Westminster Hall Sitting of 23 October 2001

Preamble
[SIR ALAN HASELHURST in the Chair]

Airport and Aircraft Safety
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Stringer.]
9.30 am
Tom Brake: I welcome the opportunity for a topical debate on aviation security; it is an issue that involves many Departments. The 1988 Lockerbie bombing provided the impetus for great changes in security and aviation. Similarly, the attacks of 11 September should make us think again about aviation security. That is not to say that there is a crisis in British airport security; in fact, we probably have the best security in the world, after Tel Aviv. Heathrow, Gatwick and Stansted airports are among the safest in the world, and use measures such as 100 per cent. whole baggage screening.
The reports of the lack of security on the flights involved in the tragedy of 11 September made shocking reading to those in the UK because we are used to taking precautions against terrorism, and have done so for many years. To UK travellers, it seemed that essential security precautions were missing. British aviation is not guilty of basic safety failings, but we should nevertheless re-examine our precautions in the wake of the attacks. It has been said that the events of 11 September have changed the world; the changes must include alterations to our approach to the prevention of terrorism in our skies.
The events of 11 September, and the war against terrorism that has begun since then, must change the way that we think about aviation safety in two ways. First, if the fight against terrorism continues for long, we must take into account the fact that we may need heightened security in the air for some time—possibly forever. How could we maintain that level of security? Secondly, the attack must make us change our tactics with hijackers. In the past, we have co-operated with them, because the motivation for hijacking was different. Many will recall the success of co-operative tactics in the case of the Afghan plane that was hijacked in February 2000 by asylum seekers who had fled the Taliban regime. The 40-minute internal flight from Kabul became a three-day hijack, which was resolved after a two-day stand-off at Stansted airport.
After the events of 11 September, we can no longer assume that co-operation will lead to a peaceful outcome. We must make changes that take new risks into account. We should consider aircraft and airport security. There are many ways to improve aircraft security, some of which have been raised in recent weeks. Some companies are considering installing double cockpit doors to create a cordon sanitaire. They are also considering strengthening existing doors with internal bars.
If we adopt a policy of non-co-operation, we must prevent hijackers from gaining access to pilots, since the policy cannot work otherwise. Similarly, there is little
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point in armoured doors unless we have a non-co-operation policy. A non-co-operation policy, combined with a secure area for pilots, would take power from hijackers and act as a disincentive, but pilots do not like the idea of cutting off the cockpit crew from the rest of the aircraft. If such a long-term or permanent measure were introduced, wide consultation would be needed with pilots and air companies, or the policy might prove to be unworkable.
Many basic issues would have to be addressed, such as calls of nature for pilots and how they would receive their meals. Whether airlines adopt a policy of co-operation or non-co-operation, we need consistency, which is currently lacking. Although some UK airlines have reviewed their procedures and abandoned cooperation, others are still using the co-operation procedures by default. Can the Minister say what efforts the Government are making to standardise those procedures, or is he satisfied to allow each airline to draw up its own procedures? Discrepancies or inconsistencies in the way in which different airlines operate would undoubtedly arise in a hijack as a result of the latter approach.
On 16 September, The Independent on Sunday quoted the Secretary of State as saying that Britain would consider deploying armed guards on aircraft, which would be another way of improving security. Some countries—notably Israel and the United States—are already planning to do that. That idea has some good points, in that if sky marshals were on board, they would be able to intervene in an incident and could act as a deterrent.
It would appear, however, that placing armed sky marshals on board would create as many problems as it would solve, if not more. Conversations with pilots and others in the industry suggest that the idea causes great unease in the UK. They can visualise bullets flying around in a cabin and imagine the risk of the aircraft depressurising. That would incapacitate the sky marshal, who would be there to protect the passengers, and could also incapacitate or kill many others. There is also the risk of hijackers using the on-board gun as their weapon of choice, instead of attempting to get their own weapons on board in the first place.
Figures from the Federal Bureau of Investigation in the United States show that 52 police officers have been killed with their own weapons over 10 years, which is 9 per cent. of the total number killed. We can only assume that in certain cases the sky marshals would find themselves being relieved of their weapons, which would be used against them or other passengers on board. The idea is still worth considering, however, as, for a number of years, the Israeli airline, E1-A1, has used plain-clothed armed guards, who step in when necessary.
Those are two major issues about aircraft security. Another more minor measure that could be effective would be to remove the facility that is available for pre-booking specific seats on planes. Terrorists' ability to spread themselves throughout a plane may have been a crucial factor in the terrorist operations on 11 September. The airlines may need to look again at that facility to see whether they want to give passengers who are in a group the ability to place themselves strategically throughout an airliner, with all the associated risks if they are planning an attack.

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On airport security, it is worth remembering that whatever measures are introduced, the hijackers focus on the weakest link. All measures must be considered and implemented with equal vigour.
The issue of security and vetting of workers has been in the newspapers recently. There has been a history of security lapses. One of the most recent was in January 1999. An undercover reporter secured a pass to work for a cleaning firm at Heathrow despite giving bogus references. In May 1999, the Department of the Environment, Transport and the Regions announced more stringent requirements for the issue of passport passes and an extension of a programme of tests to look for possible loopholes. In November 2000, another newspaper managed to get a reporter wearing a pilot's uniform into a British Airways aircraft cockpit at Birmingham airport with a genuine airside passport for £10. He even managed to pose for photographs on the steps of an aircraft at Gatwick. In the same month, DETR issued further general directions that had been planned before that incident. On 26 September 2001, a new heightened security directive was issued. On 16 October, The Times reported that staff at the largest aviation security company had worked at Heathrow without compulsory counter-terrorism clearance.
The vetting situation is extremely complex and is a problem that must be addressed. Airports are divided into two parts: groundside is where the public are, and airside is where the aircraft are. BAA and the authorities of most of the larger UK airports are responsible for overall security groundside and airside. Any security staff working airside must be counter-terrorism cleared and are then free to go anywhere airside. The airport authorities do not do security checks on anyone else as that is the responsibility of the airlines. Reliable industry sources have raised concerns about BAA not independently verifying the airlines' clearances. Does the Minister share the industry's concerns?
The airlines do normal security checks on their airside staff, for instance cleaners, refuellers and the security staff who check passengers boarding aircraft. That is a five-year work check, and the airline has one person who is authorised to pass that information on to the airport authority, which can then give workers their passes. Most airside staff working for an airline are contractors and are not employed by the airline directly. It is the job of those airport authority security staff who enact counter-terrorism checks to ensure that the other airside staff remain in the area where they are authorised to work, as they should not be working in any other area. The cleaners on aircraft are split into two categories; some are counter-terrorism checked and it is they who check for bombs or any other material that should not be on the plane. All staff who carry out baggage screening are also counter-terrorism checked. However, The Times article revealed that the counter-terrorism checking of staff employed in a security role or as contractors causes problems. With delays of between four and six weeks in completing checks, some airlines let staff go airside with a temporary pass if accompanied by a full pass holder. Has the Minister considered whether that is a satisfactory arrangement after the
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events of 11 September? Should not all security and contracted staff be counter-terrorism checked before they are able to go airside?
My summary—it was not much of a summary—of the way that the vetting procedures work, and the question of who has responsibility for vetting staff, highlights an area in which some clarification is required. There must be clarification about who is responsible for the supervision of contractors. Perhaps there should be a single body responsible for that, to reduce the likelihood of mistakes. For instance, one of the household names of the UK airline industry has 19 contractors working airside, and I am sure that others have a similar number working for them.
There is also the question of access to aircraft on the ground. The directive on heightened security measures issued on 26 September says that
"the aerodrome manager shall ensure that: … the passes of persons observed on or approaching an aircraft in a restricted zone shall be randomly checked".
I take it, therefore, that not all people approaching aircraft are security checked. Clearly, they will have had to go through a security point to have got there in the first place. However, the recent examples of relatively lax security airside suggest the need for not only random checks but checks on every individual approaching an aircraft, as that may be the most vulnerable point of a journey. Would it be feasible to check the passes of everyone approaching an aircraft, or would that be unworkable? If so, what percentage of passes should be checked—10 per cent., 20 per cent. or more? Has that figure changed in the past five weeks?
There is also the question of hand luggage on aircraft. Following the tragic incident, a new list was issued of items, including household cutlery, that were not allowed to be taken on board aircraft. I cannot go into detail because of time considerations, but it is worth noting that passengers returning from Australia to the UK can use metal cutlery until they reach Singapore, where it is confiscated and replaced with plastic cutlery. Clearly, the Government need to work on international consistency.
The next question is whether we should be allowed to take any hand luggage on board. From a business point of view, a ban would have a major impact. Obviously, there could not be a blanket ban on anyone carrying anything, as people need to take on board passports, any necessary medication, wallets and so on, but do passengers really need to take on board the current volume of hand luggage? It concerns me that some airlines introduced quite stringent policies on hand luggage immediately after 11 September but have already relaxed them.
Has the Minister considered the use of transparent bags for hand luggage and to facilitate the checking process? Has he considered requiring people to put most of their hand luggage into the luggage hold so that it can be properly screened? Perhaps we should move to a debate about what people can take on board as opposed to what they cannot.
What about hand luggage screening? The testing of staff is being increased. In other words, there will be random checks, but that can operate effectively only if staff are rotated often. I should be interested to hear the Minister's view on how long staff can concentrate

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effectively when watching things fly past on a screen. Should they work a shift of 30 minutes, an hour or two hours, and should they have 30 minutes or 10 minutes off? The Minister is nodding; he must be getting the gist of what I am saying.
I should have liked to cover many more issues, including the security around baggage holds; however, I know that several hon. Members wish to speak. As the parliamentary sponsor of the air safety group—perhaps I should register an interest—I have been told that, apparently, all the baggage holds for most of the planes can be opened with the same key. Someone working airside can access most of the baggage holds, although some are fairly inaccessible and require steps to access them.
Do we have in all UK airports a system for dealing with clean and dirty passengers? Could not someone coming in from abroad, where the security standards are not as high as those in the UK, mix with clean passengers—those who have been through our security checks—and hand over something that they might have brought into the country with them?
I would have liked to deal with the different security standards that apply at smaller airports, the more sophisticated CCTV monitoring of passengers at airport departure lounges, and the role of passenger profiling. Some companies now use advance information, such as how the payment was made and where the passenger comes from, to do some preliminary checking. My hon. Friend the Member for Bath (Mr. Foster) will discuss some of those issues shortly.
I mentioned the need for consistency at an international level. It is all very well having the best possible standards here but, if risks can enter the system from abroad, that remains an issue for us. I understand that the option of using autopilots to land an aircraft in a case of hijacking is not yet an option for technical reasons, but it cannot be many months or years before that would be possible. There is the commercial issue about who will pay the costs associated with security measures, and the issue of general aviation, which my hon. Friend the Member for Bath will discuss.
I know that the Government and the industry are not complacent. However, the tragic incident on 11 September means that, even in the UK, we must ratchet up our security even further and ensure consistency of security standards across the country. I hope that the Minister will set out the response of the Government and the industry and provide answers to some or all of my questions.
9.53 am
John McDonnell: I raised the issue of security clearance of Heathrow staff in January 1999, after learning that a journalist had been recruited to work airside at Heathrow in a secure area, despite having no security clearance. I raised it again in November last year during our debate on air traffic control and expressed concern about rumours that the practice of hiring staff without security clearance was continuing. At that stage, I believe that the Deputy Prime Minister had twice in one year reminded BAA of its responsibilities and had also launched a review of security measures at our airports.
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Last week, I raised with the Leader of the House the "exposé" in The Times about the activities of Securicor ADI. I had given him notice that I would raise it during business questions and ask for a response from the Government, because I thought that it was a significant issue for my constituents and the country overall. The response of the Leader of the House was not acceptable to me or to many of my constituents and smacked of complacency. He argued that in the aftermath of 11 September we had a choice: we either recruited more people without security clearance or had no more staff at all. That is unacceptable because people who have not been security cleared should not be able to work in secure areas at Heathrow airport and put my constituents who work there and the general travelling public at risk.
We thought that the issue exposed in The Times had been resolved 18 months ago. The solution to delays on security clearance was seen as speeding up the process rather than allowing non-security-cleared staff airside. Companies allowed such staff airside through exploitation of a loophole in the regulations that permits one security-cleared person to supervise others who are not. Anyone who has visited baggage handling or other secure areas at Heathrow will understand the complexity of the operation and the difficulty of managing staff in any case. Having to manage regular staff is difficult enough, but managing staff who have not been security cleared is virtually impossible.
The GMB union is meeting a group of Members of Parliament today. It has prepared a dossier of instances in which Securicor ADI and other firms flouted the spirit of the Heathrow security regulations, putting the union's members and the travelling public at risk. The union would welcome access to the team at the Department that reviewed security at Heathrow, and seeks a straightforward explanation of last year's incidents. The review team should be able to meet groups of staff informally without prejudice to the staff, to enable the truth to emerge.
Many frightened and worried families living around Heathrow fear that their loved ones who work in secure areas at the airport are at risk because of company exploitation of loopholes in the regulations. We must ensure that the regulations are tightened and that companies that exploit loopholes cannot operate at Heathrow. Their staff should not be allowed to work in secure areas.
If the answer is to review the regulations once more, will the Minister explain the process by which such a review will take place? Will Members of Parliament who have constituents living or working in the Heathrow area be consulted? Will the trade unions be consulted and will staff have an opportunity to meet the review team informally as I suggested? If we want to restore confidence among the travelling public and those who work at Heathrow, we need a more open discussion about security there and about the review process.
I should like to raise a final ironic point about security at Heathrow. At the same time as we are identifying security lapses in respect of staff who have not been security cleared, the Home Office is liaising with BAA about Sikhs who wear the kirpan working airside at

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Heathrow. Following the Sikh religion means following the five Ks, one of which is wearing the kirpan, a small ceremonial dagger.
In the 1980s, an agreement was reached between the Home Office, BAA and the Sikh community that, on condition that the blade be no more than 3 in long and remain a ceremonial object rather than a weapon for use, the kirpan could be worn airside in secure areas by staff who had been security cleared. That has pertained for more than 16 years, yet suddenly there is a threat to withdraw that concession from Sikhs working at Heathrow. That is bizarre because there is a lack of concern about non-security cleared staff working at Heathrow, while a group of security-cleared staff are being penalised for practising their religion, in spite of an agreement that has been honed over the years by the Sikh community, BAA and the Government. The Home Office should liaise with the Department for Transport, Local Government and the Regions and BAA to ensure that Sikhs working at Heathrow are not discriminated against as they were before the agreement was reached in the mid-1980s.
For my constituents, security at Heathrow is of prime importance. If it is a matter of speeding up security clearance, resources should be put into resolving that problem. Companies should not be allowed to avoid keeping to the spirit of the detailed and precise regulations on security clearance introduced by the Government to make the travelling public and workers at Heathrow secure. Any company that breaches those regulations must never again be able to employ staff in secure areas at Heathrow.
10.1 am
John Barrett: There is an airport in the heart of my constituency, from which I commute every week. Several passengers have raised with me their concerns, which were mentioned earlier.
In Scotland, an important issue is concern about the delay to the new air traffic control centre, which was recently confirmed by the Government, but which would give Ministers the opportunity to consider improvements to the security at air traffic control centres in the light of the events of 11 September. The prospect of sky marshals or armed guards on aircraft does not fill commuters with confidence, but prior to 11 September, the number one issue was not terrorism but the risk of an accident caused by air traffic control problems. Given the delay in the construction of the Prestwick air traffic control centre, I want to ensure that consideration is given to improving security measures at the centre when it is built.
10.2 am
Dr. Vincent Cable: My constituency, like many others in London, lies under the flight path for arriving and departing aircraft, which has worried residents for some time, as there have been incidents of objects—including, in extreme cases, bodies—falling from aircraft. London has not had anything like the appalling accident that occurred in Amsterdam, but there is apprehension about the high volume of Heathrow traffic that lands and takes off over built-up
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areas; if there were a crash, the consequences would be appalling. Such anxiety was heightened after the Concorde accident close to Charles de Gaulle airport.
Two considerations that arise from the events of 11 September have added to the sense of insecurity: first, the appalling fact that aircraft are being used as weapons, and, secondly, the story, which I suspect may well be true, that the Government have authorised the Royal Air Force to shoot down hijacked aircraft before they reach the most sensitive destinations. If either were to happen over London, the consequences would be enormous.
There is no absolute, foolproof, no-risk solution, short of grounding the entire aircraft fleet, which is not acceptable, as life must go on. However, I want to ask the Minister whether consideration has been given to minimising the risk of such a catastrophe occurring. Risks could be minimised if some flights were re-routed over less populated areas. Re-routing could involve switching between airports or, more likely, between runways. Such flexibility now exists because demand recession in the industry means that some slots are not being utilised. Does the Minister acknowledge that there is a risk, albeit small, and if so, are there mechanisms in air traffic procedures and Civil Aviation Authority rules that could give people on the ground a greater sense of security by the reallocation of flight lines?
My next point concerns the more general issue of the financing and economics of aircraft and airport security. There will be an additional cost and the question is who should pay for it—the airlines, airport authority, passengers or taxpayer? Many hon. Members, as constituency MPs in the London area, hear both sides of the argument. I have many aircraft workers, particularly aircrew, in my constituency. Many are anxious about their jobs and, reasonably from their point of view, believe that the Government should be helping. I tell them that that is not the correct approach and that the robust response given by the Government to the requests for funding from the airline industry is right. Indeed, my hon. Friend the Member for Bath (Mr. Foster) and I have written to the Chancellor to that effect.
The broad context is that the airline industry was in substantial financial difficulty anyway, for reasons wholly unconnected with the events of 11 September. A serious slump was on its way because of over-investment and misestimation of demand, and some major flag carriers were already in considerable trouble. Many smaller airlines, particularly the budget airlines, are still competitive and keen to expand into the slots that the bigger airlines cannot fill. It would be unfair to them to bail out any of the big carriers. There is also a broad principle that enhanced security is primarily for the benefit of airlines and their passengers, so it would be appropriate for them to meet the costs.
One small qualification is that we must recognise, even if we are not airport MPs, that there is a crisis in the industry. Although bail-out and state aid are not the right solution, there might be various ways in which the Government, acting in a European framework, can provide some assistance. It would be reasonable to compensate the airlines for compulsory groundings, and the airline industry could be helped with its cash flow by the retiming of tax measures. However, on security, the

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right solution is for the Government to insist that it is a proper charge on airlines' shareholders and passengers, rather than on the taxpayer.
10.8 am
Mr. Don Foster: This has been a brief but interesting debate. I want to place on record my thanks to several people working in both airline and airport security, for their briefings. From those briefings, it was clear that my hon. Friend the Member for Carshalton and Wallington (Tom Brake) was right in saying that, perhaps with the exception of Tel Aviv, we have some of the safest airports in the world. I was interested also to learn that much is going on about which it would be inappropriate to comment in public. Providing information about airport security arrangements will merely make it accessible to the very people to whom we want to avoid giving access.
I was heartened to hear what was happening in air security, although, as my hon. Friend also said, our system is only as strong as the weakest link. Although we have some of the best security systems at our airports, that does not mean that all airports around the world are as secure. It is interesting to note that while the Civil Aviation Authority may have the power to stop an aircraft landing at a UK airport because of concern about its airworthiness, it does not have similar powers when there are concerns about security at the airport from which the plane took off. We must consider airport security not just in relation to this country, but at an international and European level to ensure that it is increased worldwide.
I am therefore delighted that the Government have sought to play a key role in the European Civil Aviation Conference. I also welcome the joint ministerial statement made on behalf of US and EU Ministers on 21 September. A number of security improvements to UK airports were announced on 26 September, which brings us nicely back to the issue of our own security. While we should work with others to improve security at other airports, just because we already have a fairly good system does not mean that we should not seek to find ways of improving it still further. I noted with interest that the Home Secretary announced that
"the Secretary of State for Transport, Local Government and The Regions, will strengthen security at airports and for passengers. Powers both within restricted areas at airports and aboard aircraft will all be strengthened."—[Official Report, 15 October 2001; Vol. 373, c. 924–25.]
I hope that the Minister can give us some idea of the plans that are afoot, although I acknowledge that he will not wish to put on the public record all the measures that may be planned.
My hon. Friend the Member for Carshalton and Wallington raised many important and interesting issues, ranging from the advantages and disadvantages of locked cockpit doors to the need to reduce the amount and type of hand luggage that is taken on board planes. He mentioned the problems caused by there apparently being a universal baggage lock to most planes from different airlines and spoke of the possible removal of the facility to pre-book seats. He also raised important issues about the security arrangements for airport staff, a point picked up by the hon. Member for Hayes and Harlington (John McDonnell) who has a long record of following these matters. They both
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referred to issues that had been raised previously and to the particular concerns raised most recently in The Times about the issuing and use of passes for people working airside.
I hope that the Minister can give us some indication of plans to change the regulations and the checking systems. I hope that he will also pick up the point made by the hon. Member for Hayes and Harlington about meeting representatives from the unions to look at their list of examples of breaches that have taken place. I have one specific question for the Minister. As my hon. Friend the Member for Carshalton and Wallington made clear, the system is already complicated. The airlines are, in effect, responsible for the issuing of passes. The airline decides which person shall be given a pass and then on the basis of an authorised signature, BAA issues the pass. BAA is then responsible for carrying out random checks on whether the passes have been issued appropriately. It would not be sensible to put on the record the percentage of passes that are randomly checked in that way.
As my hon. Friend said, some people are urging the need to increase the percentage of passes checked by BAA. Has the Minister's attention been drawn to any difficulties that BAA might experience in carrying out further checks, as a result of the provisions of the Data Protection Act 1998? In checking a pass, it is important to check the references used to issue it. It has been suggested to me that the Data Protection Act makes it impossible for BAA always to check such references. There could be a situation in which many pass applicants use the same person as a reference; that might be one way of uncovering problems. BAA provides the security passes for staff who have access to all parts of the airport to check on what is happening, and those people are, quite properly, required to undergo counter-terrorism checks. Inspectors from the Department for Transport, Local Government and the Regions have responsibility for checking whether that system, and all other aspects of airport safety, work properly.
It has been put to me—I have no way of checking whether it is accurate—that there are concerns about whether those inspectors are well enough trained, not only to check whether the regulations are complied with, which is relatively easy, but in looking wider afield to problems out with existing regulations, which might draw attention to the need for regulations to be made. It has been suggested that they are good at counting whether the right number of paper clips are in the right place but not so good at looking at issues that fall outside the regulations.
My hon. Friend also made passing reference to the development of systems to help identify potential criminal elements who seek to board planes. Several such systems have been developed following the legislation on football hooligans, for example, such as the matchmaker borderguard system, which has been well developed and which is being considered in respect of passengers seeking to board aircraft. The Government intend to carry out trials of the system in the near future. I understand that Go is to be one of the trial airlines but decisions have not been made on which long-haul airline is to be used. I note with interest that the system was developed in conjunction with Virgin Atlantic. I know that that company is very keen, having already been involved in the scheme, to be the selected

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airline. The Minister must obviously look at all the offers, but it would be helpful if he could give us an idea of what progress has been made on the issue. Another question on the development of that system relates to the Data Protection Act 1998. Will the Minister look at whether that Act might present any difficulties in the use of the matchmaker borderguard system on airlines with international passengers?
My hon. Friend the Member for Edinburgh, West (John Barrett) raised understandable concerns about whether the second air traffic centre at Prestwick is to go ahead. He, and I suspect all hon. Members, would be interested to hear from the Minister what the current plans are. The dual centre system was intended not merely for ensuring that sufficient facilities are available, but as a security measure in the event that one or other of the two systems went down. My hon. Friend's concern about the future of Prestwick will have been heightened by the revelation in the past 24 hours of a possible financial crisis in the National Air Traffic Services. Will the Minister comment briefly on whether those reports are true and on whether NATS has been or might be planning to discuss the issue with him?
My hon. Friend the Member for Twickenham (Dr. Cable) rightly raised the concerns of his constituents and of others who live on the flight paths, and I am sure that he will be interested in the Minister's response. He also rightly raised concerns about who will pay for increased air security. We could ask several questions about that, but will the Minister tell us what action the Government are taking, as distinct from the EU, to investigate concerns about whether the immediate and significant increase in premiums by insurance companies was permissible under UK legislation?
My hon. Friend rightly said that it is important that the Government work within existing EU arrangements as regards any help that the airlines might be given to increase air security. He also referred to support with cash flows, and I entirely support his remarks on that.
Finally, I want to raise a concern that has not been touched on. Much of the debate has been about security on aircraft and at airports, but no mention has been made of the difficult issue of aerodromes and general aviation. I am talking not about aircraft on regular flights, but about aircraft that members of the public can hire and fly from aerodromes. The Department's document "The Future of Aviation" of December last year described general aviation as comprising
"a wide range of activities, including flying training, leisure flying by private individuals and use of aircraft owned (either outright or on a shared basis) or chartered ('air taxis') for business. This includes both fixed wing aircraft and helicopters."
When I looked into the issue, I was given a helpful brief by the Library. It stated:
"Anybody flying into an airport"—
and, in this case, aerodromes used for general aviation—
"has to get permission from the aerodrome operator and file a flight plan. It is up to the aerodrome operator to inform HM Customs & Excise and the Immigration service".
Those bodies
"then decide whether to come and check the arriving aircraft."
The issue is therefore what checks are made on passengers of aircraft that land at aerodromes? If the Minister has better information than me, I would be
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grateful to hear it, but it appears that all that is necessary in the majority of cases is for the passengers to provide the operator with copies—often faxed copies—of their passport details. It is the pilot's responsibility to check whether those are accurate and to forward them to customs. In the light of that information, customs will decide whether even to go to the aerodrome to check the passengers who get off the aircraft. I have details of several companies that operate under such arrangements and which give people the opportunity to board flights to the United Kingdom from as far away as Serbia.
There could be 13 passengers and two crew members on board a plane. In the past, it was thought that members of a group that hired an aeroplane would be unlikely to shoot or harm each other. However, after the appalling incidents of 11 September, we know that some people are prepared to do almost anything with an aircraft itself, so a loophole related to general aviation may need to be filled rapidly.
I have raised several issues and look forward to the Minister's response. I end by repeating what I said when I started: notwithstanding the concerns raised, I genuinely believe that the United Kingdom's airport system is probably one of the most secure in the world.
10.25 am
Mr. Geoffrey Clifton-Brown: I am delighted to participate, and I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) on having secured a debate on such a timely matter.
I start where the hon. Member for Bath (Mr. Foster) finished: I believe that we have one of the most secure safety records in the world. It has perhaps not been said so far, but it must be said loud and clear, that the terrorists will have won if we allow the threat of terrorism to deter people from going about their normal lives, including travelling on aircraft. People should feel safe and it is the duty of us all, especially the Government, to ensure that there is that feeling of safety among the travelling public. The debate will play a part in that.
Perhaps we should put the matter in context and consider the scale of aircraft travel. Air traffic has increased rapidly. In 1988, 93.2 million passengers passed through British airports, of whom 21.7 million had travelled on domestic flights. Ten years later in 1998, the figures had risen to 159 million and 33.6 million respectively. That was a 55.3 per cent. increase, and air traffic is forecast to increase by 50 per cent. during the next 15 years. A huge number of people travel by air, so aircraft and passenger safety must be paramount.
The report of the Transport Sub-Committee of the Select Committee on the Environment, Transport and Regional Affairs in 1999, long before the incident on 11 September, made several important recommendations. Before I go into the post-11 September scenario, it is worth looking back at the report to see what it highlighted. Richard Profit, the group director of the Safety Regulation Group, told the Committee that the recent emergence of low-cost carriers was
"stretching our resources in so far as we have to put specific regulatory effort into these new startup and low cost airlines".
He recommended that if the Safety Regulation Group continued to experience staff shortages, which could not be in anyone's interests, the Government should relax

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the pay restrictions that they impose on the Civil Aviation Authority. I know that that is controversial, especially in view of 11 September, but we cannot tolerate the safety group experiencing staff shortages.
The Committee also considered aircraft inspections, with special regard to the Malaysia Airlines Boeing 747 that landed at Heathrow with only 3.4 tonnes of fuel in its tanks. That was not enough to divert to another airport or to hold its position for any length of time if its approach to the airport had been delayed. The incident is important in terms of aircraft safety. Responsibility for inspecting foreign-registered aircraft that land in the United Kingdom—so-called ramp checks—rested with the Department of the Environment, Transport and the Regions. The Committee stated:
"We were surprised to learn that only 59 ramp checks were carried out"
in the UK
"in 1997–98, and 63 in 1998–99."
Again, that problem needs to be tackled.
The Committee identified two other issues. The Royal Aeronautical Society told the Committee that
"in the last ten to fifteen years we have seen a massive degradation in the amount of skilled staff, both pilots and engineers, in this country."
Clearly, we need to deal with that. Continuing about the lack of engineers, the society said that there was
"a significant shortage of appropriately skilled labour due to a contraction of the supply of skilled personnel from the armed services, manufacturing sector and the traditional airline apprenticeship schemes."
If we are compromising on the number of engineers, aircraft safety is being compromised.
We know that BAA spends £100 million a year on security, and that is to be greatly welcomed. We also know that since 11 September it has considered a number of security measures. For example, cockpit doors are now being locked and armour-plated doors with reinforced locking mechanisms are being installed to all aircraft types at a cost of more than £1 million. Secondary searches have been introduced for a proportion of passengers. Flight deck visits for commercial passengers have been stopped. Flights were immediately re-routed to avoid Afghan airspace. Obviously, services to Islamabad have been suspended and plastic cutlery has been introduced on all flights out of the United Kingdom. I also travelled on China Airlines recently, and all the cutlery on that flight was plastic.
The hon. Member for Hayes and Harlington (John McDonnell) rightly focused on the issue of staff at Heathrow. It is an important part of the consultation process that the GMB should be involved in all groups that are discussing aircraft and airport safety. I hope that the Minister will be able to take that on board.
Much has been said about the staff who check both passenger luggage and airport hold luggage. That is an important subject, which was raised, I think, by the hon. Member for Carshalton and Wallington. How well trained are the staff who check the luggage using X-ray machines? I have heard of students with only minimal training being employed by airlines. That is a major lacuna in safety inspection systems at airports. We should expect all staff who are employed by airports and
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airlines to check baggage—whether it be hold baggage or hand luggage—to have a minimum level of training. That is the first and paramount step that we could take.
The hon. Member for Carshalton and Wallington raised the issue of the length of baggage-checkers' shifts and how much rest they should have between those shifts. Anybody who has worked on a production line will know that the required level of concentration can be maintained for only so long. We need to consider that carefully.
We know that the Government are raising £1 billion a year in airport tax and we know that the American Government have given specific help to their airlines, which are in trouble because of the huge increase in security costs that they have had to meet since 11 September. The Government need to examine carefully—within a European regime, because that affects what we can do with state aid—whether some of the airport tax revenue might be recycled and used to improve long-term safety at our airports and on our aircraft. I would like the Minister to comment on that. I recognise that it is outside his brief to an extent, but the issue of finance for security is within his brief and he might be able to say something about it.
We need to consider how we screen luggage. During a trip to Australia last year with the Commonwealth Parliamentary Association, we were met at the airport by Australian customs and asked if we had any food in our luggage. We all said no. Dogs were sent round the luggage and a New Zealand apple was found in the luggage of one of our Labour colleagues, who shall remain nameless. That shows how careful the Australian authorities are. They screen every piece of luggage using dogs.
It may not be possible or practical to do that here, but what I have described suggests how we need to tighten our random testing of hand luggage and hold luggage. I know that that would cause increased delays, but if it becomes clear that we are taking a stringent and firm stance on airport safety with respect to luggage, and if it is widely known that detailed random checks will be made, there could be a deterrent effect.
We also need to be more stringent in the questions that we ask passengers. The other day I went on a domestic flight to Edinburgh. Somebody had checked in for me and the luggage awaited my arrival at the desk. The desk officer fired three quick questions at me, asking, "You haven't done any of those things, have you'?" I said, "Of course not," and that was it. Somewhat more stringent questioning seems to be needed. Those are elementary and simple methods of improving aircraft safety.
I understand that there are problems with various aspects of airspace control. One of those is military aircraft. A Tornado collided with a Cessna over a midlands airfield two years ago. Clearly, no compromise should be made with regard to safety, where fast military jets are concerned. That is an elementary matter, which needs to be sorted out.
The Europeans are taking more and more control of our airspace, and that needs to be considered carefully. An issue that needs to be dealt with is aircraft control above 35,000 ft, which the Europeans regulate. We need to ensure that the European standards in all countries are as good as ours in this context.

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We need to study carefully our arrangements with other countries on airspace control. For example, following the incident on 11 September the United States has tightened its safety regime considerably. That process has included the screening of passengers, hold luggage and cargo, as well as aircraft searching and guarding. No consultation took place, but the Department for Transport, Local Government and the Regions worked closely with the United States authorities and it was commendable that air traffic between the UK and the US could resume so quickly.
However, that happened on a purely bilateral basis, without the involvement of any particular regulatory bodies. In future it would be sensible if well established mechanisms of communication with countries around the world were available, so that when a rapid change in safety standards becomes necessary following an incident, systems are in place. That applies also to our European colleagues. Through the Joint Aviation Authorities and the European Civil Aviation Conference, the sort of bodies to which I am referring are beginning to emerge. However, they are not quick enough on their feet yet to be able to deal with incidents such as that of 11 September.
We have covered a lot of ground this morning, and I do not intend to repeat it. Many safety arrangements obviously cannot, and should not be, put into the public domain. The British have a record of safety measures among the most stringent in the world, along with the Israelis. An incident that occurred when I travelled to Israel exemplifies everything that I have said this morning. When I left Israel, not only was my case completely taken apart—every single thing in it was inspected—but I was subjected to a rigorous verbal examination. I had to produce travel documents to show where I had been in Israel, I was asked why I had been there, why I was leaving for the UK at that particular time and why I had visited Saudi Arabia the year before. If the Israelis can run that sort of security operation, the United Kingdom should be able to make more random checks of luggage and passengers.
We need to use modern IT equipment to check passengers more rapidly. The hon. Member for Bath referred to the problems of the Data Protection Act 1998 and to the other international security mechanisms that protect individuals. We must find a way around those problems. Every aircraft should have an IT system, so that passengers can be rapidly checked against an international blacklist should an incident occur. Again, such systems need to be developed.
We need to consider whether sky marshals should be on aircraft. I do not advocate that they should be on every aircraft, but they might be used on a random basis. They should not be armed, because that would merely give terrorists another way of obtaining arms. However, the police are testing new developments, such as stun apparatus, that could rapidly disable terrorists. We need to consider all those methods and to come up with a global system to protect air passengers.
I end where I started: let us not allow the terrorists to win this war. Let us ensure that the worldwide public have full confidence in aircraft travel, so that they can
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travel in safety and with enjoyment. That is the purpose of our debate and of the Government's action. We look forward to the Minister's reply.
10.41 am
The Parliamentary Under-Secretary of State for Transport, Local Government and the Regions (Mr. David Jamieson): I congratulate the hon. Member for Carshalton and Wallington (Tom Brake) not only on securing this debate and choosing this subject but on the measured way in which he conducted the debate. Indeed, that point applies to all hon. Members who spoke this morning.
As the hon. Gentleman said, this is a most important matter. In the end, the debate was more about security than safety, but the safety of passengers and others is at the forefront of our minds. He started by saying that there is no crisis in the United Kingdom security system, and I agree. He went on to speak about the high levels of security that obtain in our airports, as did the hon. Members for Bath (Mr. Foster) and for Cotswold (Mr. Clifton-Brown). They are absolutely correct. However, the hon. Member for Carshalton and Wallington was right to say that there is no reason for complacency. I assure him that the Government are considering all systems to ensure that they meet the standards of which he spoke.
I shall try to answer as fully and frankly as possible all the points raised today. However, as several hon. Members said, some matters are more difficult to talk about in detail because of the nature of the problem and because the answers are best not put into the public domain. If I do not cover some of the issues in the detail that hon. Members would like, I undertake, as always, to write to them about the points that they would like me to answer.
It may help if I put the debate in its context. There is no question but that the security and safety of our airlines and airports has been uppermost in everyone's minds since the appalling events in the United States of America on 11 September. I am sure that the awful images of that day will live for ever in the minds of those who witnessed them on television and especially in the minds of those who witnessed them first hand. We are determined to do everything humanly possible to ensure that nothing remotely similar happens again. I am sure that those feelings are shared by everyone in the Chamber, as has been evident from the quality and commitment shown in the speeches made today.
I assure hon. Members that the staff in my Department who have responsibility for transport security and safety have worked tirelessly since 11 September to review and improve levels of security, along with colleagues from other Departments, the Civil Aviation Authority, representatives of the transport industry and colleagues in overseas Governments and organisations such as the International Civil Aviation Organisation. I thank and congratulate the staff of all those organisations, who have worked extremely hard on this important issue.
New measures have been identified and are being implemented in response to the attacks on the United States. Hon. Members will understand that it would be inappropriate to discuss all those measures in detail but, before I address the specific points raised in the debates,

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I can reassure everyone that all that can be done is being done to provide the proper protection of all those working in the aviation industry, those who travel and others who might be affected by the workings of the industry.
It is impossible to discuss aviation security without recalling the terrible tragedy that struck Pan Am flight 103 over Lockerbie in Scotland in December 1988. That disaster marked a tangible turning point for aviation in the country—indeed, in the world. That is not to say that before 1988, aviation security was not taken seriously in the United Kingdom, but Lockerbie was a watershed that changed the world's perception of how terrorists might attack aviation. We went from a world in which the terrorist threat was concentrated on hijack to one in which it concentrated on sabotage. The events of 11 September have moved us on yet again, to a world in which the previously unthinkable threat of a suicide attack, with an aircraft being used as a weapon, has become a reality.
As a result of that attack, much work has been done and much remains to be done, in both domestic and international arenas. The progress that we have made in aviation security since 1988 has been remarkable, although I do not want to sound complacent. The Government are not complacent, but we have great confidence in the state of aviation security in this country. Because our security has moved on so far in the past 12 years, we face a far shorter journey than some other countries in dealing with the new threat.
I will address some of the issues that were raised in debate. First, questions were asked about how we could make aircraft more secure and about the screening of passengers. As with any aspect of security, there are several threads to the issue. An aircraft needs to be kept secure from interference on the ground, from any threat from the bags and cargo that go into the hold, and from threats posed by passengers during the flight. That is why all passenger flights from the United Kingdom operate from restricted zones designated under the Aviation Security Act 1982. Everyone and everything that enters a restricted zone is subject to security control.
Some hon. Members asked what that control amounts to. Every aircraft is subject to a security check when all incoming passengers have left, to ensure that nothing suspicious has been left behind. After that check, access to the aircraft is carefully controlled to ensure that no unauthorised person gets on board. Every passenger who leaves the United Kingdom passes through a security checkpoint where they are screened by metal detection equipment and where many are subject to a hands-on search. They are liable to be searched again at the departure gate. Every other person, from the pilots to the cleaner, passes through a staff checkpoint where they are screened by metal detection equipment, supplemented in many cases by a hands-on search. The United Kingdom is the only country in the world where that is done.
Mr. Don Foster: Will the Minister acknowledge, however, that that system is not in place for general aviation, and that those checks are not necessarily carried out on people flying into this country from abroad?
Mr. Jamieson: I accept that there is more to do in the case of flights that come into this country. That has been
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the subject of many of our international discussions. I was referring to the comments made by the hon. Member for Carshalton and Wallington about the situation in airports in this country. Every bag entering the restricted zone, whether it is hand baggage accompanied by the passenger, a suitcase bound for the hold of the aircraft or a bag belonging to a staff member, is screened by a trained X-ray operator.
John McDonnell: Can my hon. Friend assure me that Customs and Excise staff are also screened as they go through?
Mr. Jamieson: I do not believe that they are.
Every piece of cargo going into an aircraft hold has been subjected to security controls and every aircraft meal is supplied by a caterer whose security processes have been inspected or approved. Those measures are carried out only in the United Kingdom.
If hon. Members will bear with me—my comments might seem a little disjointed—I should like to address the considerable number of questions and points that have been raised.
The hon. Member for Carshalton and Wallington asked about standardising procedures in the event of a hijack. The Civil Aviation Authority is reviewing those procedures with UK airlines, and is trying to establish some appropriate standards. The issue of pre-booking seats will be carefully examined as part of the wide-ranging review of security measures that is under way.
The people who operate the screening machines were also mentioned. The screeners operate for only 20 minutes at a time, with at least a 40-minute break between such periods. It is a difficult and exacting job, requiring a high degree of concentration, which is why those measures are in place. Staff employed as X-ray operators, who are operators of other screen technology, are trained to a very high standard by the DTLR training providers. That training is supplemented by regular refresher training. We are introducing a new screening methodology, which incorporates threat image protection. That not only improves screening but amounts to continuous on-the-job training.
Since January 2001 it has been a legal requirement for security-screened passengers to be separated from arriving passengers. However, while UK airports have agreed time scales to achieve that, it is not done at all airports. In the meantime, compensatory measures, such as extra gate searching, are in place.
My hon. Friend the Member for Hayes and Harlington (John McDonnell), who has a very long record of concern over airport safety, spoke robustly. He mentioned the article in The Times, the thrust of which was that people were coming into the airport without having had their passes cleared. I believe that the newspaper has subsequently published a correction to the effect that the company was working to DTLR guidelines. That meant that people working with the security company could not work airside if they were unaccompanied. If trade unions and others wish to meet

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officials to develop aviation security policy, we will of course be pleased to receive views on that matter, which was also raised by the hon. Member for Cotswold.
Mr. Don Foster: I was not aware that The Times had published an apology. Is the Minister totally satisfied that existing arrangements for supervising those without full security passes are 100 per cent. adequate?
Mr. Jamieson: As the hon. Gentleman will know, I could never give such an undertaking. However, my Department has done everything humanly possible in that regard, and I can assure him that if any breaches are drawn to our attention they will be investigated thoroughly.
John McDonnell: I, too, have seen no retraction in The Times. The issue is supervision. The onus placed on security-cleared staff to supervise those who are not so cleared is almost impossible to fulfil, given working practices in parts of Heathrow airside. That is why I welcome the opportunity provided by the Minister to meet Heathrow staff and the review team.
Mr. Jamieson: I thank my hon. Friend for those comments. They underline why it would be good for unions and staff to meet officials to discuss these issues.
Tom Brake rose—
Mr. Jamieson: I will give way, but I am mindful of the time and I want to get through some of the other points that were raised.
Tom Brake: I invited the Minister to say whether, given these incidents, it would be appropriate for all staff to be counter-terrorism checked before going airside, rather than having to rely on supervision that might be of variable quality.
Mr. Jamieson: The hon. Gentleman and my hon. Friend the Member for Hayes and Harlington have raised important issues, and we have undertaken to look at them.
The hon. Member for Edinburgh, West (John Barrett) mentioned a number of matters, including NATS' request for a delay to the Scottish centre. I can assure the hon. Gentleman that safety remains—and
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will remain—absolutely paramount, and will in no way be compromised by such a delay. Nevertheless, I am grateful to him for raising that point.
The hon. Member for Twickenham (Dr. Cable) mentioned aircraft overflying London. He will know that certain restrictions were imposed immediately after 11 September. In view of the level of traffic, the location of London airports and the prevailing wind directions, it is not possible to avoid overflying London without compromising air safety and seriously impeding air travel to London. However, the points that he raised on his constituents' behalf will certainly be noted.
The hon. Member for Bath asked whether DTLR inspectors are sufficiently well trained to check compliance airside and in airports. I believe that he said that inspectors are capable only of counting paperclips, but I can assure him that they are extremely capable people—
Mr. Foster rose—
Mr. Jamieson: I will not give way, as I want to have time to answer the points that have been raised.
On data protection, an interdepartmental group is examining the feasibility of checking staff and passenger details against information that could be stored on a master database, so that potential undesirables might be identified. The group will examine any legal implications arising from, for example, data protection legislation. I hope that that is of some comfort.
On aerodromes, under recommendations issued by the European civil aviation conference, the receiving airport should be notified of any aircraft, including general aviation, to which security controls were not applied at the airport of departure. On landing, such aircraft would be made secure. We shall further investigate how that recommendation is being implemented.
The hon. Member for Cotswold raised the issues of finance for security and the general competitiveness of airlines. We are mindful of the funding that has been available in the United States. He will appreciate that those are not issues on which we can make definitive decisions at any particular moment, but he can be assured that they are being kept under review.
The debate has been useful and helpful. I am sorry that there has not been time to respond to all points, but if individual Members want to indicate matters to which I have not responded, I should be happy to reply in writing.

Breast Cancer Strategy
11 am
Joan Ruddock: I am delighted both by the opportunity to debate this subject in breast cancer awareness month and by the fact that my hon. Friend the Minister is wearing her pink ribbon.
I begin by paying tribute to the work of the breast cancer charities, which are working in partnership this month—they work extremely hard all year round—to raise awareness of the disease. Breakthrough Breast Cancer has established the Breakthrough Toby Robins Breast Cancer Research Centre, which is, of course, the United Kingdom's first centre dedicated solely to breast cancer research. The UK Breast Cancer Coalition is successfully involving hundreds of patients with direct experience of breast cancer in its advocacy work. The Breast Cancer Campaign and Breast Cancer Care work tirelessly to provide people with breast cancer with information and support.
Over the course of her lifetime, a woman's risk of developing breast cancer in this country is one in nine. Approximately 38,000 women are diagnosed with breast cancer in the UK every year. Between 200 and 250 cases of breast cancer in men are diagnosed each year, which is a tiny number by comparison, but it should not be neglected. Tragically, there are still around 1,000 deaths from breast cancer in the UK every month. Better use of breast cancer treatments in the UK has reduced deaths, but there is still a great deal to do.
This debate provides an opportunity to assess the Government's progress one year on from the publication of the national health service cancer plan. It is a chance to examine the targets in the plan and to review the action that is needed to achieve them. It is also an opportunity to consider the next steps in the Government's strategy to tackle breast cancer. Prevention is the key, so more research and a comprehensive prevention strategy are needed. Sadly, we have known for a long time that many UK breast cancer services lag behind the rest of Europe and that the quality of cancer care available often depends on where one lives. Cancer remains one of this country's biggest killers, which is why the NHS cancer plan is so vital.
There are three main targets specifically for breast cancer. First, the NHS screening programme is to be extended to all women aged 65 to 70 by 2004. That is especially welcome given that the risk of cancer increases with age. Indeed, that point has been the subject of many long campaigns involving several of those present in the Chamber. Can my hon. Friend the Minister tell us what progress has been made towards achieving that target? How many new health professionals will the NHS need to cope with the increasing numbers of women who are invited for screening? Are any of those new staff already in post, or should we expect them all to arrive in 2004?
Secondly, the plan promises a maximum one-month wait from diagnosis to treatment for breast cancer by 2001. As it is 2001, can my hon. Friend confirm that that target has been met? If not, will she explain how the Government plan to evaluate progress?
Thirdly, a maximum two-month wait from urgent GP referral to treatment for breast cancer is to be delivered by 2002. Can my hon. Friend confirm that the
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Government are on course to meet that target, and does she agree that its implementation requires careful monitoring? Concerns have been raised, especially by Breakthrough Breast Cancer, about the length of time that patients must wait between referral or diagnosis and all stages of treatment. The planned target refers only to the wait between referral and the start of treatment. Apparently, some patients receive the first stage of their treatment for breast cancer—perhaps a lumpectomy—relatively quickly, but then face a long wait until the second stage of treatment, often radiotherapy. Given that all the available evidence suggests that the chances of survival depend on timing, can my hon. Friend explain how the Government might address that in the future—especially in the light of the serious shortage of radiographers, which is a problem in my local health authority and nationally?
One of the aims of the breast cancer plan is, of course, to save lives. The ultimate way to achieve that is to learn how to prevent people from getting breast cancer in the first place, so greater priority must be given to research into its causes. Very few of the big killers are as poorly understood, and breast cancer is still the biggest killer of women aged between 35 and 54. The UK is among the worst countries in Europe in terms of the incidence of breast cancer. In a league table of 15 European countries, it is near the bottom—only Belgium, Ireland and Denmark have a higher rate of the disease. The Government's excellent progress on screening and treatment must be matched by a comprehensive primary prevention and evidence-based strategy.
Without identifying the causes of breast cancer, it is difficult for the Government or anyone else to advise on how to prevent it. We already know that many risk factors, including gender, age and family history, are beyond our control, but if there are other factors that we can address, we must do so, and we must first identify them. Scientists believe that breast cancer is influenced by a complex relationship between external factors associated with environment and life style, as well as genetics.
According to a recent Gallup poll commissioned by Avon, the cosmetics company, and Breakthrough Breast Cancer as part of their "Kiss goodbye to breast cancer" campaign, breast cancer is women's number one health concern. Many say that they are willing to make significant changes in their life style and environment if they can reduce their risk of developing the disease, but they need to know exactly what steps they can take. Unfortunately, however, there is little evidence that clearly identifies where such changes can be made, and all the available evidence is either insubstantial or conflicting.
If we are to get to the bottom of the causes of breast cancer and prevent its occurrence, we need more investment in research. International comparisons support the theory that breast cancer can be prevented. African and Asian women are at far lower risk than their western counterparts. The biggest difference is between women in China and Japan and those in western countries. Recent age-related figures show that the rate of breast cancer per 100,000 women is 24.3 in Japan and 26.5 in China, compared with 68.8 in England and Wales, 72.7 in Scotland and 90.7 in North America. The figures have been adjusted to include only white women, so that a proper comparison is made.

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Studies on Japanese women, however, show that rates of breast cancer in those who emigrate to the United States rise and become similar to United States rates in one to two generations. That indicates that environmental factors relating to everyday activities are more important than inherited factors in the development of breast cancer. Diet could be a significant factor. Various studies have tried to establish a relationship between, for example, the consumption of fruit, vegetables and soy products, or high-fat diets, and the incidence of breast cancer. Variation in diet between east and west appears to support such theories, but we need more evidence.
We are also aware that the environment must play a part in causing the disease. Oestrogen is certainly implicated in the development of some breast cancers, yet the effects of oestrogenic compounds present in the environment are poorly understood. We need to understand not only their effects but if and how we can reduce the risk. There are many questions to be asked, and I do not expect the Minister to answer those that are really directed at the scientific community. However, we need to know whether environmental oestrogen compounds are a risk and, if so, what is their main source. What is the effect of the timing of exposure to such compounds in the womb compared with pre-pubescent exposure? Have studies looked at the correct compounds and what steps have been taken to consider the influence of compound mixtures compared with single agents?
Many commentators have implicated lindane, a chlorinated hydrocarbon poison present in our environment, in the incidence of breast cancer. I pay tribute to the work of my hon. Friend the Member for Halifax (Mrs. Mahon) who has raised the issue in the House. Most registered uses of lindane were banned in 1983, including its use as an insecticidal poison in treating timber, seed grains and livestock, and in pet and human treatments for fleas, ticks, lice and scabies. Last year, the European Union decided that lindane should be banned, and it is due to be phased out across Europe. Can my hon. Friend the Minister tell me what our Government are doing, and how quickly, to ensure that the United Kingdom will comply with the ban?
Several cancer research charities are currently engaged in breast cancer research. They are doing an excellent job but do not have the resources to undertake the large-scale life style and population studies that are desperately needed to answer questions such as those that I have posed. The fantastic work of those charities must be backed up by Government-funded research. Last year, we made a little progress when the Government said that they would match, pound for pound, the money raised by charities for cancer research. Can my hon. Friend tell us when that commitment will come on stream and how the Government will foster their partnerships with the charitable and voluntary sector?
Investment in research must be the cornerstone of any prevention strategy for breast cancer. Better smoking cessation services and the national "Five a day" programme were welcome in tackling many other cancers but will not, I believe, have a very direct impact on the incidence of breast cancer. Although extension of
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NHS breast screening services to women up to 70 years of age is a step in the right direction, it promotes only early detection, not prevention. What the 38,000 women in this country who are diagnosed with breast cancer every year ultimately want is not to have developed breast cancer in the first place.
There is strong public support for greater investment in research. Today, Breakthrough Breast Cancer and Avon are announcing that they have collected more than 38,000 kiss prints from the public in support of their "Kiss goodbye to breast cancer" campaign, which, as the Minister knows, urges the Government to make breast cancer prevention a priority.
I know that the Minister will join me in expressing regret for the fact that the current UK breast cancer rates equate to one women receiving a diagnosis every 15 minutes. I hope that she can give us a report on the progress of the implementation of breast cancer targets under the breast cancer plan, and that she will give us, in breast cancer awareness month, a cast-iron commitment that the Government will provide greater investment in research to tackle this devastating disease. Breast cancer is the primary health concern of women in this country.
Several hon. Members rose—
Mr. Roger Gale: It is clear that many hon. Members take an interest in this subject, and I suspect that many who are not standing now will want to speak. If speeches are kept brief, it should be possible to accommodate everybody.
11.16 am
Mr. David Tredinnick: I am grateful to be called in this debate. My hon. Friend the Member for Broxbourne (Mrs. Roe) asked me to tell the Chamber that she was sorry not to be able attend today. She is currently chairing the Select Committee on Administration.
I congratulate the hon. Member for Lewisham, Deptford (Joan Ruddock) on securing this vital debate at an important time near the beginning of a new Parliament, when the Government can make an impact on the issue. I will confine my remarks to considering how the Government might enhance their strategy by introducing various therapies that are not currently available throughout the national health service. I suggest that the Minister should be developing a new perspective on cancer care, one that involves a range of therapists who are currently available in the private but not the public sector. I will give some examples of what is happening in the health service in Hammersmith, Bristol and Fulham. The Government will do themselves a favour by embracing such therapies. Not only would it enhance their capabilities, it would reduce their costs. We want to achieve greater remission for existing cases, save more lives and prevent more cases.
Since my election to the House almost 15 years ago, and over the course of four Parliaments, I have been involved in debates about different types of health care. We have about 30,000 doctors and 50,000 complementary practitioners in this country, and I have long held the belief that if a greater proportion of complementary practitioners worked in an integrated health care system, it would take pressure off doctors

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with expertise in specific fields, allowing them to treat the patients whom they should be treating, without having to deal with other patients.
Regrettably, evidence shows that since the switch from GP fundholding to the primary care group system that has taken place under this Government, the number of therapists engaged by the health service and the amount of money going to therapists from the health service have reduced because under the primary care group system a greater number of people must make decisions about what services to buy. The Government should consider that. I raised it with the Secretary of State at the most recent health questions, and umpteen times in the previous Parliament.
I have had quite a lot of direct experience of various therapies. It was my luck and privilege to travel to Japan with Rosie Daniels, director of Bristol cancer help centre, on a lecture tour some years ago. I was immensely struck by the work done at Bristol to take on patients whom other services and professionals had found it difficult to treat. I spoke to the director about the wide range of treatments employed to bring a cancer patient back from the edge—perhaps to save their life and certainly to enhance their remission. She talked not only about diet—as did the hon. Member for Lewisham, Deptford—herbal treatments and acupuncture, but about t'ai chi, exercise and yoga.
I have used yoga with some effect over the years—[Interruption.] The hon. Member for Norwich, North (Dr. Gibson) may think that amusing.
Dr. Ian Gibson: Oh no, it's great.
Mr. Tredinnick: The hon. Gentleman is forgiven. Joking apart, I am sure that he knows that yoga has a marked effect on reducing stress. The centre also makes extensive use of therapeutic touch and people who can channel energies. I shall say more about that later.
I suggest that the Minister consider what happens in Hammersmith Hospitals NHS trust. In 1993, the British Medical Association identified a number of complementary and alternative therapies that it believed could work alongside the NHS. In 1995, Hammersmith and Charing Cross hospitals merged into one large trust, and a set of complementary and alternative therapies were available for the trust. Those services are provided for cancer patients on the health service.
Previously, many patients wanted complementary therapies such as acupuncture or healing but were frightened to tell their consultant. That unsatisfactory state of affairs exists throughout the country where there is a degree of disapproval. In Hammersmith, however, where complementary and alternative therapies are in house, everyone knows what everyone else is doing. Patients have access to massage, art therapy, relaxation, aromatherapy and reflexology. Those treatments are used to support and relax patients, help with symptom control, enhance their quality of life and, in particular, reduce the high level of anxiety, stress and tension that goes with the development of cancer.
At Hammersmith, liaison with radiographers before patients receive treatment diverts some attention from the harsh treatment and enables them to go through
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their conventional treatment calmly. Aromatherapy is very effective in that respect—massaging oils into a patient's skin can dramatically reduce stress levels.
Ms Claire Ward indicated assent.
Mr. Tredinnick: As the hon. Member for Watford (Ms Ward) works closely with the Minister, I look forward to hearing her helpful remarks later.
Studies in the United States on the cost benefits of integrated complementary and conventional treatment show pretty conclusively that the Government will save money if they adopt that approach because it achieves a much better throughput of patients in a health service. As the hon. Member for Lewisham, Deptford pointed out, this country has a chronic problem with breast cancer. It is perhaps the most worrying disease for ladies of many ages. If the Government want to use the treatments to focus on a particular problem, they could hardly do better than focus on breast cancer.
Demand for the services at Hammersmith and Charing Cross hospitals is so high that they cannot offer the treatment to as many patients as they would like. That is probably why so many go to the Haven clinic in Fulham, which has developed specific breast cancer treatments. All are wonderful organisations, but the Hammersmith and Charing Cross hospitals are part of the national health service, whereas the Haven is certainly not. Many practices throughout the country offer a form of integrated health care, but much of it has to be paid for. The Minr should consider carefully how to channel more funds to those who support conventional practitioners—the hard-pressed doctors—and also take the pressure off them by bringing in complementary therapists.
There is another problem: many complementary practitioners are not allowed by law to treat specific diseases, one of which is cancer. There is wisdom in that, as it protects patients from being treated by quacks. Doctors regard it as a valuable safeguard, but there are side effects: if a complementary practitioner diagnoses cancer, he may not legally be able to tell the patient in so many words, and that is not necessarily a good thing.
I shall share with hon. Members the experiences of a friend—I will call him John—whom I ran into the other day. I asked him how he was getting on and he told me that he was having a pretty terrible time, as he had been diagnosed as suffering from prostate cancer. He had been to see his wife's reflexologist, who had massaged his feet and said, "You seem to have a very warm prostate. I think you should get it checked." He went back a couple of weeks later for another treatment and the reflexologist said, "This is a hot prostate. You really should get it checked." When he did so, he was told that he was an emergency case and that if he was not admitted to hospital straight away he would die. Reflexology can assess not just prostate cancer—the relevant spot is near the heel—but breast cancer. If greater use were made of reflexologists, who can detect such things by feeling the feet, many problems could be stopped before they developed.
Many integrated health care clinics use Chinese medicine, which includes Chinese herbs and acupuncture—
Sandra Gidley: The hon. Member for Bosworth (Mr. Tredinnick) is well known to be a strong

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advocate of alternative therapy, and I admit to an interest in the subject myself, but does he agree that there must be evidence-based proof that such therapies work before we devote large sums of money to funding them?
Mr. Tredinnick: The hon. Lady makes a valuable point; however, there is an extensive evidence base for almost all the therapies I have mentioned. There is some contention about the way in which certain statistics have been compiled, but there is pretty much cast-iron evidence for almost all therapies. There is certainly massive anecdotal evidence, such as the cases that I have cited. The Government should carry on with what they have done after the House of Lords Select Committee report to improve regulations, and try gradually to introduce more therapists into the health service.
Integrated practitioners usually take an holistic approach by treating the whole patient, not merely the disease. That is certainly true of Chinese medicine and acupuncture. In acupuncture, Chinese therapists adjust the meridians to get the energy to flow better through affected areas, and use herbs to strengthen the constitution. If someone's digestion is poor they try to enhance his digestive abilities so that more energy—in Chinese, chi—can flow to the places that are a problem. In breast cancer, that could mean arresting the growth of a tumour. The same applies to homeopathy: a homeopath can treat the whole, which may assist in stopping development, or accelerating or extending remission.
The hon. Member for Lewisham, Deptford also spoke about diet. She might have mentioned the Gerson diet used at Bristol and elsewhere. An exclusion diet, it is one of many ways of reducing the threat of cancer through dieting which the Government should consider further. Meditation, prayer, yoga, stilling and exercise techniques such as t'ai chi are also valuable and, along with aromatherapy, are often used in the clinics.
I should like to finish by dealing with those who practise therapeutic touch or healing. The Confederation of Healing Organisations covers about 15 disciplines in that sector, including the National Federation of Spiritual Healers. Another body of healers who channel energy from one source or another originates from Japan. Known as reiki, it has become popular in the United Kingdom. Irrespective of whether one believes that people who channel energy through their hands, either by touching or off the body, draw from a divine source or from "universal energy", some people can undoubtedly do it. We should accept that it works. Important studies have been undertaken: for example, Matthew Manning, a well known healer, carried out extensive studies on seeds, attempting to make them germinate faster, and it is scientifically proven that he succeeded.
The healing fraternity and therapeutic touch group is particularly important in hospices. They can help a great deal by treating patients who are not going to make it. They can also help dramatically with mood swings. Someone who is trained in therapeutic touch and channelling energy might well transform, perhaps overnight, the mood of a seriously depressed patient in hospital, and the patient's condition might then
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significantly improve. A patient who is physically depleted can also benefit from healing—I have seen it happen. The healer can send such a charge through the patient that he becomes tremendously energised. That helps at all levels in the healing process.
I shall not detain the Chamber further because I know that many hon. Members wish to speak. However, I ask the Minister to reflect seriously on what I have said. I passionately believe that when different practitioners work together in integrated health care, the resulting treatment will be better in terms of quality and value. The Government should acknowledge that message.
11.32 am
Mrs. Alice Mahon: I am pleased that my hon. Friend the Member for Lewisham, Deptford (Joan Ruddock), who is secretary of the all-party breast cancer group, has secured this debate. With the hon. Members for Broxbourne (Mrs. Roe) and for Richmond Park (Dr. Tonge), I jointly chair the all-party group, so I know how hard my hon. Friend works.
I agree that we should pay tribute to the breast cancer charities, which are working in partnership this month to raise awareness of the disease. In particular, we should continue our support for Breakthrough Breast Cancer, the UK's first centre dedicated solely to breast cancer research. The organisation will be somewhat disappointed with me, because I lost my ribbon somewhere on the way to our debate. I also pay tribute to local events on the ground: for example, an Asda store in Halifax works every October to raise awareness of the disease in the community, with considerable success. That is a terrific initiative from a commercial enterprise.
Breast cancer treatment is sometimes seen solely in terms of surgery, chemotherapy, radiotherapy or drugs such as tamoxifen. Those are, of course, life-saving treatments, but from a patient's point of view treatment is as much about effective communication with health professionals and provision of timely and accurate information as it is about access to the most up-to-date and effective drugs. I am a big fan of the NHS, but it does not always put the needs of patients first. Ministers have been receptive to ideas about new ways in which to involve patients and improve services: one example of a good initiative is inviting patients to sit on the cancer taskforce.
We have a beautiful new hospital in Halifax, the Calderdale Royal. Its physical facilities are excellent and I have seen improvement over the years in, for example, the employment of breast care nurses. There is a local survivors group incorporating Halifax and the Calder valley, whose members have hands-on experience of the disease; it would be great if we could make more use of it. Does the Minister envisage creating more systems to tap into such expertise and develop services at a local level, perhaps by using survivors' ideas?
The National Institute for Clinical Excellence needs more resources. I know that the Minister hears that every day about some part of her Department, but NICE should be given consideration. It could be extremely effective in the future and we must not neglect it. NICE is in the process of developing breast cancer services guidance, although the original timetable for consultation on the guidance appears to have slipped.

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As the Minister is aware, NICE is also conducting an appraisal of herceptin, a drug known to extend and improve the quality of life of women with terminal breast cancer—any extension is precious to women who have only a limited time to live. When can we expect the publication of the NICE guidance? Does the Minister agree that patients deserve to see the postcode lottery of treatment addressed more quickly? While we wait for NICE to deliver its verdict on herceptin, women are dying prematurely.
Last week, the all-party breast cancer group held its annual general meeting and planned a programme of work for the next 12 months. We have decided to reexamine lindane, the use of which my hon. Friend the Member for Lewisham, Deptford has questioned. I also pay tribute to Unison and its women's committees, which have campaigned long and hard on the issue. I agree with the hon. Member for Bosworth that we should take diet seriously, and the all-party group has agreed to take evidence and examine diet, in particular the one known as the Japanese diet, to see whether it can be pushed on to the agenda.
I am delighted that the Government have improved and extended breast cancer screening services, but I am concerned about some older women. The Government accept that they should be invited for screening, but some women might miss out because of the time it will take for the intention to extend screening services to become a reality. Some women will miss the boat: for example, a woman who is 68 today will not be invited for screening because by 2004, when the screening target is to be met, she will have passed her 70th birthday. A group of women will miss out, despite having a higher risk of developing breast cancer than the younger women who will gain from the new screening services. Does the Minister share my concern? What could be done to ensure that the health of such women is as well looked after as that of their younger counterparts? The problem is encouraging older women to go once they have got out of the habit. In addition, we still have a lot of work to do in some of the ethnic minority communities.
I should be grateful if the Minister took those points on board. We should never forget the statistics outlined by my hon. Friend the Member for Lewisham, Deptford: 38,000 women are diagnosed with breast cancer in the UK every year, and there are about 1,000 deaths from breast cancer every month. The sufferers from this dreadful disease are the foot soldiers, and it is up to us all to carry on working for them. They are overwhelmingly women, so whole families are touched when they develop the disease. These women are sisters, wives, partners, daughters or precious friends, and we must continue to support them. I echo my hon. Friend's initial plea: we must campaign to make breast cancer prevention the absolute priority.
11.40 am
Dr. Andrew Murrison: I am extremely grateful to be called to speak in this important debate. I congratulate the hon. Member for Lewisham, Deptford (Joan Ruddock) on securing a debate on the Government's approach to one of the UK's most prevalent cancers and one in which benchmarking suggests we are not doing well.
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The Government took the early step of appointing a cancer tsar to oversee their strategy. The tsar has presided over the most obvious feature of their approach, which has been the apportionment of sums of money—mainly in lots of penny packets, a bit like the distribution of the Queen's Maundy money. As Professor Karol Sikora pointed out, after each announcement of cash for this or that cancer, there follows a feeding frenzy as rival institutions compete for the available funds.
The overall impression is that despite the tsar there has been precious little joined-up thinking in recent cancer strategy. The Government have consistently been warned to beware of false targets, yet there has been an unhealthy reliance on intermediate outcomes—how quickly patients get to see a specialist—rather than definitive outcomes, or their chances of survival. Moreover, there is an opportunity cost to imposing crude targets: Mr. Jim Johnson, a vascular surgeon and chairman of the British Medical Association central consultants and specialists committee, told the Labour party way back in 1996 that an attack on waiting lists should be a relatively low priority because there were more important issues to be tackled, such as access to acute medical beds.
It seems likely that the Government's two-week standard has been harmful. We understand that that will now be joined by another target—time to treatment. To the extent that it is more realistic, that is to be welcomed. However, we should recognise that target-setting risks distorting clinical priorities, and that the more targets are set, the greater is the potential distortion. All of that has a profoundly demoralising effect on the health professions.
Last week The Lancet cast some doubt on the value of breast screening. Of course we must not entertain interventions without a sound evidence base, and we do people a great disservice if we stoke up unnecessary anxiety by promoting inappropriate screening. My mother experienced several distressing days while awaiting the results of such a test—that human cost of screening is rarely factored into the cost-benefit analysis. Yet we sometimes ignore strong evidence. It is likely that women over 70 are being denied operations for breast cancer, despite clear evidence from the colourfully styled "golden oldies" trial that they would benefit from such treatment.
There is evidence that highly prevalent but less appealing cancers, such as prostate and bowel cancer, are relatively poorly resourced even though their treatment may be more productive than the treatment of breast cancer. We must take a balanced view in determining priorities. Although I wear my pink ribbon gladly, I am mindful that the Government appear susceptible to high-profile pressure. I suspect that that has informed the cancer agenda, possibly to the detriment of some forms of the disease, and of health care in general.
Cancer morbidity and mortality rates are still relatively unsatisfactory in the United Kingdom, and we compare badly with similar countries. However, the fashionable expedient of blaming health workers is unhelpful; huge strides have been made since the early 1970s. I well recall the alarm that I felt as a junior doctor

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about the rough and ready approach to cancer in general, and breast cancer in particular. Happily, today's landscape is very different indeed.
11.45 am
Dr. Ian Gibson: I wish that I had time to decimate the argument of the hon. Member for Westbury (Dr. Murrison), but I wish to concentrate on something much more positive. I congratulate my hon. Friends the Members for Lewisham, Deptford (Joan Ruddock) and for Halifax (Mrs. Mahon) on the sterling work that they have done to highlight the issue of breast cancer both inside and outside the House.
I entered Parliament not because of my political background but because I was appalled by what the Conservative Government had failed to do for health generally, particularly in the field of cancer—an area in which I was interested. I could not have expected what the Labour Government achieved in one year. It is absolutely amazing that we have a national health plan, a national cancer plan, and money being directed as never before towards research into treatment. We should sing the praises of those initiatives, which might not bear fruit overnight but which are certainly moves in the right direction to provide better health care for our people.
My hon. Friend the Member for Lewisham, Deptford mentioned research. This country is in the forefront of breast cancer research: recently, two of our researchers won a Nobel prize for work in the cancer arena. Oddly, their work was not on cancer cells as such, but on a yeast micro-organism. That triumph for blue-skies scientific research shows that one never knows what will be discovered when one carries out that sort of work. It is essential that we continue to fund such research, which has implications for many health problems.
Understanding of cancer has advanced by leaps and bounds, principally because of work in this country and in the United States. It was discovered in this country that a breast cancer gene runs in families. We now understand that genes might be targeted. Individuals have different genes and instead of treating organs with tumours, we can now treat individuals. Such research is primarily being carried out in this country and is funded by the Government. The prospect is that the science budget will double in the next five years.
Cancer charities are merging: I did not think that I would see the day when the Imperial Cancer Research Fund and the Cancer Research Campaign would set aside their rivalries and merge. In a Select Committee sitting, I challenged my friend Sir Paul Nurse—a Nobel prize winner, along with Tim Hunt and Leland Hartwell, who is an old friend from the university of Washington in Seattle. I never thought that I would get the answer from him that Omo and Daz will never mix. In fact, Omo and Daz do mix—they are the same chemical. I knew that they would mix, and I think that they knew that, too.
The rivalries have been sunk, and we have before us the great prospect that those organisations and other groups that work closely with them will combine their research to give it a British flavour, particularly research into breast cancer, where so much has been achieved. I
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predict that there will be other Nobel prizes for people who discover factors relating to the biological, chemical and other events that occur in breast cancer cells. Genetic differences among individuals allow us to target the problem in a specific way. We do not have to give blanket treatments that result in dreadful side effects, but can instead target particular problems through molecular profiling. Breast cancer research in this country is leading the way.
I support everything that has been said, and I would like to highlight some of the Government's achievements. The National Cancer Institute, for example, is not sufficiently loudly trumpeted: it is a tremendous innovation that brings together many people to co-ordinate work in this country—work that extends all the way from involvement of patient groups to basic research. Another great move, one which was instituted by the national cancer plan, involves the national cancer networks. People who have never before worked together—pharmacists, doctors, GPs and, now, physiotherapists—are discussing the problem of cancer in their regions and devoting their energies to developing plans. I hope that they will receive the money right at the coal face, as it were, to ensure that their priorities—whether lindane, prevention issues or complementary medicine—are addressed, or at least discussed.
The Government have initiated a tremendous spirit, not only in terms of breast cancer but right across the board, and it is a spirit from which we will all benefit. We should congratulate the Government on what they have done and sing their praises to the heights.
11.50 am
Sandra Gidley: I congratulate the hon. Member for Lewisham, Deptford (Joan Ruddock) on securing the debate, which in breast cancer awareness month is timely. I always have to wait weeks and weeks before securing an Adjournment debate. I hope that she will let me into her secret.
As has been said, breast cancer strategies are an important subject. Each year, 38,000 women are diagnosed with breast cancer, and almost a third of them will die of the disease. We must do all we can to reduce those numbers. In deciding what to say, I had to cobble together sections pertinent to breast cancer from the NHS cancer plan. The easiest way of approaching the subject is to identify the separate stages of the process.
I endorse all the comments about prevention in terms of diet and alcohol. I will not repeat those points. Many women are first diagnosed with cancer at the point of screening. The NHS cancer plan proudly states that death rates from breast cancer have fallen with the introduction of national screening programmes and new and better treatments, although it does not say which measure has had the greatest effect. The plan goes on to say that among comparable countries, Britain has the most comprehensive nationwide screening programme. However, in the five-year survival rates for breast cancer, Britain lags behind Europe and is way behind survival rates in the United States. That obviously raises the question of why, if breast screening is the key factor and our screening is the most comprehensive, our survival rates are not the best.

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The Minister will no doubt be aware of the work of Ole Olsen and Peter Gotzsche, which was recently published in The Lancet. The authors reviewed seven randomised trials of screening mammography and concluded that
"screening is unjustified because there was no evidence that it reduces mortality".
That idea was mooted a year or so ago, and the recent paper is the result of a second look at the problem. I cannot stress enough that it reflects a single, controversial opinion and it would be irresponsible to discourage women from attending routine screening appointments solely on that basis. However, as such a large sum of money is devoted to the screening programme, it is vital that further work is undertaken to get to the truth. What is the Government's estimate of the cost-effectiveness of screening? What is the cost per case detected, per life saved and per quality-life-adjusted year?
If screening is ultimately recognised as a good measure, it is money well spent, but if there are no overall benefits, would not the money be better spent on other treatments or on an education programme? It is a sad indictment of our society that there is a gap of approximately 7.5 per cent. in the five-year breast cancer survival rates between the most affluent and the most deprived sections of our society. What are the Government doing to address that problem?
Tim Loughton: Is the hon. Lady saying that breast screening is counterproductive and that it is her party's policy to curtail it?
Sandra Gidley: I am afraid that the hon. Gentleman was not listening. I said that it would irresponsible to discourage women from attending breast-screening clinics, but that we need more evidence that screening has all the benefits that it is cracked up to have. Despite the screening programme, the cancer plan acknowledges that by the time they are treated, breast cancer patients in Britain are at a more advanced stage of the disease than their European counterparts.
I would like to pursue the arguments made by the hon. Member for Westbury (Dr. Murrison). The target of a two-week waiting time between referral and outpatient appointment is a cornerstone of the Government's approach. It is obvious that patients with alarming symptoms will want to be seen as quickly as possible, but what is the evidence that bringing appointments forward from two months to two weeks will improve outcomes? It is outcomes in which we are interested, not intermediate targets.
Is the waiting time more important than the time between diagnosis and treatment, which is set at a month? If I were diagnosed with breast cancer, I would not want to wait a month. Approximately 90 per cent. of women referred by GPs have non-malignant lumps, so are the Government's priorities right? Will the Minister guarantee to implement the two-week wait for diagnosis, and will she assure us that the money involved would not have been better spent reducing the waiting time between diagnosis and treatment?
My next point is fairly parochial, but I make no apologies for raising it. It is crucial that GPs receive adequate training in the diagnosis of breast cancer. A
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problem arose in the treatment of a constituent of mine, who was in her early 20s. The rate of breast cancer in women of that age is low—one in 15,000—but there is still a risk. My young constituent had recently had a child and had breast-fed, but she knew her body and knew that something was not right. She made repeated visits to her GP and was repeatedly fobbed off: she was told that there was nothing to worry about and that the problem was related to her breast-feeding. She was persistent, but not persistent enough. By the time that she was taken seriously, her cancer had spread. So that no other young woman is put in the same position as my constituent, I ask the Minister to ensure that all GPs are adequately trained and so do not dismiss young women on the grounds of probability.
Another aspect of the Government's strategy was highlighted by the hon. Member for Halifax (Mrs. Mahon). I reluctantly accept that it is appropriate for new treatments to be referred to the National Institute for Clinical Excellence, but it is becoming apparent that the process is too long and cumbersome. Women are literally dying while they wait for decisions. If NICE worked well, it would enable the Government to be fleet of foot; as it is, it is more like a rapidly developing bunion that considerably impedes delivery of the latest treatments.
I will use the story of herceptin to highlight some typical problems. The drug has been found to be effective in many cases, and some clinicians in this country prescribe it because they believe that there is enough evidence to support its use. However, we need to go back a step. Herceptin is of use in only certain types of breast cancer: an especially aggressive form of the disease, in which women over-express a protein called HER2, can now be tested for and the appropriate course of treatment identified. In the United States of America, 98 per cent. of women are tested, but in the United Kingdom only 19 per cent. are. We also compare unfavourably with Europe: 32 per cent. of the relevant group are tested in France, and 57 per cent. in Spain. Some doctors have claimed that testing is not worth while because the drug has not yet been given the go-ahead by NICE, but others are happy with the evidence.
NICE's review of herceptin started in December 2000 and a decision was expected in May. I asked in a parliamentary question when the guidance would be issued and was told that it was unlikely to appear before the end of the year. I would be grateful if the Minister could let us know the reasons for the delay. My understanding is that the review of herceptin in combination with paclitaxel is more or less complete and that a provisional decision was reached in April. Is that so? If it is, why has guidance not been issued so that women can benefit from the therapy?
It is rumoured that the delay is due to the institute examining the use of herceptin as a monotherapy, evidence for which is taking a little longer to collect. Will the Minister confirm that that is the case, and explain to those women who could benefit from the treatment the justification for delaying the guidance? Most of the women benefiting from the treatment are those who can afford private medicine; are the Government happy with that situation?
No one has referred to aftercare, which can be problematic. I pay tribute to the many charities that work in this field. Recently, a carping article in a

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national newspaper complained about the number of breast cancer charities compared to those for lung cancer, for example. In my experience, most breast cancer charities were set up to address a specific need, such as research or providing information and support. Women are good at providing support networks; if what they want is not available, they usually set to and set it up. The fact that those networks have been established suggests that post-operative support within the NHS is lacking, although in some areas of the country it works very well indeed and we need to learn from such examples. I could not find a reference in the cancer plan to the sort of post-operative support that many women would like to receive at that traumatic stage in their lives. Will the Minister tell us how the Government intend to proceed in that sensitive area?
Generally, the position is improving, but we continue to lag behind our European counterparts, and the United States simply leaves us standing. My research has led me to believe that there is no cause for complacency.
12.1 pm
Tim Loughton: I, too, congratulate the hon. Member for Lewisham, Deptford (Joan Ruddock) on securing this timely debate. I praise her and the other hon. Members who have spoken for their interest and knowledge of the subject. It has been a good debate with some excellent contributions. I also echo her congratulations to the many charities involved in cancer work, especially in respect of breast cancer, and on the great success of the "Kiss goodbye to breast cancer" campaign. I hope that it is not too late to send in my card; when I tired to get the lipstick out, it broke, and as I am not especially au fait with putting lipstick on I have not found another one, but I shall do so. The lack of a ribbon on my breast today means only that I have left mine at home.
It is important, too, to praise the many health service staff involved in cancer treatment. Enormous pressures have been placed on them to reach various targets—some of them may be misplaced, but that is another matter. We should pay tribute to the work done by nurses, doctors, radiologists and other staff.
It is vital that we consider this topic four and a half years on from the election of a Government who raised cancer treatment as a campaigning theme, and a year on from the publication of the national health service cancer plan. The hon. Member for Norwich, North (Dr. Gibson) said that the amount that had been done was breath-taking. He then reeled off a list of plans, targets and schemes that had been published. However, such things will not be the benchmark of the Government's success in tackling the causes and treating cancer in our population. What will be measured is actual output and outcomes, not the amount of paperwork, which the Government are so good at producing.
The hon. Gentleman was right to pay tribute to Dr. Timothy Hunt and Sir Paul Nurse, the Nobel prize winners of a few weeks ago. It is an irony that in this country, which is a leader in cancer research, the standards for survival do not compare with many of our European counterparts and the United States. We have
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heard the figures relating to women affected by breast cancer and the fact that some 13,000 women die from it each year. We support all genuine moves to reduce cancer deaths and we hope that the Government's target to reduce the death rate in people under 75 by at least 20 per cent. by 2010—thereby saving some 100,000 lives—is reached, so that we can compare with the best in Europe. We must also make progress in deprived inner-city areas and among many ethnic minorities, where the incidence of breast cancer and other forms of cancer is worrying.
The hon. Member for Lewisham, Deptford was right to mention the importance of preventive treatments. My hon. Friend the Member for Bosworth (Mr. Tredinnick) made, as he always does, many interesting comments. I always learn something from him when he speaks about complementary medicine. It is worrying that the demise of GP fundholders has diminished the availability of complementary medicines. The interesting tale about his friend John's "hot prostate" is perhaps a good case in point, showing that there is much to be gained from liaising with complementary medicine.
The risk of developing cancer appears to be increasing and we still do not know why. There are 200,000 new cases of cancer every year. There has been something like a 30 per cent. improvement in survival rates in the past 30 years, but an alarming divergence in survival rates between different parts of the country, as well as between us and our European counterparts. The breast cancer five-year survival rate in this country is about 67 per cent., compared a figure of 80 per cent. in France. That gap is too great and I am sure that all hon. Members agree that we need to raise our game.
We can look for clues to the cause of the disparity in the availability of drugs—an issued mentioned by various hon. Members. Chemotherapy drugs spending per head of population in this country works out at around 95 pence, compared with £6.24 for Germany and £3.31 for Italy. Breast cancer drugs are available to about 20 per cent. of the population affected in Europe, but only 5.9 per cent. in the United Kingdom. There is evidence that cancer patients in this country have their chemotherapy doses reduced to avoid the onset of neutropenia, which reduces protection against infection, and ensure that they do not need the expensive drugs needed to counteract that. A study by doctors at Addenbrooke's hospital showed that 32 per cent. of breast cancer patients receive sub-optimal treatment as a result of that rationing.
The hon. Member for Halifax (Mrs. Mahon)—to whose vast experience and familiarity with the subject through the all-party breast cancer group I pay tribute—mentioned NICE and postcode lottery prescribing. NICE has recommended paclitaxel and docetaxel for breast cancer at a cost of about £16 million per annum, and has recommended that they should be available to all. However, in practice, many health authorities are financially unable to provide that treatment. A study by the Campaign for Effective and Rational Treatment suggested that about 70,000 patients are being denied vital treatment, mainly because of rationing based on where people live. Wiltshire health authority has refused in the past to fund paclitaxel for ovarian cancer even though an average of 55 cases each year are reported in that county. Women

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with breast cancer who live in Avon are denied docetaxel, but if they lived two miles away in Somerset the drug would be available to them.
When health authorities are reorganised, will things become even worse? When even larger areas replace the health authorities that decide, as a matter of financial planning, that they cannot afford various drugs, will even more women miss out? What progress has been made in ironing out the problems of postcode prescribing? I read today that there is to be a large clinical trial of a new chemotherapy cocktail drug based on taxtere. I wonder whether that will be readily available if the trials show it to be effective. I gather that there is great hope of that.
What progress has been made with survival rates in the past few years? Last year's report, "Cancer Research—A Fresh Look" by the Science and Technology Committee, of which the hon. Member for Norwich, North was a member, stated that the Committee was
"unconvinced that guidance from NICE alone will ensure national availability of recommended treatments."
The Committee recommended that
"the Government ensures that its follow-up procedures require all Health Authorities to provide anti-cancer treatments which are approved by NICE where the patient's consultant regards them as clinically appropriate and prescription is within the guidelines set by NICE".
My hon. Friend the Member for Westbury (Dr. Murrison) mentioned the two-week pledge. It is right to speed up referrals, but it is even more important to speed up the time to treatment. As the hon. Member for Lewisham, Deptford said, we are talking not only about an initial treatment, but about a series of treatments. The Labour party gave the two-week pledge a great fanfare before being elected in 1997, but the most important issue is surely the time to effective treatment at all stages. The real delay in dealing with cancer has come between diagnosis and treatment: many women have been diagnosed as suffering from breast cancer and then left to sweat for far too long before getting the full and appropriate treatment. I echo the hon. Lady's question to the Minister: what progress has been made on the pledge to reduce delays between diagnosis and treatment to one month by 2001? We are almost at the end of the year.
Simply throwing money at cancer will not suffice; investment must be soundly based. We must offer a coherent system of care from the presentation of symptoms to completion of treatment. There is little point reducing the waiting time to see a consultant if there is a delay in access to diagnostic equipment or the treatment is not available on the NHS. As my hon. Friend the Member for Westbury mentioned, there is evidence that the two-week rule is proving counterproductive in many cases. Specialists must now concentrate their valuable time and resources on consultations for diagnosis, leaving them little time for the more important treatment thereafter. Barry Jackson, the president of the Royal College of Surgeons, said:
"Clinics are being snowed under with inappropriate referrals for breast cancer."
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He said that 90 per cent. of women with suspected breast cancer were subsequently found to be clear of the disease. Dr. Joan Austoker of the Cancer Research Campaign said:
"The 2 week rule has completely backfired. It has led to a waste of resources and a waste of specialists' time."
The National Cancer Forum stated:
"Nowhere does a state health department have a 2 week policy or sound out such gratuitous advice to doctors yet many have better outcomes for cancer care."
I ask the Minister to consider the effectiveness of the two-week ruling.
There is also the technical definition of the two-week referrals, which applies only when a GP makes a referral within 24 hours of deciding to refer. A doctor who puts a letter in the post to the consultant would not meet the 24-hour ruling. The figures are slightly artificial, but even they show that for the last quarter of 2000, 95.9 per cent. of women qualified under the two-week rule—down from 96.4 per cent. in the corresponding quarter of the previous year. The benchmark in 1997 was quite high, although I agree that it was not high enough. Some 77 per cent. of women who were diagnosed with cancer had their operations within 14 days. Will the Minister give us an update on the figure and tell us whether it is improving?
There is concern about big variations in the number of women who test positive in oestrogen receptor testing. Figures can range between 5 per cent. and 80 per cent. between different hospitals. That means not that there is a lower incidence among women in certain areas, but that the level of testing leaves a lot to be desired. What progress has been made on the important matter of raising the lowest to the standard of the highest?
The hon. Member for Halifax referred to the important issue of age discrimination, although she did not put it in quite those terms. There is evidence that women are not getting full access to treatment and, worse still, that many older women who get screened do not get treatment. The Cancer Research Campaign revealed that women over 70 are being denied operations for breast cancer, and claims that whereas younger women routinely have surgery to remove tumours, older women usually only get the drug tamoxifen. The CRC says that doctors believe that older women are too frail to be operated on successfully, although, as my hon. Friend the Member for Westbury mentioned, the CRC's "golden oldies" study gave a different view.
I do not want to be quite as alarmist as the hon. Member for Romsey (Sandra Gidley) about the effectiveness of screening. The Danish study was an isolated case, and I go along with the Imperial Cancer Research Fund's claims that women who attend regular breast screenings might reduce their risk of dying from breast cancer by more than 50 per cent. However, we need to ask questions about the cost-effectiveness of breast screening against all the other treatments further down the line that I mentioned earlier.
There is also a question about the capacity of our hospitals to deal with breast screening for older women. Last year, I visited the breast screening unit at Worthing hospital in my constituency. The team there is very hard-working, but there is only one consultant radiologist

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dealing with a population of 100,000 in the town, as well as people from the surrounding area. Her plea to me was, "For goodness sake, don't extend the breast screening programme, because we can't cope with it." It was not that she did not want to extend it or did not think that it might be effective, but because her service could not cope.
There is a big shortage of radiographers. They do not get included enough in the publicity about terms and conditions for nurses and doctors and the technical staff behind them. The standard of radiography equipment in this country is also a problem, with many consultants refusing to accept scans from certain machines because they are out of date and the images not clear enough.
Breast cancer is an important subject, but it is not the only cancer and it should be put into the context of other cancers, including those that affect men. Some 10,000 men die of prostate cancer each year. Government spending last year on research into breast cancer supported through the Medical Research Council and the Department of Health amounted to slightly more than £9 million, whereas the figure for prostate cancer was £1.52 million. Every year, approximately 21,000 men are diagnosed with prostate cancer—a form of cancer that needs early diagnosis and treatment. It is excellent if we are making progress with the treatment of women with breast cancer and survival rates are increasing—although the opening remarks of the hon. Member for Lewisham, Deptford made it clear that we have a long way to go. However, there are many other forms of cancer that affect many of our constituents and I hope that they will all be treated with a degree of seriousness and given a higher profile than many of them currently enjoy, putting them on a par with breast cancer.
12.16 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I thank my hon. Friend the Member for Lewisham, Deptford (Joan Ruddock) for raising this important issue. We have all been given an opportunity to contribute to an excellent debate. All the contributions have reflected real depth of expertise in and knowledge of the issues and I have learnt a great deal. I should also like to place on the record my thanks to all the breast cancer charities for their hard work and their determination in raising the issue of breast cancer. I have had an opportunity to work with many of my hon. Friends on these issues and I am familiar with the amount of energy and commitment that the charities show in representing the interests of patients. It is also opportune that the debate takes place in breast cancer awareness month. The huge effort by the charities has been a great success this year, as in previous years.
The theme of breast cancer awareness month is myths and facts about breast cancer. Despite the fact that more women are being successfully treated than ever before and women are no longer afraid to talk about the disease, there remain several myths about the disease and it would be helpful to know the facts. One of the myths is that not many women survive breast cancer; in fact, although one in nine women will develop the disease at some point in their lives, the latest figures show that around 75 per cent. of women are alive five years after being treated for breast
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cancer. It is important that we give hope and confidence to people who are diagnosed by telling them that survival rates are extremely good.
It is also important to know that breast cancer is not primarily an hereditary disease. Only between 5 and 10 per cent. of breast cancers are linked to hereditary genes. It is very important that people know that. Another myth is that breast cancer screening by mammography is 100 per cent. effective. We are the first to say that that is not the case. It is the most reliable method of detecting breast cancer, but like other screening tests, it is not perfect. Women who are invited to come for breast cancer screening need to understand its potential benefits and limitations, so that they are able to make an informed choice about whether they wish to proceed.
That is relevant to the point made by my hon. Friend the Member for Halifax (Mrs. Mahon) about patients having information to enable them to become partners in their health care and make decisions with the professionals who are treating them. Information and communication are key. That is why we said in the cancer plan that all women would receive a national information leaflet on breast screening. The new leaflets will be launched at the end of the month. They are based on research and include text of the discussion with community groups and a wide range of women from diverse backgrounds. They are being overseen by the Advisory Committee on Breast Cancer Screening and the national cancer director. Information in the leaflets is evidence-based, and the advisory committee has included patients in formulating the information in those leaflets, in recognition of the importance that the Government attach to involving patients, their families and carers in developing policy.
The leaflets are a brave step in openness because they clearly outline the benefits and allow people to make a real choice. As several hon. Members said, only last week, the question of whether breast screening works came under scrutiny in a medical journal and was picked up widely by the national media. It is important to state that the majority of experts still believe that breast screening by mammography saves lives. That view is backed by all the cancer charities, and the Government share that view.
Sandra Gidley: I think that the article will probably be dismissed, but in light of the now acknowledged scientific method of rating research papers it is incumbent on us all to investigate further the allegations that it contained, especially as it repeated work done a year previously. The article picked up on the fact that some of the research highlighting the benefits of screening did not meet the criteria that would class it as high quality research—indeed, it was regarded as poor quality research by the authors.
Mr. Peter Pike: Order. Interventions must be brief.
Ms Blears: The hon. Lady asked about research. I understand that Professor Valerie Beral, chair of the Advisory Committee on Breast Cancer Screening, said:
"Taken as a whole, the seven studies reviewed show that breast screening by mammography reduces mortality from breast cancer."
The British Medical Journal reported on further research from last September by Blanks et al, which indicated that 30 per cent. of the decrease in breast

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cancer mortality could be attributed to screening. That represents 320 lives saved in 1998. It is clear that lives are being saved. Experts will always dispute some research, but the vast majority of people are still of the view that mammography screening saves lives.
Although not perfect, we believe that the facts about breast screening speak for themselves. Last year, 1.3 million women were screened in England through the national programme, and more than 8,000 cancers were detected. Almost half of them were small cancers that could not have been detected by hand, and more than 90 per cent. of women who have had breast cancer detected through screening are alive five years later. That is the real benefit of screening. Research has shown that breast cancer mortality fell by more than 21 per cent. between 1990 and 1998; a third of that fall was attributed to breast screening. However, the true effect of screening may be much greater, and experts believe that it is likely to be 2005 to 2010 before the full effect is seen in national mortality trends, as the benefits begin to work through.
We have confidence in our breast screening programme, which is why we are extending it. The NHS cancer plan was that by 2004 we should have extended routine invitations for breast screening to women aged up to 70. That will benefit 400,000 extra women. I am pleased to be able to tell my hon. Friend the Member for Lewisham, Deptford that we are not waiting until 2004 to start that extension of screening; we are implementing the change now. Twelve per cent. of breast cancer screening units will expand their services this year, which is well ahead of the target of 10 per cent. An additional 50,000 women will be screened this year, and we shall build on that increase in the years leading to the target date. We have already made a start, and we shall be increasing that during the next few years.
Mr. Tredinnick: Previously, the Minister said that patients and carers would help in evolving policy. She has just referred to screening. Does she recall my remarks about how reflexology can detect cancer, and does she intend to look further at complementary treatments?
Ms Blears: I was coming to the points raised by the hon. Gentleman. I shall have some good news for him shortly.
My hon. Friend the Member for Lewisham, Deptford and others have mentioned the shortage of radiographers, whose role in the extension of the screening programme is vital. Although theirs is not a high-profile service, it is crucial. There are now nine pilot sites looking at new ways for radiographers to work, extending the skills of health care assistants and introducing new radiographer practitioners, to determine whether the skills mix can be broadened. There is a new programme of near patient screening that uses technology to screen patients as fast as possible, although we realise that it remains necessary to recruit extra radiologists.
As is the case throughout the NHS, there are some demarcations and boundaries in working practice that are not appropriate. The more that practitioners can extend their skills through training and education so that they are able to take on some of the work previously done by other members of their team, the more effective and efficient screening can be. We expect to have the
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results of the pilot programmes by 2003; that will provide evidence on how those new ways of working can be extended.
The NHS cancer plan set out the Government's commitment to improve cancer services across the board. It is important to recognise that time limits and targets are not plucked out of thin air without considering the outcomes. Outcomes are crucial to patients. The programme links prevention, diagnosis, treatment, care and research, and puts an extra £570 million into the process. I take issue with the hon. Member for Westbury (Dr. Murrison), who spoke of tiny little bits of funding: £570 million to improve cancer care represents significant progress.
The hon. Member for Bosworth (Mr. Tredinnick) asked about complementary therapies, which are important in palliative care and in supporting patients by dealing with their symptoms. I hope that he will be encouraged to know that his drive to integrate such services with the NHS is being taken seriously by NICE, which is to publish evidence-based guidance on supportive and palliative care. One of the issues that it will consider is the potential benefit to cancer patients of complementary services.
My hon. Friend the Member for Halifax mentioned extending screening to women aged 65 to 70, and the possibility that those aged over 70 could fall through the net. I have good news for her. Women aged over 70 will be offered free three-yearly screening on request, as women over 65 are now. Those who have been in the programme will automatically be notified of their right to that. The Government have been working with Age Concern to produce a leaflet and a video to publicise the entitlement of those aged 65 or over to breast screening.
I know that hon. Members are anxious that guidance on herceptin be published. So far as I am aware, the latest information is that, as the hon. Member for Romsey (Sandra Gidley) said, it will be published at the end of this year or early next year. I do not know of any specific reason for the delay, but I shall look into it and respond to any issues it raises.
I am delighted to say a word about men, because it is certainly not the Government's intention to ignore them. We take prostate cancer extremely seriously, and the decision has been taken to invest £6 million—not the £1.2 million mentioned by the hon. Member for East Worthing and Shoreham (Tim Loughton)—to set up two centres of excellence for research into screening for prostate cancer and its treatment. We have to find out what works and obtain an evidence base. Currently, there is not a good evidence base for screening for and treatment of prostate cancer, but we want to invest in it because we recognise that it is a huge problem for men.
GP training is crucial to detection, early diagnosis and early referral, but no single step will reduce breast cancer. There has to be an integrated approach involving diagnosis, prevention, diet, cessation of smoking, proper treatment, proper drugs, the extension of cancer collaboratives and the introduction of hundreds more cancer care consultants into the system. The issue of cancer has been pushed up the agenda by the Government in a way that has never happened before. As many hon. Members have said, cancer in general and breast cancer in particular devastate lives and families. That is why they must be at the top of our agenda, not just this year or next year, but in the years to come.

Night Flights
12.30 pm
Mr. George Osborne: I am grateful for this second opportunity in my brief parliamentary career to talk about aircraft noise, which, as I am sure the Minister will remember from the last time that we discussed it, makes a great impact on the quality of life of the people whom I represent. Judging by the considerable interest that hon. Members and outside organisations have shown in this debate, it is not only the constituents of Tatton who suffer the tyranny of sleepless nights caused by unnecessary commercial night flights.
My hon. Friend the hon. Member for East Surrey (Mr. Ainsworth) has contacted me about the matter. He has been a strong voice arguing for a more balanced approach to be taken towards airport policy. I am delighted that my hon. Friend the Member for Windsor (Mr. Trend) is present for the debate. He is a tireless campaigner on such issues and I look forward to hearing what he has to say. I have even been contacted by the hon. Member for Hull, North (Mr. McNamara), who is concerned about helicopter night flights in south Armagh, but that may be beyond the scope of today's debate.
Since the Minister and I last met, the landmark ruling of the European Court of Human Rights on 2 October 2001 has been a major development in the whole vexed question of night flights. The ruling, which relates specifically to Heathrow, will have a major impact on Manchester airport near my constituency because it adopts the same night flight policy as Heathrow. I shall not go into whether the European Court of Human Rights should be ruling on such issues. Some of us believe that it has gone far beyond its original remit, but we are signatories to the convention and usually accept its judgments. Indeed, the Government are so enamoured of the convention that they have gone so far as to incorporate it into our domestic law.
On 2 October, the court found that the Government
"failed to strike a fair balance between the United Kingdom's economic well-being and the applicants' effective enjoyment of their right to respect for their homes and their private and family lives. There had accordingly been a violation of Article 8."
It also found that
"mere reference to the economic well-being of the country"—
the Government's standard defence of night flights—
"was not sufficient to outweigh the rights of others."
The court said that the Government
"had a positive duty to take reasonable and appropriate measures…to strike a fair balance between the competing interests of the individual and of the community as a whole".
A fair balance should mean that people who live under flight paths and near airports should at least have the right to a good night's sleep. Reasonable and appropriate measures should therefore include the banning of night flights.
I suspect from the Minister's recent written reply to my hon. Friend the Member for Windsor that he will say that the Government are studying the judgment, that they have three months until it becomes final and that they are commissioning yet another study into attitudes to sleep disturbance. In other words, he will not say
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anything interesting about how the Government will respond to the problem. We do not need the Government to undertake further consideration of the matter. We do not need any more studies into sleep disturbance. We already know that night flights disturb the sleep of hundreds of thousands of people in Cheshire, Manchester, London and elsewhere. My constituent, Mrs. Taylor of Knutsford, said:
"I was awakened by noisy aircraft no fewer than four times during the night."
Mr. and Mrs. Suckling of Northwich said:
"once we are awake the damage is done. We are irritable and tired. This is not the way we had hoped to spend our retirement."
Mr. Thomas said:
"We can't even get a decent night's sleep. I would have thought it a basic human right."
We do not have to rely only on the powerful anecdotal evidence of our constituents. The Minister will know that the World Health Organisation's recent charter on transport, environment and health stated that excessive noise can
"cause difficulty in falling asleep, reduction in deep resting sleep, increased awakenings during sleep and adverse after effects such as fatigue and decreased performance".
He will further know that the WHO charter sets out what it calls "community noise guidelines", which state that night-time noise levels should not exceed 60 decibels for an individual noise event such as the flying over of an aeroplane.
I am sure that the Minister will also know that the charter has been signed by two of his fellow Ministers, including the right hon. Member for Dulwich and West Norwood (Tessa Jowell), who is now in the Cabinet, as Secretary of State for Culture, Media and Sport. He will also know that in a letter to campaigners at Gatwick, a copy of which I have here. Elizabeth Duthie of his Department's aviation environmental division confirms that Britain is a signatory to the charter, which, although not legally binding, represents a "political commitment" on which the Government need to act in three years. In other words, the Government, through their political commitment to the WHO charter, are committed to a 60-decibel limit for an individual noise event at night such as the flying over of an aeroplane.
According to Manchester airport's fixed noise monitor between Knutsford and Mobberley in my constituency, in July and August this year the average noise level at night from aircraft was 78 decibels—18 decibels higher than the WHO charter allows for. Given how the sound scale works, that means that the average aeroplane at night is four times higher in perceived loudness than the WHO guidelines allow. I emphasise the word "average", because some aeroplanes are much louder even than that. The latest noise fines from Manchester airport show that its night noise limit of 87 decibels, a full 27 points higher than the WHO guidelines, was breached several times during the summer by, for example, Pakistan International Airlines three times, Scandinavian Airlines twice and a couple of freight company aeroplanes.
Each of those aircraft would have woken up thousands of people in my constituency, but the fine received would have been no more than a few hundred pounds. That is why I argued in our first debate on the issue that as a first step and a bare minimum we need much stiffer fines for airlines that break noise limits,

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including the sanction of banning or withdrawing slot allocations for persistent noise offenders such as Pakistan International Airlines.
As I said in our previous debate, I am not anti-airport, and I accept that we will not stop people wanting to fly. In dealing with airport policy we need, as the European Court of Human Rights says, to strike a
"fair balance between the competing interests of the individual and of the community as a whole".
The ECHR is obviously right in its judgment that it is
"at the very least likely that night flights contribute to a certain extent to the national economy as a whole",
although it also states that the
"importance of that contribution has never been assessed critically".
The contribution to our economy is insufficient to outweigh the detrimental impact on people's quality of life. Airports and airlines do not need to fly at night to make a profit. The theoretical limit on night flights at Manchester is just 7 per cent. of total daily flights from the airport, and the actual number of night flights is far less. Last winter, the last period for which I have seen figures, the number of night flights was just half the theoretical limit. I understand that at Heathrow there are just a couple of dozen flights at night, although, as at Manchester, the definition of "night" does not include 6 o'clock in the morning, when most people are asleep.
However the figures are examined, night flights are a relatively small proportion of airport business. "Ah," the airlines and airports cry, "There may be only a few flights, but they are very lucrative, and if we banned them all, our customers would all go to Charles de Gaulle or Schiphol or another European airport." They certainly cannot switch to Tokyo or Sydney airport, not only because they are on the other side of the world, but because those airports already ban night flights. Being such good Europeans, the Government will recognise that one of the advantages of the ECHR ruling is that it will apply to night flights out of other, continental European airports too, and with such a level playing field there is no danger of customers landing at 4 am in Paris instead of Manchester. The Government should regard the ECHR judgment not as a setback but as a blessing.
When I asked for a debate, I knew that the Minister would not be able to detail the Government's response to the ECHR judgment in full, but I know from my experience of working in Whitehall that the time to try to influence Government policy is before it is announced, rather than after. The message from my constituents that I should like the Minister to take back to his Department today as he considers his response to the judgment is simple. We do not need any more studies into attitudes to sleep disturbance. We do not need any more Government flannel about unspecified economic benefits to the country. The only practical way in which the Government can satisfy the European Court of Human Rights judgment, meet their commitments under the World Health Organisation charter that they have signed, and give my constituents a decent quality of life, is by banning night flights.
12.40 pm
Mr. Michael Trend: I thank my hon. Friend very much for allowing me to intervene briefly in the debate and I also thank the Minister. I congratulate
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my hon. Friend on his good sense in bringing this debate and on his good fortune in securing it. I pay tribute to the clear way in which he has outlined the continuous distress caused to our constituents by night flights. I also want to congratulate the brave people from Heathrow Association for the Control of Aircraft Noise—HACAN—who took the case. I was among those present, at a photo opportunity at Waterloo station, who waved them goodbye on their way to Strasbourg, many months ago.
This has never been a partisan issue, as the presence of the hon. Member for Putney (Mr. Colman) shows. I have banged my head against the brick wall of this Government, and of the Conservative Government whom I supported. It has been difficult to explain to Governments that our constituents have a serious problem, and we have a duty faithfully and accurately to represent the widely held views of our constituents to the Government. My hon. Friend referred to the irony of Conservatives supporting a judgment of the European Court of Human Rights. That is an irony with which I can easily live. It may not be the means that I would prefer—I would prefer to make such progress in this House—but it is the means, we hope, to an end. I hope that the Government will take the ruling seriously.
I want to touch on one or two points that have already been raised. Most importantly, we are not anti-airport. We have kept an open mind on many of the issues relating to the airport. I congratulate it frequently on being a good neighbour in lots of ways—its public relations staff do a lot of good work throughout my constituency, many of my constituents work for the airport, and many of my constituents use it for holidays and business trips. However, night noise is unacceptable. Whatever efforts we have made in the past, which have not been successful, have now had a result through the European Court. My hon. Friend mentioned that the Court thought that a fair balance had not been struck between two competing interests—that of the state and of the individual. That is what we have argued in the past. We believe that there should be a balance, and we do not want to deliberately set out to destroy a greater economic interest.
The judgment shows three things in particular, and vindicates some of what we have been saying over the years. First, the 1993 scheme has not achieved the stated aim of keeping overall noise levels below those in 1988. We made that point frequently, and the Court judges that to be the case. Secondly, the bogus distinction used when the sleep research was originally done—between sleep disturbance and sleep prevention—was a thorn in our side for many years. We tried to make Governments of all parties understand that they were missing the point in terms of disturbance and prevention, and that the research was fundamentally flawed as a result. The court has agreed with us on that. Thirdly, on the economic interest of the country, the court finds that in terms of the national economy as a whole, the importance of that contribution has never been assessed critically. That is terribly important, because we have tried on many occasions to make the Government say what the cost would be if the night flights were no longer allowed to carry on. Neither the Government nor the agencies that they have asked to look into the matter in the past have made that assessment. If that had been

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done, we could have had a sensible debate in this House. However, the European Court of Human Rights is right to say that that has not been done.
We shall keep up the pressure. The hon. Member for Putney and I have asked for responses, as my hon. Friend the Member for Tatton (Mr. Osborne) is doing today. We know that the Government have a certain amount of time to respond to the case, but we urge them to take the matter seriously. We are here to try to articulate the views of our constituents. If the brick wall that we in Westminster have been banging our heads against has finally collapsed in Strasbourg, so much the better. However, the heart of the matter is the distress of those—the elderly, young people with exams the next day, those who are anxious about their lives in many different ways—who are unable to wake up feeling refreshed and ready to face the day. That is indeed a matter of human rights.
12.45 pm
The Parliamentary Under-Secretary of State for Transport, Local Government and the Regions (Mr. David Jamieson): I congratulate the hon. Member for Tatton (Mr. Osborne) on securing this debate and on the way in which he has conducted it. As usual, he has proved sensible and well informed, and as the hon. Member for Windsor (Mr. Trend) said, he has put his constituents first. I also thank him for making my speech for me. That was very kind of him, and he anticipated its content absolutely correctly. His own speech was wide-ranging, but it would be sensible for me to restrict my comments to the title of the debate. Although I may not be able to consider all his points in the detail that he would like, I can assure him that we have listened carefully to them, and to those made by the hon. Member for Windsor.
The hon. Member for Tatton has been most diligent in securing a second debate on aircraft noise so soon after 17 July, when we last met in this Chamber. However, he will appreciate that unfortunately, my comments today must be somewhat constrained, given that the court judgment in the Hatton case was published as recently as 2 October. I am sure that he does not expect me to say today what the Government are going to do. Indeed, if I did so hon. Members who represent the many different and conflicting interests involved would be quick to criticise the Government for not giving this important judgment the careful consideration that it deserves.
In the weeks ahead, we shall indeed be giving the judgment the careful consideration that it warrants, before deciding what action—if any—to take. Furthermore, there is time for such consideration. According to the procedures of the European Court of Human Rights in Strasbourg, the judgment cannot become final until at least three months after the date of its publication on 2 October. There will therefore be no immediate changes to the present situation—neither at Heathrow, which is the focus of that particular case, nor elsewhere.
In considering the judgment, it will of course be necessary to keep at the forefront of our minds the fundamental principles that underpin article 8 of the
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European convention on human rights. Such rights are central to this case. Article 8 of the convention makes the following guarantee:
"Everyone has the right to respect for his private and family life, his home and his correspondence."
The essence of those rights has been covered by both today's speeches. However, like many rights that the convention guarantees, they are necessarily qualified by the second part of the article, which states:
"There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others."
Such qualified rights give rise to the "fair balance" or "proportionality" test, as there is often a need to strike a balance between the rights of the individual and the competing rights and interests of others—including, as in cases such as this, the economic well-being of the country.
The Government also have a positive duty to safeguard the rights of individuals as guaranteed by the convention. I should mention steps that the Government have taken, through the Human Rights Act 1998, to make such rights more accessible in our domestic courts. I was delighted to discover that the hon. Member for Windsor now agrees with that approach. I wonder what he might have said about the matter and how he might have voted on it when it came before us a few years ago. However, I shall move on rapidly from that.
Incidentally, that step has remedied the second violation found by the judgment, that of article 13, which concerns
"the right to an effective remedy before a national authority".
Where, in pursuit of a legitimate aim, it is necessary to interfere with the rights of individuals, and that aim can be attained in more than one way, the way least harmful to the convention rights should be chosen. Within the limits of reasonableness, Governments should consider all relevant facts in striking a fair balance between conflicting rights and interests. In the case law that has been developed over the years, the court has allowed states a certain margin of appreciation. However, I do not wish to dwell too long on those important principles, although they are central to the case and will inform our consideration of the judgment.
An important issue in the Hatton case is whether the Government got that balance right when they introduced a modified scheme of restrictions on night flights at Heathrow in 1993 and 1995. The court clearly has its doubts on that score. It is concerned by the way in which, in the 1993 and 1995 decisions, the balance was struck between the conflicting rights and interests. It is particularly concerned by the amount of information that the Government had available to them at that time, and whether that information was adequate. We must consider those issues carefully. We also need to reflect on the fact that the 1993 night restrictions regime was replaced by more stringent arrangements at Heathrow in 1999. We must therefore consider what further measures may be necessary in light of the judgment. We also need to consider whether the judgment has wider implications beyond Heathrow night flights.

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Because of the media interest in the case, some of which has been less than objective, it is important to make it clear that we do not currently consider that the court judgment says that the disturbance that a limited number of night flights can cause necessarily amounts to a violation of human rights, and therefore they should not be allowed. In our view, the court continues to recognise the principle that a fair balance needs to be struck.
The court also recognises that part of the problem in striking the right balance is the difficulty of measuring the economic importance of night flights and the harm that they can cause. The latter is a little easier to assess than the former. A great deal of the best research has been conducted in this country, looking into the effects of night flights in causing interference with sleep, including premature awakening and sleep prevention. Much of that research has been carried out around Manchester and Heathrow.
As with the more difficult area of researching the contribution of air transport to the economy, sleep research is too often casually dismissed when it does not conform to preconceived ideas or is held to be counterintuitive.
Mr. Tony Colman: Will my hon. Friend give way?
Mr. Jamieson: I will not give way because we have little time left in this debate. I am sure that my hon. Friend understands that I must try to respond to the points that have been made.
Although it may be possible, after careful study, to estimate the value of night flights to the economy, it would certainly not be a simple matter. It would have to involve key assumptions for the purpose of estimating the important secondary economic benefits. Sadly, the result would inevitably be open to criticism as either an overestimate or an underestimate, depending, of course, on one's point of view, and not necessarily on the facts of the case. Indeed, that was the case with the Oxford Economic Forecasting report on the "Contribution of the Aviation Industry to the UK Economy" in 1999.
Not all things can be measured precisely. Night flights form part of an integrated network of services, and their economic value cannot readily be teased out from the other services that they complement and with which they interconnect. There are important economic regions of the world that are best served by night services, simply because of the geography of the world, the time-zone differences and the duration of flights. This is not a uniquely British problem, as the same services operate at night to all other major European cities, although our one-hour local time difference from continental Europe does exacerbate the problem in the UK for airlines wishing to compete on broadly equal terms with those based in Paris, Frankfurt and Amsterdam.
The charter airline industry is also particularly dependent on night flights to achieve the efficient use of its aircraft that is necessary to compete effectively with
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continental competitors and to provide affordable holidays. Time-sensitive mail and express cargo, including perishables, rely heavily on night flights. As a society, we expect and demand these things, but are often reluctant to accept the consequences that go with them.
Despite the difficulties of conducting scientifically robust research in such controversial areas, the Government are not throwing in the towel. Indeed, we are in the process of commissioning a major new study to reassess attitudes to aircraft noise, which will include further research into subjective responses to annoyance by night and day. That was announced by the Parliamentary Under-Secretary of State for the Home Department, my hon. Friend the Member for Coventry, North-East (Mr. Ainsworth) on 8 May 2001. The aviation industry should meet the external costs that it imposes, and the new study will give us more information on the value that people give to relief from noise. However, it would be premature to initiate further studies of any other aspects of night flights while we are considering the implications of the judgment.
We have a few more moments, so I thought that it might be helpful to respond to some of the points that the hon. Gentleman raised in the debate on 17 July, when there was insufficient time to do so. I shall try to make amends for that deficiency. He said that people at Manchester airport had told him that pilots could do little to reduce noise when coming in to land, which is why there are fines for aircraft that exceed the maximum permitted noise limits on take-off only. There is a kernel of truth in that, but the matter is a little more complicated. On take-off, pilots have considerable scope to operate their aircraft in ways that will reduce the noise that they make, especially when they are encouraged to climb as quickly as possible. Therefore the departure noise limits, and the fines that Manchester and other airports levy on aircraft that exceed them, serve an important role in influencing pilots to operate their aircraft in the most noise-efficient way.
However, on the final approach to landing pilots have to follow the precisely defined 3 deg descending glideslope of the instrument landing system and adhere strictly to the specified approach speeds. That leaves them with little scope to influence the amount of noise that their aircraft make, especially when flaps are deployed to provide essential lift at lower speeds and when the landing gear has been lowered. Consequently, fines would not influence pilot behaviour or techniques, and there is concern in some quarters that they could have safety implications. Further from the airport, however, before aircraft are established on the final approach track, pilots can do much more to reduce noise. In particular, whenever practicable they can follow the best practice "continuous descent approach" procedure and maintain their aircraft in a "low power and low drag" configuration.
My Department has been working closely with the Civil Aviation Authority, air traffic controllers and airline pilots to develop best practice guidance for pilots to improve their approach procedures. Although there is some scope to reduce noise during the approach phase, it is very limited closer to the airport, as would be the case over Knutsford in the constituency of the hon. Member for Tatton.

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This has been a narrowly focused debate. I have even managed to insert one or two comments on matters raised in a previous debate, which may help the hon. Gentleman. I am sure that he and other hon. Members appreciate that at this stage the Government are somewhat limited in framing our full response, but I hope that my comments have been helpful in the context of this important matter.

Putney Post Office
12.58 pm
Mr. Tony Colman: I am grateful for the opportunity to introduce this Adjournment debate, which has important lessons for all Members of Parliament with Crown post offices in their constituencies, and will require Ministers to change—or rather, I hope, halt—the sale of such post offices, including Putney post office, and subsequent franchise arrangements. I thank the Minister for his presence, and I hope that I manage to touch on all three aspects of his ministerial responsibilities.
Before I start, I take this opportunity to pay tribute to all postal workers who are dealing with the threat of bio-terrorism at this time, especially those working here in the House of Commons. They deserve our support and gratitude. Although the actual threat has been in the United States, we need to continue vigilance here.
That is one reason why I oppose the privatisation of the Post Office. What is happening at Putney post office is the thin end of the wedge of privatisation. On 2 August, I was telephoned out of the blue by the local Post Office Counters official to be told of the sale of the Putney post office site and franchise to a third party. All existing post office staff would go. There would be a consultation period until 12 October, and the decision could be rescinded.
Putney post office is on a prime retail site, has a training school above it and a large yard at the rear. It is held on a very long lease, is profitable and has 10 retail windows and a minimal stationery offering. During the two-hour telephone conversation, I discovered that the franchisee was to be London Post Ltd., which had contacted Post Office Counters to say that it was interested in any Crown post offices going in London. It thus became the preferred franchisee, to pay a franchise fee set by the Post Office to enable it to make a profit, and with a tender list consisting of itself alone, to agree the price of a substantial freehold or long leasehold for the whole site.
In an area where modest flats sell for up to £500,000 each, considering that a substantial block of flats could be built above the post office, the value of the whole site should be very high. I wished to meet the franchisee, but was told that he would not agree to a meeting because the last time he took up a post office franchise, the local MP had caused him "considerable hassle". A deal has been done behind closed doors involving only one bidder, who refuses to meet the MP or any other democratically elected representative.
What is proposed? I have seen no plans. Incidentally, in the franchising of Morden and Wimbledon post offices, carried out in the 1990s when I was the leader of Merton council, Safeway and Elys, the respective franchisees, had negotiated in great detail about their proposals with me, as a local democratically elected representative. In each case, the original post office buildings did not come with the deal.
There have been public meetings in Putney. Post Office Counters did not help itself by changing its management structures half way through so that we ended up with people who had little idea of the background except that someone else higher up had

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agreed the deals. I had no choice other than to ask the National Audit Office to investigate, and I also asked to meet board members of Consignia plc, who have not yet agreed to the meeting.
On 13 October, however, the letter came stating that the consultation was at an end, that there were to be no changes to the deal and that the franchisee was taking over both site and franchise in November. A new code of practice has apparently come in, negotiated with Postwatch, the post office consumers council, but that does not affect this consultation, or bring about the fundamental changes to procedures that I believe are necessary.
I do not believe that Crown town centre post offices should be franchised. They provide a key service to the public and, given their prime sites, could make considerable profits for the Post Office. As a former retailer, I am astonished that there has been no attempt to recruit to Post Office Counters retailers of quality who know how to make prime retail space work as Crown post offices. If the Post Office is going to walk away from retailing and the Government are, to their shame, going to allow it to do so, there must be safeguards: first, for the public purse—because we all own the Post Office—to stop a scandalous rip-off of assets; secondly, for us all as users of the Post Office; and thirdly, for the postal workers who will lose their jobs.
First, any proposals to franchise a Crown post office should be made public six months before the tenders open. That would give time for the public to understand why the franchising was proposed, and alert local business men and women to the opportunity that might become available. It would also allow for a proper consultation period before the making of any decisions. That is a specific measure being sought by Postwatch, which has outlined to me that although the Post Office will say that no decision has been made until the consultation is over, decisions are almost always a fait accompli. If no deal is ever altered or rescinded, it not only makes a mockery of the consultation period, but means that sensible suggestions that arise from consultation, from the public or Postwatch, cannot be taken on board. That, surely, is not good business practice, especially since Postwatch and its predecessor have many years of experience of examining the good management of post offices.
Secondly, a tender should be based on profit and loss statements given to the tenderers on a commercially confidential basis. That would allow the highest tender on the basis of the maximum performance standards to be identified. In Putney, the proposal to franchise was not made public until after the deal was done with one bidder. No local businesses could therefore compete, and there was no tender for an extremely profitable franchise; the Post Office set the fee.
Thirdly, any staff working for the Post Office on site should be given the option of transferring to the franchisee. They have the expertise and should not have to move to other potentially distant remaining Crown post offices. In Putney, the franchisee has not been required to retain existing staff, who have been told that they can have jobs elsewhere in the Post Office if they want them. Apparently, the franchisee has to guarantee that new staff are of the quality of the old staff. Why will
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he not accept the Transfer of Undertakings (Protection of Employment) Regulations 1981—TUPE—and the continuity of staffing?
Fourthly, before a contract is signed for the franchise, the final tenderer should be required to show Postwatch and locally elected representatives, such as MPs, their proposal for the retail operation, and demonstrate that there will be no diminution of standards; the tenderer should reveal details of layout and other retail offerings. Safeways and Elys did that in Morden and Wimbledon. Why was London Post Ltd. able to get away with not telling people in Putney? What is it afraid of telling the public before it is too late?
Fifthly, the franchise contract should be for a maximum of seven years, and the Post Office should be able to retender at that point, or withdraw the franchise at any time if performance standards fall. In Putney, the franchisee is required to keep the Post Office where it is for seven years. It may be moved elsewhere for seven years, and the contract may then he terminated if the franchisee wishes. In the case of Putney, the franchise deal is actually a property deal.
Sixthly, I propose that where franchising takes place in an existing Post Office-owned site, the franchisee should pay, in addition to the franchise fee and all other property outgoings, the market rent to the Post Office. If the Post Office has a long lease or a freehold, as it does in Putney, before franchising, it should sell and lease back the property, pocket the proceeds of the sale and leaseback, and pass the market rent to the franchisee. That is normal franchising practice.
Seventhly, any property rights relating to upper floors, air rights for development and any developable area, such as yards or outbuildings, not needed for the operation of the franchise should be separately developed by the Post Office, either on its own or with a private sector partner to maximise the profit from the Post Office estate for reinvestment. The Post Office should be doing that for every building it owns where no operational use is being made of such spare space.
In the case of Putney, such common sense has gone out of the window. The franchisee, who was chosen by the Post Office, has been charged a franchise fee and offered a very long lease on the entire Putney post office estate, the price of which has been set, I am told, by internal post office valuers on the basis of needing to make the franchise attractive. To date, the Post Office has refused to tell me the price that London Post Ltd. paid for that valuable site. Although commercial confidentiality is understandable when a deal is being negotiated, once the deal is done, the rules of confidentiality should no longer apply, particularly in the case of the disposal of publicly owned assets. The Post Office management have been challenged again and again on why they have not approached the transaction on normal sane commercial lines. I do not believe that they are corrupt, but I do believe that there is whiff of a fire sale of assets within Consignia; it is not privatisation, but close to it. I believe in public-private partnerships when they are to the public's advantage, but I do not believe that Crown post offices have to be franchised, or that the estates should be sold off for all time.
The Government should intervene to point out that the commercial independence of Consignia plc should not mean financial illiteracy, and failing to value staff

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and listen to customers and elected representatives. No private sector retailer would do that. The shareholders would object, and ultimately throw the management out. We are all shareholders in the Post Office. It speaks volumes that the management of the Post Office spent £2 million on changing the name to Consignia. Our representative on the board is the Minister. Will he stop the shenanigans at Putney? Will he halt the sale of the site and the franchise, and order a rethink and a proper consultation? Will he use the ideas in this speech to ensure that the licence to operate does not have to be taken away from the Post Office for future generations in Britain because of the failure of this generation's management?
The Government, via the performance and innovation unit, have laid out plans to keep the Post Office as a vital centre for our towns and villages. The universal bank will not only provide access to banking services for many who were previously left out, it will give the Post Office a profitable key role in providing services at the heart of communities. Plans for internet access, for one-stop shops for Government information and transactions, and for e-commerce opportunities in post offices are on the agenda. If people could order goods or services and collect goods ordered on the internet at a post office it would increase thousands of people's access to a wide range of products and would certainly be welcomed by my constituents. Might we even see coffee being served for those on the internet or those waiting their turn? What better hub of the community could we ask for?
Can the Minister explain how the Post Office is driving forward that modernisation agenda, which provides the opportunity to retain profitable Crown post offices in the major high streets of this country? The Post Office seems too keen on getting rid of assets, rather than modernising them into workable, socially inclusive, profitable businesses. I know that my hon. Friend the Minister, with his portfolio for e-commerce, has ensured that post offices such as Putney do not miss out on the potential for services that can be provided on the internet. As in Putney, post offices are often in prime locations. Location is everything in retail, so they are in an excellent position to compete with other retailers and increase competitiveness. Why can they not sell computers, stationery or other services? One further suggestion would be to give my hon. Friend an extra power, akin to the power of his ministerial colleague with responsibility for planning. He could then call in proposed sales or franchises and demand to be shown the facts and figures, with the power to stop the proposal if it seemed that it was not the best available course of action.
I have digressed slightly, but only to try to draw some attention to the options available to the Post Office, other than the disposal of publicly owned assets as fast and as secretly as possible, as in the case of Putney post office.
At the beginning of this speech I mentioned the current threats to postal workers, particularly US postal workers. I was in Massachusetts and New York this recess before the terrible events of 11 September. One of the things that my family noticed was that whether in the smallest villages of northern Massachusetts or in
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downtown New York, the US postal service premises were at the centre of the community. They are substantial civic buildings, often new and always well maintained. They are a matter of pride. As we pride ourselves on sharing a common heritage with America, may I try to persuade my hon. Friend that Crown post offices should remain owned and run successfully by the Post Office on behalf of the Government? That includes Putney post office.
1.13 pm
The Minister for E-Commerce and Competitiveness (Mr. Douglas Alexander): First, may I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing the debate on the future of Putney post office, and start by echoing his praise of post office workers not just here in the House of Commons, but right across the UK. They deserve our support and gratitude during these difficult days.
I listened carefully to his speech, and welcome the opportunity to respond to the issues and the points that he has raised. I know of his strong commitment to the Post Office as an institution and to the community that he represents with such diligence. His concerns centre on whether the change of status from Crown post office to franchise outlet will have an adverse impact on post office customers in the locality. I can reassure hon. Members that the Post Office Ltd. proposals that I have seen are intended to secure the long-term viability of post office facilities and services for the local Putney community, bringing a number of improvements including the extension of opening hours and improved facilities.
My hon. Friend will be aware that under the Government's reforms we have given the Post Office greater commercial freedom, and established an arm's-length relationship so that the board can structure the business as it decides how best to meet the challenges of market developments and changing needs.
From 26 March this year, under the Postal Services Act 2000, the Government's role became not director but shareholder in a public limited company. Decisions relating to the day-to-day running of the business are the responsibility of the Consignia board and management.
With regard to operational matters, I should emphasise that this is not a new development. It has been the policy of successive Governments since 1969, when the Post Office was established as a public corporation, that decisions relating to day-to-day operational matters, such as the status and location of individual post offices, were the responsibility of the Post Office board and management.
Given the size of the post office network, it was, and remains, inappropriate and impractical for Ministers to become involved in decisions relating to individual offices. With almost 600 Crown offices operating, the suggestion that franchising and conversion plans be called in for ministerial consideration and assessment is, I fear, not practical. The method of sale that the management of Post Office Ltd. choose to employ when offering franchises to the market and deciding how best value for money is achieved is a matter for their own commercial judment.
The conversion of Crown post offices to agency or franchise status is by no means a new issue. The process began in the late 1980s as a means of strengthening the

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economic viability of the post office network. Because of concerns that resulted from some earlier conversions, on taking office in May 1997 the new Government imposed a moratorium on further conversions pending a review. That moratorium was lifted in December 1998, following agreement on proposals put by the Post Office to the trade unions on a future strategy for the Crown office network. The arrangements were included in the White Paper, "Post Office Reform: A World Class Service for the 21st Century", published in July 1999.
This strategy provided for more Crown offices to be converted to privately run operations, while ensuring that the total proportion of business transactions carried out at Crown offices was maintained at no less than 15 per cent. of the total business transacted by the post office network as a whole. This percentage figure, which established that Post Office Ltd. should maintain a substantial core of Crown offices within the network, forms the basis on which the May 1997 moratorium was lifted.
The Cabinet Office's performance and innovation unit report on "Modernising the Post Office Network", published in June 2000, concluded that, as a matter of priority, the Post Office should carry out work to maximise the commercial potential of the network, the efficiency of its operations and the quality of individual post offices. The PIU report contained 24 specific recommendations, all of which the Government accepted.
My hon. Friend suggested that Putney post office was profitable. However, a particular conclusion of the PIU report was that more Crown offices should be converted to privately run operations as a means of addressing the poor profitability of the Crown office part of the network, which is currently losing about £50 million annually.
Clearly such a situation needs to be addressed in the wider interests of the network as a whole, in view of the major changes and challenges that it faces. Decisive and urgent action to reduce costs, including measures such as the planned changes at Putney post office as well as other Crown offices, is increasingly necessary. It is the clear aim of Post Office Ltd. to address the losses generated by the Crown offices and contribute towards establishing a sustainable future for the urban network as a whole by establishing bigger, brighter, better post offices with robust business potential to deliver sufficient returns to sub-postmasters.
Mr. Colman: Given that Putney post office is profitable, will the Minister confirm whether there is a pattern of first franchising the most profitable post offices rather than addressing the problems of the unprofitable ones?
Mr. Alexander: I would like to make it clear that proposals regarding the Crown office part of the network are judged on the merits of both the profitability that can be achieved in the network as a totality and the individual circumstances of individual offices.
In proceeding with conversion of Crown offices, Post Office Ltd. will continue to fulfil its publicly stated commitment to maintain a network of main post offices that offer the full range of products and services, while enabling it to invest in improving the whole network.
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However, the process is subject to public consultation with interested parties. That provides customers and local representative bodies with specific details about the facilities being offered under the proposed new arrangements, and allows for objective evaluation and feedback. The overall process has been updated recently following discussions with the Consumer Council for Postal Services, which is more commonly known as Postwatch. The revisions are included in a code of practice on the network agreed between the Post Office and Postwatch to cover post office branch relocation, closure and conversion.
Although the consultation process under the code does not extend to the principle of conversion of a particular Crown office to franchise or agency status, it gives customers and other interested parties the chance to express their views about the operational and customer service implications of planned changes. If significant issues emerge from the consultation, Post Office Ltd. will review its plans and, wherever possible, incorporate appropriate modifications. In addition to customers, the code of practice requires Post Office Ltd. to notify other interested parties, which include the relevant parish council, local authority, local chamber of commerce, Member of Parliament, Postwatch at headquarters and regional level, and the local branch of the National Federation of Sub-Postmasters.
In Putney, Post Office Ltd. adhered fully to the code of practice on public consultation. The code states:
"The act of conversion as such is not a matter for consultation, the service implications, which are normally enhancements, are of interest to local customer groups".
As well as standard provisions relating to post office relocations, the section on conversions provides for Post Office Ltd. to allow an eight-week period for consultation, to provide information on the proposed franchisee, to display prominently information about the proposed change in the post office concerned and to invite customers to write in with their views on the proposal. Post Office Ltd. stated that, in considering a range of options for the Putney premises, it is satisfied that the contractual arrangement reached with Mr. Patel represents the best commercial option. Against the background of commercial freedom and nonintervention by Government, that is a judgment for Post Office Ltd. to make.
My hon. Friend the Member for Putney criticised the consultation as being meaningless because a deal with the franchisee had already been struck before the views of customers and other interested parties were sought. In the past, Post Office Ltd. put out broad proposals for change before any specific agent, franchisee or location had been identified. However, it found such an approach was unsatisfactory both from its perspective and from that of customers, who criticised the absence of any specific plan or proposals on which they could comment. Clear plans for the proposed changes allow informed and constructive debate.
Postwatch, as one body consulted about the conversion of Putney post office, has closely monitored the plans of Post Office Ltd. Postwatch's Greater London committee has sought assurances, on behalf of Putney customers, on future service provision under the new franchise arrangements. Post Office Ltd. has given Postwatch Greater London the assurance it sought: that customers in Putney will continue to receive the same range and quality of service as is currently available.

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Other key assurances received by Postwatch Greater London include commitments that the services currently provided will continue to be available throughout the extended opening hours; that, after refurbishment, there will be nine counter positions, compared with the current 10, of which a maximum of eight are in service at any one time; and that the space for post office operations will conform to the requirements of Post Office Ltd.
Postwatch was also told that the franchisee would make a substantial investment in refurbishing the post office, including installing new counters in full compliance with the requirements of the Disability Discrimination Act 1995, and that for measuring quality of service—including queuing times—and for staff training, the same procedures as those applied at Crown offices will continue. Postwatch was also reassured that the franchisee had experience and an excellent track record in operating franchise post offices. However, it will monitor the situation carefully to ensure that facilities and staffing standards are maintained and that customers receive improved service levels.
My hon. Friend asked about the existing staff at Putney post office. That is an important issue. They are Post Office Ltd. employees, and none expressed a wish to continue to work under the franchise arrangements. All have been easily and successfully reassigned to posts in nearby offices under their existing terms and conditions of employment, so there will be no compulsory redundancies.
Post Office Ltd. has been criticised for failing to advertise the franchise opportunity at Putney more directly in the locality. However, it is the long-standing policy of Post Office Ltd. to market franchise opportunities in the business community at franchise fairs and trade shows and in trade and retail press advertising, including local press such as the Evening Standard, without specifying particular offices, because to do so would create considerable uncertainty and concern for the future among the staff and customers of the named office. That might be prolonged if there were no early expressions of interest from prospective franchisees in that office.
Concern has also been expressed at the refusal by Post Office Ltd. to disclose the detailed terms and proceeds of the sale of the lease on the grounds of commercial confidentiality. However, it is operating in a commercial market and is subject to the prevailing customs and practices. I understand that it has confirmed to my hon. Friend that an extensive range of options relating to the sale of the premises of Putney post office were reviewed and considered before concluding that the terms agreed represented the best commercial option both in the wider interests of the network and in the specific continuing provision of main post office services in Putney.
Anxiety has been expressed that the move to franchise Putney post office provides no long-term guarantee of continued service provision. However, I understand that although the standard term of a franchise is seven years, in Putney's case there is a requirement for the post office to remain at the existing site for 14 years. There is
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also provision for an 18-month notice period, so ample time is available to find alternative premises for a post office should that be necessary.
My hon. Friend, who has considerable retail experience, expressed surprise that there had been no attempt to recruit those with retail experience to the post office network. However, I can confirm that such steps are being taken. The appointment of the highly experienced Allan Leighton to the main Consignia board with a role as "network champion" will be followed shortly by the recruitment of a new chief executive for the network to address the issues raised by my hon. Friend.
I acknowledge my hon. Friend's genuine desire to protect and maintain the provision of first-class postal services for his constituents. I hope that during this short debate I have been able to clarify some matters for him and provide reassurance on others. I hope that he and his constituents will draw reassurance from the detailed inquiries made, and the reassurances received, by Postwatch, which will monitor developments in Putney closely in the coming months. If my hon. Friend wishes to raise further issues with me, I shall be happy to respond to him in writing.
Mr. Colman: I made a series of proposals for a new code of practice to ensure that future Crown post offices are dealt with in a different way. Is the Minister considering those proposals as a way of ensuring that we do not have similar debates about every Crown post office in the UK?
Mr. Alexander: I assure my hon. Friend that I shall consider the matters that he raised in the debate and discuss them with him either in person or in correspondence. It is clear from the PIU report that there is a genuine commitment to the Crown offices as part of the network's future; there is an equal determination to tackle the matter of retailing raised by my hon. Friend. In considering the sustainability of the Post Office network in the years to come, it is essential that we advance the retailing agenda in what are often prime locations in communities in urban and rural Britain. The Government are committed to implementing the recommendations of the PIU report; as I said, we are already driving forward the agenda with a network champion specifically allocated those responsibilities on the board of Consignia. I am also confident that the chief executive who will be appointed to look after issues related to the Post Office network will regard those issues as being high in the in-tray when he or she takes up the post. It is important that the Government continue to support the Post Office network; there is a great deal of work to be done to ensure that we realise the considerable retailing potential for Crown offices and for the sub-post offices throughout the country.
I applaud my hon. Friend's concern about the post office in Putney; I have received representations from several hon. Members on the issue. I am fully cognisant of the strength of feeling in the House about the Post Office. I assure my hon. Friend that the issues that he has raised receive considerable attention in my Department. Even in the present difficult international circumstances, in which the focus tends to be on the delivery of mail, there is much work being done to ensure that we sustain the network's viability throughout the country.

Asperger Syndrome
1.29 pm
Mrs. Angela Browning: I declare a non-remunerated interest: I am a special councillor on the national council of the National Autistic Society.
I believe that this is the first time that the House has considered a debate specifically dedicated to Asperger syndrome. I am aware, of course, that many Members of Parliament have raised individual cases from their constituencies—all too often when a crisis has occurred and an MP's help has been sought.
Asperger syndrome was first described in the 1940s by Hans Asperger, but received little attention in this country until the late 1980s and early 1990s. It is part of the autistic spectrum, affecting some 71 people in 10,000. It is characterised by qualitative impairment in social interaction and restrictive, repetitive and stereotyped patterns of behaviour, interests and activities. There is a serious risk of mental health problems, particularly in the late teens and adulthood. The syndrome is also characterised by autistic behaviour, which can present a challenge and often be misinterpreted as a mental disorder.
What characterises people with Asperger syndrome compared to others with autism is that they usually have good language skills and often have an average or above average IQ. Contrary to the stereotype of a person with autism being withdrawn, a person with Asperger syndrome may talk on and on, regardless of the listener's interest. A two-way conversation may be restricted simply to the giving and receiving of specific pieces of information. Because of their IQ, people with the syndrome can obtain educational qualifications, in some cases at degree level.
Initially, all that may sound rather quirky, but not like a major disability. I initiated the debate to tell Ministers that we now know enough about Asperger syndrome to identify good practice where it exists and to provide services and support. Throughout the country, unfortunately, there is still very much a lottery. People with the syndrome may just happen to live in a part of the country where expertise and support services are available.
The key requirements are recognition of the condition, appropriate support before a crisis occurs, and an understanding by professionals and statutory bodies that they cannot provide services in the short term and then walk away. The situation deteriorates quickly. Perhaps I can put that in context and explain why, as with an iceberg, what you see on the surface belies the depth of the problem underneath.
I shall focus on the over-18s. Education and support at school are important. However, many adults with Asperger syndrome may be well educated but unable to manage cooking or even to seek appropriate help if they have a physical medical condition. It is rare for people with the syndrome to marry. Indeed, I know of none who has. The inability to form social relationships denies them friends and permanent relationships. They are only too aware that they miss out in their teens and adulthood on what they clearly see is normal interaction among their siblings and peer group.
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Equally, the communication impairment affects people's position in the workplace, if they are fortunate enough to have a job. Many suffer bullying at school, which affects their self-esteem and often stays with them for the rest of their lives. Inappropriate behaviour, which is often a normal autistic response, is frequently seen by other adults as intimidating. At worst, mental health professionals misdiagnose it.
It is not uncommon for adults with Asperger syndrome to be sectioned under the Mental Health Act or prescribed drugs, because their autistic behaviour is not recognised as such but is misdiagnosed as a mental health problem. That is not to disregard the fact that mental health problems occur, and one does not have to be a psychiatrist to understand why. Factors include growing into adulthood with no friends, having no social life while peer groups go through the usual growing up periods such as going out at weekends, never forming personal relationships that lead to marriage, poor job opportunities and, for some, being denied the opportunity to drive a car because they have difficulty in anticipating dangerous situations, which means that they are obviously not allowed to hold a driving licence. All those issues come together in young people who have average or above average IQs and who are desperate to be part of life. Their daily battle denies them what we take for granted. It is no wonder that depression is common, that mental health problems develop on top of autism and that the suicide rate is high.
A report published earlier this year by the National Autistic Society found an 8 per cent. suicide or attempted suicide rate among a group that it surveyed. The Government are interested in reducing suicide rates across the board. It would be helpful if we could identify how many suicides, especially those involving young men, are autism based. It is tragic when somebody contemplates, attempts or commits suicide, but we know that there are circumstances in which people do so as a cry for help because they have reached rock bottom. People with autism do not think like that. Cause and effect is not part of their thinking. When a person with autism decides to take their life it is not because they hope that somebody will come and rescue them; it is because they have had enough of life. I hope that the Department of Health will consider the shocking figures for suicide attempts and suicides with the help of a group of people who are aware of the difference between those with Asperger syndrome and those around them.
The situation does not have to be this bad. If appropriate services are provided and support is sustained, many people with Asperger syndrome can have a vastly improved quality of life and can be supported to live with a degree of independence. Unfortunately, tapping into such services is crisis-driven. It is a postcode lottery whether services are available locally or a great distance away. All too often, elderly carers look after an adult child, and getting to the point where a crisis becomes serious enough to warrant consideration of a package of care places a huge burden not only on the person with Asperger syndrome, but on carers and those who take immediate responsibility.
I have not called this debate because I want to raise awareness of Asperger syndrome. There is greater awareness of Asperger syndrome than there was 10 years ago, which is good, but we have reached a stage

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where I am looking for action, which is why I have asked hon. Members to consider the matter today. I welcome bringing together health and social services because communication between the various agencies is important in identifying appropriate support packages. All too often social services departments have to find packages of support in a crisis, which means that such packages are necessarily expensive. That puts health and social services off Asperger syndrome. They are terrified whenever they see that there is another case of Asperger syndrome or autism to consider, because they know it will cost them a great deal of money. It costs tens of thousands of pounds a year to support somebody who presents in crisis.
If social services departments were to take advice from those who specialise in the condition to set up a strategy to support adults with Asperger syndrome, they would find that lurching from crisis to crisis is not the only option. There are ways of supporting people and improving their quality of life. However, input is needed before the crisis occurs. I am sure that the economics of that, notwithstanding the humanitarian benefits, would prove to be more beneficial to the statutory bodies.
The Government recently published a strategy for learning disabilities entitled "Valuing People: A New Strategy for Learning Disability for the 21st Century", and I flag up some concerns about the document. Over a year ago—before the report was published—I corresponded with the Minister of State, Department of Health. He assured me that the Government had started to develop a national strategy for learning disabilities, and that matters relating to autism and learning disabilities among those with an IQ of more than 70 would be considered. However, I am worried by what I read in the document.
Section 8.42 of the document states:
"Adults with autism need a range of living and working environments."
The section specifically addresses autism and recognises that person-centred planning should make it possible for individuals to exercise choice about the provision of their housing and support. However, section 1.6 of the document states that the definition of a learning disability
"encompasses people with a broad range of disabilities. The presence of a low intelligence quotient, for example an IQ below 70, is not, of itself, a sufficient reason for deciding whether an individual should be provided with additional health and social care support."
I do not disagree with that. However, the report continues:
"An assessment of social functioning and communication skills should also be taken into account when determining need. Many people with learning disabilities also have physical and/or sensory impairments. The definition covers adults with autism who also have learning disabilities, but not those with a higher level autistic spectrum disorder who may be of average or above average intelligence, such as people with Asperger's syndrome."
That is discrimination, and I say that as somebody who willingly sat on the Committee on the Bill that set up the Disability Rights Commission.
I ask the Minister to examine the document seriously because it singles out people with Asperger syndrome who are, apparently, not to share in the document's aims
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of dealing with the problems and challenges of learning disabilities. I ask the Government to issue clear guidelines to social services and those involved in health, mental health and education as a matter of urgency to ensure that the statutory services do not deny people with Asperger syndrome their rights purely because they have an IQ of over 70.
I shall put life for a person with Asperger syndrome in context by referring to a report by the National Autistic Society, which was published earlier this year for autism awareness week. In a survey, the NAS identified that only 12 per cent. of such people are in full-time paid employment. Many do nothing but help around the house. Late diagnosis is an on-going problem: 46 per cent. of people did not receive a diagnosis until after the age of 16. There is on-going confusion between the statutory agencies about which has responsibility for funding because, all too often, the responsibility falls between the various agencies. When mental health agencies take responsibility, people are ineligible for help because of their IQ, until they suffer a breakdown in their mental health.
It is difficult to know which statutory agency to approach for help for an individual with Asperger syndrome. I receive a huge amount of post from all over the country about the subject, and can comment about a young man who suffered a severe mental breakdown. The mental health service responded, "Sorry, we can't do anything for him; he has GCSEs." If a person with Asperger syndrome has GCSEs, it does not mean, that they are necessarily a person whom the statutory services should ignore or deny appropriate services to.
I want the Government to recognise what the NAS has concluded: that people with Asperger syndrome are marginalised and excluded. Sufferers carry no white stick, and on a good day, one would wonder whether they had a problem at all. Those who suffer from Asperger syndrome are discriminated against because they have a life-long disability, but are also intelligent. Since when has IQ prevented the recognition of a disability? Do we not recognise those who have no sight but are intelligent? Do we discount wheelchair users who have an IQ of more than 70? Of course not, but that is what happens to those who suffer from Asperger syndrome. It is time to rectify a gross injustice against some of the most vulnerable and socially excluded people in society.
1.45 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I congratulate the hon. Member for Tiverton and Honiton (Mrs. Browning) on securing a debate on such an important subject, and for presenting it so passionately. She has a tremendous personal commitment to the issue. Today's debate ought to raise the profile of Asperger syndrome across the piece, and I congratulate her on that.
Asperger syndrome is a complex and distressing condition, and the Government are conscious that services must be responsive to sufferers' needs. I sympathise with those who care for family members affected by Asperger syndrome. Caring for someone with any disorder from the spectrum of autisms is a lifelong commitment that continues even when the person lives away from the family home. Carers make a vital

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contribution to the lives of those with autism, often providing most of the support that the sufferer needs. The Government's determination to improve support for carers—particularly in such fields—is made clear in the report, "Caring about Carers: A national strategy for carers", which sets out our approach.
Asperger syndrome is a form of autism characterised by abnormalities of reciprocal interaction. The hon. Lady explained it graphically, and in more human language, when she described the difficulty that sufferers have in gaining social skills and learning to respond to others in ways that we might take for granted. It is also characterised by a restricted, stereotyped and repetitive repertoire of activities, although language and cognitive development are not delayed. Many sufferers, as the hon. Lady said, are highly intelligent. That is why it was difficult to identify the syndrome for many years; there was little evidence of how prevalent it was.
A report commissioned by the Department of Health from Dr. Tony Holland of Cambridge university suggests that one in 350 people have Asperger syndrome. In that case, there would be approximately 140,000 sufferers in England. It is not clear why there has been such an increase in the number of sufferers in recent years, but I think that that is partly due to improvements in diagnosis in the past 30 or 40 years.
Asperger syndrome has received much media attention recently, and rightly so. I must compliment the NAS for raising the syndrome's profile. I also thank the all-party autism group, which has raised the issue with the Department of Health, the Department for Education and Skills and the Department for Work and Pensions. The all-party group has been active across the piece to make sure that the Government are aware of the issue.
We recognise that some, like the hon. Lady, are disappointed that "Valuing People: A New Strategy for Learning Disability for the 21st Century", the White Paper on learning disabilities published in March, only deals with adults with autism who also have a learning disability. The White Paper focuses primarily on those with learning disabilities, many of whom also have autism. That is not to say that we are not doing anything for those with Asperger syndrome, which is a higher functioning autism. "Valuing People" brings together health, social care and educational agencies, and helps us to improve opportunities and services for people from across the autistic spectrum.
I want to make it clear that "Valuing People" does not preclude those with Asperger syndrome from benefiting from learning disabilities services if that is the best way of meeting their needs in their local community. We made that point prominently in the guidance that was issued on 31 August. Representations from the National Autistic Society caused us to issue that guidance, in which we stated explicitly that people with Asperger syndrome may require an assessment of their social functioning and social skills in order to establish their level of need. It is the most explicit statement on the importance of caring for people with Asperger syndrome that has ever been included in departmental guidance. I recognise that the hon. Lady is impatient for action and wants to see much more done. It is to her credit, and to the credit of others acting on this issue,
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that, for the first time, there is such explicit recognition in the departmental guidance, on which I am sure she will want to build in the coming months.
Diagnosis is an important first step for those with autism. The hon. Lady has made some important points about the effectiveness of early intervention when early diagnosis is made. It is clear from the report of the National Autistic Society that early interventions—whether in education, social skills or opportunities for employment—were much more effective than waiting until the syndrome had been diagnosed at a later age.
One of our top priorities must be to raise the awareness of the syndrome among professionals in primary care and in all services. Raising awareness was the reason for the commissioning of Tony Holland's report. It has now been shared with a wide range of interested bodies including nursing, paediatrics and child health bodies, the Royal College of Psychiatrists, the British Psychological Society and the National Autistic Society. Dr. Holland has taken account of their comments, and copies of the final report are now available from the university of Cambridge. Dr. Holland's recommendations relate to a wide range of issues: the need for professional groups to develop their awareness of Asperger syndrome; the roles of health, social and other services to work together; and the need for population-based studies in both children and adults to try to establish the prevalence and range of disabilities in people who meet the criteria for this condition.
I acknowledge the hon. Lady's remark that we already have the research on prevalence and that what we need now is action. It is right, however, that we continue to gather and refine as much information as we can to support the action that we want to take. That is why we have tried to improve the information on prevalence, and on 5 March 2001 we commissioned the Medical Research Council to undertake a detailed review of the current state of knowledge about autism and to suggest possible areas for further research. The review panel is being chaired by Professor Eve Johnstone, who is an eminent psychiatrist at the university of Edinburgh and chair of the Medical Research Council's neurosciences and mental health board.
The aim of that research is to get a clear and comprehensive picture of what is currently known about the incidence, prevalence and causes of autism and the strength of the evidence that underpins that knowledge. That research will be crucial in helping us to develop further projects that will enable us to tackle the problems faced by people with the syndrome.
The Medical Research Council's review group will consider current knowledge about those with Asperger syndrome to identify gaps and to examine possible areas for developing that knowledge. It is actively involving lay persons' understanding and experience of autism, as well as that of recognised experts, which is a real move forward. It is not merely looking to the scientific community, but is talking to carers and families about their experience of the syndrome. The report's time scale is challenging: it is supposed to report by the end of November. I understand that it is still on track to do so, and I am sure that the hon. Lady will take a close interest in its recommendations.

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There is also an independent national initiative on autism, chaired by Professor Le Couteur. The Department of Health and the Department for Education and Skills are both represented on that body and are taking a keen interest in its recommendations. In addition to the research, it is important that we take action throughout health and social services, and that we try to give people access to employment opportunities. As part of our welfare-to-work strategy, local authorities have just produced the first of three annual joint investment plans on welfare-to-work for disabled people. The hon. Lady explained clearly the difficulties that people with the syndrome have in accessing employment. We hope that the welfare-to-work plans for disabled people can provide specific help and assistance for people with the syndrome who want to work, stay in work or move closer to the world of work through a transition process. There is also quality protects, a huge new five-year programme that is underpinned by £450 million of funding, as well as £60 million for spending on services for disabled children and their families that has been specifically ring-fenced from the children's grant.
An extra £85 million is going into child and adolescent mental health services. As the hon. Lady said, many people with the syndrome also suffer from mental health problems as a result of exclusion and isolation due to the lack of relationships that they experience in their lives. Therefore improving mental health services has to be a top priority. It is also important to help people to improve their social skills so that they can begin to make relationships.
Mrs. Browning: Something as basic as a befriending scheme, which does not cost very much, is simple yet very effective. It is true that people with Asperger syndrome can improve their social skills. However, I think it would be rather over-optimistic to think that their social skills would improve to the extent that they were able to form relationships with other people. I am not aware of any sort of support that would go that far, but there are simple low-cost types of support like befriending schemes. Just to be able to go out for a drink once a week with someone of one's own age can make a world of difference between total isolation and taking a course that teaches systematic social skills.
Ms Blears: The hon. Lady is right. I have some experience of incredibly successful befriending schemes,
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from which the person being befriended and the befriender can gain equally. They find such schemes a really worthwhile and enjoyable experience; simple things like going out for a drink, going bowling and the other activities that everybody else takes for granted are vital. Social services at a local level already provide those schemes in many areas, but trying to provide extra funding for support for young people through the quality protects programme can go a long way to putting in place simple, effective services.
A balance is needed between getting the science right—doing the research on incidence, prevalence and filling in the gaps in our knowledge—and the practical things that we can do to help people in the community, as well as their families and carers, who bear much of the responsibility for looking after people. I assure the hon. Lady that the Government are keen to take action on both fronts. We want to establish the science and get a base of proper evidence. We do not mean to use that to delay action but to take action now, where we can, so that in the future, properly informed by research, our projects can he even more effective in supporting this group of people who are desperately in need.
The hon. Lady raised an important point about the number of suicides among young men. There is a higher incidence of suicide among young men in the population generally, often connected with depression, lack of self-esteem, lack of self-confidence, and a feeling that they do not have a role in the world. We should consider some of the real issues behind those statistics to see whether there is a link. We must not simply take the bald statistics but look at the issues that give rise to people becoming so desperate and so much in despair that they would take a decision of such tragic proportions.
The Government are determined that services for everyone with autism, including those with the Asperger syndrome, should continue to improve. We are sure that they will be among the many groups that will benefit from the positive action that is already taking place. In conclusion, the hon. Lady and others like her have done a great service to people with autism, and Asperger syndrome in particular, in moving the issue up the Government's agenda. It is not an issue that is going to go away. We hope to work with partners, including the National Autistic Society, to develop first class services and make sure that this group of people are treated with equity, respect and dignity.
Question put and agreed to.
Adjourned accordingly at one minute to Two o'clock.