charged events.
My hon. Friend said that he looked forward to legislation, but the problem is not confined to health. I hope that we shall look beyond health, important though it is, and consider the way in which we deal with all such matters, whether through judicial processes, coroners procedures or inquiry procedures that are available to Secretaries of State and the Prime Minister. We do not handle such events well. That is not a criticism of my hon. Friend the Minister or the Government. We have simply inherited a set of accumulated practices that do not measure up to the difficulties.
When the Redfern inquiry was in progress, I was a member of the Government and I tried to arrange a meeting between me, the solicitor who represented many of the families and Lord Hunt, the Minister who was responsible at the time. I was unable to do that. In 15 years as a Member of Parliament, I have never been refused a meeting with a Minister. I am still angry about my treatment by Lord Hunt, not only because I was a

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member of the Government, but because I felt that such treatment of any hon. Member was a discourtesy. Today is the first opportunity to put that on the record, and I am pleased to do that.
I shall not go through all the detail that my hon. Friend the Member for Halton outlined so ably. Sir Alan, I therefore conclude by saying that I hope that, as we review the procedures, we will find better ways of dealing with such problems. We are left with a series of unresolved issues and many aggrieved families, who do not know how matters will end. Although it may not be possible to find perfect procedures, I hope that we can find better solutions than those that have applied so far.
Mr. Deputy Speaker: I did not interrupt the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth), but the correct form of address when a Deputy Speaker is in the Chair in Westminster Hall is "Mr. Deputy Speaker". Members of the Chairman's Panel are addressed by name.
Mr. Howarth: My apologies.
Mr. Deputy Speaker: I accept that it is confusing.
9.48 am
Mr. Robert N. Wareing: I must get that form of address right.
I congratulate my hon. Friend the Member for Halton (Derek Twigg) on introducing the debate, which is about one of the most appalling scandals in recent medical history. It happened before the Minister assumed her responsibilities, so any comments that sound critical of the Government do not apply to her. She was generous enough to meet me and Robin Makin, a solicitor from Liverpool who is covering several hundred cases, on 23 October. I thank her for that.
I agree with the comments of my hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) about Alder Hey hospital, which was always regarded as a centre of excellence. It looked after children from Merseyside, the north-west, north Wales, the Isle of Man and further afield and it had a wonderful reputation, but that has been marred by recent events. It has devoted employees, and I make no criticism of the staff as a whole, but considerable trauma has been caused for the parents. They are still traumatised. After all, some have attended two, three or even four funerals to bury the hearts of their children. We must bring those responsible to book.
I understand from talking to the Secretary of State on the day that the Redfern report was published that no criminal sanctions are available. There are the disciplinary proceedings to which my hon. Friends referred, but a considerable number of wrongdoers have got off scot free. Hilary Rowland, the hospital's chief executive, was dismissed, but one might say that she is the tip of the iceberg. Perhaps "tip" is the wrong word; she may be lower down the scale and she may not have had complete responsibility, as has been alleged. In September 1999, she warned Robert Tinston, director of the north-west NHS executive, that the situation at the hospital constituted a major issue, but the executive failed to ensure that appropriate disaster planning, guidance and measures were introduced and implemented.
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On 23 March 2000, the chairman of Alder Hey was sacked. Professor Robert Tinston was put in charge and given personal responsibility for ensuring that arrangements for the return of the organs were in place and reporting fortnightly to the Minister on progress. On 18 July 2000, I asked the Secretary of State to make public Professor Tinston's report. Hon. Members should note when I asked my question and that I received a reply on 20 November, which stated:
"Internal reports between officials and Ministers are normally exempt from disclosure under exemption 2 of the Code of Practice on Access to Government Information that relates to information that would harm the frankness and candour of internal discussion, unless justifiable reasons are presented why they should not be covered by this exemption clause."—[Official Report, 20 November 2000; Vol. 357, c. 42W.]
I would have thought that there is no justification for the Government concealing from those with a vital interest information about the state of knowledge regarding organs removed and retained at Alder Hey and that among those people are the parents of the children involved.
On 30 January 2001—the day that the Redfern report was published—the Secretary of State answered a question from my hon. Friend the Member for Liverpool, Walton (Mr. Kilfoyle). On the sale of live tissue to pharmaceutical companies, my right hon. Friend said:
"it is our understanding that there was such a practice at the hospital in the early 1990s."—[Official Report, 30 January 2001; Vol. 362, c. 184.]
I am appalled. I acknowledge what my hon. Friends have said about the culture at the hospital, but, candidly, a culture that allows large private companies to profit from the remains of children is surely criminal. I hope that such activity has ceased, and I believe that it has.
We must get a strong grip on the hospital authorities, but I agree that Alder Hey must not be sacrificed because the problem is national and has existed in hospitals all over the country for a considerable time. Indeed, we know that, as long ago as 1995, Alder Hey and Liverpool university were aware of the existence of accumulated human material, so the problem arose long before Redfern was brought into play.
There have been failings much higher up the chain of command than Hilary Rowland. I have referred to one such person—the chief executive of the north-west NHS executive, Professor Tinston—and I believe that they should all go. The Government must get a grip on the situation and I want the Minister to say what is being done and what progress they are making. For example, what is being done to research the psychological features of the problem and have they kept faith by consulting all the parents who were prepared to give evidence? I hope that she supplies that information.
Many parents are suffering traumas and no doubt my colleagues have, like me, received postcards from individuals. I have half a dozen in my hand: they call for action against the wrongdoers and hope that parliamentary privilege will protect us as we make our remarks today. I do not intend to name any other person, but I am concerned about what the Government are doing.
A great many Britons go abroad as tourists or on business, so I would have thought that the international implications of the problem were being researched. We

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should consider what happens in other countries. For example, I understand that when a person dies in Austria, hospitals have an automatic right to strip the body of any organs or tissue that they believe that they require. That may affect British holidaymakers and British business men who visit that country, but we do not appear to know what happens, even in European Union countries. Perhaps the problem should be discussed in the Council of Ministers to achieve uniformity throughout the EU.
The good name of Alder Hey must not be sacrificed, because the problem is national, but we must legislate to ensure that criminal sanctions are available to punish wrongdoers. No such sanctions appear to exist. I would insist on a code of conduct, but not only to regulate the doctors. We need an over-arching system to regulate all in the NHS and that has to include the administrators, who must be made accountable and subject to individual scrutiny.
I hope that the Minister responds to those points and that a genuine search is made for the answers to the questions that cannot be dealt with today to ensure that this never happens again. That has been said so often in the past, but this time we must really mean it.
9.59 am
Mr. Colin Pickthall: I thank my hon. Friend the Member for Halton (Derek Twigg) for securing a debate on a matter that is important to all of us, especially those in the north-west. Eight families have contacted me since the publication of the Redfern report, and no doubt many more constituents who have not been in touch have also been affected.
I strongly agree with what my hon. Friend said about what I think he called a whispering campaign, suggesting that families were overreacting. That is not true of the families to whom I have spoken, who, although deeply hurt, have taken a restrained and responsible approach and done their homework—researching on the internet, for example, to try to ensure that they get the facts right.
Merseyside has had more than its fair share of tragedies in recent years. Like the Hillsborough disaster, the Alder Hey scandal needs to be dealt with in a comprehensive way, allowing relatives to bring an end to their grief and anger in the knowledge that all relevant information has been exposed publicly, guilt has been acknowledged and, where appropriate, action has been taken against those who have failed in their duty—and, most important, that systems have been changed so that such tragedies do not happen in future.
The grief and anger stemming from Hillsborough—I make no excuse for the comparison—has never been fully assuaged, although the disaster occurred some 12 years ago. We must not allow the feelings of the Alder Hey parents, and their friends and relatives, to go unanswered, as happened for far too long after Hillsborough. It is hard to overstate the deep distress caused to parents who discovered that their children's organs had been removed without their permission, or even their knowledge.
I want to raise a specific issue, at the request of my constituents Janette and Stephen Robinson of Skelmersdale, whose son Michael was one of the
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unfortunately deceased children whose organs were removed. They point out that, although some senior figures have been disciplined —we heard today that the chief executive was among them—Mrs. Karen England, who was at least involved in some of the cover-up, has avoided any formal censure, if such was appropriate, by moving to another job.
I seriously dislike referring to this lady by name, but her involvement is an important aspect of the case, and I could not describe what happened without identifying her. I realise that it is not pleasant to talk about an individual who is not present to speak for herself, but by virtue of her role as a senior administrator working with Professor van Velzen, Mrs. England must have known the truth—or at least part of it—about the removal and retention of organs. She was put in charge of handling relationships with the parents when the scandal broke, and is heavily criticised in the Redfern report for mishandling them. It seems that she may well have falsified records in at least one case, and she has certainly misled families.
When the chairman of Alder Hey was removed and the chief executive was sent on gardening leave, Mrs. England was seconded to Warrington General hospital. In January this year, she was suspended by Alder Hey, but it turned out that in the interim she had secured a full-time post at Warrington, and therefore could not be disciplined or investigated by Alder Hey. When those at Warrington looked into the case, quite properly, they found that Mrs. England had not broken her contract as far as they were concerned, so there was nothing that they felt they should do.
I realise that when one goes into a particular case like this, it may seem like a witch-hunt aimed at an individual. I do not intend that; I simply assert that there is at least a prima facie case to answer in connection with one person.
I have some questions for the Minister. I understand that she may not be able to answer them today, but perhaps she could do so later in writing. They were put to me by my constituents Mr. and Mrs. Robinson, who attempted repeatedly to speak to Mrs. England about what had happened to their son. She refused to respond, so they never received an answer. I am now seeking answers on their behalf.
First, my constituents ask why Mrs. England was allowed to remove herself from the Royal Liverpool Children's NHS Trust when an external inquiry was taking place in which she was a key player. Secondly, who at the trust supplied references in connection with the full-time post that she secured at Warrington General? Thirdly, what did Warrington General know of her background, and her possible involvement in the events that we are discussing? Is she obliged to reveal her involvement when she applies for another post?
In a letter sent to me earlier this week, Mr. and Mrs. Robinson make points reiterated today by my hon. Friends the Members for Knowsley, North and Sefton, East (Mr. Howarth) and for Liverpool, West Derby (Mr. Wareing). They say:
"We are not trying to damage the name of Alder Hey or to vilify the hospital. We would like some natural justice for what happened to our own child and to all the other children involved. It seems completely inconceivable that people involved in wrong doing have been let off scot free. This would not be allowed to happen to others in positions of authority in other professions."

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I agree with all of that final paragraph in the letter, except the last sentence. This is, in fact, allowed to happen to others in positions of authority in other professions. We saw it happen in the case of Hillsborough: we saw people who should have been examined and possibly disciplined for their negligence in regard to that terrible event managing to escape by retiring at the appropriate moment. In this case, someone who may well have been involved—or at least had something to explain to the health authorities—has been able to escape, possibly by accident, through the simple mechanism of changing job and moving from one trust to another, which has removed her from any further investigation.
I do not believe that that is right. I feel that it should be addressed by the NHS as a whole, so that people such as Mr. and Mrs. Robinson and the other parents mentioned by my hon. Friends can be confident that the health service will not allow such things to happen again—or, should they happen again, will not allow those responsible to go unpunished.
Several hon. Members rose—
Mr. John Butterffil (in the Chair): Order. A number of hon. Members still wish to speak. It would be helpful if speeches were reasonably short, to allow time for the Minister to reply to the debate.
10.8 am
Dr. John Pugh: Like one of the earlier speakers, I have a family connection with Alder Hey: my brother was born there, and a young child received medical help there. Until the very recent and very sad events, Alder Hey had a sound reputation throughout the Liverpool area.
I thank the hon. Member for Halton (Derek Twigg) for raising this issue. One phrase has stuck in my mind—a reference in, I believe, the British Medical Journal to the spurious distinction between culture and individuals: culture can be blamed, but individuals cannot. I submit that that distinction has no validity. Blame cannot simply be laid on an anonymous culture; it must be embodied in the actions of individuals.
The Redfern report identified two necessary and important changes, which bear on individuals as well as cultures. As is widely acknowledged, there must be legislative change, but there must also be cultural change. What happened at Alder Hey was not simply a consequence of the behaviour of one rogue doctor; a number of people were implicated or involved, or overlooked what was going on—administrators, for instance, and the coroner's office. It is not simply the actions of that one particular doctor. The administration subsequently was not desirable. As a result of the incompetence of administrators, constituents of mine have had to suffer the pain of multiple burials of members of their family. No one would wish that upon anyone.
We must remember that there has been a police investigation and that reforms are promised which we would all collectively support—a new law on consent, a review of the coroner system and a review of management accountability. We would endorse that and be comfortable with it, but the question put by the
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hon. Member for Halton is whether there has been sufficient cultural change—whether it has really got home—and whether it is universal. That is what this debate appears to highlight best.
There has been an element of cultural change. I was speaking last night to Ed Bradley, who organised on behalf of parents much of the action that brought the sad events at Alder Hey to light. He is now working with the Institute of Pathologists in order to provide a better way of behaving and of proceeding, and to avoid the unfortunate aspects that have characterised Alder Hey—unfortunate is to put it very mildly.
However, there are other indications—the hon. Member for Halton has drawn them to our attention—that the cultural change has not bitten sufficiently. One mentions in that respect the comments in the British Medical Journal, where there seems to be an unwillingness to accept that to ask for appropriate disciplinary procedures is distinct from pure witch-hunting. There is a clear intellectual distinction that I think we would all support.
As I have said, I thank the hon. Member for Halton for securing the debate. If it serves any good, it is to highlight that there is some way to go in changing the culture. I hope that the Minister will bear in mind the fact that there is certainly some way to go in changing the legislation. There is work to be done there. Sadly, there is some way to go in apportioning blame.
10.12 am
Mr. David Watts: I congratulate my hon. Friend the Member for Halton (Derek Twigg) on securing the debate. Many hon. Members have tried for some weeks to secure a similar debate to put on record our concerns and those of the parents who have contacted us over the past few weeks.
I pay tribute to Pity II, which has been campaigning for justice for that group of people for the past few years, and the solicitors who are acting on their behalf. I am not a lover of solicitors as a group, even though my son is one, but I believe that there are some good solicitors and the two who have been involved, Mr. Cohen and Mr. Makin, have done an excellent job in ensuring that the case is heard.
I would like to be associated with some of the comments about Alder Hey. There is no doubt that many parents throughout the north-west and a wider area owe their lives to the skill and dedication of staff at Alder Hey. There is no doubt that the current investigation and the controversy about what went on is having a tremendous effect on the staff who are still working at Alder Hey. The message from here is that we support those general staff, and we want that hospital to go from strength to strength and welcome the contribution that it has made over many years.
There is no doubt, however, that many parents have been let down by Alder Hey hospital and Liverpool university. We have heard a lot about the hospital, but it was a joint action. It would have happened only with the support of Liverpool university and Alder Hey. There was clear involvement of both medical and administrative staff in bringing about the problems.
No one should underestimate the grief that the parents felt. Anyone who has ever known someone who has lost a child understands that it leaves them with an

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emptiness and hopelessness. Often they cannot rebuild their lives. We cannot overestimate the strain, stress and profound effect that the death of a child, regardless of the age, has on a family. Therefore, it is possible to imagine what the grief would be like when they find out that the child they buried, or thought they buried, had had their organs removed without consent. The grief would refocus and they would not be able to get back to rebuilding their lives.
That is bad enough, but let us remember what happened. Even when those parents found out that their children's organs had been retained and they had a second burial for those organs, a third element of organs was left in either the university or the hospital, so they often had to have three burial services. That is a scandal.
Then the parents found out that the organs had been retained for no good purpose, that they had not been used for anything that was worth while. Therefore, not only have they gone through that traumatic experience, but they have found that it had no purpose. They were told initially that there was nothing wrong, it was normal practice and that they had no case. They were asked what they were moaning about. They were told that it was standard practice in hospitals and universities. They are very angry, and rightly so, to find out that their child's organs were retained without their permission.
The parents want to know the detail of the investigation. They want to know the detail of the administration disciplinary hearings that took place. A number of my colleagues have raised those issues. There are three administration staff at Alder Hey. One has been named today. The accusation is that that person lied to the inquiry and falsified documents. That person was then transferred to another hospital. If that is the case, it is another scandal. The one thing we need to know from the Minister is, if those allegations are true, is it acceptable for someone who has been found to do those two things to still be working in the NHS? The answer is no. I hope that the Minister will ensure that there is an investigation into that issue and that action is taken, if it is needed.
For those people who do not know, 76 doctors were referred to the General Medical Council for investigation to examine whether there was a case against them. Only a small number of those doctors are now going through the disciplinary hearing system. I was amazed when I met the GMC yesterday with my hon. Friend the Member for Halton to find out that the GMC cannot take action against a doctor unless it believes that he is unfit to practise—even if it believes that he has made a terrible mistake or misjudgment, it cannot take action. The proof has to be that he is not able to do his job and should have his registration papers removed. The test for whether action is taken against a doctor is too high.
In fairness to the GMC, it accepts that. I understand that it is campaigning for and has contacted the Government to say that it wants wider powers, to be able to take action below that threshold. That is right.
My experience is that self-regulation is no regulation at all. As a Member of Parliament, I have had dealings with the GMC before—I am sure everyone in the
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Chamber has. I have also had contact with the Office for the Supervision of Solicitors and even with the Association of British Travel Agents. When we try to get accountability into those professions and services, we find that we are dealing with people who are more interested in their members than the general public. The Government should take action to make those bodies independent and to ensure that, when they review issues regarding the public's interest, the public interest will come first.
Derek Twigg: On that last point, my hon. Friend may recall that I mentioned that doctors are now attacking the GMC too. We assume that none of the doctors is stupid. They obviously are not attacking it for no reason. Does he think that they are attacking it because they feel that it has been too hard on doctors and their colleagues, or do they want to give the impression that the GMC has been unfair—it must have been because the doctors are attacking it?
Mr. Watts: My hon. Friend raises an interesting point. There are two reasons for that. First, there is an arrogance in the medical profession. It believes that lay people, the ordinary public, should not be able to hold those groups to account. Secondly, it is trying to hide the facts of the case. It sets itself high standards, which we would all expect doctors to do, but it has failed in this case. It has failed in the investigation, failed to protect its good reputation and failed to take action to ensure that those events could not happen again.
I leave hon. Members with one thought. People believe that, after this scandal, the matter has been resolved, that accountability systems have been put in place and that legislation is on its way. I do not believe that it is. The purpose of the debate is to make sure that Ministers hear loud and clear that we want legislation on this matter, and that we want it quickly.
However, we must start to make sure that the good practice developed in Alder Hey following the inquiry is maintained throughout the system. Two weeks ago, a constituent told me that a hospital close to my constituency had retained organs without permission. It was not Alder Hey, and I shall not name it in this debate. I wrote to the hospital two weeks ago for an explanation, and have yet to receive one. I sent a fax yesterday, telling the hospital that I was taking part in this debate and asking whether there was any truth in the allegation.
So far, I have received no reply, so I take it that there is something in the allegation. If so, that demonstrates once again the arrogance and lack of accountability of the medical profession. I strongly urge my hon. Friend the Minister to take immediate action to ensure that the legislation is changed so that what happened at Alder Hey cannot happen again.
10.21 am
Sandra Gidley: I congratulate the hon. Member for Halton (Derek Twigg) on securing the debate. All hon. Members who have spoken have highlighted the human aspects of the story and, as politicians, we must take careful note of them.
I am sure that no one can fail to be horrified at the extent of what went on at Alder Hey. Most people will be familiar with the unfortunate story: a large number of

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organs were retained without parental consent, and that nightmare was exacerbated by the actions of van Velzen, which can only be described as bizarre. I make no excuses for him, but every profession contains some bizarre individual of whom no one is proud but who seems to get away with totally unacceptable behaviour. We need to make sure that the public are protected from those rare people.
Similar problems in other parts of the country have not received so much national publicity. For example, local hospitals in Southampton retained a large number of organs, and perhaps lessons should have been learned from their handling of the matter. They were proactive and honest about what had happened. They spent much time, effort and manpower talking and explaining things to parents.
In addition, the hospitals in Southampton apologised for what had happened. Members of the medical profession are not good at apologising and saying that they are wrong. My postbag would be halved if people occasionally could say, "I'm sorry, what we did was wrong."
However, I do not want to dwell on the past. The law as it stands is clear: organs should not be removed and retained for medical purposes after a coroner's post-mortem examination unless prior consent has been obtained. It is depressing to acknowledge that it seems to have been common practice to flout that law, but the important question is how we move on.
The hon. Member for Halton made some important points about openness in the NHS. I agree that the perceived culture is that everyone in the medical profession stands together. That often leads people to believe that matters have been covered up, and the GMC has come in for a lot of criticism.
I hope that such allegations will become things of the past. Last night, the House of Commons discussed the National Health Service Reform and Health Professions Bill, which will establish the Council for the Regulation of Health Care Professionals. I hope that the new council will take the best practice from all the different regulatory bodies, so that all such bodies perform their duties in a spirit of openness, and with greater transparency in their processes.
The hon. Member for Halton also referred to criticism of indiscriminate referral of people to the GMC. I stand to be corrected in this respect, but my understanding is that the referral of people to the GMC was indiscriminate, and that some of the people referred were doctors but were not in fact medically qualified. As the GMC deals with only the medical profession, it is therefore fair to say that some of the referrals were indiscriminate.
I am not an apologist for the GMC, but my view is that it can deal only with professional misconduct. It has no remit to deal with poor judgment, and that is why the people involved were let off. The key people involved were responsible for about 90 per cent. of the problem. What those key players did amounted to professional misconduct, and it is right and proper that they should be referred to the GMC.
There seems to be a general feeling in the debate today that everybody involved should be brought to book, even if they were only bit players. My question is, would that do anything to progress matters, and to make sure
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that the same thing did not happen in the future? I believe that that is what we, as politicians, should be concerned about.
Derek Twigg: I think that I heard the hon. Lady aright, and that she said that she considers that indiscriminate referral took place. Does she believe that Professor Donaldson, who undertook that referral, behaved unprofessionally?
Sandra Gidley: I am saying that I would question his judgment. Professor Donaldson thought that he was right, but I would question his judgment. Sufficient research to ensure that the correct people were referred does not seem to have been done.
Mr. Watts: On what basis does the hon. Lady reach that assumption? Has she gone through all the cases, one after another, and decided on the merits of each case whether they should have been forwarded, or does she base her statement on what certain doctors and consultants have said?
Sandra Gidley: As I said earlier, the list of those referred to the GMC includes people who are not medically qualified. The GMC can deal only with medically qualified doctors. If that is not indiscriminate, I do not what know is.
I agree that the whole process is grindingly slow, as has been stated already. We must do all that we can to speed matters up, without sacrificing fairness. We must ensure that disciplinary action is swift and fair. That would be in the interests of patients, relatives and the medical profession as a whole. The "Doctor as God" culture is disappearing, thankfully, but it remains prevalent. I believe that it was present at Alder Hey.
The experience gives us a chance to ensure that a proper framework is in place so that we will never be in the same position again. Work has been done on a proper code of conduct, and I do not understand why legislation should be needed. Many hospitals have implemented that code of conduct, as they have no desire to become known as "Alder Hey 2". However, given the scale of the problem, I believe that legislation is needed, as there should be no possibility of anyone being able to get away with such malpractice in the future, and no excuse available if it happens.
Mr. George Howarth: I hope that the hon. Lady will help me on one point. Is she saying that, on the one hand, she does not think that legislation is necessary but that, on the other, there should be legislation for some other reason? I find that very strange.
Sandra Gidley: I am saying that it is a shame that we need to have legislation. In a perfect world—and I accept that we do not live in one—hospitals and doctors would be keen to put in place the right procedures. However, there can be no excuse for any recurrence of what happened at Alder Hey. For that reason, as a safeguard against people like van Velzen and others who are equally off the wall, we need to put legislation in place. I wish that that were not necessary, but we must protect the public. The system has been shown to fail and we must do something about that.

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Medical students and doctors are not trained to deal with such delicate matters. It must be extremely difficult to explain to a bereaved parent that the hospital might want to keep a child's organ for the greater good. If those matters are faced sensibly and sensitively, some parents might think it heartening that something good can come out of the situation. However, the secret and surreptitious way in which it was done meant that parents felt that their children had been violated. Medical students and doctors must have the training to ensure that that does not happen again.
Hon. Members have raised questions today about disciplinary procedures in hospitals. What plans does the Minister have to ensure that in future the hospital disciplinary systems are more effective and transparent, given that there have been accusations of cover-ups? That is not an issue solely for Alder Hey, but for all hospitals around the country.
Dr. Pugh: Is the hon. Lady saying that the lack of transparency at Alder Hey has made it difficult to operate a perfectly proper pathology and for the medical fraternity to feel that it is secure in doing things that would in the long term benefit children, parents and the community? In other words, has the lack of transparency and the attempts at a cover-up by some members of the medical profession harmed the interests of not only parents and communities but the profession itself?
Sandra Gidley: Almost definitely. The lack of transparency and doctors' unwillingness to share information and explain what is going on has a knock-on effect on everybody. We have to move towards a culture in which medics explain the problem and the situation and have a transparent disciplinary procedure, if such is necessary. In that way, the public can see what is going on and know that justice is being done.
It is fair to say that events at Alder Hey have had a knock-on effect on people donating organs. There has been a detrimental effect on the medical profession because it has not learned to move with the times and operate with greater transparency.
These are the issues that we have to address. I will finish now so that the Minister has time to address them.
10.32 am
Mr. Simon Burns: I add my congratulations to the hon. Member for Halton (Derek Twigg) on securing this important debate. As we are all aware, it is more than two years since the tragic and horrific scandal that occurred at Alder Hey children's hospital became known. What took place over the past decade needs no explanation here; suffice it to say that the deeply disturbing actions of some at that hospital are the most horrific and distressing that I have heard about in our health system.
We cannot begin to know the pain and suffering that was caused to so many parents and their families by the callous, barbaric actions of a few at Alder Hey. That pain and suffering continues for far too many. As all hon. Members who have contributed to the debate have said, this is a deeply upsetting and disgraceful affair.
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It is also important to put this matter in context, as the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth) said in his speech. There was a culture at the hospital that involved some people, but we should, to be fair, draw a distinction and avoid making a sweeping condemnation of the hospital itself. Alder Hey has, throughout its history, pioneered significant improvements in surgical techniques and care, and has made a valuable contribution to paediatric medicine. Inevitably, Alder Hey will for ever be scarred by these cataclysmic events, but we must try to ensure that the work of the hospital is not harmed in the future because of the horrific events of the past.
There is no point in reliving the events surrounding this horrific case. We have all become familiar with them as the whole sad story has unfolded. Reliving what happened would serve no purpose today, especially in the light of yesterday's announcement that Alder Hey's chief executive has been found guilty of misconduct and of bringing the hospital into disrepute.
I would like an update on the progress in dealing with this case. Most importantly, can the Minister inform us of the progress that has been made with regard to the special commission that has been established to oversee the return to families of organs and tissues from around the country? It is essential that as much help and assistance as possible be provided to the families affected and that a proactive approach be taken to support them and endeavour to relieve some of the pain that they have endured over the past years.
The overriding concern of the families affected is to be able to put their children to rest so that they can try to move on with their lives. Until they can do that, there can be little relief for their bereavement. I fully understand that, owing to the nature of the case, such action is not easily achieved in all cases. That is the crux of why this case is so distressing. However, where finality can be sought, every effort should and must be made, and unparalleled assistance should be provided to ensure that it is.
Can the Minister inform us of the steps taken to ensure that all NHS trusts provide support and advice to families at the time of their bereavement? The spotlight is on Alder Hey, but it must not be forgotten that the unravelling of the events there has shown that this practice has been going on in varying degrees throughout the country. There are deeply distressed families elsewhere in the country as well as in the Merseyside area.
Can the Minister also inform us of the progress that has been made in the review of the coroners system, established following the scandal? The review was intended to inform us of the lessons we can learn from these events and thus help to establish safety mechanisms to prevent such instances from ever recurring. Linked to that is the wider review of existing law on all aspects of taking, storing and using tissue and organs from both the living and the dead. Many hon. Members have highlighted this issue, and I know that we all look forward to hearing what the Minister has to say on it.
Furthermore, there is the question of the Government's commitment to introduce legislation to make any necessary changes. Is the Minister in a

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position to enlighten us as to when that might happen? If that is not possible, does she have in mind a time scale that she can share with us?
I hope that the changes in the law will be supported by a new statutory code of practice that will cover organs used by the pharmaceutical industry. Can the Minister assure us that a standardised consent form to be introduced throughout the health service will accompany such a measure if one does not exist at present?
A number of hon. Members have also referred to the procedures and systems in place when it becomes apparent, following investigations, that someone has been grossly negligent in carrying out their duties or—with regard to some of the allegations that have been made in this debate—has allegedly sought to cover the tracks of the activities of some. I believe, as I think any reasonable person would, that those are very serious allegations. If I were a parent who had been affected and had had this appalling experience, I would want anybody who had been abusing the system or seeking to cover up such an abuse punished, and punished severely, not simply for the sake of vengeance but because of the degree and scale of the offence they had committed or the negligence for which they had been responsible.
I do not think it acceptable for people to be shunted around from job to job if they have been grossly negligent or inefficient in their job or have deliberately taken part in any cover-up. It is not good enough to say that, because someone has gone from one trust to another, nothing can be done to bring them to account—if the evidence warrants it. I hope that the Minister will look into that issue further if she is unable to say anything today about those concerns, which many hon. Members share. I have personal experience with my local trust of health care performance being of serious concern to health Ministers, and that was during the lifetime of the Labour Government. It could have been assumed that because certain members of staff had grossly failed, they would be removed from their jobs and would need to look for another job in another sphere. They were, however, shunted sideways to another job in the NHS. The lack of accountability for performance in the profession is extraordinary.
Everyone will agree that the case of Alder Hey is alarming and distressing. We must ensure that its consequences are dealt with swiftly and thoroughly, and with as much sympathy as possible. Above all, we must ensure that mechanisms are in place to change the culture, so that such events, which have caused so much grief and suffering to so many, can never happen again in our health system.
10.42 am
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I join in congratulating my hon. Friend the Member for Halton (Derek Twigg) on initiating today's debate. I have been involved for several months with the issues that have been raised by hon. Members. Some months ago, I visited Liverpool to meet many of the families, under the auspices of the Pity II group. I spent some time with them listening to their concerns, and they shared with me their grief, distress and anger at the events connected with the taking of organs without consent at Alder Hey. I discussed with
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the families the way forward and how we could develop mechanisms—through legislation, codes of practice, guidance and changes in the system and culture, as many hon. Members have mentioned—to try to ensure that other families are not put in a position similar to those families from Liverpool and the north-west region.
Last week, I was invited to join parents and relatives in remembrance of the children whose organs had been retained by the Alder Hey hospital at a memorial service held in Liverpool's Anglican cathedral. It was not possible to remain unmoved by such an occasion, but we need to try to keep a clear head to ensure that we take action in the future. That is what the parents want. They have to live with their grief and the damage that has been done to their families, and it will take many of them years to come to terms with what has happened. They want the Government to hear their concerns and to act upon them. That is the responsibility of Government and of politicians generally.
Everybody acknowledged that many of the children who died received first-class care at Alder Hey, and many hon. Members have today recognised the dedication of the staff. In Liverpool and across the north-west region, people respect Alder Hey for the top quality services that it provides. In the immediate sadness and grief after the death of their children, the parents took their bodies away and buried them in accordance with their cultural beliefs, but afterwards they felt let down by some of the people on whom they had relied. The parents felt that their trust had been betrayed in the light of subsequent events.
I understand why it is so difficult for these families to regain their trust in the medical profession. We all now know that organ retention was widespread throughout the NHS at the time. Although we have taken urgent steps to end that abhorrent situation, many parents are not yet ready for their confidence and trust to be restored in the organisations and, especially, in the individuals who let them down. It is up to us, as a Government, and the staff working in the NHS to try to win back that trust. That will take time to achieve because, as the Bishop of Liverpool said last Saturday, the families
"feel betrayed, so much so that it becomes difficult to trust anybody in authority".
It is our responsibility to try to heal the emotional wounds and, without forgetting the past, to put in place the practical measures that will begin to rebuild the trust of those families.
I am grateful to my hon. Friend for raising the issue, because it gives me a chance to update hon. Members on the progress that has been made since the Redfern inquiry, and on the recommendations of the chief medical officer and their implementation and development. I am hopeful that that progress will go some way towards restoring confidence in those parents and families. I am also grateful for the opportunity to place on record my thanks to the staff at Alder Hey hospital who have gone through some difficult times but have continued to care for families from across the region.
I know that families have felt frustrated in their quest for answers to some of their questions. I also know that they feel deeply that no family should ever again

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experience what they have experienced. It was the concerns about organ retention at Alder Hey that led the chief medical officer to conduct an investigation to see how widely that practice was followed in the NHS. That is why last year we issued the interim guidance— to which the hon. Member for Romsey (Sandra Gidley) referred—to ensure that in future there will be no ambiguity about the need to obtain consent for the retention of organs for the purposes of teaching, research or donation. That is also why we are preparing full guidance and consent forms, which are being piloted. The families have been fully consulted about the content of those consent forms and whether they are appropriate, sensitive, easy to understand and accessible.
We have to ensure that when parents consent to the retention of organs, they do so in the full knowledge of what is likely to happen to them. Hon. Members will recognise that some families are content for research to take place if they are provided with the full information. It is not that they do not want to co-operate. They know that the research can assist in preventing illnesses affecting children in the future, and that can be a tremendous testament to their own children. However, transparency, honesty and openness in dealing with families are crucial, as they mean that they can trust the profession in dealing with those matters.
The Redfern report made a series of recommendations covering serious incident procedures, the training and management of staff, record keeping, the development of audit trails, the roles of clinicians, the review of the coroner system, and the necessary review of the Human Tissue Act 1961, as well as the issue of consent. My hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) made an interesting point about the way we deal with serious incidents generally, not just those that happen in the NHS. We are poorly prepared for the emotional distress that arises from serious incidents. Over the past few years, we have seen several such incidents and I take seriously the need to learn the lessons from each of those events and to prepare an over-arching strategy, so that we do not try to reinvent the wheel. That strategy could include bereavement counselling, the role of the emergency services and contingency plans to support people after a serious incident.
When the report was published, we introduced a number of early measures that we could implement straight away. My right hon. Friend the Secretary of State established the retained organs commission to oversee the return of organs and tissue to families around the country. I have held several meetings with members of the commission, whose procedures are well established. They have kept in close consultation with all the families concerned, and have held several public meetings where families have expressed their point of view. The commission is fulfilling an extremely worthwhile role in ensuring the orderly return of organs, and in trying to minimise the distress suffered by many families who had to hold multiple funerals. Managing the process of return is an important part of the measures we have taken.
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The Home Secretary set in train a review of the coroners system. The Department of Health is keeping in close contact with the review. Tom Luce, a former head of social care policy at the Department of Health, has been appointed as chairman of the review, so there are clear links between the two Departments. It is crucial that the coroners review should not take place in isolation from the events that led to the need for the review.
One of the recommendations in the guidance from the chief medical officer was that we should consider new, non-invasive forms of post mortem and, where possible, use new technology, such as scanning, that can provide an authoritative cause of death. In some cases, there would thus be no need for an invasive post mortem, which would alleviate much of the distress experienced by families when such procedures are carried out on a child. The coroners review will be considering that recommendation.
The Secretary of State for Education and Skills has established a review of the joint contracts of employment between trusts and universities. The accountability of academic staff, through their contracts of employment, as between the university and the trust is a key issue, so it is an important part of the review.
A commitment was given to ensure that all trusts provide support and advice to families at the time of bereavement. An extensive mapping exercise is under way to assess existing bereavement services throughout the country—where they are patchy and where they need improvement—to ensure that every family has access, if they want it, to bereavement counselling and psychological support. From my personal experience with the families, I know that their psychological well-being has been affected by the events that they suffered, so it is extremely important to ensure that they have psychological support and counselling if they want it.
We gave a commitment to enshrine the concept of consent in law. Many hon. Members have asked when that legal review will take place and when legislation will be introduced. There was a proposal to publish a simple, two-clause Bill, but after examination it is clear that we need a wider and more comprehensive review of the Human Tissue Act. A consultation document is due to be published shortly; we are seeking the views of a range of people as to how we can strengthen the legislation on retained organs. We must ensure that we think the process through properly, that the right sanctions are implemented, and that our definition of "consent" is right.
Dr. Pugh: Can the Minister tell us when there will be new legislation? When can we envisage the introduction of new legislation if it is to be preceded by lengthy consultation?
Ms Blears: The consultation need not be lengthy, but I want it to be thorough because I want to get the legislation right, since this is such a sensitive matter. Obviously, the introduction of legislation depends on parliamentary time. That is why I told the parents that I did not envisage it in this parliamentary Session, but hon. Members can rest assured that I shall press extremely strongly for parliamentary time to enable a Bill to be introduced. We made a commitment to the families at the time of the inquiry, and we certainly intend to honour it.

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I have also undertaken to keep the families involved in the consultation process. Many of the problems in relation to retained organs have arisen owing to a breakdown of communication between people in authority and many of the families. The families have my personal assurance that I shall keep in very close contact with them.
Mr. Watts: Will my hon. Friend deal with the issue of the GMC structures and their reform?
Ms Blears: I want to deal both with the disciplinary procedures that have been taken against managers and administrative staff and with the GMC procedures. As hon. Members heard earlier, the former chief executive at Alder Hey has been dismissed. Members have expressed much concern, and indeed the chief executive was named in this Chamber today—as was Karen England.
Mr. Burns: Will the dismissed member of staff receive a financial pay-off?
Ms Blears: I understand that it was a summary dismissal, in accordance with her terms and conditions of employment, after the finding of misconduct. In those circumstances, there is not normally financial recompense. It is a disciplinary matter and the person has been summarily dismissed.
I understand that, in May 2000, Karen England was seconded to a temporary post at Warrington hospital for a period of up to six months, but in August 2000, before her suspension, she successfully obtained a substantive post at the Warrington hospitals trust. I also understand that that post was advertised externally, that references were taken up and that she was appointed through the usual recruitment procedures. It was not a case of her being transferred or, as one hon. Member said, "shunted", into an alternative post. She applied, references were taken up and she was appointed in the normal way.
All the disciplinary proceedings were conducted in accordance with the disciplinary procedures used in the various trusts. As there was concern as to whether the proceedings would be robust and rigorous, an external human resources adviser was appointed who had nothing to do with Alder Hey and who independently validated the procedures. Although I understand the anger, concern and frustration of the parents, the disciplinary proceedings were conducted in accordance with the individual contracts of employment and were externally validated.
I understand the desire of the parents to read the detail of those disciplinary matters, but as there is a legal mutual duty of confidence between employer and employee it is extremely difficult to put such matters in the public domain once the trusts have undertaken and resolved disciplinary proceedings. As there was concern about how the proceedings would be conducted, there
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was external validation by someone completely unconnected with the trusts involved. I hope that gives hon. Members some reassurance, but I entirely understand that concerns will remain.
I am pleased that the GMC is considering radical changes to the way it deals with fitness to practise issues. The Government are considering the GMC's proposals with interest and encouragement. As my hon. Friend the Member for Halton and other hon. Members said, the current system is extremely rigid: when someone is unfit to practice, one can either take action or do nothing. A halfway house system is proposed—the issuing of a yellow card to doctors that acts as a warning.
Mr. Watts: If those discussions are not fruitful or successful, will my hon. Friend legislate?
Ms Blears: Obviously, the regulation of the health care professions is governed by their regulating bodies. We want to ensure that we maintain that regulation system. Furthermore, the NHS Reform and Health Care Professions Bill proposes the establishment of a Council for the Regulation of Health Care Professionals. That would be the over-arching body that many Members want, and would consider how all the regulatory bodies function. For the first time, there will be a public interest element in the council, so that if a regulatory body takes a decision that is manifestly against the public interest, an independent body will be able to refer the matter to the courts for reconsideration.
That is a huge step forward. When I explained it to the families, they were extremely encouraged at the prospect that somebody could intervene when a decision was taken by a regulatory body that was clearly not in the public interest. I think that hon. Members will welcome that development. Furthermore, the adoption of a type of yellow-card scheme, so that action can be taken if similar matters arise in future, would also be an extremely positive way forward.
As many hon. Members have pointed out, the GMC has been criticised from both sides. The parents feel strongly that doctors have not been brought to account. Many doctors feel strongly that the chief medical officer was wrong to refer them. Our experience in this place makes us aware that we sometimes receive criticism from both sides, but that occasionally we may nevertheless tread the right path. Obviously, serious matters have arisen.
It is unfair to say that the chief medical officer referred doctors indiscriminately. He sent a copy of the Redfern inquiry report; it was then for the GMC to take action. Obviously, the CMG was concerned about doctors' behaviour in this case and referred the report.
The Government are taking these matters extremely seriously. I am grateful for all the contributions that hon. Members have made to the debate and I shall certainly take note of the suggestions and ideas that have been proposed. I hope that over the months to come we can begin to re-establish trust between the families that have been affected and the health service.

Farming (North-West)
11 am
Mr. Nigel Evans: I am grateful for this opportunity to debate farming in the north-west. This is a vital time for farming, and the industry is at a crossroads and will need clear direction from the Government. I have received an apology from my right hon. Friend the Member for Fylde (Mr. Jack), who is a member of the Select Committee on the Environment, Food and Rural Affairs, for not being able to be here.
There is no doubt that farming is now seen in a completely different light since the outbreak of foot and mouth disease. Those who felt that it was a stand-alone industry can think again. Farming was reeling from its own recession, which has lasted for about the past five years, and foot and mouth was just another body blow to it. Its impact has also hit tourism and allied trades with enormous repercussions.
The foot and mouth outbreak is obviously important to tourism—one of the fastest, if not the fastest, growing industries in the world. The outbreak has had enormous repercussions in Ribble Valley on industries such as rural garages. There are still some garages in villages, and they have been hit, as have post offices. Many post offices run tearooms, which rely on passing trade for business, and at least one simply shut up shop halfway through the outbreak because of the fall in custom.
Pubs have also experienced a decline in trade. I spoke to the landlord of the Coach and Horses at Bolton-by-Bowland today, and he said that the trade from walkers, which is the cream to his industry, fell away completely as paths were closed. That had an enormous impact on him, and he could not make the financial progress that he wished to make. An enormous investment in time as well as money is made in village pubs.
The foot and mouth outbreak hit the Lake district particularly hard. In March this year, the Cumbria tourist board conducted a business survey, which showed that the total tourism spend in that month suffered a 53 to 68 per cent. drop, which has had enormous repercussions throughout the Lake district.
So a healthy, vibrant countryside means a healthy, prosperous countryside. Although my debate is entitled, "Farming in the North-West", we should also consider the state of the north-west itself. There are almost 18,000 farms in the north-west, supporting 38,800 workers, and 17 per cent. of the cattle and calf population of England and Wales is found in the north-west. The Council for the Protection of Rural England reported in a paper that it published on the strategic lessons of the outbreak of foot and mouth disease that 40 per cent. of rural microbusinesses in the north-east had suffered a high or medium financial impact, according to a survey carried out in April. The outbreak had also adversely affected a quarter of all firms in the United Kingdom, and we know that to be the case in the north-west.
In October 2001, a survey by Deloitte and Touche showed that farm incomes had declined, year on year. For example, a 500 acre family farm earned £18,000 in 1995–96, but that figure was down to £8,000 last year, and it is estimated that that farm would now earn about £2,500. Farmgate prices have fallen, although consumers might be forgiven for thinking that they have not.
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It has also been estimated that there are 500,000 farmers in the country and that 50,000 have left the industry in the past two years. That, too, will have an enormous impact. Many farmers who were involved in full-time farming have switched to part-time farming. Commenting on the haemorrhage from the industry, the president of the National Farmers Union, Ben Gill, said:
"These figures are a dire reflection of the continuing desperate situation in British agriculture. They illustrate what we have warned: that the crisis has cut so deeply into the heart of farming in this country that, in spite of the survival instincts of our farmers, many simply cannot carry on."
That has had an impact on farmers in many ways; bank borrowing has increased; farm incomes have decreased by 70 per cent. over five years; and investment in the industry is at its lowest level since the 1970s, which will, of course, have an enormous follow-on effect in years to come.
Dugdales—a feed merchant in my constituency—is a perfect example. I spoke to Stephen Dugdale today, and he said that the tonnage of feed that he was selling had decreased—people simply do not feed dead animals. It will take a long time for that business to come back; it is doing so slowly, but the impact on businesses such as his has been enormous, especially during the outbreak's peak.
One farmer in my patch—Andrew Bristol—spoke scathingly about the way in which the clean-up operation was handled, especially given the delays that followed the Prime Minister's intervention in it. Andrew had to wait eight weeks for his contract to arrive, which has delayed considerably the clean-up and disinfection of his farm. Fortunately, he was signed off just two days ago, but he thinks that he will not restock his farm until March or even later. When he does restock it, he says that he will have to wait before his first cheque comes in.
There are similar examples. A farmer from Grindleton—David Coupland—showed me his initial contract for the clean-up operation. It was estimated that it would take him two hours to clean one very large shed, with concrete at the back and wooden sleepers on each side. That estimate is totally unrealistic; it takes me more than two hours to clean my living room. I simply do not know how anyone can reasonably be expected to clean and disinfect a barn properly in that time. Even J. K. Row-ling would not get away with that—it is more potty than Potter. We need realism in the estimate times for the clean-ups. The contracts need to be issued more quickly and the payments need to be made on time.
That view was reinforced by Steve Fawcett of the NFU. He said that the mood of farmers in Ribble Valley was still downbeat, with many questioning whether there is a future for farming. Henry Rowntree—another farmer—believes that the industry now needs more focus. He said that there is no doubt that some farmers will have to bite the bullet and that they will leave the industry. He also said that they definitely need to become more competitive, but he has told me that the French will introduce a ban on imports of sheep older than six months with their spinal cords in place as from 1 January and that they are using certain health measures to do so.
Many people ask why we cannot restrict imports into this country. We are told that we cannot do that because of the single market, yet the French manage to do it.

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Why cannot we look very carefully at the rules and regulations that they are using to protect their industry and do exactly the same? No, we play by the rules, and others do not quite do so.
There has been a lot of unease about the importation of cheap or inferior meat into this country. I suspect that no debate on farming would be complete without the term, "level playing field", so let us get it out of the way sooner rather than later. I spoke to a farmer in my constituency. Janet Wallbank, who said that, when one of her friends took a car across to Ireland, the family was questioned by officials when they got off the ferry to discover whether they had any food on board. They said, "We've only got some milk", so the officials took the milk from them, yet on their return to the United Kingdom, they were not even questioned about whether they were bringing in any food.
I went to Australia this summer, and there were posters on either side of the entrance to the main hallway at Sydney airport, and one person was employed to shout at the passengers, while pointing at the bin, that it was their last opportunity to get rid of any foodstuffs that they had brought into the country, including anything that was on the plane; otherwise they could end up with a costly fine. That does focus the attention, but nothing like that happened when I returned to the United Kingdom. So we must consider, yet again, what happens with food imports into this country.
Those involved in airport security are very strict about anyone with knives or metal objects, and we need the same effort to be made against the importation of foodstuffs, which we believe led to the initial outbreak of food and mouth disease. We need the same determination to stop foodstuffs coming in as we show in preventing metal objects or anything that might be dangerous from being taken on to planes. We need to focus our attention on that problem.
Janet also said something about the insurance problem. It has been argued that all farmers should insure against an outbreak of foot and mouth but, once the outbreak began, we know that it was impossible to obtain insurance. Henry Rowntree wondered what factors the insurance companies would consider in determining a proper premium and he told me that one of the issues that they would examine is how the outbreak was handled this time. Before they can set a realistic premium, they will want to know exactly what action the Government will take in any future outbreak. I ask the Minister to address that issue.
Touch wood, we hope that we are coming towards the end of this outbreak; there has not been a case in my patch or in the country for several weeks. It is therefore time to focus attention on what we will do to prevent any future outbreaks.
Henry Rowntree told me that the then Ministry of Agriculture, Fisheries and Food knew that there were virulent strains of foot and mouth in other parts of the world and that it had been told about the imports coming into this country. However, no checks were made on the meat stuffs coming in. He also told me that farming was under great economic strain—we know that from the decline in farm incomes—that the state veterinary service had been cut and that there was fragmentation of holdings within the industry.
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However, we now know that there were no contingency plans whatever for foot and mouth. That was a clear recipe for an outbreak, and he said that he had spoken to people from New Zealand and Australia who told him that they were not surprised that we had had an outbreak in this country.
The Minister for Rural Affairs (Alun Michael): It is only fair to ask the hon. Gentleman to put to one side the comment that there were no contingency plans. Whether those plans were adequate for the recent outbreak, which was quite different from the one that we had in the 1960s, is an entirely different matter. However, the suggestion that there were no contingency plans has been refuted on a number of occasions.
Mr. Evans: I want to come to that point shortly. I have reported what a farmer in my patch said, so the Minister must accept that many farmers believe it. However, when Ministers were asked about the rumours that abounded that phone calls were made before the outbreak to order wood for funeral pyres, we were told that they had been made because rehearsals and practice take place every year.
Alun Michael: My memory from when we were in opposition is that it is the role of the Opposition to spread enlightenment rather than unfounded rumours. Some things are believed because they are repeated. It is not the job of Members on either side of the House to repeat things that are not true.
Mr. Evans: It is also the job of Opposition to spread a little realism in light of whatever we face from those on the Government Benches. Although biosecurity will never be perfect whatever we do, the Minister must accept that it could be better. We must work towards improving it.
Mr. Stephen O'Brien: The Minister has just referred to the contingency plans, but my hon. Friend will be aware that I tabled many written questions about those plans towards the end of last Session and received very inadequate and exceptionally late answers. They did not deal satisfactorily with the questions of what contingency plans were in place and why, after a gap of 34 years, certain people had been rung up for timber supplies. It is incumbent on us to question seriously why, at least two months before the initial outbreak was announced, such inquiries for supplies had suddenly been made. Satisfactory answers have simply not yet been produced. It is our job to hold the Government to account.
Mr. Evans: That is one issue on which there were not rumours. We know that the phone calls were made and that perhaps explains the feeling that the Government knew more than they were letting on.
Such questions relate to the 1967 outbreak and to the report that followed an independent inquiry. Recommendations were made but we wonder why they were not properly followed in the current outbreak. Perhaps they were not good enough.
Mrs. Ann Winterton: My hon. Friend raises important issues. Everyone will come to their own

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view as to whether the contingency plans were in place or whether they were inadequate. However, one of the recommendations in the Northumberland report was that action should be taken immediately after an outbreak was diagnosed. Did not the Government make the mistake of leaving three critical days in February in which livestock movements continued as usual? Decisions were delayed unnecessarily.
Mr. Evans: If I were quicker on my feet, I would come straight to that point. My hon. Friend raises an important issue, and I shall come shortly to the concerns expressed that delays led to the outbreak being far worse than it would have been if action had been taken straight away.
I have already mentioned David Coupland, and he came to see my at my surgery. Any Member who represents a rural constituency has been visited by farmers since the outbreak began and some of the stories that they relate are very sad. There are also some horror stories about the mishandling of the outbreak. David told me that a number of animals were culled on his farm and that the vehicles that turned up to remove the dead bodies spilled all sorts of fluids on to the roads. Anyone who knows my constituency will realise that farmers drive around those roads.
David Coupland also said that some of the personnel involved clearly did not follow their guidelines. It was a hot day and they were wearing only half their protective uniforms; they had no protection on their heads. He said that what was most depressing is that farmers were blamed for spreading the disease. It is upsetting when farmers are told that they and their animal movements are spreading the disease when the people from MAFF and latterly the Department for Environment, Food and Rural Affairs were not following the guidelines.
Robert Parker of the Clitheroe auction mart believes that there is much talent in farming that the Government are not using. He hopes that, after the outbreak, they will listen more to the experts who can provide good advice about biosecurity and the future for farming. I give the Clitheroe auction mart 100 per cent. support, because it has suffered badly since the cessation of sales. Robert has started a farmers' market where he has more than 20 stalls and he says that it is doing really well. That is a superb example of the industry supporting the industry.
I turned up at the auction mart a couple of weeks ago when John Barber of the rural stress network organised a whole day of activities so that the community could support the farming industry. A number of stalls from all sorts of countryside organisations were present and more than 1,200 people turned up to support the day. It ended with an auction of items that had been donated by the community, and the money went to the charities that have supported the farming industry since the outbreak of foot and mouth. I congratulate everyone involved.
Will the Minister specifically consider the activities of the Bowland initiative in my constituency? It is supported by a number of organisations, including, in the past two years, MAFF and DEFRA. However, DEFRA has announced that it will no longer support the initiative, which is sad because that support has been
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especially necessary since the outbreak began. The initiative employs 10 people and, to date, it has given advice and assistance with grants to more than 120 farmers in the area; another 400 are on the waiting list. Farmers now need advice on diversification and assistance in filling out forms. If they are late sending the forms back, they do not receive anything but the forms are sometimes very confusing. To be able to obtain assistance from an organisation such as the Bowland initiative is very valuable. Will the Minister consider the support that DEFRA gives it?
Alun Michael: The hon. Gentleman makes an important point about the assistance and advice that is available to farmers. The Bowland initiative is excellent and I have given it specific consideration. The problem is that it was part of the objective 5b arrangements. Those have been changed and that option is no longer open to us. I assure him, however, that we have learned lessons from the Bowland initiative and objective 5b. We are keen to make advice and help available and are considering ways in which that can be delivered. Unfortunately, the strand of funding to which the hon. Gentleman refers is no longer available. That is the simple answer.
Mr. Evans: I accept that and I am sure that farmers will be grateful for the right hon. Gentleman's remarks. I hope that the ingenuity and flexibility of his Department will allow it to find a way to support that initiative so that it continues.
On the need for an independent inquiry, we know that Devon county council held its own inquiry. It is sad that DEFRA did not give evidence to it. No doubt the Minister will want to comment on that.
Alun Michael: I am grateful to the hon. Gentleman for letting me correct him immediately. The Devon inquiry issued a press release welcoming my response to its questions. We made it clear from the beginning that getting involved in giving evidence directly might look as though we were anticipating the independent inquiries established by the Government. That was understood by the Devon inquiry and the chairman, to whom I spoke only last week.
Mr. Evans: I am grateful for that clarification. I understood that written rather than oral evidence was submitted. I appreciate why the right hon. Gentleman has acted in that way. However, if he believes that the two inquiries announced by the Government will be sufficient to compensate for a full and independent inquiry he is sadly mistaken. Northumberland county council is holding an inquiry and I asked Hazel Harding of Lancashire county council to do the same because of the impact of foot and mouth outbreaks on our patch. Sadly, she said that the council is not prepared to do that. It is a pity that we have to rely on county councils to do the Government's job of setting up inquiries.
The Farmers Guardian, which is published in my constituency, had an interesting front-page article on 9 November about the lack of an early ban on animal movements to combat the spread of foot and mouth disease, which relates to what my hon. Friend the Member for Congleton (Mrs. Winterton) said. It refers to what two Government advisers, Mark Woolhouse

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and Professor Roy Anderson, say about the spread of foot and mouth. They believe that the delay resulted in far more animals being culled. According to Mark Woolhouse, the number of cases could have been halved if livestock movements had been banned immediately. Professor Roy Anderson, advising the Government on the fight against the disease, said that
"the speed it spread meant the consequences of any delays were huge".
He went on to point out that it might sound odd
"'to say a three-day delay was crucial, but it was crucial."'
That is what Government advisers are saying.
It is also interesting to note that page 2 has an article on the foot and mouth disease inquiry in Strasbourg. It is fair to say that I am not the greatest supporter of the European Union, but it is odd that we have to rely on county councils and the European Parliament when we cannot rely on our Government to establish an independent inquiry. I suspect that the Government fear that something may come out of an inquiry which will embarrass them, but they should take that embarrassment on the chin. It is far better to have a full independent inquiry that gets to the core of why the disease spread as quickly as it did because it did not spread in the same way in France or Ireland. We need to get to the real reasons for that. Let us take evidence from as many groups as possible so that if we have another outbreak—heaven forbid that we do—we will at least have learned the lessons and have recommendations to follow, such as those in the Devon county council report. Far better to be embarrassed than to have no proper full public inquiry.
Alun Michael: The hon. Gentleman has come to a disgraceful part of his speech. If he really cared about the farming industry, farmers and the damage that foot and mouth has done, he would want as he has said that he does—a full independent inquiry to get to the bottom of the matter. We have established three inquiries to do just that and speedily provide recommendations for the future. There is an open invitation for people to give evidence to them. The diversion of pretending that a public inquiry would be a magic wand is an irresponsible indulgence.
Mr. Evans: Having set up two inquiries that will not be as thorough as they could be shows that the Government are totally irresponsible because they want to push the problem into the long grass.
Mr. Bill Wiggin: I am keen to take issue with the Minister. If he is correct about how quick and efficient his inquiries will be, why on earth has he introduced the Animal Health Bill when he has not received the results from those inquiries?
Mr. Evans: The case for a full public inquiry is overwhelming. Those who suffered from the worst outbreak of foot and mouth ever to occur in this country want it; the only people who do not are the Government. I can only conclude that they are afraid of what a full and independent inquiry would produce, but it would be much better for the industry and its future if such an inquiry were held. Farmers whose animals were culled are thinking about restocking. They are unsure about
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the future of their industry. A full and independent inquiry, with proper recommendations, would reassure them.
Mr. Tim Collins: As the only representative in the Chamber of Cumbria, the county that was by far the worst affected by foot and mouth, I have yet to meet a single farmer, tourist business or constituent of any party political affiliation who does not want a full public independent inquiry and who believes that the Government's proposals are adequate.
Mr. Evans: That is also the opinion of every organisation involved in the farming industry, and I suspect that it goes further. We saw the disease's impact on tourism and other allied trades. The Government should bite the bullet and get on with it.
I am glad to say that the last outbreak in my patch was in July. We have just moved from being classified as a high-risk area to an at-risk area. I hope that we will be free of foot and mouth disease next week, which offers the industry some light at the end of the tunnel. We need an integrated approach on the part of organisations in the north-west, with the North West Development Agency, the county councils and rural development bodies working together to ensure that there is a future for the industry.
Certain issues—the old chestnuts—still need to be resolved, and it is important that we get things right. Supermarkets should prioritise local produce, which needs to be clearly labelled and promoted. We talk about the web of industries that rely on one another, and local supermarkets can do much to help local farmers. We must reconsider the costs and burdens on the industry. The livestock markets—the auction marts—need to be given hope that they can start up again because they are an important part of the farming industry. British produce needs to be properly marketed again to enable consumers to appreciate the benefits of buying British meat.
There must be proper and clear guidance for the future. There can be no hidden agenda for the farming industry. Our farmers are important not just as producers of foodstuffs, but for the health of the countryside, of tourism and of employment in areas where it is difficult to create new jobs. Farmers will look to the Government, post-foot and mouth, to come up with the answers. I hope that the Minister will reassure them.
Several hon. Members rose—
Mr. John Butterfill (in the Chair): Order. Quite a number of Back Benchers are seeking to catch my eye. We have a limited amount of time for the debate, so if contributions are relatively brief it may enable everyone who wishes to speak to do so.
11.29 am
Mr. David Borrow: I congratulate the hon. Member for Ribble Valley (Mr. Evans) on securing a debate on an important issue for many of us in the north-west. The hon. Gentleman represents the upper reaches of the Ribble Valley, where the countryside is

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hillier than it is at my end of the valley, which is very flat. Significantly, he focused on the livestock industry, which is obviously the main farming activity in his constituency, whereas I shall focus on horticulture and market gardening, which is the main activity in my constituency. First, however, I shall mention a few issues surrounding the foot and mouth outbreak this year.
As we look to restructure the farming industry in the north-west, we should recognise that the parts of the industry that will face the biggest challenge in restructuring are those that depend on subsidy or trade protection measures. As a result of the reform of the common agricultural policy, the recent agreement at the meeting of the World Trade Organisation in Doha and the continuation of those changes, many upland farmers who are involved in livestock farming face real challenges in maintaining the sustainability of those farms. Over the next few years, the challenge for my Government—and for the industry—will be to consider ways to ensure that as many of those farms as possible are sustainable and viable in the medium to long term, and ways to move from direct production-based support for the livestock industry to different forms of support.
Those changes are coming: we cannot assume that the existing regime will last more than a few years. Change arising from forces outside the United Kingdom is inevitable, so the Government and the industry must work closely together to ensure that as many businesses as possible survive, and that those that do survive are sustainable and have a long-term future. Some very difficult, painful decisions—which have little to do with foot and mouth disease—will have to be taken.
On the inquiries that have been set up into foot and mouth disease, my view is that it is important to get some interim reports back into Government on what has happened and what measures need to be taken to prevent a repeat of the outbreak. The inquiries that have been set up by the Government are independent of Government. They may not take the form of an independent public inquiry of the type that some people have demanded but, given the time that it took for the public inquiry into BSE to report, I am not sure that we can afford to wait so many years before we have something definitive on which to base a decision.
My view, which differs from that of Ministers, is that when those inquiries have reported and we have studied the reports, there may well be a demand for a further public inquiry of the traditional type, which may take several years, but which may be welcome at that point. I am not yet convinced that such an inquiry can happen now.
The hon. Member for Leominster (Mr. Wiggin) made a comment about the Animal Health Bill. In my view, we need to take measures urgently to deal with possible further outbreaks of the disease on the basis of the information that we have, so I support the Bill. On Second Reading, I commented on the way in which the Government had handled its introduction, but the need for the measure has been demonstrated. We need to sort
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out some of its details in the next few weeks. We cannot afford to delay until we have held a massive public inquiry on the issue.
Mr. Wiggin: The difficulty in what the hon. Gentleman has just said stems from the fact that none of the inquiries has reported, so your argument, which so sensibly suggested that you would wait to find out what the results were before legislating—
Mr. John Butterfill (in the Chair): Order. I am not making any arguments.
Mr. Wiggin: I apologise. The argument that we should wait before legislating is negated because the legislation is already under way. What is disturbing is that, whatever evidence emerges from these public inquiries, it will be too late to help shape the Animal Health Bill.
Mr. Borrow: In my view, if Ministers have information on the ways in which the existing system is not adequate, they have a duty to report to Parliament and to introduce legislation as soon as possible to put those things right. They may not be able to put everything right because they may not have all the information, and when the inquiries are concluded the Government may need to introduce further measures, but I do not believe that one should delay doing anything simply because one does not have all the information necessary to get everything right at once.
Mrs. Ann Winterton: Will the hon. Gentleman give way?
Mr. Borrow: I wish to move on.
I am aware that my hon. Friend the Member for Chorley (Mr. Hoyle) is here this morning. I was fortunate in that none of the livestock farmers in my constituency suffered from the foot and mouth disease, but the nearest outbreak was in my hon. Friend's constituency, so I am sure that he will refer to the subject if he gets the opportunity to speak.
I wish to discuss some of the broader issues surrounding agriculture. In the past few years, it has often been assumed that all agriculture is livestock agriculture. That assumption is wrong and causes difficulties. In my constituency and others in the north-west, thousands of people work in agriculture that has nothing to do with livestock. The bulk of those constituents work in parts of agriculture where the CAP does not apply. They do not rely on subsidies at all. In the arable sector and the horticulture sector, they are working in a market situation, competing with producers throughout the world.
Most people who work in the livestock sector are members of a farming family, who own and run the business themselves. Most of the horticultural firms in my constituency are family firms, but they do not simply consist of a farming family. A significant aspect of the horticulture sector is the large number of employees who work in it. Consequently, the horticulture sector operates differently.

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In the four and a half years that I have represented South Ribble I have noticed that, in the arable and horticulture sector, the industry has moved away from the north-west towards eastern England. Several aspects have contributed to that move.
Given the good quality of the land in Cheshire and the Lancashire plain, the north-west has traditionally been an important area for arable farming and market gardening, but the areas are somewhat isolated from the main part of the rest of UK agriculture. Although they have strong local markets, many of the major supermarkets and other purchasers of products have moved their purchasing to eastern England. That change has come about partly as a result of the decline in traditional wholesale markets—Liverpool and Manchester in particular.
Many of the small businesses that, traditionally, took their produce to the wholesale markets no longer have that means of access to the market, and most production now goes directly to supermarkets. Therefore, for many supermarkets, contracts are increasingly made through large companies in eastern England rather than with smaller companies in the north-west. There needs to be recognition that one problem of the sector in the northwest is the fact that many businesses are not operating in a co-operative way with one another as happens in other parts of the country, and many businesses are relatively small, which means that, in a market situation, they do not have the muscle of producers in eastern England.
I believe that the weather in the north-west has helped to encourage production and purchasing in eastern England. In the very wet autumn of last year, a large proportion of the vegetable production was never taken out of the ground. Many of the potatoes were left frozen in the ground, which delayed the spring planting, so most of the production moved from winter crops to spring crops, which are less profitable. That ties in with the long-term decline of production in the north-west.
Figures that I got from the National Farmers Union in my area yesterday show that some 20 out of the 60 sugar beet producers in the north-west are likely to leave the industry in the immediate future. All that points to the fact that the arable sector in the north-west is in decline, and much of the production is moving to eastern England. We need to look seriously at those issues.
I turn now to horticulture. The hon. Member for Ribble Valley mentioned the number of people leaving farming. Horticulture relies to a large extent on casual labour, much of which now has to come from overseas, and that is a significant problem. The season for horticulture production is longer than the period for which the seasonal agriculture worker scheme operates. Many businesses in my constituency use the scheme to bring in workers, particularly from eastern Europe, but they are not in the UK long enough to complete the season. There have been incidents of gangmasters bringing in illegal workers, but the farmers to whom I have spoken would much prefer to know that their casual employees are here legitimately.
Mr. Stephen O'Brien: In considering those issues, and given the weather patterns in the north-west, and his constituency in particular, has the hon. Gentleman also
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made an honest and thorough assessment of the cost to horticulture of the Government's climate change levy, which penalises that sector?
Mr. Borrow: That is on the list of matters on which I intend to comment later, if the hon. Gentleman will wait.
As local farmers have pointed out to me, in a constituency where the unemployment rate is under 1.5 per cent., there is a long-term problem in recruiting full-time, permanent employees, even when people are paid significantly above the agricultural wages board figures. There are casual workers who show aptitude and could take on a full-time post, but immigration rules do not allow them do so. I am aware that the Home Office is reviewing the rules governing workers from overseas taking specific jobs in the UK, and the needs of horticulture must be considered in that review.
Another bugbear for the horticulture and market gardening sector is its relationship with supermarkets. The Department of Trade and Industry has introduced a voluntary code of practice covering the relationships between supermarkets and farmers, but there is concern that the consultation on it was largely with the supermarkets, and not to any significant extent with farmers. In addition, the code of practice simply deals with foodstuffs and excludes the domestic plants sector. The production of house plants is a growth area in horticulture, and if it is not covered by the code of practice, there will be no solution to the problem of the producers' weakness in relation to the supermarkets. In addition, many of the companies that sell house plants are not supermarkets but big do-it-yourself chains, and they are not covered by the code of practice—
Mr. John Butterfill (in the Chair): Order. The hon. Gentleman is going a little wide of the debate. There is a boundary between horticulture and fanning, although it is not always clear. He is pursuing the subject of horticulture into areas that are beyond the normal definition of farming, and I hope that he will be brief. I have been indulgent so far.
Mr. Borrow: Thank you, Mr. Butterfill. I am not sure that my farmers would make that distinction, but I will abide by the rules of the Chamber on that matter.
The hon. Member for Eddisbury (Mr. O'Brien) mentioned the climate change levy. I have always found it difficult to understand how we can apply that policy to greenhouse horticulture. I am pleased that the Government have agreed to a 50 per cent. discount for horticulture, but I am not convinced that it will solve the problem. The levy is linked to the use of energy rather than to emissions. In the glasshouse sector, emissions are used within the glasshouses and are absorbed by the plants, so we can ask whether the levy should apply at all. A year ago, when gas prices were increasing rapidly, I suggested that Ministers should monitor the situation towards the end of the first year of operation of the climate change levy, to see what impact it is having on horticulture. I should be grateful if the Minister could say in his reply whether he is prepared to do that.
The Government are introducing a fruit for schools scheme to encourage healthy eating among children. Many salad-growers in my constituency have suggested

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introducing a similar scheme to promote salad crops. Companies such as Flavourfresh in my constituency produce small, sweet tomatoes, which are part of a range of salad crops that would be very attractive to children, so I urge Ministers to consider extending the scheme.
Finally, I turn to the long-term effects of the decline in salad crop and vegetable production in the north-west and nationally. If we increasingly import salad and vegetables, instead of producing them in the UK, and particularly in the north-west, we will not only lose jobs in agriculture, but find that the food processing industry increasingly relocates. If potatoes are being imported rather than produced locally, there is less need for factories making crisps, and when those companies are looking to reinvest, they are increasingly likely to do so overseas. If we lose a large proportion of the vegetable and horticulture sector in the north-west, that will have serious effects on food processing.
Those sectors are not subsidised and expect to compete with other countries on a level playing field. The Government need to think what they can do to ensure that these industries are not affected by short-term changes, and if long-term movements are taking place, they need to consider how to assist them so that they remain viable.
Mr. John Butterfill (in the Chair): I appealed for relatively short speeches so that all hon. Members could speak, but I think that it will now be difficult for them all to have the chance.
11.48 am
Mr. Stephen O'Brien: Farming in the north-west, like that in other regions, has already diversified. Eddisbury shares with Congleton, Tatton and North Shropshire the largest milk field in Europe.
Mr. Nicholas Winterton: And with Macclesfield.
Mr. O'Brien: Indeed. I think that my hon. Friend's constituency contains a few more sheep than mine. As a result of the foot and mouth crisis, we have had to face yet again a major collapse in confidence, as well as the very severe practical difficulties that have been heaped on the farming community. Although the incidence of foot and mouth in the current outbreak has been considerably lower than in 1967, it should not be suggested that that has in any way diminished the sheer fear, concern and stress that have been the condition of life for farmers and their families throughout my constituency.
Given the pressure of time, I need not rehearse all the criticisms about the Government's actions, or rather inactions, in relation to the crisis that we have just experienced—luckily, Cheshire has had FMD-free status since the middle of last month, so certain movements are now occurring again under licence. In 1967, when my constituency was the epicentre of the outbreak, the Northumberland inquiry reported within nine months. The inquiry was holistic, complete and thorough. As it happens—I make no connection—the
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crisis occurred under a Labour Government. The then Minister of Agriculture, Fred Peart, later Lord Peart, came out of it with a greatly enhanced reputation. His handling of the crisis, the way in which the Northumberland report was prepared and the actions that it recommended redounded to the credit of Governments generally, irrespective of party-political affiliation.
My farmers and the communities in the rural areas of Eddisbury wish that what happened then could have been emulated now. I dare say that that feeling reaches across the north-west, especially in Cumbria, where my right hon. Friend the Member for Penrith and The Border (David Maclean) and my hon. Friend the Member for Westmorland and Lonsdale (Mr. Collins) have had to face by far the worst of the crisis. There have been lost opportunities, for which the Government must stand accountable, in what all of us feel has been a very sad episode in the life of farming in the north-west. I urge them to think again about having a collection of inquiries, not least as there is a very large question mark about whether they are truly of a public nature. While they have a number of inquiries, it is impossible to dispel concern and suspicion about their motivation being an intention to divide and rule. There is anxiety that the inquiries represent the desire to use a more manipulative approach, rather than a genuine attempt to learn the lessons, however hard, for all concerned, as we go forward and try to build a future for the rural economy, which is so critical to my constituents and to people throughout the north-west.
It is right that the Animal Health Bill has been criticised. Yet again, the Government are using the title of a Bill to try to lull people into false security. If one looks very carefully at the detail of the clauses, one has the impression that animal health is not necessarily the motivation of the Bill. The more that I have looked into the matter, the more that I am concerned, especially in the light of representations from my farmers, that the Bill is the nearest that I have seen in my two and a half years in the House to the introduction into a Parliament of a Stalinist measure—a suggestion that I am loth to make.
There is something that the Government could do now—or could have done previously—that would alleviate the problems. I refer to the need to address issues relating to honesty in food labelling. I make no apology for the fact that this matter is something of a passion of mine. By dealing with it, the Government could not only help farmers, but demonstrate once and for all that they have grasped that the link between producers and consumers is essential to the survival of the rural economy in the north-west and elsewhere. By breaking that link in the value chain— a simple and obvious business and economic notion—through the Food Standards Agency's introduction of labelling regulations, they have ensured that accountability now rests with the Department of Health. The Government have suggested that they have only a consumerist agenda—or perhaps an eye on voting intentions—rather than a true understanding of the true drivers and economic underpinning of food production in this country.
There is a need for honesty in food labelling in countries of origin, as there is an enormous need for the consumer to have confidence in where food has come

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from. A proper approach is also required in terms of the control and expectations of high-quality production standards. Our farmers, not least in Eddisbury, and throughout the north-west, have production standards that are not only the highest in Europe, but can match the best in the world. It was a huge disappointment that yet again, when a private Member's Bill on food labelling was recently introduced, it was a Minister, this time from the Department of Health, who talked it out. The same thing happened when I introduced a private Member's Bill on the subject in the last Session. That Bill was blocked by the right hon. Member for Gateshead, East and Washington, West (Joyce Quin), then a Minister in the Ministry of Agriculture, Fisheries and Food.
It is a great shame that the Government are taking that approach. Such proposals are a lost opportunity and they could easily take them forward, instead of hiding behind what is becoming a nightmarish and bureaucratic set of skirts around the EU. To realise what they are doing, one has only to look at the latest letter from Lord Whitty, the Minister for food, farming and waterways, to the public relations manager of the National Farmers Union. In the letter, which is dated 15 November, Lord Whitty talks much about illegal imports and tries to give some sense of confidence to all of us who are concerned about these matters and the desperately anti-competitive position that is created for our farmers, but there is not a word about food labelling and the need for honesty. The letter is yet another smokescreen that attempts to get away from the essential element that should be addressed.
Dairy farming is, patently, critical to my constituents, but it is also fundamental throughout the north-west. It is clear that the collapse in incomes has been severe. The Government are often focused on the need to dispel the idea that intensive farming is a way forward and to suggest that we should consider diversification. Most of my farmers have diversified to the nth degree and have continued to try to do so. When the Prime Minister appeared in the Ceredigion by-election and was spouting diversification, it was notable that he came with none in his pocket. In a number of conversations, farmers in my constituency have told me that diversification is all very well, but often relies on the tourism industry. That has also been shattered by the foot and mouth epidemic, which has broken confidence in tourism. For most farmers, who cannot alienate the asset—the land is where it is—such an approach is tinkering at the edges and is not fundamental. Many have been encouraged by the Government to go organic, but the organic market is now over-supplied, often by products from abroad—a problem that is causing intense difficulty for those who have got to undergo a long period of adjustment.
Mr. Nicholas Winterton: My hon. Friend presents a splendid case on behalf of farmers in the north-west. Will he also comment briefly on the right to roam, which will cause immense difficulty for livestock farmers, especially in respect of guaranteeing safety for people when they are on the land? Moreover, the Government
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seem to have extended the right beyond heath, moor and down to ordinary farmland. Will there be no privacy, security and rights for farmers in this country?
Mr. O'Brien: As always, my hon. Friend makes a topical and important point. Cheshire is one of the first areas in the country to be mapped for those purposes. To relate the matter to the debate, I turn to one of the major points that I hope the Minister for Rural Affairs will take away with him, even if he is not in a position to respond to it today. In the light of the Lord Haskins report, there has been a comprehensive attack on the underpinning of the rural economy and market. I refer to the suggestion that cattle marts should be put to a slow—or even fast—death. The lorry that comes to take cattle to the abattoir—sadly, this one of the only services that works—can go past the end of the farm gate. The calves cannot be taken to the gate for picking up. However, people who would like to roam and ramble can come to the lane, if there happens to be a public footpath, and there is no control over them, especially as the vehicles will travel along the route. There is a complete and utter discrepancy between the approach regarding those who wish to enjoy the countryside for its amenity—I would certainly encourage them to do so—and that which relates to those who have to earn their living from it. That is causing deep distress to many of my constituents.
Mr. Michael: Does the hon. Gentleman accept that his words about encouraging people to come to the countryside contrast starkly with what he has just said? He appears to be suggesting that there is a risk of walkers spreading foot and mouth disease when the veterinary risk assessment demonstrates that that is not the case.
Mr. O'Brien: On the contrary. The Minister has helped to reinforce the point that the discrepancy works against farmers, rather than for the ramblers. No doubt, there will be discussion of routes that ramblers can take, but many of my constituents are upset by the fact that farmers are continually subject to enormous pressures from regulation, which is driving many of them to despair and is certainly attacking their income. Fear of a renewed outbreak of foot and mouth has created the difficulty that sheep from north Wales will not be overwintered on the flat pastures of the Cheshire plain, which will lead to further loss of income. Cheshire county council and Business Link are aware of that and have sought to give advice, without much funding to back them up, to help businesses through the worst of recent times.
It would be right to record that during the collapse of incomes there has been a dearth of young people wishing to join the industry, which is causing intense concern among family businesses. To make sure that the Minister at least takes something away from our debate, I should like to put on record again the fact that Cheshire is on the front line in the increasing spread of tuberculosis. We are waiting, with bated breath—if we carry on holding our breath I dare say that we will all expire before we get an answer—the results of tests originally conducted on the recommendation of Professor Krebs. Measures on the spread of TB need to be thought through, and we must consider whether the

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problem is related to the badger population. We need a conclusion on the tests, because the disease is causing intense concern in Cheshire. I know that farmers in the north-west feel that if Cheshire is breached, they will all be at exceptionally serious risk.
This is not a case of special pleading for farmers; we are doing the job of representing our constituents—our farmers, all those involved in the rural economy and communities that are dependent, first and foremost, on a thriving farming industry and have faced many pressures recently. I accept that there is probably no quick fix, but a number of farmers will no longer be able to survive in the industry. I urge the Government to look at that major strategic issue. The industry is worth fighting for. The Government should not simply tinker at the margins and give priority to people who see the countryside as something to be enjoyed. If farmers in the north-west are not supported, the countryside will not be the attractive place that the rest of the community wishes to enjoy.
12.2 pm
Mr. Lindsay Hoyle: I thank the hon. Member for Ribble Valley (Mr. Evans) for ensuring that this debate has taken place. I am sorry that we do not have more time; Members have been a little greedy this morning, and could have shared the time a little more.
My constituency was one of the first to be affected by foot and mouth; one of the first cases in the country occurred there. We were lucky that MAFF was effective in south Lancashire; it dealt with the case although, unfortunately, a neighbouring farm lost its cattle as well. However, I congratulate the Department on the way in which it dealt with the problem; we had no further cases. I am pleased that our farmers were lucky. However, I am concerned about the effect on farmers whose animals did get foot and mouth. They suffered, are still suffering and have not secured free transportation for their animals; they cannot get into the export market. Farmers in our area got out of beef farming because of BSE and the problems that it created. They went into sheep farming, but now they cannot get a proper price for their animals and are beginning to suffer. Will the Minister consider seriously the idea of blood-testing sheep to get them into the export market? I hope that he will take that on board because Mr. Lawrence, a farmer in my constituency, is suffering; he has done everything right but, through no fault of his own, is beginning to suffer because he cannot get back into the export market.
On BSE, I am interested in figures for France and Germany, since our export markets are still blocked. We must look at that and get the ban lifted; we want to make sure that the same thing applies to all countries. Without question, tourism in south Lancashire has been affected. The Salmon family have run Rivington Barn for many years, and provided a good quality service. However, it was affected, just like the farming community. I hope that we can ensure that tourism will return.
Tony Cunningham: I apologise for my late arrival; I have just come from a Select Committee.
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When talking about farmers and tourism, we must remember that many farmers are also involved in the tourism industry; we need to protect the industry because it is important to farmers as well.
Mr. Hoyle: I agree with my hon. Friend. We must look at how to assist farmers who want to diversify; it is important that we help them. A moorland farm in my constituency can apply for funding, but the adjoining farm cannot. We need to deal with that and ensure that there is a level playing field for all farmers—that all have an equal opportunity to diversify and can all apply for funding.
I turn to the issue of labelling, which has already been raised. We need clear, open labelling to ensure that people know where food is sourced from, where it has gone and what is on the shelf. We want to develop that and make sure that it is introduced. People have asked for a public inquiry, and I believe that we should have one: indeed, I would go even further. Many people will not agree but, once this is over, we should have a royal commission on the future of farming in the new millennium. The Government could consider that proposal. We should also conduct research into vaccination and the effects of cattle vaccination on wildlife, because without vaccination, foot and mouth can be transferred to deer herds. More money, resources and research are needed. In future, better resources for the Department for Environment, Food and Rural Affairs are needed; at the moment, they come in cycles and we never know when the next cycle will be. We want to ensure that money is available.
The armed forces played a major role during the outbreak, but did so too late. They should have been brought in much earlier and quicker. They were good and effective and we ought to be ready if they are needed again; we must ensure that they know what their role is and what they are expected to do. It is important that their role is established, and they are ready if the situation ever arises again. I hope that it does not, as many farmers have been affected in the north-west and we must look after them.
Members of Parliament should have been briefed at the beginning of the outbreak. MAFF would not reply to us and said that we had to go to a Minister. How could a Minister deal with our inquiries, when we were asking questions posed by our farmers? We cannot rely on the press to inform Members of Parliament; it should be us who inform the press. Local authorities were receiving information. Luckily, I have a good working relationship with my local authority, which informed me of what was happening, but that is not right. There should be a clear route from DEFRA, locally and regionally, to Members of Parliament and their offices. At the end of the day, farmers were in dire straits. They were suffering and were under the cosh. They needed support, and the way to provide that is to ensure that we have the information in the first place.
I shall conclude now, as I know that others wish to speak.
12.7 pm
Mr. Colin Breed: I add my congratulations to those already offered to the hon. Member for Ribble Valley (Mr. Evans). This is a timely

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debate because, just as the crisis has slipped from the newspapers and from many people's minds, many farmers and people involved in farming activities are beginning to feel the pinch. Most of them have managed to get through the summer; they have had a reasonable cash flow, and there is evidence of people visiting their village pubs, shops, post offices and so on. Now, however, we are hitting winter and farmers' cash flow is certainly drying up; now is the time when some will clearly fail.
I want to say a couple of things about something that is turning into a great divide. Some farmers have a choice because they have received compensation and have a particular holding that gives them opportunities. Their age and family situation give them a choice about what they can do in the next year, or in two, five or 10 years' time. However, a considerable number of struggling farmers have little choice. They have not received any compensation, but have been hugely affected by foot and mouth, especially the movement restrictions. The banks have been sympathetic to them, but they have had to borrow considerably more money. Although interests rates have come down a bit, which has cushioned their position a little, they are now borrowing more than they have ever borrowed in their lives. Their borrowing is going up and the value of their assets is going down; they are locked into a bleak future. Some of them are tenant farmers who have received little—in some cases, nothing—in assistance at this critical time.
There needs to be a strategy for both sets of farmers. For those who have a choice, there should be an understanding of the Government's over-arching strategy. They need to know how they will play their part in future farming patterns. Diversification is a matter for them. They also need to know what investment they may be able to make and how they can spend their compensation money in restocking or moving into something else. In other words, they need to understand what their future is and the best way of using their assets to invest.
Those farmers will be able to have a future, but we need a strategy for those who will remain in agriculture, to ensure that they can provide the safe, sustainable, animal welfare-friendly and properly labelled food that we all want.
I have considerable sympathy with the views of the hon. Members for Eddisbury (Mr. O'Brien) and for Chorley (Mr. Hoyle). There is a desire to move the debate on and to tackle the issues. I know that some of them are difficult from a European perspective, but consumers want us to get on and do our job in providing honesty in labelling.
Will farmers who have seen their income fall and costs increase be able to trade their way out of that situation? If the answer is yes, how long will the process take? Will banks be sympathetic for ever? What support can be given to them? What is the strategy for those who are locked in?
What about farmers who have reached the age at which they are thinking of retiring? Many farmers in my constituency, and I am sure in the south-west as a whole, are rapidly approaching the time when they would like to retire, but they cannot. They are locked into an
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extremely difficult situation. Is there no hope of a dignified early retirement scheme to allow them to get out of a situation for which they are not to blame?
There are businesses that will fail this winter; through no fault of their own, they will not make it through to next summer. Given the costs that they have endured and the income that they have not had during the summer, they will go under. There will be little information about that published in the newspapers. I hope that the Government will not abandon farmers who find themselves in that position.
12.13 pm
Mrs. Ann Winterton: I join other Members in congratulating my hon. Friend the Member for Ribble Valley (Mr. Evans) on introducing this timely debate, which has been extremely interesting. I shall have to gallop to pick up some of the points that have been made.
My hon. Friend stated categorically that agriculture does not stand alone. It underpins the economy of rural areas. Foot and mouth disease has had an enormous impact on farming, with shock waves going through allied industries, including machinery and feed merchants, and particularly tourism.
The north-west is a large livestock area. The impact of the foot and mouth epidemic, especially in counties such as Cumbria, has been dramatic. It has devastated the industry. The point has been well made that those whose farms have been culled out have the time to consider whether they should restock or change their enterprise. Livestock owners whose farms have not been culled out are suffering dreadfully, especially those in the hills. Over-stocking has taken place because of the inability to move the animals. There are difficulties with forage. This is the busiest time of year for movements of sheep, but livestock owners have been unable to move anything from their holdings.
Mr. Collins: My hon. Friend is entirely right. Does she agree that it would be helpful if the Minister addressed the great difficulties for hill farmers in my constituency and elsewhere which stem from the operation of the 21-day restrictions, and their fear that they will be made permanent? There are serious agricultural necessities that make it necessary for farmers to move livestock on and off farms within 21 days. The weather makes it impossible to operate otherwise. The Minister must address the difficulties that arise from the introduction of such a system.
Mrs. Winterton: I cannot add more to the important point that has been made by my hon. Friend. Having been fortunate enough to visit his constituency recently, I know only too well that what he says is true. The sheep sector and other livestock sectors would be devastated if the 21-day rule remained.
There must be an understanding of the difference between intensive agriculture and extensive agriculture. In the uplands, we have extensive agriculture, and there have to be animal movements.
My hon. Friend the Member for Ribble Valley called for fair competition for farmers, with no more added regulation being placed on their shoulders by the Government. The climate change levy is one example

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that has been mentioned. In addition, cheap food imports are flooding in, bringing with them the possibility of both animal disease and human disease. The problem needs to be tackled. In introducing the Animal Health Bill, the Minister has put the cart before the horse. Surely the Government should have done something about illegal imports and other imports as a matter of priority. The important issue of keeping disease out of the country needs to be addressed.
Biosecurity has been mentioned. Farmers feel sore about being accused of spreading disease themselves. I said only the other day that Department for Environment, Food and Rural Affairs officials and others are equally to blame, if blame is to be apportioned. In another area—not the north-west—I have seen the poor biosecurity arrangements at DEFRA headquarters. In Cumbria, however, I was most impressed by what the county council had done in terms of biosecurity. We all know that delays in the slaughter and disposal of dead livestock were more responsible for spreading foot and mouth. The initial delay in making decisions meant that twice the number of animals were slaughtered than need have been.
I think that everyone is still in favour of a full independent inquiry. We believe that that is essential if there is to be transparency. Until the Government face what went wrong, no real progress can be made. Confidence in the Government's integrity will remain shattered until such an inquiry takes place. Every farming and rural organisation demands an independent inquiry. We commend Devon and other counties for their individual initiatives, but the Government should be taking the lead.
The hon. Member for South Ribble (Mr. Borrow) mentioned horticulture and arable areas. Those are extremely important, but we should perhaps concentrate on the livestock sector. The hon. Gentleman talked about the need for co-operation among smaller units if they are to get together to build a critical mass. That is equally true of the livestock sector. Unless it can negotiate with supermarket chains on better terms than at present, it will continue to be screwed into the ground.
My hon. Friend the Member for Eddisbury mentioned the Northumberland report and the lessons from that which were not learned by the Government. He mentioned the importance of honesty in food labelling. He referred to diversification, which has been going on since the 1980s. However, that can never replace the necessity for farming and agriculture to thrive in the United Kingdom, with commodity prices at added value, to ensure that the countryside is kept as we all wish to see it kept. We all want to see a vibrant industry.
Mr. Nicholas Winterton: My hon. Friend has raised an important point. Will she emphasise that unless the countryside is farmed and farmers are making a profit, we shall not be able to maintain the countryside in a way that will attract tourism, which is so important?
Mrs. Ann Winterton: My hon. Friend is right. At present, cash flow is extremely difficult. Perhaps many
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farmers will leave the land when the crunch comes. The Government can help them now. For example, the annual sheep premium is at a low level, and we could have a national supplement. The hill farm allowance was introduced at 90 per cent of the former hill livestock compensatory allowance. Will the allowance be maintained at that level until 2002 and later, and not cut to 50 per cent.? Will the Minister ensure that the teams that are now not having to test for foot and mouth will move on, as we hope, to test for TB? That testing has gone by the board. It is a vital issue for livestock farmers in the west of the UK.
12.19 pm
The Minister for Rural Affairs (Alun Michael): I congratulate the hon. Member for Ribble Valley (Mr. Evans) on obtaining a timely debate, in which we have examined the impact of foot and mouth disease on the north-west; I have witnessed its effects on people and the economy in the region. Monday was the 50th day since the last outbreak. It must be cause for some optimism that 52 days have passed since 30 September, when the last outbreak occurred. Despite that, there is no doubt that times are tough for many farmers, and foot and mouth disease has hit the north-west hard. The problems have been compounded by low world commodity prices, exchange rates and other matters.
Several excellent contributions have been made to our short debate. It is difficult to do it justice, especially when many contributions were one-sentence interventions about massive issues. It is impossible to respond to them adequately in such a short time. For example, my hon. Friend the Member for South Ribble (Mr. Borrow) made a thoughtful speech in which he referred to the inevitability of change and the importance of events at Doha, and challenged the Government to engage with change. We accept that challenge.
We must record the success of farmers such as those in my hon. Friend's constituency who compete effectively as businesses. He was right to stress the need for farmers to work co-operatively if they are to have enough muscle to ensure that a greater proportion of supermarket prices reaches their pockets as primary producers. Good examples exist, but we must continue to encourage that. Many more farmers need to learn the importance of working together. Pressure of time prevents me from responding to all the points in my hon. Friend's considered contribution, but I shall do that in writing.
I shall also write to the hon. Member for South-East Cornwall (Mr. Breed) about some of the points that he made and to the hon. Member for Westmorland and Lonsdale (Mr. Collins), whose intervention covered a big question, to which there is hardly time to refer, let alone respond in detail.
My hon. Friend the Member for Chorley (Mr. Hoyle) stressed the need to get back into export markets. I assure him that we are focusing on the international dimension of the challenge to farming. Diversification and extending opportunities are also important.
The hon. Members for Eddisbury (Mr. O'Brien) and for Congleton (Mrs. Winterton) missed an opportunity when they referred to measures that are currently being considered. Surely they acknowledge that speedy action

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is crucial in tackling an outbreak. When culling was challenged, delays caused problems. Imagine the criticism that Conservative Members would be levelling at us if we had not acted to take powers, and another outbreak of foot and mouth disease had come rushing through the country.
Mrs. Ann Winterton: What about prevention?
Alun Michael: Of course prevention is important and the Government are putting a great deal of effort into it to ensure that outbreaks do not recur.
We are tackling import control. Conservative Members do not appear to understand that diversification is not only about tourism.
Mr. Nicholas Winterton: Of course we do. We are part of the community. It is the right hon. Gentleman who does not understand.
Alun Michael: The hon. Gentleman is blustering as usual. He should listen for once.
Mr. Nicholas Winterton: Rubbish.
Alun Michael: The hon. Gentleman claimed that the organic market was oversupplied. It is not being oversupplied by British farming. That is why the Government support diversification into organic produce.
The hon. Gentleman's ranting intervention about opening rights of way should have been treated with contempt. If Conservative Members examine the veterinary risk assessment of a variety of activities—farm-related and non-farm-related—they will appreciate the care with which controls have been placed on them. All controls are based on the assessment.
Promoting the myth that walkers spread foot and mouth disease damages the countryside and farmers who depend on tourism, as my hon. Friend the Member for Workington (Tony Cunningham) said. Movement between farms and groups of animals creates the problems. Farmers have commented on the interdependency of farming and tourism. Many say that they had never appreciated it before they witnessed the impact of the outbreak on the whole rural economy.
The hon. Member for Ribble Valley made several serious points, although I fear that most of them were negative. However, he and the hon. Member for Congleton indulged in some regrettable populism when they suggested that a public inquiry would act as a magic wand. The Government's arrangements, which comprise three strands—consideration of veterinary issues, the future of food and farming and especially what may have gone wrong at different stages of the outbreak—have been established to ensure that lessons are learned quickly and measures are introduced so that failures are not repeated. That is the correct approach to issues that hon. Members have rightly raised.
I have spoken to many people involved in farming and other parts of the rural economy. Some understand the difference between a public inquiry, and the mantra that suggests that it is simple, and the alternatives—
Mr. Nicholas Winterton: What about transparency?
Alun Michael: The alternatives will be transparent and bring information into the public domain. They will
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be speedy and exhaustive. Those who understand the difference have said that the Government are doing the right thing. [Interruption.] Those who suggest that a public inquiry is a magic wand which reaches parts that the three strands cannot reach are irresponsible. [Interruption.] Conservative Members are being irresponsible.
Mr. Nicholas Winterton: You don't want the truth.
Alun Michael: The hon. Gentleman is wrong.
Mr. Joe Benton (in the Chair): Order. I am sure that hon. Members appreciate that the Minister has 10 minutes in which to reply. There are tried and tested, orthodox means of intervening. May I prevail on hon. Members to keep the background music at its lowest volume?
Alun Michael: I am grateful, Mr. Benton. It would be nice if Conservative Members listened. Having put them right on a public inquiry, I need to set the record straight on the Government, who have been a good friend to farmers.
Mr. Nicholas Winterton: Arrogance.
Alun Michael: No, it is the hon. Gentleman who is being arrogant in trying to shout down the truth. He is irresponsible.
Mr. Nicholas Winterton: I am not. You are.
Mr. Joe Benton (in the Chair): Order. I have already asked for hon. Members' co-operation. I now ask hon. Members to listen patiently to the remainder of the winding-up speech. If any hon. Member feels it necessary to intervene, it is up to the Minister to decide whether to give way. I ask again for the background music to be kept low.
Alun Michael: I am tempted to suggest that Conservative Members simply want to cut the time available for the response.
Those who peddle scare stories are not undermining the Government, but the confidence of those who deserve encouragement and support. Those people desperately need confidence. Let me nail the rural myths. The Government are not trying to shut down British livestock farming; there is no European Union plot to sabotage farming; we are not using foot and mouth to close down large parts of the sheep sector. The Government are committed to viable, vibrant and sustainable British agriculture, which comprises livestock and arable farms.
Mrs. Ann Winterton: Will the Minister give way?
Alun Michael: No, the hon. Lady had her chance.
Mr. Nicholas Winterton: Oh!
Alun Michael: The hon. Lady should control her husband; we would then have more time for debate.
Mrs. Ann Winterton: On a point of order, Mr. Benton. I understood that you were in charge of proceedings and

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that you would call hon. Members to order if necessary. It is not for me to call any hon. Member to order and I should like the Minister to withdraw his rather silly remark.
Mr. Joe Benton (in the Chair): I call the Minister.
Alun Michael: It is understandable that most of the debate has focused on foot and mouth disease because the crisis has devastated farming communities. It has affected not only farmers but tourism and rural businesses generally. It has also highlighted the strong interdependence of farming and other parts of the rural economy. It is therefore encouraging that the crisis has brought together previously disparate rural interests to collaborate on mutually supportive solutions. I am sad that that has not been reflected in Conservative Members' contributions.
I want to place on record my thanks and those of my ministerial colleagues to the staff who have shown such dedication and commitment throughout this period. I have visited the disease control centres in Carlisle and the north-east. Many relatively junior members of staff have taken on major roles and risen to the occasion, and they deserve our appreciation.
The interruptions have meant that I have had little time to respond. I undertake to examine the record of what has been said by all hon. Members, especially the hon. Member for Ribble Valley, and ensure that I do not fail to cover in correspondence any points that I have been unable to tackle in the debate.

Children Act
12.30 pm
Ms Karen Buck: I am grateful for the opportunity to raise this issue. The 35th anniversary of Ken Loach's groundbreaking documentary "Cathy Come Home" falls next month. The programme put homelessness on the post-war map by dramatically showing the effect it can have on attempts to keep families together.
A great deal has changed since that television programme was made. Indeed, it was part of the reason why changes took place. The safety net for homeless families has been strengthened considerably, most notably by the Housing (Homeless Persons) Act 1977 and, following a setback under the Housing Act 1996, the Homelessness Bill, which is going through Parliament. As I said in a debate on the Bill, it is attempting to rewrite "Cathy Come Home" with a happy ending, but, unfortunately and separately from mainstream housing legislation, two recent court decisions on the operation of the Children Act threaten to undermine some of the good work and once again raise the spectre of homelessness leading to parents facing separation from their children.
Under the 1996 Act, local authorities have a duty to provide accommodation for unintentionally homeless people in priority need, but where families with children are not to be housed by a housing department the Children Act provides a further safety net, which is particularly important when families are found to be intentionally homeless. Approximately 9,000 households are found to be intentionally homeless every year; the majority are families with children.
Decisions on intentional homelessness are notoriously complex. Shelter's experience is that local authority intentionality assessments are often harsh—I can bear out that experience from my case load—and in many examples inadequate. Housing aid centres often successfully overturn assessments when they can prosecute cases to conclusion. In addition, some authorities apply the letter of the law so strictly that households may be found intentionally homeless in circumstances that appear unjust. For example, a family may experience unexpected financial difficulty and sell their home to avoid falling into debt.
The consequences of being found intentionally homeless are severe. The household are given only limited time in temporary accommodation—usually about 28 days—and are often barred from the housing register. In such circumstances, their options are likely to be extremely limited. Private sector accommodation requires a deposit and rent in advance—resources that are beyond the reach of many homeless households. Again, I have extensive constituency experience of such difficulties.
The Children Act provides an important means to secure vital assistance for families with children when the housing department is not under a duty to house them. Families are often given assistance by social services authorities under section 17 of the Act. For example, help with a deposit or the rent is provided or, in some cases, accommodation, which may also be provided under section 20, is offered.

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Although the combination of the duties placed on housing departments under the homelessness legislation and the powers available to social services under the Children Act has provided a reasonably satisfactory, though far from perfect, safety net for homeless families with children, the nature of the obligations on social services authorities under the Act has been considered in two recent cases.
The Court of Appeal decision of 11 April 2001 on the application for judicial review by G found that section 17 merely confers a power rather than a duty for local authorities to provide assistance and that the duty to provide accommodation under section 20 is one to house the child, not the parents with the child. The High Court reiterated that judgment in A v. London Borough of Lambeth on 25 May 2001. The decision was reconfirmed in the Court of Appeal on 5 November.
The decision of the courts in those cases is likely to have a significant impact on homeless families seeking assistance in finding accommodation from social services authorities. As a result of the judgments, social services authorities are likely to provide help in far fewer cases. When help is provided, it is much more likely to be an offer to house the children, without their parents, under section 20. It will be an offer to take the children into care.
In my judgment, that severely undermines the central principles of the Children Act: that the needs of the children are paramount and that families should be kept together wherever possible. Parents will clearly not want to be separated from their children and, in practice, it is likely that families confronted with a social services offer to take a child into care will search desperately for other alternatives to stay together, no matter how inadequate or short term.
I am conscious of the fact that such threats and pressure may be a salutary experience for families that get into difficulties with rent or mortgage arrears or whose older children become involved in antisocial behaviour, but, when the final penalty is applied and the families are effectively homeless and without further call on public support having exhausted their various options, it can lead to a rapid deterioration in family circumstances.
The result may be that families sleep on friends' floors, often in highly overcrowded and volatile circumstances, and I have experience of families and children sleeping in cars. Furthermore, enhanced mobility makes it difficult to track families, particularly those with younger children. I do not want to overplay the situation, but the Victoria Climbie inquiry shows the dangers for that small minority of children who fall through the service net. Such mobility may lead to teenage boys and girls drifting into casual arrangements with friends or girlfriends, which are unsuitable in terms of minimising the risk of becoming involved in unfortunate circumstances such as unplanned pregnancy or antisocial behaviour.
I accept that parents may be at fault and that some intentionality decisions are justified according to the letter of the law, but that does not justify the unacceptable risks arising for families from the removal of all the legislative safety nets.
I refer briefly to a letter sent to me by ATD Fourth World following the recent article on the issue in The Observer. It makes a point that I agree with:
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"Most of the families we work with have had experience of being in care as children … again and again we see evidence that the deeper the poverty of the family, the wider the range of disadvantages they struggle with, the more likely they are to lose their children rather than get long term help and support to stay with them."
I shall run through cases that have come to Shelter's attention as a result of the recent judgments. One involves a family with children aged six, 10 and 13. There were no health or child protection issues and the household were found to be intentionally homeless because of rent arrears. They stayed with in-laws until asked to leave and they then approached the homeless persons unit, which refused to assist. They slept on the streets for a night and returned to the homeless persons unit, which referred them to social services.
Social services said that no help could be provided for the family as a whole and offered to take the children into care. Shelter contacted the social services department to arrange an assessment under the Children Act. The parents called back the next day to say that they had been refused additional assistance. At that point, Shelter lost contact with the family. That is exactly the risk of vulnerable families falling through the net to which I referred.
The second case involves a woman with mental health problems stemming from being sexually abused as a child. She brought her assured shorthold tenancy to an end because she could no longer afford the rent. She has two children aged 15 and 10, and the youngest, who attends a special needs school, has learning difficulties. They approached the local authority for assistance under the homelessness legislation and were placed in hostel accommodation for a month.
The family were then found to be intentionally homeless—a decision that was upheld on review—and they applied to the social services authority for assistance under the Children Act. It offered accommodation for the children only when the hostel accommodation was no longer available. The woman refused the offer.
The housing department has sought possession of the family's hostel accommodation. With representation from Shelter, the possession order has been delayed for six weeks, and a judicial review is now under way against the social services authority. Although the opinion of the health authority community care team is that the mother is vulnerable and in need of on-going support, and that her condition is being exacerbated by uncertainty about her housing and fear that her children will be taken into care, the recent court decisions mean that the prospect of success is weak.
Another family, with two children aged six and three months, were refused assistance by the housing department. They stayed secretly in a friend's room in a single person's homelessness hostel. The hostel found out, and asked them to leave. They sought advice from Shelterline, which arranged for them to be referred to social services for an assessment under the Children Act. Social services responded by offering to take the children into care. Although the mother was still breastfeeding her three-month-old baby, they told the Shelterline adviser that separating the children from their parents was not against their best interests, and no further assistance was offered.

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Shelter has been involved in other cases. I am currently dealing with two. On Friday, the mother of an 11-year-old was told to leave her homelessness accommodation. I do not query the validity of the intentionality decision; I do not know whether it is correct or not. What I do know is that the mother refused a review, and then consulted me on the day on which she was due to leave. I have reason to suspect that anyone who refuses a review in such circumstances is confused and vulnerable, and in need of a high level of assistance.
Another case involves the mother of five sons, two of whom, regrettably, have been involved in serious antisocial behaviour. The family face eviction, and an offer has been made for the three youngest children to be taken into care by social services. I have no doubt that the family are likely to end up sleeping casually and with friends in the area where the antisocial behaviour was occurring, and that the proposal will not offer a long-term solution.
A number of people have written to me since The Observer article, pointing out that part of the problem is that it is becoming increasingly difficult for families on housing benefit or low incomes, and particularly families with a chequered housing history, to gain access to private rented accommodation. Alternative provision, particularly in London and the south-east, simply does not exist.
I raised these issues in July, in the Standing Committee considering the Homelessness Bill. In last week's Second Reading debate in another place, they were raised by several peers. Lord Falconer said that the Government took the matter very seriously and were giving it careful consideration, and that he intended to meet representatives of local authorities and social services and report what they had said. I am sure that he is doing that, and I welcome the seriousness with which he is taking the issue.
I have had my own conversations with representatives of local government and social services, who have described court decisions on the Children Act as retrograde steps. They have also made important points about the resource implications for hard-pressed social services departments.
I know that the problem is being addressed. My aim is to push things further, especially in the context of legislation currently being considered in Parliament. I believe that sections 17 and 20 of the Children Act, which have been called into question by the courts, should be amended to strengthen social services' duty to give assistance to homeless families with children. Guidance should not be sufficient. In the case of R v. Lambeth Borough Council ex parte A, Lord Justice Laws said:
"The guidance is not a legal resource for the construction of the statute".
Guidance therefore will not be sufficient. I hope that if the Homelessness Bill cannot be amended—and we were advised that such amendments would be outside its scope—an amendment can be tabled to the Adoption and Children Bill, which is currently before a Special Standing Committee in the House of Commons.
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The court cases have thrown up a serious issue that particularly affects vulnerable families at a time of nothing less than housing crisis, especially in London and the south-east. It is essential for the Government to use whatever opportunities are available to close the loophole.
I am grateful for the opportunity to raise the matter, and I look forward to the Minister's reply.
12.44 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I welcome the chance to discuss this important issue. The debate is timely, because these matters are at the forefront of our minds following the recent Court of Appeal judgment—referred to by my hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck)—in the case of A v. London Borough of Lambeth. We all agree that our social legislation should provide an adequate safety net for the most vulnerable members of the community.
The Children Act 1989 remains extremely important to the establishment of such a safety net. The Act, its accompanying regulations and the associated volumes of guidance cover all statutory care of children in England and Wales. The Act created a comprehensive framework of powers and duties for local authorities with social services responsibilities, to ensure that children receive the care and protection that they need. It promotes co-operation among the various statutory agencies and among professionals to safeguard and promote the welfare of children, and imposes a range of responsibilities on local authorities for the care and protection of children and young people under the age of 18.
My hon. Friend drew particular attention to issues raised by sections 17 and 20. Section 17 requires local authorities to promote and safeguard the welfare of children in their areas who are in need and, so far as is consistent with that duty, to promote their upbringing within families. It gives authorities a range of powers that they can exercise to fulfil that duty. They can, for instance, assess children's needs, provide assistance in kind or in cash, and arrange for others to provide any necessary services. Section 17 also makes clear that assistance can be given to the family of a child in need—my hon. Friend referred to that important point—or to any member of the family, as long as it is intended to promote or safeguard the welfare of the child. A connection must be made: the main consideration must be the child's welfare, but if in the fulfilment of the child's needs it is necessary to assist the family, section 17 allows that.
The Act and, more recently, the legal judgments from which my hon. Friend's concerns stem make clear that the section 17 duty is not a specific duty relating to the needs of an individual child, but a general duty. Local authorities must meet the needs of children in their areas. They must provide a range of services that promote and safeguard the welfare of all children in need, but those services do not have to be perfect for each child. Authorities have no legal obligation to address the needs of individual children in any particular way.
Under section 20, however, authorities have a duty to individual children in need. It is, specifically, to provide them with accommodation if they have no parents, or if

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those who have been caring for them cannot give them suitable accommodation and care for whatever reason. That safety net is probably used most often by local authorities to accommodate disabled children for short periods, allowing their families a respite from their caring responsibilities, but it can also be used as a support by homeless parents, giving them time to find suitable accommodation without having to worry about their children's safety in the meantime.
I know that my hon. Friend is very concerned about the effects of recent court judgments. Officials in my Department are still considering them carefully, particularly the one that my hon. Friend mentioned most—the A v. Lambeth Borough Council judgment, handed down only on 5 November. These are clearly important cases that will have far-reaching effects, and my hon. Friend has done us all a service by drawing their implications to our attention.
The case of G v. London Borough of Barnet defined section 17 duties more specifically. It made clear that once an offer of help under the section had been rejected—provided that accommodation for a child was available under section 20 and the offer of help under section 17 remained open—a local authority was under no obligation to offer a different form of help, although its offer might not be entirely what the family wanted. When an authority has made an offer of help under section 17, it has a fallback under section 20. If a family chooses not to accept the offer, the authority has met its legal requirements.
The finding of the High Court in the second case again confirms that the section 17 duty is a general duty. However, the judgment of Sir Philip Otton and Lord Justice Chadwick went rather further than the matters being considered by the court. They concluded that section 17 did not encompass, or give powers in relation to, the provision of accommodation. I believe that in the past some authorities have used section 17 as a permissive power enabling them to give families accommodation, perhaps on a short-term basis—despite having no legal duty to do so—when that has been judged to be in the best interests of a child in need. The worrying part is that, if the A v. London Borough of Lambeth judgment were to hold, there would be no such power under section 17, which could limit the actions of local authorities. As I say, officials in the Department are considering the judgment extremely carefully to ascertain the implications of the comments by Sir Philip Otton and Lord Justice Chadwick.
Before April this year, housing authorities that had assessed a family as intentionally homeless sometimes told local social services that there might be one or more children in need in the family. Social services would then carry out an assessment of the needs of the children. It might end up housing the family, sometimes in less than satisfactory bed-and-breakfast or hostel accommodation. There is a desperate shortage of housing, certainly in the London area, so accommodation is hard to come by. That is not always the case in other parts of the country, as my hon. Friend is aware. Indeed, in the area that I represent, there is a surplus of accommodation, but I recognise the stresses in London and the south-east area.
Housing people in bed-and-breakfast or hostel accommodation and carrying out assessments took up a great deal of social services' time and often did not result
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in a satisfactory solution for the families concerned. I am pleased to be able to tell my hon. Friend that, perhaps as a welcome spin-off from some of those judgments, some local authorities are trying to work far more constructively with intentionally homeless families in their area. The London borough of Lambeth has taken the view that the clarification of roles between local authority housing departments and local authority social services departments has given it a fresh opportunity to provide intentionally homeless families more effective help in securing long-term accommodation. Rather than providing short-term, unsatisfactory solutions, they have been working together to support families in some of the difficult areas that my hon. Friend has mentioned such as access to private sector housing, where there is a need for initial deposits and sometimes a need for extra financial assistance. Lambeth council has appointed three specialist workers to provide advice, assistance and support to those families as well as advice from the housing department.
I understand that so far the borough has supported at least 30 families in finding long-term accommodation and securing financial assistance for the initial deposit and the first month's rent.
Ms Buck: I am impressed by that example. I congratulate the London borough of Lambeth on its work. Does my hon. Friend not agree that, if that example were followed to its conclusion, homeless families would face a postcode lottery in terms of the quality of service? If they were lucky enough to reach the end of the road, as it were, in a borough that had developed a positive strategy, that would be excellent, but many local authorities have simply not made such provision. Families could end up in the worst possible circumstances without a legislative framework or good local authority practice.
Ms Blears: I accept my hon. Friend's point that provision of a range of services for local communities varies from local authority to local authority. She has highlighted examples of families who have found themselves in extremely unsatisfactory circumstances, such as sleeping in motor vehicles and on the floors of friends' houses. We do not want vulnerable children in need to be placed in that position as a result of current circumstances.
Since April this year, Lambeth has worked with 50 intentionally homeless families. Although I am aware that Shelter has expressed concern that more children will be taken into care and accommodated by local authorities as a result of the current situation, Lambeth has not had to accommodate any more children as a result of the current legal interpretation of its statutory powers and duties. In fact, it has been able to provide better care.
We hope that local authorities across the country will begin to develop such services to support people. That is why, as my hon. Friend has said, discussions are going on with the Association of Directors of Social Services and local authorities across the piece to try to gather information on the way in which procedures may have changed as a result of the judgments. We need to map out the practices that local authorities are adopting as a

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result of the judgments that might lead them to make decisions different from those that they would have made previously.
Lord Falconer, with officials from the Department of Health, is meeting directors of social services next week to discuss those issues. We are writing to Shelter to ask it to let us have full details of any examples. Obviously, we will take on board the examples that my hon. Friend has highlighted, so that we can gauge the extent of the problem. Officials in the Department will then meet Shelter to discuss taking up those matters.
We will consider the judgments very carefully, especially the judgment of 5 November, in terms of the powers under section 17. We will then decide whether any action needs to be taken and, if so, what would be most appropriate. The amendment of primary legislation, both the Children Act and the housing legislation, has already been suggested. Although I accept that my hon. Friend does not feel that guidance would be sufficient to amend the situation, it is an option that is open to us. We want to study the judgment and examine what effect it is having in the field. We want to find out whether local authorities are deciding to change their practices. We shall certainly encourage the type of scheme that Lambeth and other authorities are beginning to establish. It is far better if families with vulnerable children in need can be assisted to find long-term sustainable solutions, rather than provided with short-term unsatisfactory ones.
Ms Buck: Part of the problem is that the definition of children in need is itself subjective. My view is that part of the problem is that children may not be deemed to be in need at the beginning of the Children Act process before becoming homeless, but that the homelessness process tips them over into being vulnerable and in need. Living in the circumstances that I have described or in hostel and bed-and-breakfast accommodation is virtually equivalent to defining a child as being in need,
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and has serious consequences for the child's health, educational performance and behaviour. That wider context also needs to be borne in mind.
Ms Blears: I accept what my hon. Friend says. I have met many families who face a series of issues, which multiply and create a huge layer of deprivation, poverty and difficulties. It is very difficult for families in such circumstances to see a way out and to look at their future.
My hon. Friend has highlighted one of the key difficulties for all of us—striking the right balance. Access to social services must not be used almost in direct contravention of our housing policy. Where people are intentionally homeless as a result of their actions—for example, serious antisocial behaviour—they should not seek recourse simply to social services and end up being rehoused perhaps two or three doors away from where they committed the antisocial behaviour.
I am aware that that has happened occasionally, and it has caused immense distress to the wider community. Although I accept that the priority is children who are in need and who are vulnerable through no fault of their own because of family circumstances—we as a society have a fundamental duty to meet the needs of those children—we must balance that with the needs of the wider community and other families.
Resources are limited. Local authorities are under immense pressure to find appropriate and adequate housing solutions for many people. Certainly in the London area, there is a shortage of housing. Trying to strike the right balance between all the people who need support and proper housing—housing is a fundamental platform from which people manage to organise the rest of their lives, whether it be work, training or employment—is very difficult, but we undertake to study the judgments extremely carefully, look at their implications, and see what needs to be done. However, overall, our top priority must be to ensure that those vulnerable children in need receive the protection and care of all of us.

Small Acute Hospitals
1 pm
Andrew George: I am pleased to have secured this important debate. I had hoped that it would be longer, but I am happy with a short debate and I shall try to keep my comments brief.
I raised related matters in connection with the small acute West Cornwall hospital in Penzance in my constituency in a debate in this Chamber on 13 March. Today, I want to deal with developments since then, and to raise questions relevant to small hospitals in general. I may of course refer to West Cornwall hospital in particular, as I know it well.
I should also declare an interest, as my wife works at West Cornwall hospital. If time allows, Mr. Benton, I hope that the hon. Member for Wyre Forest (Dr. Taylor) may make a short contribution.
A number of things have happened since the debate on 13 March. At the beginning of that debate I mentioned that my oldest brother, Mark, had been admitted to West Cornwall hospital. He was seriously ill, and ultimately he was transferred to the Treliske hospital. Before going to hospital, my brother had been staying with me and my wife. I am sad to say that, after returning to our home for a short time, my brother tragically died on 2 May at Treliske.
Since then, I have had meetings with the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), at which matters were discussed with local representatives and the district council. The promised risk assessment at West Cornwall was completed at the end of May. Its conclusions, which were not a surprise to anyone, were that the hospital had inadequate anaesthetic cover, and that it needed more investment in its diagnostic facilities—especially in radiology, ultrasound, CT scanner equipment, and so on. It also found limitations in the accident and emergency service, especially at night, when the service is led by nurses. I have asked the trust to address the concerns that have been raised, rather than wait for the end of the review period.
I am pleased that the West Cornwall hospital trust has, with other partners, produced a strategic outline case for investment in the hospital, with remote diagnostic and treatment centres throughout Cornwall. I and other Cornish Members have another meeting with the Under-Secretary tomorrow to discuss that outline bid. I welcome that as an important step forward in the process.
Finally, I draw the Minister's attention to the document published by the Nuffield trust entitled "Local Medical Emergency Units". It recommends a different approach to the opportunities that small acute hospitals provide.
The case for the maintenance and retention of accident and emergency services at small acute hospitals rests on the fact that they are clearly closer to events and therefore to the commencement of the episode. In addition, the lengths of time that people wait to be assessed, and the trolley waits that they have to endure, are generally shorter than in larger district general hospitals. I am not criticising the staff in DGHs, who I consider to be as dedicated and committed to the health
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service as staff in smaller hospitals. It is simply a fact of life that trolley waits are longer in the larger DGHs. That is certainly true in my constituency.
However, patient confidence remains high, as is shown in campaigns that have been held across the country. In west Cornwall, 8,000 people have signed letters expressing support for the retention and expansion of services at West Cornwall hospital. In general, communities do not campaign to prop up bad services. If people perceive services to be good, they want to keep them and thus are moved to campaign on their behalf.
The pressures on small hospitals must be recognised. It is harder to provide 24-hour cover when junior doctors' hours are under pressure. As was mentioned in the debate on 13 March, that will be increasingly the case from August 2003. The fact that consultants are increasingly unwilling to work rotas that affect their family lives must be taken into account. Specialisation in medicine is creating fewer general physicians and doctors who are good at managing medical emergencies. Emergency admissions are rising, and it is sometimes difficult to appoint additional staff in smaller hospitals, where there is a sense that the environment is in decline.
Those difficulties must be seen against a background of rising expectations, the increasing incidence of litigation by patients, and the commitment to changes in clinical governance. The favoured model for dealing with the problems faced by small hospitals is to create large, central hospitals. As a result, local hospitals become the focus for discharge treatment and outpatient services in general.
The problem with that model is that it creates logjams in the service. As the Nuffield report to which I referred earlier noted, there is a lack of shared care between the central and the smaller hospitals. As a result, there is a weakening in people's appreciation of the systems of nursing care in the smaller hospitals.
The report contains a model proposed by the former chief executive of Middlesex general hospital, Andy Black, who is now a health consultant. He suggests that that whole approach be turned on its head, and that local hospitals should become the front doors of the district general hospitals. Moreover, local hospitals would provide assessment and rapid consultation using modern systems of digital transmission. They would also use telemedicine, a matter about which my questions to the Department have received useful replies. In that way, the model suggests that medical and nursing staff would be part of the same team, working in rotation between the main site and the local site or sites.
Crucially, Andy Black's model proposes that the local hospital would have imaging and laboratory support, and high-quality electronic links. That is another matter about which I have asked questions, and I am pleased that over the past two years the Department has been looking into the availability of the technology. A report will be published next year on the results of that investigation and on the recommendations that flow from it. Finally, it is clear that a critical transfer team will be needed in the structure that I have described.
The advantage of the model is that patients would arrive at hospital sooner after an incident, and that they would be seen more quickly. Moreover, the structure would ensure a good link with primary care.

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When my constituents in west Cornwall—from Land's End, the Lizard and the Isles of Scilly, for instance—go to a central hospital, it is much more difficult to discharge them back home. That results in bed blocking and the clogging of services in the central hospital. The model proposed by Andy Black would lead to the quicker discharge of patients.
Moreover, many patients would not need to go to the central DGH once they had been assessed, diagnosed and treated locally. Those who had to go to the DGH would not need to be assessed and diagnosed again, as a lot of that work would have been undertaken by the local hospital. The transfer team—and there would also be a team capable of dealing with the transfer of critical cases—would take people to the DGH, where the process would continue rather than start again.
I have a series of questions for the Minister on these matters. No doubt he will say that small hospitals are a good thing and that we should keep them, but the moot point is what facilities are retained at them. I have had meetings with the president of the Royal College of Physicians and I detect that the college is changing its approach. It does not seem to see itself as the institution that has to pronounce on the future of small hospitals, but as a body that exists to advise and reflect on the professional standards that should apply in them.
As a result, the Government should give a political steer on this matter. The Department needs to make a clear statement about how the configuration of services should be provided, especially in the remoter rural areas.
The report mentions Downpatrick in Northern Ireland, which is already implementing a model of what Andy Black describes as a step-up rather than a step-down approach. In the latter, patients come into the centre and ultimately step down to the local centre. Under a step-up approach, they come in the front door of the small hospital and step up into the district general hospital if required.
That process is being increasingly considered in other places. There are reviews at West Cornwall hospital and no doubt there will be pressure in areas that face similar pressures because of the small size of their hospitals. It would be helpful if the Department of Health, rather than leaving it to the Royal College of Physicians, indicated where it believed the priorities were and in which direction local services should go in this type of delivery. Otherwise, we are moving increasingly towards centralising services rather than creating or using the front doors that already exist.
I am grateful for the opportunity to introduce this subject and look forward to the remainder of the debate.
1.11 pm
Dr. Richard Taylor: I am grateful to my hon. Friend the Member for St. Ives (Andrew George) for allowing me to speak briefly on a subject that, as the Minister knows, is close to the interests of my constituents.
To emphasise the importance of the change of view from the Royal College of Physicians, the president told a group of Members of Parliament that there are already
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40 hospitals in the country taking acute medical admissions that do not have full surgical services to back that up. That is a crucial change.
The president also said that hospitals must have a front door for emergencies. That was borne home to me only today after talking to an elderly lady who went to Kidderminster hospital this week for a breast cancer screening report. Her elderly husband went with her but had an epileptic fit in the out-patients department and was taken to the minor injuries unit. He was told that no doctor was available and had to go 18 miles to Worcester. The knock-on effects on the larger hospitals make this a very important issue.
Other patients have invited the Secretary of State to spend 24 hours on a trolley in the medical assessment unit at Worcester to see what it is like. Many small hospitals that are close to larger ones have not been mentioned. I refer in particular to Pontefract, which is close to Wakefield, and to Macclesfield. Runcorn and Ashington. They could all be under threat from the sort of moves that have taken services away from some hospitals.
Let me conclude by paraphrasing the words of the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), at the end of an Adjournment debate that I was lucky enough to secure. Can we go forward in partnership, because if we do, we can avoid conflict and come to a resolution that will be more satisfactory to the large numbers of patients who have, until now, relied on small acute hospitals?
1.14 pm
The Minister of State, Department of Health (Mr. John Hutton): First, may I say how sorry I was to hear about the brother of the hon. Member for St. Ives (Andrew George)? I genuinely did not know that that had happened, and I send him and his family my sincere condolences. It must have been a terrible time for them.
The hon. Gentleman has raised what most people in the House would rightly regard as very important issues that not only affect the future of the West Cornwall hospital but address the wider question of change in the national health service and the balance that needs to be struck between ensuring that services are fully accessible and of the highest possible quality. The hon. Member for Wyre Forest (Dr. Taylor) also alluded to those concerns.
The provision of comprehensive and accessible services of the highest quality, free at the point of use, lies at the heart of the NHS and its rationale, ethos and purpose. The Government remain strongly committed to the values that underpin the NHS. The NHS plan offers what I believe to be a good and strong framework for ensuring that those values can be reflected in a modern setting in which technology is changing quickly, advances in science occur almost daily and public expectations have risen substantially. To meet those needs, we need a broad range of provision—local and regional as well as national—that guarantees the best possible access to the full spectrum of care services.
The hon. Member for St. Ives was right about anticipating what I was going to say—he must have seen a copy of my speech. In this context, local hospitals such as West Cornwall have a very important role to play. There is, by the same token, one obvious pitfall to try to

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avoid. When we think of modernising medical care, it is easy to think of sophisticated, high-tech treatments provided in large, specialised hospitals. It is true that certain complex services and high-risk conditions require a critical mass that can be found only in larger centres, but that tells only part of the story. In determining care for a new century, it is vital that, wherever possible, we place at the centre of our thinking the views of the people and patients that the NHS is here t o serve.
The public place a high value on locally available acute care; so do we. That means providing treatment as close to where people live as is practical, in hospitals that serve local communities and that are focused on meeting their needs.
When the hon. Gentleman raised the subject of acute hospital services in remote areas in March, he acknowledged the need to strike an appropriate balance between the convenience of local services and the requirement to concentrate expertise for reasons of safety and quality. He was right to do it then and right to emphasise the point again today. However, many needs can and should be met locally, close to home, by delivering care through networks of skilled providers, working together rather than in isolation and utilising the latest advances in telemedicine, to which he referred. It is a strategy based on local solutions that sets standards and quality measurements. That is what we must remain focused on.
The hon. Gentleman expressed his continuing concerns about the future of the West Cornwall hospital in his constituency. The local primary care trust, in conjunction with the acute trust—the Royal Cornwall Hospitals NHS Trust—is reviewing the services provided at that hospital. He is aware, as I am, that one of the main reasons for the review has been concern to ensure that patients at the hospital receive the best possible clinical care.
There is a clear commitment on the part of the Royal Cornwall Hospitals NHS Trust to develop the West Cornwall hospital. In August, a major scheme to expand the day case surgery and out-patients departments was opened. I understand that the hon. Gentleman was there for that. That will mean that more patients will be seen and treated closer to home; there are extra staff and more beds than ever before. A new treatment room for endoscopies has also been created, with the ability to reduce waiting times—an important objective—by increasing the number of weekly sessions from three to five. Three years ago, capital investment of more than £250,000 saw the renal unit's capacity double. Altogether, I think that that constitutes a clear commitment to the future of the hospital. However, let me repeat again the assurances that have been given to him before. There is no intention whatever to close the West Cornwall hospital or its casualty service. Indeed, the review is looking at proposals that would increase the number of services provided and patients treated at the hospital.
Since the hon. Gentleman raised the subject in March, the review process has largely been completed. A range of models of service provision at West Cornwall hospital have been developed by local clinicians and are being tested against criteria drawn up by local people. The Royal College of Physicians has been asked to comment
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on the suitability of the models, and it is the intention of the local primary care trust that formal consultation on the proposals will commence in February.
The review of services at the West Cornwall hospital is feeding into work on service and capital developments to modernise health services across the county. It is being undertaken by the entire Cornwall health community, led by the Royal Cornwall Hospitals NHS Trust. The emphasis in this work to modernise health services is on achieving the closer integration of acute, community and primary care, and providing acute care as close to patients' homes as possible. Of course, the public have a right to be consulted on matters of this importance.
The review process in West Cornwall is, I understand, being carried out in as open and transparent a manner as possible, with heavy public involvement. I hope that the hon. Gentleman is satisfied with the way in which the process is being conducted. There have been numerous local meetings, including with all the local councils and the community health councils. If he has any concerns about the detail of that process, I hope that he will raise them with me and I will pursue them on his behalf.
I shall say a few more general words about the future of acute care, which was the subject of most of the hon. Gentleman's remarks today. As I said at the start, I fully understand the desire of people to receive care as close to home as possible. It is clear in that regard that small hospitals have an important role to play, provided that safety and quality are not compromised. I hope that both hon. Members who have spoken in the debate would agree with that observation. However, there is no one model to fit all local scenarios. It is properly a matter for local consultation, taking into account as fully as possible the views of local people.
Historically, there has been a gap between care provided in hospitals and care provided in the community. The need for efficient, effective and joined-up care requires that those separate parts of the system should work more closely together. For example, cancer networks have been developed to improve linkages across hospitals and between acute and primary care. Through those networks, services can be planned across the care pathway for cancer patients, with resources targeted where they are most needed to serve the needs of the local population. Such networks have already proved very effective in many areas. The Devon and Cornwall network, for example, is participating in a national programme to educate and support district and community nurses in the general principles and practices of palliative care. That will allow more patients to be cared for at home, if that is their wish—and that is probably true of most people—and avoid unnecessary hospital admissions. I hope that the hon. Member for St. Ives agrees that that is the right direction to take.
Primary care trusts will play an increasingly important role. Shifting the balance of power in the NHS means that local PCTs will have much greater influence in developing local services and will be better able to tailor services to local needs. If that is to be achieved successfully, they will need to engage front-line staff and local communities and partners in their plans for improving health services. In their role as primarily local organisations, PCTs will bring about improvements in local services, by engaging with and empowering local people, patients and staff.

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Small hospitals are working hard to develop their role and to embrace new ways of working. The challenge is to deliver the right care in the right place at the right time—as the hon. Gentleman said, and I agree with him—across the system. Internal organisation of hospital services can be substantially improved through a redesign process, such as that of the booked admissions programme. Some 5 million patients are expected to benefit from the national booked admissions programme by 2005.
Andrew George: I am grateful to the Minister for giving way and for his response thus far. My points were mainly about acute emergency admissions to local hospitals. While I appreciate that local hospitals make a significant contribution to primary care, and will continue to do so, I would appreciate it if he would address emergency admissions to small hospitals before the end of the debate.
Mr. Hutton: I certainly intend to do so, and this might be an appropriate point. One often runs out of time in these short Adjournment debates. The hon. Gentleman mentioned the Nuffield report and the work of Andy Black, which are both important. We need to consider their wider implications carefully, and we are doing so. The Nuffield report considered routine emergency medical cases and how they could be treated, as opposed to traumatic cases that require a full range of surgical and intensive care procedures, which are very different. The only useful point that I can add to the ground that the hon. Gentleman and I covered earlier is that it is a difficult balancing act.
Local hospitals have huge amounts of expertise available and we will not fritter that away. That would be stupid. However, we need to strike a balance between quality and good patient outcomes on the one hand and the natural desire for people to receive critical care as close to their communities as possible on the other. It is difficult to get that right, but we have had the opportunity to consider what has already been done. The Nuffield work has been piloted in several different areas, including Scotland, east Kent and Witney, so that we can look, listen and learn about the safest and best way to adapt and modernise emergency care services.
I lived in Hexham for many years, and the hon. Member for Wyre Forest often mentions that area. We need to try to ensure that services are appropriate to local needs and geography. The constituency of the hon. Member for St. Ives is probably one of the most remote in the country. I know it well, because my father lived in Cornwall for many years, and he also died there. The needs of people in Cornwall differ from those of people in the north-east, in terms of geography and the spread of services.
Shifting the balance of power and moving decision making in the NHS much closer to the front line—of staff and of local communities—offers us an
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opportunity to consider the issues in a different way so that the right judgments can be made. We have to make difficult judgment calls and if the hon. Gentleman ever has the chance to sit in my place, he will learn just how difficult it is. It is not possible to ensure that everyone is 100 per cent. happy with all the decisions that have to be made, but we work hard to try to ensure that the proposals are fully consulted on. We take care to ensure that we have the best clinical advice available to us to inform the decisions made locally and—if necessary—for the benefit of Ministers who make such decisions. We certainly do not take decisions on the provision of emergency medical care lightly.
Andrew George: Before the Minister returns to his prescriptive notes and while he is speaking ad lib, will he comment on the fact that the Royal College of Physicians, in its report on West Cornwall hospital, identified the need to establish one clinical community, rather than the artificial divide between the district general hospital and the small hospital as two separate clinical communities? The work done by Andy Black suggests the possibility of rotating staff. If a Minister were to welcome an environment in which rotation happened, between sites and within trusts, it would help to enable further progress to he made.
Mr. Hutton: I accept that point and I will draw the hon. Gentleman's remarks to the attention of the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), who has responsibility for the development of emergency care services. At the risk of stating the obvious, the NHS is a service based around science. Unfortunately, medical science is not an exact science, but it is a science and our decisions are informed, first and foremost, by the science and what we understand about advances in technology and what they mean for the patients and services of the NHS. That will continue to be the case, and we always listen carefully to the professional advice given to the Department from different quarters about the best way to proceed.
The advice is not always one way. Sometimes, there are two or three different schools of thought and Ministers are then expected to exercise the judgment of Solomon. However, I wish to assure the hon. Gentleman that our judgments are informed by the best clinical information that we have and that will remain the case.
The hon. Gentleman politely and charmingly described me as ad libbing so I had better return to my text, to reassure my officials and before any further policy is developed in a somewhat unannounced way. He talked extensively about telemedicine, which will be an exciting opportunity for us to work more collaboratively and make better use of resources in the NHS. It is one way to tackle what he described as the divide between local hospitals, trauma centres and district general hospitals—
Mr. Joe Benton (in the Chair): Order.

Education Funding (Stoke-on-Trent)
1.30 pm
Mr. George Stevenson: The problems associated with the standard spending assessment formula did not start at the 1997 general election. The problems and the basic unfairness of the SSA, especially as it applies to education, have been with us for a generation. I do not want to give the impression that the problems affecting education funding in Stoke-on-Trent began when the Labour Government were elected. Nevertheless, the issues—the challenges and the unfairness—are still with us, and are certainly having an increasingly serious effect in Stoke-on-Trent.
For example, in 2000–01, the education SSA in Stoke increased by 4.6 per cent. That contrasts with the lean, dark years of Conservative Government when we experienced year after year of cuts. However, that 4.6 per cent. must be compared with a national average increase in the education SSA of 6.1 per cent. In 2001–02, the education SSA in Stoke is increasing by 3.8 per cent., compared with 4.8 per cent. nationally.
The point I need to drive home to my hon. Friend the Minister for School Standards is that, although the Government are rightly providing additional resources for education, the gap is getting wider due to the inequities of the SSA system, especially as it applies in areas such as Stoke-on-Trent. We are very much aware of that. Indeed, the SSA in the current year was so low compared with the national average that the Government agreed to provide Stoke-on-Trent with an education support grant of £140,000, which of course we welcomed. The result of that education SSA is that Stoke is, and has been for many years, rooted in the lowest third of all local education authorities.
Another example is to he found in the local schools budgets, which provide the interface between the local education authority and the schools—where the Government rightly want the money to go. One definition of local schools budgets is all expenditure relating to schools. The Government's target for 2001–02 is that the percentage of the local schools budget that should be delegated should increase from 85 per cent. to 87 per cent. in April 2002. I can report that in Stoke, 88.3 per cent. of the budget was delegated last year, so we are way ahead on the delegation. We are not dragging our feet on Government policy.
If we compare the percentage of delegated local schools budget in Stoke-on-Trent with the unitary authority average of 86.3 per cent. and the national average of 86.5 per cent., we see that Stoke-on-Trent is doing very well on the implementation of Government policy, despite the problems of its relatively low SSA.
The position on delegation continues to improve. The Government target for 2001–02 is that there should be a minimum increase of 5 per cent. per pupil in the delegated budget. That target has been more than met in Stoke-on-Trent: the figure was no less than 9.9 per cent. I realise that the Minister may question the strictness of the reference of some elements of that delegation to the SSA issue, but the figures are further evidence of the success of Stoke-on-Trent LEA's policy of maximising the delegation of resources to schools.
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As far as the LEA has the capacity to do so, it ensures that money goes to the schools and is not retained by the centre. I make that point to show that Stoke-on-Trent LEA has a good record on the use of its resources, no matter which comparator is used.
If we consider the delegated budget in Stoke-on-Trent in absolute terms—the delegated funding per pupil—we see that the figure was £2,466 per pupil in 2001–02. The unitary authority average was £2,523 per pupil and the national average was £2,546 per pupil. I do not want to trip out a series of statistics, but the figures that I have given make the point vividly. If schools in Stoke-on-Trent received the national average amount of delegated funding—nothing special, just the national average—we estimate that an additional £2.9 million per year would be available to schools.
If we consider the amount of resources per pupil in the local schools budget as an inclusive figure, comprising the delegated and non-delegated resources—the funding kept by the centre to ensure that the LEA can implement its responsibilities—the situation is even starker. Using that base of comparison, the amount per pupil in Stoke is £2,793; the unitary average is £2,922 and the national average is £2,944. Using that yardstick, if Stoke-on-Trent LEA were funded at the national rate—nothing special, just the national average—it would receive an extra £5.5 million a year.
We should not think that one of the elements in this is the money held centrally by the LEA—I am sure that the Minister understands that. The central administrative costs for Stoke-on-Trent LEA are £46 per pupil. That compares with a Government target for this year of a maximum of £60 per pupil, and with an average for all unitary authorities of £50. Stoke is doing very well on central administration compared with not only the Government target, but with the unitary authority average.
That is the picture. It shows the direct result of the injustice and unfairness of the present SSA system.
I want to praise the Government, however, because much progress has been made. There has been much Government action. Despite the difficulties in Stoke-on-Trent, there has been excellent progress in educational achievement. The Minister is very much aware of that. That progress is manifest and can be illustrated by referring to two of its elements.
We have three beacon schools. Janet Worthington, the head teacher at Adderley Green infants school, and her staff do an excellent job. Weston Coyney infants school, where Janet Phillips is head teacher, is an excellent school, with excellent staff doing ground-breaking work, and the same is true of Sandon high school, where Barbara Hall is head teacher. I visit those schools regularly, as all three of them are in my constituency, and I am very happy and proud about that. Excellent work is being done—they are some of the best schools in the country, and they are all in areas of significant deprivation. That shows what can be done, with the Government's support, and we are grateful to them for that.
Stoke-on-Trent LEA met the maximum class-size target of 30 for five, six and seven-year-olds a good 12 months before the date on which it was due to do so. We have a progressive LEA. which has been groundbreaking in some respects, and the private finance

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initiative for schools is one of the best in the country. We are grateful to the Government for that, but the ideas came from Stoke-on-Trent, and we are proud of that.
The Government have given us a positive response to the difficulties—it would be wrong and unfair to say otherwise. In Stoke-on-Trent, the standards fund has been increased significantly, but the Minister will know that the LEA's ability to match the standards fund resources is becoming critical simply because of the problems of the base funding of the SSA.
In conclusion, I wish to offer one or two points, to which I hope that the Minister will be able to respond. First, the House was told earlier this year that the Government intended to produce a White Paper on local government finance and reform. Indeed, in a press release, dated 16 October, from the Department for Transport, Local Government and the Regions, the Minister for Local Government was quoted as saying that
"the forthcoming White Paper will set out measures to build on the modernisation agenda already under way."
On the same day, a parliamentary written answer referred to:
"The Local Government White Paper due to be published later this year".—[Official Report, 16 October 2001; Vol. 372, c. 1173W.]
However, I began to get worried when I read a letter, dated 5 November, from the Minister because he said:
"The work that we have done so far with external partners has shown that we need to put in more time to get the new education formula right."
On 16 October, we were told that the White Paper was imminent; on 5 November, I was told that the Government wanted more time. I hope that the Minister can not only confirm that the White Paper will be published this year, but give us some idea when it will be published.
Secondly, the Government have announced that, unfortunately, they have had to delay any change in the local government resource formula until 2003–04. That is a great disappointment, because the situation is critical in Stoke-on-Trent now. A delay until 2003–04 poses really serious problems for us, and it will mean that we shall have had almost two Labour Governments since 1997, but this important issue will not have been tackled effectively.
Thirdly, I wonder whether the Minister would care to consider rolling the standards fund into the SSA. There are precedents for that. My understanding is that, in Stoke-on-Trent, ring-fenced funding in social services has been rolled into the SSA when it had been available for two or three years. That has been enormously important. Will the Minister consider doing that, or at the very least exercising some flexibility on the need for match funding?
There is a real danger in Stoke-on-Trent that, because of the SSA, we will not be able to provide the funds to match the standards fund, which would be a tragedy. There should be no increase in the area cost adjustment. There is no reason why any increase in SSA should be reflected in the area cost adjustment, as that would simply widen the problem.
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Finally, the Minister said in his letter of 5 November that he could not meet us for all sorts of diary reasons. I repeat that request today, because the issues that affect the LEA in Stoke-on-Trent are so critical that a meeting with the Minister would, I hope, prove useful. We have some concrete suggestions to make, and I hope that he will reconsider that request.
1.45 pm
The Minister for School Standards (Mr. Stephen Timms): I congratulate my hon. Friend the Member for Stoke-on-Trent, South (Mr Stevenson) on securing this debate. I am very much aware of the strength of feeling about this issue in Stoke-on-Trent and, indeed, in Staffordshire. I am aware of it from his letters to me, and if I was in any doubt about it, he has made it very clear in this debate.
I join my hon. Friend in paying tribute to the schools in his constituency for their achievements and those of the LEA as well. For example, he has drawn attention to the early achievement of the class-size target. That achievement is important, and I gladly join him in paying tribute to those involved.
I do not see it as my job today to defend the current system of standard spending assessments. Our commitment is that the system will be reformed. We are working on the new formula, together with others who represent local government and other education interests, such as the Local Government Association, the teacher unions, governors' organisations and other schools bodies.
Our aim is to create a new system that reflects fairly, on the basis of up-to-date evidence, the needs of authorities in different parts of the country. I have listened carefully to what my hon. Friend has said about Stoke-on-Trent, but, of course, it is by no means the lowest funded authority under the present system. It comes 80th out of 150 authorities—about the halfway mark in terms of education funding. The national average figure for SSA per pupil is £2,911, compared with a figure of £2,845 per pupil in Stoke-on-Trent. So the figure is somewhat less, but the figure for some other areas is approximately £2,600—significantly less.
Our view is that, where differences in funding exist—there will inevitably need to be such differences—they should be considered on the basis of the educational needs of the children affected. I accept that that is not the case under the current system, but the task of devising a new system is not straightforward. It is an important priority for us, but we need to ensure that there is sufficient time to develop proposals and to consult on them before a new system can be introduced. It is not just a case of reviewing education funding; we also need to consider the impact of the proposed changes on other local government services and to look at the broader picture.
The work we have done so far shows that—my hon. Friend touched on this—we need to put in more time to get the new education formula right. That is why we have decided to introduce the new system in 2003–04, as he said. We believe that that will give us the time that we need. That decision has disappointed authorities such as Stoke-on-Trent, which had hoped for earlier reform, but it will give us more time to get the new arrangements right. We do not want to change the system every year, as has happened before, especially under the previous Government.

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It is important for local authorities to have confidence in the system and for us to ensure that we do not return to the unpredictability that was a problem in the past. We have already brought about greater stability in the system, by freezing formula changes and introducing floors and ceilings. Local authorities have welcomed the additional stability, and we certainly do not want to throw it away.
My hon. Friend may also know that we tried to change the system in our first year in office. He said that there had been a Labour Government for some time now, but this is certainly not the first time that we have addressed this issue. We got everyone together—from the LGA, the counties and the urban areas, including London. He will not be surprised to know that not one local authority leader admitted to doing well under the present SSA structure. That is where the problem lies. Some people—not my hon. Friend—have argued that London is particularly well funded, but it faces many of the toughest recruitment pressures in education. London authorities can point to the especially strong challenges that they face.
Mr. Stevenson: I realise that time is short but, before the Minister moves off that point, will he confirm or otherwise that the White Paper will be published this year?
Mr. Timms: I can confirm that the local government White Paper will be published as announced. However, it will not contain the new SSA formula. The formula is being drawn up on a different timetable from the White Paper, which is going ahead.
The current SSA system has been in place for more than 10 years. My hon. Friend and others have been very assiduous on behalf of their constituents in pressing to get the formula changed, and we have accepted their case that the system needs to be altered.
We have said that the new formula will have two separate elements: one for schools and another for an LEA's central core functions. I join my hon. Friend in paying tribute to the extent of delegation that has taken place in Stoke-on-Trent. That is to be commended. The split between schools and LEAs' core functions will be a feature of the new formula, and it will be assessed on the basis of data in authorities' budget statements for 2002–03. It will thereafter be updated annually on the basis of the most recent data.
There will need to be an element to reflect levels of deprivation in an area and an enhancement for areas that need to pay more to recruit and retain teaching staff. However, we want those enhancements to be decided on the basis of evidence in pupil characteristics, of data on costs and of achievements rather than on a regression analysis of historic spending. That is the basis on which the formula has operated in the past. I anticipate that we should have a more detailed set of proposals by next spring and we should then be able to start discussions with authorities about whether the initial proposals are right.
My hon. Friend has drawn attention to a major difference. Under this Government, we have substantially increased the funding going into schools. Between 1992–93 and 1997–98, average recurrent funding per pupil fell by £120 or 4 per cent. in real terms.
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Since then it has risen by an average of £540 or 20 per cent. in real terms to £3,250 this year. If one considers all the funding for education—the SSA and other elements—going into Stoke-on-Trent, one sees that the figure per pupil is above the average and comes to £3,360 per pupil this year. There will be further increases during the current spending review period and following the Budget announcement last March. By 2003–04, national spending per pupil will have increased by around £750 in real terms—compared to £540 so far—since 1997–98.
There is no doubt that funding has been part of the problem for education in Britain. In 1960, we spent a higher proportion of gross domestic product on education than most comparable countries. By 1988, however, an Organisation for Economic Co-operation and Development study of 24 members showed that our spending was the lowest of all those involved. The share of GDP committed to education fell from 6.5 per cent. in 1975–76 to 4.7 per cent. at the time we were elected. I came across the remarks of Howard Glennerster the other day. He said:
"The significance of this change should not be underestimated. No such previous reduction in education's share of the nation's resources had occurred this century … it is not to be found in the experience of any other leading nation."
That is now starting to change. We have raised the proportion to 5 per cent. already. The Prime Minister pointed out at the Labour party conference that we were the only European country to be increasing the proportion of our GDP committed to education. It will rise to 5.3 per cent. over the next three years. We are committing unprecedentedly large additional sums to education this year, next year and the year after. Schools and head teachers can see the difference.
My hon. Friend referred to the standards fund, and there have been substantial rises in that for Stoke-on-Trent in the past few years. He mentioned the difficulties of providing match funding for the standards grant, but I am pleased that Stoke-on-Trent has been able to take in full its standards fund allocation for this year. Nationally, 99.5 per cent. of standards fund grant offered has been taken up by local education authorities this year, so they have been able to provide the match funding where that has been needed. Next year, LEAs' match funding requirements will be allowed for in the national increase in education standard spending.
One of the things that has changed between the previous Government and this one is that there are a number of different routes—not just the SSA—for funding to go into schools. Stoke-on-Trent's grant for revenue costs in the standards fund this year is almost £10 million, rising with the council's contribution to just over £13 million. Standards fund grant for individual authorities has yet to be finalised for 2002–03 but, at national level, the grant is increasing by more than £85 million next year compared to this.
My hon. Friend suggested that the standards fund should be rolled into the SSA formula. He has drawn attention to some of the difficulties with that formula. Some areas and some hon. Members, including him, think that it is unfair, so if we were to roll the standards fund into it, we would increase the difficulties that some see with the present system. We expect to announce at the end of this month the provisional SSAs for individual authorities.

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Let me say a word about capital investment because it is an important part of the picture. The figures for Staffordshire local authority—which included Stoke-on-Trent before it became a separate authority—show that, in 1996–97, the capital expenditure was £3.5 million. This year, in Stoke-on-Trent alone, the figure is £8.3 million and, for the rest of Staffordshire, it is £25.4 million. Adding the figures together shows that the capital allocation for the whole of Staffordshire is almost 10 times what it was in 1997.
My hon. Friend also mentioned the private finance initiative credit support from which Stoke-on-Trent has benefited. As he said, £93 million has been used creatively to provide energy, energy management and repair and maintenance work to all 120 maintained schools in the area. Although the work will be completed over a period of five years, the benefits will last for the 25 years of the contract. This is the highest level of PFI credit that has yet been awarded to any LEA in England.
In making all those points, it is no part of my intention to seek to defend the current SSA funding formula. We are committed, with all reasonable speed, to changing the system on the principle that funding differences should be based on differences in cost, and not just on a regression analysis of how things were in the past. The system will change and we have set up
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consultative arrangements under which we will take those changes forward. It is important that we consult fully and carefully before we introduce the changes, so that we are as confident as we possibly can be that the new formula is right.
However, as my hon. Friend has said, children in Stoke-on-Trent receive significantly more money for their education than they have done in the past. Because of the investment that we have made, schools and buildings are certainly in better shape and are starting to look fit for education in the 21st century. What he said about the achievements of schools in his constituency reflects all that.
Of course, there is a good deal more to be done, and addressing concerns about the funding formula are an important part of that. However, I also want to draw attention to the substantial improvements from which Stoke has already benefited.
My hon. Friend has made the case for a meeting, as he did in his letter. We will shortly make announcements about the SSA, the standards grant and the capital grant. If, having seen the figures, he thinks that there is a problem of which I should be aware and which I should discuss with him and colleagues in his local authority, I shall be more than happy to accept his proposal for a meeting.
Question put and agreed to.
Adjourned accordingly at Two o'clock.