Westminster Hall Sitting of 26 February 2002

Preamble
[SIR ALAN HASELHURST in the Chair]

Care Homes (Lancashire)
Motion made, and Question proposed, That the sitting be now adjourned.—[Jacqui Smith.]
9.30 am
Mr. Gordon Prentice: I welcome the fact that I have been given this opportunity to raise a matter of huge interest to my constituents in Pendle and to the wider public in Lancashire. It is the proposed closure of a large number of residential homes run by Lancashire county council. I shall not speak for long because I want to leave time for hon. Members of all parties who represent the other Lancashire constituencies to contribute to the debate. However, my hon. Friend the Member for West Lancashire (Mr. Pickthall) will have to leave before the end of the debate for an urgent meeting at the Home Office, and he will not be able to contribute as he would have wished.
These are days of tremendous anxiety for the many elderly people in my constituency. They and their relatives are fearful about what is to happen. I have seen nothing quite like it. Action groups have sprung up around the county. The county council's proposals have convulsed the local communities. In public houses, petitions saying, "Sign the petition to keep the old folks' homes open" have been raised spontaneously. On Friday, my constituency Labour party carried a resolution to fight the proposals.
We read in the local press of people's despair about the proposed closures, yet the area has a Labour MP, a Labour Government, a Labour district council and a Labour county council, so no one else's fingerprints are on it. There are no Liberal Democrat or Conservative fingerprints on it. The issue has to be resolved by the Labour party—by the Government and the local authorities.
The sheer scale of the proposal meant that it struck as a shell burst. Residential care homes have been closed before, but the county council proposes reducing the number of homes in the county from 48 to 13, and although the residual 13 homes will still be owned by the county council, they may not be managed by it. The justification for that cataclysm is that the county council, with an annual budget of close to £1 billion, cannot afford to bring the residential care homes up to the standard that has been set by the Government.
The county council talks of its vision for the future and the provision it wants to make for elderly people, but that vision has been obliterated by the headline fact of the closures. That fact dominates, and everything else cascades down from it. We cannot hold a discussion an intelligent conversation about future provisions because of the headline fact that many of the homes will close.
Mr. Hilton Dawson: I agree with my hon. Friend that funding is a headline fact, but
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the substantial issue is not funding but the provision of quality community care in a county that is under special measures—partly as a result of its over-concentration on institutional forms of care.
Mr. Prentice: My hon. Friend will be able to develop that point in his own speech.
People are angry about a consultation exercise that they perceive to be bogus. The county council has presented one option, not a series of alternatives. When people ask what the alternative is to the closure of residential homes, the county council promises consultation with other providers, but there is nothing substantial for people to get a grip on.
Last week I visited the five residential care homes in my constituency—I have visited them many times over the years—because I wanted to see how far they fell below the standards that we hear so much about. I visited Favordale in Colne, the home that has been identified for retention; Pendle Brook in Barrowford, a very popular home; and Wheatley Court in Fence, where the oldest resident is 102, going on 103. We are talking about very elderly, frail people.
I asked the manager of Wheatley Court, a small home with 15 bedrooms, how many bedrooms do not meet the standards. I was told that 14 meet the standards and only one does not. At Cravenside, a larger home in Barnoldswick, where I live, people are bemused. When I asked them the same question, I was told that 44 of 45 bedrooms meet the standards. Cravenside was built 16 years ago, so it is a relatively new home. People there are mystified when they read in the consultation document that homes must close because they cannot be brought up to standard.
Mrs. Joan Humble: Does my hon. Friend agree that much of the debate on standards has centred on the fabric of the buildings and the size of the rooms, whereas to many of the residents and their relatives the standards and quality of care are most important? In fact, they value the quality and the high standard of care in Lancashire county council homes so much that they want to stay in them and want the homes to be retained.
Mr. Prentice: That is true. Many people who have the option want to stay in a county council residential home rather than enter a private home. What really rubbed salt into the wounds in Barnoldswick, which is a town of 12,000 people, was that just after the bombshell was dropped that Cravenside—built 16 years ago and up to standard—was destined for closure, through the letterboxes fluttered a leaflet that said:
"Our home is your home. High quality residential care for the elderly…Thornton Hill"—
That private sector home just outside my constituency is cashing in. People tell me that they have nothing against Thornton Hill or other private homes for the elderly, but they want them elderly relatives to remain in a county home. They do not understand why they should be driven out of the county sector.
My hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) and others may feel that I think that the county council is acting with malign intent, but that is not so. I believe that the chair of social services, the

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leader of the council and my colleagues in Preston are acting with the best intentions. I do not believe that they have it in for the elderly. They have considered the Government's proposals for the future care of elderly people and are trying to tailor their services accordingly, but it has all gone badly wrong. By alleging that it has insufficient money to bring all the homes up to standard, and then compounding it by saying that it is being forced by the Government to close homes, the county council has lost a lot of sympathy.
We are all signed up to the Care Standards Act 2000. We do not want the elderly living in tiny bedrooms in which you cannot swing a cat. I visited the Walverdene home in my constituency and asked the manager to show me some of the rooms that did not meet the standard, and I was quite shocked: Walverdene was built in 1974–75—none of the buildings that we are discussing are Victorian workhouses—but, incredibly, it was not possible to get even an armchair into those rooms; there was room only for the bed and a washbasin in the corner. So cramped were the surroundings that no one should be expected to live in them.
All parties signed up to the Care Standards Act, and we all want to drive up standards. The county council said that meeting the necessary standards would cost more than £14 million, but that is a bogus figure: the true one is a third of that. The county council told us that essential associated remedial renovation work would take the cost to £14 million, but that is not true.
Another claim is also not true—although I say that respectfully, because it was made by a Labour party colleague. On 15 February, the chairman of the social services committee, Councillor Chris Cheetham, told my local paper, the Lancashire Evening Telegraph:
"If we just do nothing"—
about getting homes up to standard—
"then all the homes will close in 2007—simple as that."
Well, it is not as simple as that. I have read the circulars and the Minister's letters to the National Care Standards Commission, which was presumably copied to all the social services authorities. The word that appears over and over again in those documents is flexibility—no one will be driven out of a home for the elderly that marginally failed to meet one standard.
We are all signed up to the vision that the county council paints for us. I am not wedded to a specific sort of institutional care for the elderly, nor do I believe that we must preserve in aspic the form of residential care that we have in Lancashire. Last week, the Chairman of the Select Committee on Health, which deals with social services, reminded me that there is no institutional care for elderly people in Denmark: they are looked after in small sheltered housing units, and that works well. The answer to the question why we cannot have such provision in the UK is that we can, but it will cost money, just as care in the community does.
The county council has discussed bringing in providers from the private and voluntary sectors, but there has been no detailed discussion with them. The consultation document mentions workers' cooperatives, but I cannot get a handle on them; I have asked staff, but no one knows about them. They have
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simply been dropped in to the document, and, like so much else, have not been thought through. The county council has not discussed the options with providers or with the national health service in the north-west. If lots of frail elderly people leave residential care, they may end up bed blocking in our hospitals, and who wants that?
As far as I can gather, there has been no discussion with the district councils or with the housing associations that are flagged up in the consultation document and would be expected to provide sheltered housing for the elderly. I believe—this is a divide between me and the Prime Minister and a few others—that councils that want to be should be in the business of providing residential care services directly to the public. We should not contract out all such services so that we get bargain basement prices for everything.
We should do what works, but not if what works is putting people into the private sector where they are paid the minimum wage and have lousy terms and conditions. I do not want that. If my mother were in residential care, I would not want someone looking after her who was scraping by on the minimum wage with poor terms and conditions. Many people want their relatives to be in a residential care home that is run by the county council, because the staff in such homes are treated well. The council document states that staff in the county homes would have to be paid less to make the homes competitive with the private sector. What state of affairs have we reached when we read that in a Labour council document?
The county council must withdraw the proposals. The sword of Damocles hangs over the homes, their residents and the wider community. The county council should start talking to the other providers in the private and voluntary sectors, and propose a plan for care for the elderly in Lancashire.
I always want something from the Government, and sometimes I am disappointed. I want them to reconsider funding for social care. Many of us received the document from the social policy on ageing information network, which lists the main actors in social policy that have signed up to it, including Age Concern, the Alzheimer's Society, Anchor Trust, Arthritis Care, Carers UK—the list goes on and on. The document states:
"Social services departments routinely budget more than 10% (almost £1 billion) above government guidelines for social services, and even so, they overspend."
On 1 February, my right hon. Friend the Member for Norwich, South (Mr. Clarke) gave an interview to The Independent that appeared under the headline "Minister admits more should be spent on care for the elderly". That is common ground between us. It is what I believe.
I grieve that we have got ourselves into a situation in which so many elderly people are wracked with anxiety. We can correct that if the county council can sweep the proposals off the table and have an intelligent conversation with the other providers and the Minister.
Several hon. Members rose—
Mr. Deputy Speaker: Order. A great many hon. Members—at least eight—applied in writing to speak in the debate. There are 45 minutes available to them. If

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the arrangement is to be consensual, those 45 minutes indicate the length of speech required if everyone is to catch my eye.
9.48 am
Mr. Michael Jack: I congratulate the hon. Member for Pendle (Mr. Prentice) on securing the debate. I agree that the council's proposal should be withdrawn. During the constituency break, like other hon. Members, I visited homes that the proposal affects, and I found that people were very emotional. An 86-year-old lady broke down in tears when I talked to her about the proposal, and all the residents at one home said that it was their home and that the care was fantastic. I wonder how Councillor Cheetham would feel if someone walked up to his front door, told him that his home did not meet the required standards, and invited him to move out. I suspect that he would give them short shrift and send them away. That is how many people feel.
Just before Christmas, I wrote to the county council about my concern that because of the many recent closures, there were not enough nursing home or care places in Fylde to enable people to be discharged properly from hospital over Christmas. The council replied that the work was being done. In December, the council did not know the relationship between the capacity of the care sector and the requirements of the hospital sector. Just as I was recovering from that, suddenly, like that Volkswagen commercial where the car arrives out of the blue into the midst of a group of surprised people, so dropped the consultation document.
It is ironic that I received a letter this morning from a Mr. Slater of the county council telling me that the county council is holding a consultation exercise on the closure of old people's homes; he asked me whether I would like a copy of the document and to take part in the consultation. For weeks now, the argument about our old peoples' homes has been raging in Lancashire's newspapers. As the hon. Member for Pendle says, the proposal looks like a fait accompli.
Nobody who knows anything about care for the elderly can be ignorant of the changes that have taken place. The Care Standards Act has been passed and more people are being looked after in their own home, but where is the analysis? How do we know what is happening in our constituencies?
I asked Councillor Joyce Stewart, the Conservative spokesman on social service matters in the county, whether she had seen the consultants' document that had been produced by the county council justifying its policy. She replied that she had not. It had not been shown to county councillors. Why has that document not been made available to us all? We need to know how the decisions are made. Mr. Slater, who describes himself as an "assistant director special projects", wrote to other and me colleagues on 8 February enclosing a document marked "Private and Confidential". I will not reveal all the information in the document, but it purports to tell us how the various sites were selected. There is nothing about occupancy rates or running costs.
I am a veteran fighter for one of two homes in my constituency that have been fingered to have their day care facilities removed. Our campaign to save Milbank
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in Kirkham from closure was based on the fact there was a real need for that type of facility in rural Fylde and the private sector had not fully catered for the demand. We won the argument. I do not know what the reasons now are for taking the day care centre out of Milbank, but I know that an unspecified sum of money is to be spent on making it one of the survivors. That is all well and good—but hang on a minute. What about all the people who are not in rural Fylde who would not find it easy to go to that home? What will happen to the people who use the day care facility at Milbank in Kirkham? I do not know.
Crossacres, which is threatened with total closure, does not look run down inside, although it needs some en-suite facilities. About £250,000 needs to be spent on it. However, one can almost see from the external fabric that the decisions about its future have already been taken: it has been allowed to run down. The county council thought about all of that a long time ago.
The problem is that we do not know or understand what the options are. Take the day care out of Crossacres and where do those people go? There is only one day care centre left in the Fylde constituency—the Church road Methodist day care centre—and it is already chock-a-block. It is basic details like that that are completely lacking from this inhumane method of consulting elderly people.
I saw a copy of a letter dated 31 January from Councillor Cheetham to our elderly people. I asked the staff and the elderly residents whether they understood what was happening. Had anyone sat down with them and gone through it? Yes, there were meetings, but many of the elderly people are frail and confused. They are in their 80s, 90s or bordering on a century and, with no disrespect to them, it is difficult for them to understand and properly contribute to a sophisticated consultation exercise. When I asked them where their loved ones were, the replies were varied, but they included Canada, New Zealand, and the south of England. Those people had no back-up and no one to help them. Some people's relatives were present because they knew I was coming, and they spoke to me, but it is difficult to have a proper consultation in such circumstances.
Where is the imagination in the proposal? All it talks about is closure and sale-of-site values. There was no thought about whether Crossacres could be developed into a more advanced care village. Much about the consultation exercise rings of fait accompli. The facts have not been put before us. I agree with the hon. Member for Pendle that the proposal should be withdrawn straight away. A proper study should be done which takes into account all the needs of the elderly in every part of Lancashire.
9.55 am
Mr. Peter Pike: I, too, congratulate my hon. Friend the Member for Pendle (Mr. Prentice) on securing the debate on a subject that is important to elderly people living in homes throughout Lancashire, and to their families. The equation proposed by the county council does not consider what will happen to the private sector, which, if it is to meet the Government's requirements, faces major challenges. I have grave fears that there is not enough capital in the

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private sector to bring in the new standards for homes, and many will lose bedrooms, which will make them uneconomical and so likely to close. If that happens, the number of private sector homes in Lancashire will decrease at the same time as the closure of a large number of county care homes is being proposed. It is extremely important to consider that possibility before any closures are agreed.
Sheltered housing has been mentioned. Everyone, including the county council, accepts that normal sheltered housing would not be adequate, and "super-sheltered" housing has been mentioned, but that would need more staff, supervision and care than there are at present. That is another factor in the equation that we must consider more closely before any hasty decision is taken after the consultation.
I was first approached on the matter of the new standards on 4 May 1999, when a Mr. Porter of Jalna, a private home in my constituency, raised the issues with me. I looked into the matter and I have been in correspondence about the size of the rooms with the county council and Ministers for the past two or three years. I accept that the type and size of the rooms described by my hon. Friend the Member for Pendle are nonsensical, but one must accept that the old rooms containing four or five beds were also nonsensical, and that Lancashire got rid of them. We must look carefully at room sizes.
I have received letters on the subject of en-suite provision asking how many old people will actually be able to use such provision given the care and assistance that they need. Is it really necessary to incur such capital costs, whether they are met by Lancashire care homes or by the private sector?
In January, I visited all six Lancashire care homes in my constituency, five of which are proposed for closure, which is more than in any other constituency or borough in Lancashire. I have visited the homes every year in January since I became a Member of Parliament. The standard of the care that they provide is excellent. I have also visited some private homes and was present when the unions signed an agreement with the Lancashire Care Association on standards and training for staff. Some of the old arguments used many years ago against the private homes no longer apply, because there is a much greater acceptance that a good standard of care needs good staff.
As I went round the homes, not knowing that the proposal would advance so speedily, it struck me forcefully that most of the people there were in their 80s and 90s, or even more than 100 years old—the number of people there in their 100s is incredible—and that 90 per cent. of them would not be able to go back into the community or back to their own home. They had gone to the residential home because that was the only way in which they could get the care and the lifestyle that they needed and to which they were entitled. I visited one of the homes for which closure is proposed, Ebor House. As Labour party organiser in Burnley, I attended its opening in the mid 1960s. The age profile in the home at that time was different: most residents were in their late 60s and 70s.
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The £4 million that has been mentioned to improve homes to meet the new Government standards, and the £10 million in county council budgets for the period until 2007, are chicken feed. We must ensure that the consultation is genuine. Society as a whole, the Government, county councils, local authorities and all of us in public life are judged by the care and attention that we give our vulnerable people and the elderly.
I have received a mass of letters from my constituents on the subject, as I am sure has every hon. Member. I shall quote a letter from Hazel Harding, the leader of the county council, to my constituent Mr. Beint. She says:
"I would like to assure you that this is a true consultation stretching over many months in which all views will be listened to."
If the county does not withdraw the proposals, I hope that that assurance proves genuine. I also hope that the other parts of the equation to which insufficient consideration have been given—the private sector and the new super-sheltered accommodation—will be taken into account. Whatever changes take place, we will be judged by the care that our elderly people in Lancashire receive.
10.1 am
Mr. Nigel Evans: I congratulate the hon. Member for Pendle (Mr. Prentice) on securing the debate. I am sure that we have all been inundated with letters and that we have all been visiting care homes, especially over the past few weeks. I am proud of both my private care homes and my local authority homes, which seem to be of the highest standard.
The so-called consultation has not been properly thought out—indeed, the way in which it has been carried out is tantamount to abuse of the elderly. As my right hon. Friend the Member for Fylde (Mr. Jack) said, we are talking about very vulnerable, confused people, who are now fearful for their futures. Does Councillor Cheetham understand what he has done by initiating the consultation in such a fashion? On page 6 of his consultation document he says:
"Clearly the closure of Local Authority homes is distressing for residents and their relatives and staff."
That is an understatement. In the letter that accompanies it he says:
"I realise that putting the plans into practice will disrupt the lives of many residents."
Of course it will—so why has he embarked on the exercise in such a way? I spoke to Councillor Pat Case, who was unaware of the proposals.
I have visited Castleford in Clitheroe and Fell View in Longridge—two excellent homes. The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) will know Castleford because there a few years ago she opened the day centre, which receives up to 120 people a week. They get meals there and are properly looked after and monitored, which would not happen if they were living at home. Some of those people live in the most isolated and rural parts of the Ribble Valley and they look forward to coming to the day centre, where they can mix with people of their own age who have the same interests. They are picked up from their home, taken to the day centre, and taken home at the end of the day. They can have two meals and breakfast, which they might not get if they are isolated at home.

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For some of those people, their home can be a prison. If the council thinks that condemning such people to confinement in their home will create no cost, it should think again. It would have huge implications for social care if people had to stay in their homes 24 hours a day, seven days a week.
Homes also provide entertainment for the elderly. They can be taken out on day visits to other parts of the country. Rehabilitation is another important part of the day centres' work. Those who have gone into nursing homes from hospitals are taught again how to use kitchen and bathroom facilities. Who will carry out such important work in future? Elderly people who come into day care centres regularly can be properly monitored, weighed and checked to see whether they are eating properly. If they have any ailments or are taking medication, they can be supervised.
Should the proposal go through, the residential part of Castleford would be expanded slightly, but the day centre would go. That would be a cruel policy to people living in that area. I congratulate Eireen McGee and all the staff there on the work that they do. They are dedicated and skilled professionals.
Fell View, which opened in 1967, is in exactly the same position. I was shown around by Margaret Buckingham, who has worked there for 21 years. What price can be put on her skills? I have a letter from the Royal British Legion saying how important the home is to local people. Some of the residents are regularly visited by their spouses who still live in their own home. What would happen to the bathing facilities, rehabilitation and medical supervision if that home closes? We know that if elderly people are confined to their homes they become ill more quickly, are confined to hospitals more regularly and block beds.
When the announcement of proposals to save money was made, the county council published an advertisement that was an insult. "'Dynamic duo' to spin closures tale" was the headline in the local press. The county council seek to spend £50,000 on a couple of spin doctors to try to dress up their policy as humane. They must be joking. The hon. Member for Pendle mentioned that the misinformation is about the cost of bringing care homes up to standard. The council has been giving one set of figures, but the real cost is a fraction of that. It is time that we had some honesty about what the council intend to do and why.
A member of staff at one of the homes told me that she was thinking of putting a poster in the window that says, "They fought for us. It is now time that we fought for them." That is absolutely right. I say to councillor Chris Cheetham, "Think again and ditch these proposals." Let us ensure that we give proper care to the elderly in Lancashire.
10.7 am
Mr. Greg Pope: It is unusual that I agree with everything that my hon. Friend the Member for Pendle (Mr. Prentice) says, and rare that I agree with everything said by the right hon. Member for Fylde (Mr. Jack), but it is completely unheard of for me to agree with both of them. It is a measure of the seriousness of the issue that there is such consensus among Lancashire Members of Parliament.
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I am a friend of the county council and a personal friend of its leader and deputy leader. Sometimes, it is a friend's duty to let people know when they have got it wrong, when they have made a mistake. Today I say in public what I have already said in private to the leadership of the county council: they have got this matter completely wrong and mishandled it from the beginning. They must take the proposal away and think again.
Like every other Lancashire MP, I have been inundated with letters from constituents and concerned relatives. One said that residents want to be treated
"with respect, not like animals…herded like cattle, placed here and there in an area that they do not"
call their home. Another said that
"they give you tablets to keep you going and then"
when
"they do this to you, I…wish they would give me a tablet to end it all".
One old lady was in tears: she had no family and was not sleeping; she did not know where or when she was going. The letter ends by asking me
"how would you feel if she was your mum"?
I feel pretty unhappy even though she is not my mum. The proposals are completely wrong-headed and must be withdrawn.
We need a mature debate about the future of the sector. That debate should include carers, residents, the private sector and local health trusts. It is shocking that Lancashire has not engaged properly with the local health service, or with the private and voluntary sectors. It would have been sensible to have held the consultation and debate before any concrete proposal was made. However, such a debate is not possible when, as my hon. Friend the Member for Pendle said, certain homes have the sword of Damocles hanging over them. Lancashire must withdraw the hit list—there is no other appropriate term—of 35 homes.
I think that we would all agree that some homes might have to close. The current number of 48 homes may not be right for Lancashire. Demographic trends are changing, and an increasing number of old people do not want to go into a home—they want to remain in their own home and be looked after there. Perhaps 48 is not the right number, but it is impossible to have a proper debate while there is a hit list of homes. I repeat, Lancashire county council should withdraw that list.
Local Labour MPs met the county council a fortnight ago. We had a robust exchange of views. My understanding is that the council refuses to rethink its position. I am sure that we can all think of examples of politicians refusing to withdraw unpopular policies because they think that to do so would be a sign of weakness. It is a sign not of weakness, but of strength to hold up one's hands and say, "I've made a mistake." It is a sign of confidence in one's own politics, and I urge my good friends and colleagues on the county council to take that brave step and admit that they may not have handled the matter terribly well. They should acknowledge that it would be sensible to withdraw the hit list and invite everybody to have a proper debate.
10.11 am
Mrs. Joan Humble: It is a great pleasure to follow my hon. Friend the Member for Hyndburn (Mr. Pope), because I want to reinforce some of the points that he made and set our debate in the context of the Community Care (Residential Accommodation) Act 1992, which was passed under the Conservative Government and which received all-party support, as does the current debate on care standards.
The 1992 Act was debated and passed with everybody agreeing that we needed to look after elderly people in a variety of different settings, that residential care was not the right answer for everybody, and that more and more people needed and wanted to be supported in their own home. That legislation placed a burden on local authorities to manage a process of change from residential to domiciliary care. However, in many parts of the country there has been a substantial reduction in the amount of residential care available, which has resulted in problems of bed blocking and elderly people not receiving the support that they should receive.
We in Lancashire are in a fortunate position: we still have both county council care homes and a private care sector. We ought to take advantage of that fact and have a debate about how many care facilities and what sort of increased domiciliary care or day care provision we need. We should ask how we can best use our existing residential provision. We should not lose the opportunity to do that and end up in the same position as many other local authorities, which do not have that sort of provision. Let us have the informed debate for which we have all been asking. Let us examine the needs of our elderly people.
The care homes run by the county council do not provide only residential care and day care. Excellent facilities such as the one referred to by the hon. Member for Ribble Valley (Mr. Evans)—I remember opening that day centre—also provide respite care. Many people neither need nor want full-time residential care, but need respite care on occasions.
Like other hon. Members, I have taken the opportunity to visit the two homes in my constituency that are involved in this debate. Worsley House is earmarked for closure. The local authority must face up to the fact that an area as large as the district of Wyre contains many towns. Fleetwood has its own identity, and those of its people who use Worsley House do not want to go to the far end of the constituency of my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson)—I hope that he will forgive me—even though it is in the same district. They want to have the choice of a Lancashire county council home or a private home in Fleetwood, and they feel strongly about that.
It is suggested that Thornton House be retained, but its residents would still have to be moved out because an enormous amount of work needs to be done to remodel the home as the county council suggests. There will, therefore, be disruption even in homes that are proposed for retention.
I thank my hon. Friend the Minister for seeing a delegation from the Lancashire private sector last week. As my hon. Friend the Member for Burnley (Mr. Pike) emphasised, the, proposals would affect the private sector. The number of residential placements has
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decreased. We must take all care providers into consideration. We must value the work that they have done to improve the care that they offer and the buildings in which they offer it.
Let us think about the needs of the people of Lancashire and ensure that they have respite care, nursing care, rehabilitative care and day care when they need them. Domiciliary care, too, is important. Many constituents tell me that they want that to be improved so that they can remain in their own homes for as long as possible, until they really do need residential care.
10.15 am
Mr. Hilton Dawson: I am grateful to my hon. Friend the Member for Pendle (Mr. Prentice) for securing this important debate. We have reached the same conclusions, although by very different routes.
I support change, because there is too much residential care provision in Lancashire. I want facilities to be transformed to provide better day care services, better support in the community, and better support for sheltered housing. The action that Lancashire county council has taken shows that it is trying to work within the framework of the good policies that the Government have laid down. It is trying to work in the serious, stringent context of special measures.
Changes are always difficult, even those that will improve the lives of the current generation of vulnerable people who live in residential care. Those people must have the first call on everyone's support, compassion and assistance. I do not always support the council, but it is only fair to acknowledge its record of helping elderly people through difficult and traumatic changes in compassionate, caring, sensitive and highly professional ways.
I believe that the consultation is genuine, but fatally flawed, and hon. Members have drawn attention to the lack of partnership with health services. The national standards framework for older people requires the council to enter into such a partnership. A couple of weeks ago, I and my colleagues were told that the health service was unable to meet that requirement because it was in a process of transition, but that excuse is unacceptable.
The council needs to enter into a powerful partnership with the private sector. On Friday afternoon, I held a meeting with a couple of representatives from the Lancashire Care Association and with County Councillor Chris Cheetham. It was a good meeting because there was real communication—people said that it was the first time that they had been able to communicate. It is unacceptable that the proposals did not emanate from a robust partnership between social services, health, the private and voluntary sectors and the district councils. That is why the consultation is flawed and must be reconsidered.
There are important issues to tackle in Lancashire, and we desperately need to improve services. The argument is not about money, nor can it be until proper structures, proper communication systems and proper ways of working in partnership are in place. We must get those partnerships going. The county council operates good services and is trying to implement changes in difficult circumstances, but the structures work against

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it. I was told on Friday that there is a structure for consultation with the private sector, but the fact is that there is no substance or content to the process. There is a crying need for a health and social services trust. We need to use the greater flexibility that the current Government have introduced because we need major changes to the way in which services operate.
10.20 am
Mr. David Borrow: Like many hon. Members, I visited the care homes in my constituency last week—Peterfield House in Penwortham, New Manor in Longton and Broadfield House in Leyland. I had constructive meetings with residents and their families at all three homes, but I was unable to reassure residents about their future as they get older.
Figures in the consultation document demonstrate that in December 2001 there were sufficient care home places in the private sector in Lancashire. Under the proposals, 746 places in the county council sector would be closed. At the end of December, there were 1,215 vacancies in the private sector. That would mean that 65 people in South Ribble would have to be moved out of Lancashire care homes. There are currently 82 vacancies in the private sector.
The problem with the document is that the county council has not consulted the health service or the private sector, nor has it analysed probable future need for residential, care. Hon. Members have heard tales of the potential closure of private care homes in the next few years, and it is self-evident that some will decide not to spend their money to bring their care home up to the new standards. The demand that will be placed on the residential care sector is unclear, but in three years' time, I do not want to have to tell a constituent with an elderly relative who visits my surgery that there are no vacancies in South Ribble, and that they must go to Manchester, Yorkshire or Merseyside to find a vacancy.
I want to ensure that there will be vacancies for respite care if people who are caring for elderly relatives need to make use of it. I want to ensure that residential care will be available for people who have been in hospital but are not fit to go straight home, and that that care will be available to them until they are sufficiently recovered. I want to ensure that the right sort of residential care in the right place, which is in people's communities, is retained. That provision might not be in a Lancashire county council care home, but I am not convinced that the county council has a clue about whether there are enough places now and whether there will be enough places in 2007 or 2012. Until it is sure, the document should be withdrawn. The necessary information should be obtained so that we can have a grown-up, constructive discussion about all the issues.
10.23 am
Mr. Lindsay Hoyle: I congratulate my hon. Friend the Member for Pendle (Mr. Prentice) on enabling us to -lake part in an important debate about the future for old people in Lancashire.
I am one of the first to say that the decision is crass and should never have been taken in such a way. Of the three homes in Chorley, two are to be closed and one is to remain open—what a lottery. Care homes in Lancashire are 98 per cent. full. It is unacceptable that
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a Labour-controlled Lancashire county council should scuttle around Lancashire announcing closures, upsetting some of the most vulnerable people in society, and leaving them with no hope and no future.
People turned to Lancashire county council when they applied to its care homes, which offered provision of which we could all be proud. Two days before Christmas, a private home closed in Chorley. Where was the safety net when emergency beds had to be found? It was with Lancashire county council. That safety net will disappear if we allow the proposals to be implemented.
Lancashire county council must withdraw its proposal immediately and ensure that people have a choice. People should be able to choose to live in private or county homes—or to remain in their own home, with appropriate support. I accept all that, but if our county provision is taken away, there will be nothing left for those who need it. Will we have to tell a 95-year-old, "I am sorry, but this home is down for closure. You will have to find somewhere else"?
People living in the homes have already been told to start looking for private accommodation. Sadly, they are being told that they must look around quickly, because there will not be enough accommodation left if they all look at the same time. The danger is that those vulnerable people will opt for a private home that might close in four or five years' time. That is not acceptable.
There is nothing wrong with the homes in Chorley. I invite the Minister to come to my constituency to see the quality of those homes and to see the damage that is being done by our county council. It should withdraw its proposals now, so that people can feel once again that we have a listening county council.
10.25 am
Geraldine Smith: I congratulate my hon. Friend the Member for Pendle (Mr. Prentice) on obtaining today's debate. I am saddened and angered by Lancashire county council's proposed closure of 35 care homes. I am saddened because over the years the county council has, by and large, provided good service to the people of Lancashire. I am extremely angry about the acute distress and bewilderment that has already been inflicted upon the elderly residents of those homes as a result of the cavalier and uncaring way in which the proposals were announced.
Three of the care homes threatened with closure are in my constituency—Beaumont View, the Craggs and Slyne House. All have an excellent reputation for providing high quality care. Before travelling to Westminster yesterday, I took the opportunity to visit Slyne House and the Craggs. It was heartbreaking to hear people in their 90s saying that they were being well cared for and looked after, and how much they dreaded being uprooted and moved elsewhere.
One elderly resident had his wartime medals in his bedroom. That an elderly gentleman who had fought in the war should now 'be rewarded in such a way is heartbreaking. Another resident, a wonderful lady, is celebrating her 100th birthday today, but it has been overshadowed by the proposals: she is frightened that she will lose her home. It is not only the elderly residents who will be affected, but also their relatives. I spoke to the sons and daughters and the husbands and wives of

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residents who were distressed and worried about their elderly relatives. That is cruel. Many of the residents were at a loss to understand why their home was going to close. They were desperate to know what was to become of them. I felt ashamed that proposals that have caused such heartache and pain were put forward by a Labour-controlled council.
Of equal concern is the fact that staff and residents of the care homes have been told by Lancashire county council that the closures were being forced upon it by the Government because the homes do not meet best value criteria. They have been told that the homes have to close, and that if the county council will not do it, the Government will step in and do it. I ask the Minister to confirm whether that is true.
I am sure that all hon. Members know that the provision of good quality care such as that provided by Lancashire county council is not cheap, but that care is what the elderly in our communities need and deserve. We should ensure that care in the private sector is raised to the standard of that provided by the county council, not try to round it down to the lowest common denominator. It must be clearly understood that the proposal entails the mass relocation of frail, elderly people. It is our duty to ensure that their interests come first and that they are considered before any decisions are made.
When considering future provision of residential care homes in Lancashire, I am aware that we need to improve and expand other areas of care and support as well as residential care. Yes, people prefer to stay in their own homes if possible, but it is not always an option if they are too frail or require a great deal of care. Regardless of the success of other measures, there will be an ever-increasing need for residential care. People are living much longer and, even though they stay longer in their homes, they still need to go into residential care later in life.
My hon. Friend the Minister will know that Lancashire county council is also cutting back on the number of private sector placements. If we accept its policy and fail to ensure that sufficient residential care places, both public and private, are available to those who want and need them, we will not only fail the elderly in Lancashire, but put an intolerable strain on the health service by causing massive bed blocking.
10.30 am
Mr. Paul Burstow: I congratulate the hon. Member for Pendle (Mr. Prentice) on securing the debate, and all those who have taken part. They succinctly stated the serious concerns that hon. Members on both sides of the House have about the proposals for the reduction in public sector care home capacity in Lancashire. I shall address some of the concerns that have been raised in the debate and ask the Minister some questions.
As I listened to the debate, three phrases came to mind: "piecemeal", "ill conceived" and "lacking in vision". That is what strikes me about the proposals about care homes controlled by Lancashire county council that are out for consultation. The fact that the consultation continues until 14 June is no comfort to the
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residents of the care homes that have been nominated for closure, or to their relatives and friends, or to the staff who are affected. I am aware of the trauma and difficulties that accompany the closure of care homes, whether they are in the private, independent or public sectors. It is a sad fact that poorly managed closures can increase the possibility of death among residents who are transferred. That fact must fuel the anxiety of relatives and staff.
Members made several important points that go to the heart of the wider debate about the provision of residential and nursing care in institutional settings. I shall comment on them, but I was very struck by the right hon. Member for Fylde (Mr. Jack) pointing out the feeling of ownership that residents in care homes have. When a well run home is established and doing a good job, it ceases to be an institution and becomes a home. When a resident describes it as "My home," we should listen and take it as a serious sign of that person's feelings about the place.
The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) referred to the overall context of the community care legislation that set local authorities' responsibilities for managing care home places. That is a fair point, but it is worth bearing in mind that the same legislation placed on local authorities a fairly onerous and difficult gatekeeping role. There is a tension in being both the gatekeeper and the person that commissions care provision for residents on their behalf. That does not sit well in many cases, and I suspect that in Lancashire it has resulted in the introduction of a poor set of options.
I am strongly of the view that although a spectrum of different types of care in different settings—ranging from low intensity domiciliary care packages that enable people to stay independent in their own homes, through to the most intensive home care and residential sector—should be available in this country, and Lancashire in particular, it must not become a matter of dogma that people must stay at home. Any vision must always be built around the needs of the individual and proper analysis of them.
The debate has highlighted an apparent lack of analysis or serious engagement with the other partners and players in the provision of care in the community and residential care. I am shocked to learn from today's debate that Lancashire county council has failed to engage seriously with the NHS about the impact of the proposed reduction in capacity, and that it has also failed to have that dialogue with the independent sector. To remove up to a third of bed capacity simply by removing places from the public sector fails to acknowledge what is happening in the private sector.
All hon. Members know from their mailbags and conversations with care home owners about the pressure in the private and independent sectors in terms of the costs and new standards and how they are making many contemplate leaving the sector altogether. In some parts of the country, many people have already left the sector: they have decided that they could no longer do a decent form of business because they were not getting any return.
As the hon. Member for Pendle said, when the Care Standards Act was passed, Members on both sides of the House were committed to national minimum

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standards to drive up quality in all sectors. It is important to recognise that although there is no straightforward relationship, there is undoubtedly a cost attached to that compliance. I emphasised that several times during the passage of that Act. Today's debate has proved that some statements made in the regulatory impact assessment failed to provide an accurate estimate of the cost of complying with the new standards. That is why local authorities—not only Lancashire—are saying that they plan to close homes: they cannot find the capital to fund the changes. The hon. Gentleman was right to set his remarks in the context of the budgetary pressures that fall on local authorities, particularly social services authorities, when trying to manage such issues.
Physical standards—lifts, doorways and room sizes—present problems: they often carry the greatest capital costs, but they are not the best proxies for quality. That point has been made by hon. Members and was acknowledged by the Government in a letter sent by the Minister to Anne Parker, the chair of the National Care Standards Commission. In it, the Government recognised that the standards in respect of room sizes that are due to come into effect from 2007 must be interpreted flexibly. It would appear that Lancashire county council has ignored that in its calculations and proposals.
I hope that hon. Members will continue to challenge the council about that, and that the Minister can confirm what, she wrote to the chair of the NCSC. The letter makes the specific point that
"For example if it were harmful for a resident to be moved, it would be open to the Commission to decide that a room which falls below the standard nevertheless suits the persons' needs."
That is as clear as possible, and Lancashire county council should take the point into account.
The hon. Member for Pendle mentioned the social policy on ageing information network report. Research into the funding available for social services was conducted by charities and private sector interests. He referred also to the £1 billion above standard spending assessment that social services authorities throughout England spend on providing services for the elderly and children. Interestingly, just two weeks ago, a new survey was published by the Local Government Association and the Association of Directors of Social Services. It examined current, not historical, budget pressures and, unsurprisingly, confirmed that there has been no change. In the coming year, councils throughout the country expect to overspend their budgets by more than £218 million. They are already spending dramatically more than the Government think that they need to spend, as reflected in SSAs. Nine of out 10 will overspend their budgets in the coming year, and many forecast further pressures looming in later years.
Everything boils down to capacity and whether it is being planned. In Lancashire, it is not. The Minister should ask the county council, through the social services inspectorate and others, what it is doing to improve its understanding of the knock-on consequences of its proposals on care for the elderly throughout the county. There is no doubt that the proposals will reduce choice and increase pressures elsewhere in the care system.
Hon. Members said that a lack of capacity in the care home sector had a knock-on effect on the NHS in the form of delayed discharges and more people waiting
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longer to leave hospital, with all the attendant consequences for their health. That effect works its way through the system, and ends in people waiting longer on trolleys because there are no beds to which they can be admitted. All that is happening and will continue to happen if there is not a proper dialogue between all the players in Lancashire to address the problem.
The hon. Member for Burnley (Mr. Pike) mentioned the loss of private sector capacity, and other important points were made, to which I hope the Minister will respond today.
10.40 am
Mr. Oliver Heald: This has been a passionate debate, and rightly so. The hon. Member for Sutton and Cheam (Mr. Burstow) described the proposals as piecemeal, misconceived and showing a lack of vision. Many hon. Members might have gone further and said that the proposals are heartless and cynical in the way that they strip assets from the public sector and shunt costs, and that the county council has been arrogant in not listening to the views of elected Members of Parliament. As the hon. Member for Hyndburn (Mr. Pope) said, he and his colleagues approached the county council but it simply did not listen.
I congratulate the hon. Member for Pendle (Mr. Prentice) on instigating this important debate, because it is clear that the proposals are not acceptable. As my hon. Friend the Member for Ribble Valley (Mr. Evans) said, the idea that the problem can be solved by spending £50,000 on a couple of spin doctors shows the values of Lancashire county council. There is no doubt that this is a tragedy in the making.
The hon. Member for Morecambe and Lunesdale (Geraldine Smith) touched on what is happening in the private sector as well as the public sector. The Lancashire Care Association was told before Christmas by Lancashire county council that it planned to reduce residential care home placements in the private sector for the frail elderly by two thirds between now and 2007—a decrease of 1,200 places, from 1,880 to 600 a year. At the same time, the council plans to close 35 of the 48 county homes—a loss of 700 places. Two thousand places for frail elderly people in Lancashire are to be stripped out within a very short period.
That is a tragedy for the individuals concerned. My right hon. Friend the Member for Fylde (Mr. Jack) spoke to a resident who said, "This is my home." The hon. Member for Burnley (Mr. Pike) said that people involved are in their 80s and 90s, and the hon. Member for Pendle spoke about people being fearful. The hon. Member for Morecambe and Lunesdale spoke about wartime medals on their walls, and the hon. Member for Chorley (Mr. Hoyle) said that this treatment was being meted out to some of the most vulnerable people in Lancashire.
My hon. Friend the Member for Ribble Valley said that some of the most frail residents were living in fear of the proposals, and pointed out that day centres were important to people if they were not to be imprisoned in their own home. The hon. Member for Hyndburn said that people were being treated like animals, and the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) pointed out the loss of respite care places. There is no doubt that the effect on individuals who live in homes is dramatic and that the policy is heartless.

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The hon. Member for Burnley also talked about the staff. We should not forget that there are 600 jobs in care homes in the public sector in Lancashire. In an intervention, the hon. Member for Blackpool, North and Fleetwood referred to the standard of care that is so appreciated by residents. That is not an accident: the staff are committed to providing excellent care. Given what all the expert evidence and research shows, it is odd to put their jobs and those of all the caring people in the private sector at risk.
The leading institute that considers demography and projections for the future is the personal social services research unit. Its latest research, published in Health Statistics Quarterly, shows that there will be a huge rise in the number of over-65s in the next 30 years. The Government Actuary's projections show that that number will rise by 60 per cent and that the number of over-85s will increase by almost 90 per cent. It is projected that the number of residential places throughout the country needs to rise by 65 per cent. to meet that demand—in addition to what is needed in domiciliary care, where it is estimated that a 48 per cent. increase will be needed in home care hours provision.
Against that background and the fact that all the evidence is that we need more places and more capacity—the Government say that, too—why on earth is Lancashire county council stripping out places? That goes back to the point made by the hon. Member for South Ribble (Mr. Borrow): the council simply has not done the analysis. This is a national issue because getting rid of places in care homes makes the NHS inefficient. The Government are spending much more money on the NHS but are not getting much more activity out of it, because although elderly people in NHS beds throughout the country want to move into a nursing or residential home, places are not available. Making the situation worse, which is what Lancashire county council suggests, is wrong.
We have to wonder about the reason behind the proposals, and I think it is that the council has problems—indeed, special measures have been mentioned. If it does not provide care home places in the public or private sector, it does not have to pay for them, and other authorities have to pick up the tab. Housing is the district council's responsibility, so it will have to provide more sheltered housing, and the NHS will have to do more work on intermediate care to provide places. The financial burden is thereby shifted from the county council to the district council and the NHS. That may be a good accounting trick, but it takes no account of the costs to the individuals involved—people who will lose their home and be treated like animals. Nor does it pay attention to the loyal staff who have worked for the county council for years.
What is so stupid is that the council has not even troubled itself to consult the NHS or the independent sector before going down this route. I join in the pleas made by hon. Members on both sides of the House for the consultation to end and for the proposals to be taken away and reconsidered. The Minister is reported in the local press in Lancashire as saying that she is "ordering a probe". What does that mean and what action will she take? The situation is intolerable.
10.48 am
The Minister of State, Department of Health (Jacqui Smith): I join in the congratulations to my hon. Friend the Member for Pendle (Mr. Prentice) on securing a debate on a matter of considerable importance to Lancashire. I commend all hon. Members who have spoken: they have made good use of their role as constituency Members of Parliament to raise a significant local issue. Even before today's debate, I was well aware of those concerns. The decision is clearly one for Lancashire county council, but as we have heard it has wider implications. I shall state the reality of the Government's policy and its relationship to the activities of Lancashire county council.
As my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) pointed out, Lancashire county council has had a relatively high number of admissions into residential and nursing care. In 1999–2000, it made 182 admissions to residential and nursing care per 1,000 people aged over 65. By 2000–01, that had dropped to 146 per 1,000, but even so, it was still 45 per cent. higher than the average for shire counties.
It is right that Lancashire considers its commissioning strategy. It should assess whether it offers the right balance of care for older people in the county. However, as my hon. Friend the Member for Hyndburn (Mr. Pope) made clear, it is crucial for this type of consideration and planning to take place in the context of consultation with older people themselves, with partners in care provision in both the statutory and independent sector, with other local authorities, with the NHS and with other local representatives, including those who have spoken so ably today.
It is important to understand, as noted by my hon. Friend the Member for Morecambe and Lunesdale (Geraldine Smith) and the hon. Member for Ribble Valley (Mr. Evans), that the proposals could lead to 700 older people having to move from their care homes. Our debate is not merely a theoretical discussion about the design of a system. Many could have lived in their existing homes for many years and the move could entail significant disruption. Any changes should be contemplated only after thorough consultation, up-to-date care assessments and detailed discussions with residents and their families.
A central aim of Government policy is to reduce reliance on long-term institutional solutions to the needs of older people and to encourage the development of services to promote their independence. As right hon. and hon. Members have made clear, provision of services for older people is complex, so we need a range of alternatives to provide an opportunity for older people to exercise choice.
Complex objectives can be achieved only if they are well planned and if change is well managed and accompanied by investment. That has been the Government's national approach to achieving the reconfiguration of services that we all want in the longer term. It is a testament to those measures that we now support more people living at home than in the past: in 1998–99, of every 1,000 older people 82 were supported to live at home; by 2000–01, that number had risen to 84. All sorts of support—home care, community equipment, home adaptations and repairs—are included.

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Also central to the Government's plans to reform the care system is the development of intermediate care services, so that we can prevent avoidable admissions into hospital and allow patients—especially older people—the time and care necessary for rehabilitation. Such services will enable older people to live independently for longer. The NHS plans investment of an extra £900 million to be made available by 2003–04 for new intermediate care and related services. It is already bringing benefits and will be part of the overall reconfiguration of older people's services.
The Government have already provided significant extra support to local authorities engaged in the reconfiguration to ensure that we avoid the problems associated with delayed discharge, to which some hon. Members have referred. From the £300 million made available by the Government last autumn, Lancashire county council received £1.6 million in 2001–02 and will receive a further £3.4 million in 2002–03. That funding will be available for the purchase of nursing home placements, intensive home care packages and disability equipment, and for the expansion of existing intermediate care and rehabilitation schemes.
We need to offer our older people a range of services. Generally, people want to live in their homes as long as they can, but in some cases residential care is the best option and we must provide the necessary capacity to cater for it—either in the statutory or independent sector. My hon. Friends the Members for Burnley (Mr. Pike) and for Blackpool, North and Fleetwood (Mrs. Humble) mentioned their concerns about private sector capacity in Lancashire. On that account, last week I met representatives of Lancashire Care Association in a delegation led by my hon. Friend the Member for Blackpool, North and Fleetwood. They expressed the association's desire to work with Lancashire county council to ensure that residential and other provision is made available to Lancashire people in a planned and strategically managed way.
The Government are committed to working in partnership with the independent sector to use its capacity and resources to achieve the best possible outcome. That is why we established a strategic commissioning group—initially chaired by my fellow Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), and now by me—which published an agreement setting out the responsibilities and expectations for central Government, local government, the NHS and independent providers.
The agreement focuses on councils and the independent sector entering into long-term agreements about placing people into care homes or providing other forms of support. It also highlights the need for fees to reflect the costs incurred. I expect all local authorities to follow the agreement; otherwise we shall be unable to achieve the necessary changes in capacity and the sort of planning which, as my hon. Friend the Member for South Ribble (Mr. Borrow) and others pointed out, is missing in Lancashire.
Several hon. Members mentioned national care standards. We are all agreed on the need for uniform standards to cover not just environmental issues, but quality of care, training and the rights of residents. Those standards are being introduced sensibly. The Government have issued statutory guidance to the
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National Care Standards Commission to ensure that the application of new standards does not lead to the closure of good quality homes. The guidance states that the commission should assess whether care homes can fulfil the needs of service users without making environmental changes to meet the standards. It especially covers issues surrounding room sizes, lifts, and baths and shared rooms. To respond to a point made by my hon. Friend the Member for Burnley, existing homes are not required to provide en-suite bathrooms in future.
Care home representatives have welcomed the guidance. Some people, including hon. Members here today, have raised questions about the public statements made by Lancashire county council about the cost of bringing its in-house provision up to the level of the new care standards. I understand that the publicly stated figure of £14 million is inaccurate and that the real one is nearer to £4 million. Any higher sum would include expenditure on routine maintenance.
I understand the significant concerns expressed in today's debate. The social services inspectorate is already closely monitoring the council in several respects, because it was placed under special measures in February 2000. I also understand the concern about the intention to decrease dramatically the number of nursing and residential placements. That is why the social services inspectorate is following closely the work undertaken by Lancashire county council to assess its current care provision. Consultation on future strategies is taking place with the NHS, local people and other interested parties.
Concerns have been expressed that the local authority is not communicating properly. The social services inspectorate is actively seeking to open lines of constructive communication between the two parties. Today the SSI is holding a regional workshop attended by representatives of the local council and the Lancashire Care Association, and further meetings will follow. I have instructed the SSI to monitor closely the outcome of those discussions. I have also asked to be kept up to date with crucial research on capacity in Lancashire. I shall regularly examine SSI reports to ensure that progress is being made in the areas about which hon. Members have voiced concern today.
The Government's reforms are intended to lead to an evolutionary change in the care sector—
Mr. Deputy Speaker (Mr. Frank Cook): Order. It is time for the next debate.

MMR Vaccine
11 am
Miss Julie Kirkbride: May I start by saying how grateful I am—[Interruption.]
Mr. Deputy Speaker (Mr. Frank Cook): Order. Will right hon. and hon. Members please leave the Chamber quietly so that we may proceed with our business in proper order?
Miss Kirkbride: I am grateful to the Speaker for agreeing to this morning's one-and-a-half-hour debate on a topical issue that has become heated during the past few months. I look forward to hearing what the Minister has to say not just on my campaign for single vaccines to be provided by the national health service but on related issues on which the House would like more clarification. No doubt we shall hear a variety of voices from around the Chamber, but the principal point of the debate is to impress on Ministers why they should introduce the right to single vaccinations on the national health service.
Single vaccinations were available under the national health service until the Government came to power in 1997 when the Department of Health changed the guidance and MMR became the only vaccination available against dangerous childhood diseases. It was a fatal mistake to withdraw the right to single vaccinations. The purpose of the exercise is to ensure that the maximum number of children receive important vaccinations against damaging diseases. My purpose in pursuing the campaign is to increase the level of herd immunity, which has fallen to the dangerous level of 85 per cent. and possibly lower. That is not good enough to ensure that we do not have a worrying measles outbreak.
Whatever the Minister says today about restoring public confidence, advertising campaigns and bullying tactics in doctors' surgeries—if we can believe the press—will not persuade parents to do something against their gut instinct. The only way to restore public confidence is to respond to what parents want and 85 per cent. want the right to single vaccinations on the national health service. The Government would be acting in the best interests of children and public health—pregnant women as well as children need to be protected from rubella—if the right to single vaccinations were re-introduced on the NHS.
Dr. Evan Harris: If the hon. Lady's campaign reduced the level of herd immunity because people abandoned immunisation altogether, would she change her view? Is there anything to be learned from the whooping cough vaccination scare, which led to reduced coverage, higher incidence of the illness and deaths?
Miss Kirkbride: We cannot compare different scares. There is worrying evidence concerning the MMR vaccine. It does not prove a link between MMR and autism, but it gives parents cause for concern. I speak as a parent and for many parents who make difficult decisions on behalf of their children. I examined the
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evidence and did not feel entirely comfortable about giving my child the MMR jab. We know from the newspapers that I am not alone in that view and I could name many public figures who agree with me. The uncertainties about whooping cough and MMR vaccinations are not the same. The way to increase the number of children who are vaccinated against measles, mumps and rubella is to give parents the choice they want.
Dr. Harris: I know that the hon. Lady wants to make progress, but this is a key point. If she were persuaded that a change in policy to the one she wants would lead to fewer children being vaccinated—not among the group that may choose single vaccinations, but among those who would simply give up on the whole idea—would she change her view because of the risk of lower coverage resulting in more disease and deaths?
Miss Kirkbride: I do not agree with that hypothesis, so it is difficult to give the hon. Gentleman a relevant answer to his question. If he had been listening, he would know that I believe that the way to boost immunisation levels is to give parents the choice that they want. That is the tenet of my debate so I cannot give him a better answer.
Lynne Jones: The hon. Lady is right to say that measles, mumps and rubella are dangerous. I feel strongly about this because I almost died as a baby from pneumonia associated with a measles infection. The hon. Lady is raising the matter in an irresponsible way. Of course parents are worried—parents are always worried about possible harm to their children—but while a negative can never be proved, the risks associated with not having the MMR vaccination are far greater than the risks of having it.
Miss Kirkbride: The hon. Lady speaks from bitter personal experience, but as parents, we do not consider the risk in the wider context that only a few children are likely to be damaged by the MMR vaccination; we ask whether our child might be damaged. We know that some people believe—and we do not know whether they are right or wrong—that their children were damaged by the MMR vaccine and we ask ourselves whether we could bear it if our child were damaged in the same way. That makes the point for allowing parents the choice of single vaccinations. If they were allowed that choice and if the door had not been closed in 1997–98, the position today would be different because we would not have the present crisis in herd immunity.
Ms Julia Drown: Will the hon. Lady give way?
Miss Kirkbride: I would like to make some progress, but I shall then give way.
One of the Government's reasons for not allowing single vaccinations is that they involve six jabs. However, the manufacturers' packets state that single vaccinations provide 98 per cent. effectiveness, while the MMR jab provides up to 90 per cent. effectiveness, so children have to be inoculated twice for MMR, first

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when they are just over a year old and again just before they are four. The 10 per cent. difference is not sufficient to provide herd immunity.
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): Is the hon. Lady aware that the Medicines Control Agency has specifically disputed the claim of 98 per cent. coverage, which is wrong?
Miss Kirkbride: I am aware of what the Medicines Control Agency said and of what the manufacturers state on the packets. Someone is not telling the truth and we must establish who is telling the truth. I am well aware of the point made by the Minister, but we need more clarity instead of the muddled facts that are available at the moment.
Another of the Government's arguments against single vaccinations is the time between each vaccination—it must be at least three months. They say that that is dangerous because more children are liable to get measles in the meantime. That may be true in essence, except that some children are not being vaccinated at all. Given the choice of MMR or nothing, too many parents are choosing nothing. If we compare reality with the Government's comments, we are banging our heads against a brick wall. Parents are told, "If you are not prepared to have MMR, you will have nothing." Ergo, parents are choosing to have nothing, and the risks to the wider community are that much greater. The Minister must let a little daylight into those considerations by accepting life as it is, rather than as she would like it to be.
The Government's rules are one reason why it is more dangerous to proceed on the basis of the single vaccine. Parents can access single vaccinations for their children by having the rubella vaccination, which is licensed in Britain, first. Children are entitled to have it in order to protect unborn children, who may contract rubella.
If the Government changed the rules so that children could have the measles vaccination first, the most dangerous childhood disease would be tackled first. That would mean a longer period of exposure to mumps and rubella, but we must live with life as it really is. Changing the rules would remove a large part of the Government's objections.
Dr. Stephen Ladyman: The hon. Lady raised the issue of rubella and talked about pandering to people's perceptions. Does she realise that one perception in the community is that boys do not need to be immunised against rubella? Given that that is, as she puts it, the reality in the world, how does she expect to get herd immunity to rubella if we provide single vaccines?
Miss Kirkbride: It is a patronising argument used by Labour Members—and it remains to be seen whether it is used by Opposition Members—to claim that parents will not take their children back for the other two inoculations. Parents who want single vaccinations are by definition responsible because they have clearly been thinking about whether that inoculation is right for their children; of course they will go back. I do not know whether the hon. Gentleman has children, but if he does he will remember that they go for a series of inoculations
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when they are three, six and nine months old. It is wonderful to say that most people take up those inoculations. Of course parents will have their children inoculated against those dangerous diseases, and it is outrageous that people who oppose my point of view suggest otherwise.
Ms Drown: I am grateful to the hon. Lady for giving way. She talked earlier about her difficulty, which I understand, as a parent thinking about whether her child might be exposed to a possible side effect of the vaccine. As a parent, however, does she not also consider the risk of her child being exposed to one of those diseases? Is that not a difficult choice that all parents have to make?
I should like to hear the hon. Lady's policy on when the single vaccines, which include not only rubella, but also mumps, should be given. Has she taken medical advice on the gap between vaccinations? Why does she think that her particular view is different from that of the stream of medical organisations that have looked at the evidence in detail?
Mr. Deputy Speaker: Order. Interventions must be brief and to the point.
Miss Kirkbride: Thank you, Mr. Deputy Speaker. If the hon. Lady catches your eye she will be able to expand on those points.
The hon. Lady raised a number of questions, and I have several concerns that the Government should take seriously. Returning to my previous point, I believe the vaccines to be largely safe. Let me put on record that I believe in the childhood immunisation programme, which has done wonders for childhood mortality in the past 10, 20, 30 and 40 years. It has been a fantastic achievement, and I pay tribute to the medical establishment for having achieved wonderful progress. However, the fact that it has achieved wonderful progress in the past does not make it right about absolutely everything. It does not necessarily make it right about MMR and whether there is a problem in a small spectrum of children. The problem for parents is that they do not know whether their child might be susceptible.
On a wider point, the hon. Lady asked about the gap between vaccinations. Private clinics, which offer those vaccinations, start with the rubella vaccine and give the measles vaccine three months later. I think that there is a longer gap after that to the mumps vaccine. The hon. Member for South Swindon (Ms Drown) seems surprised, but if she knew more about the subject she would know that the measles vaccine is the most virulent, and therefore the one with which we must be most cautious.
Peter Bradley: Will the hon. Lady give way?
Miss Kirkbride: I have been generous in giving way, and I should like to make my own points rather than dealing with barracking from Labour Members.
The fact is that 2,000 parents are taking the Government to court because, rightly or wrongly—and this will be tested in court—they believe that the MMR

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vaccine has damaged their children. Whatever our views about MMR, our hearts go out to those parents because, according to their stories, their children were developing completely normally until the day on which they had their MMR jab. Those children's personalities changed as they developed regressive autism, which stripped from them the functions that they had previously acquired. Those parents face difficult lives because they have to deal with what has happened to their children. We do not know whether it was caused by MMR, but those parents believe that it was. We all know how intimately we know and understand our children. Those parents' stories deserve a more careful approach than the dismissive attitude we presently have from the Department of Health.
Peter Bradley: I do not want to barrack the hon. Lady, but she seeks certainty; I am not sure that there is certainty in life or, for that matter, in science. Can she be certain that the active measles ingredient in the single measles vaccine, rather than MMR in combination, could not be construed or suggested as a cause of autism?
Miss Kirkbride: The simple answer is no. No medical science can be proved absolutely, and that is why we have to offer parents choice. We have to offer them choice because there is no certainty. At the moment, we cannot prove or disprove any of those things. One cannot disprove a negative.
Parents want choice because they believe that as a result of the three live vaccines, which are stronger, more virulent vaccines in MMR—all other childhood inoculations are not live vaccines—children who have a predisposition to be unable to cope with an attack on their immune systems suffer damage to their guts and bowels, which leads to toxins leaking out and damaging their brains. If that is true, and those parents cannot prove it, it is likely that the measles vaccine is responsible. We know that toxins in the brain are a likely cause of autism, but we do not know how and why it occurs.
The Government know that environmental factors are likely to cause autism. I was pleased to learn that there is going to be more research into the causes of autism because we need to know why we appear to be having an epidemic. I would not suggest that MMR is the reason why there has been a massive increase in autism, but the evidence needs to be examined as it raises fears among parents about whether MMR is a contributory factor.
I draw Members' attention to the work of Dr. Andrew Wakefield, and the more recent research by Professor John O'Leary in Dublin. They looked at cases and examined the parents' story. They brought in parents who believe that their child changed on the day on which they had the MMR vaccine. They investigated whether there could be any truth in the parent's belief that having the MMR vaccine caused their child a problem. They examined 91 children whose parents all told the same story that their children had the MMR vaccine, developed an irritable bowel problem and then showed signs of regressive autism, which is such a dreadful thing to see in one's child. They found measles
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virus in the gut of 75 of the 91 children whom they examined, as compared with a normal cohort of children in which only 6 per cent. had traces of measles virus left in their gut.
That does not prove anything, but it does give me, as a parent, cause for concern. The Minister and the medical establishment seem to have closed ears when it comes to that subject. They want to discredit Dr. Andrew Wakefield, who has been driven out of the Royal Free hospital and is now working in America. Other people have raised the same concerns, and we need to look at the matter.
Mr. Andrew Lansley: Before my hon. Friend concludes, will she consider scientific studies that have examined each hypothesis presented by Andrew Wakefield, and have found no evidence to support them? Will she consider the Finnish study, which is a randomised, placebo-controlled, double-blind study that provides no evidence to support his conclusions? Has she spoken to those on the Medical Research Council panel, as I have done in my constituency, who listened to Andrew Wakefield, but who found no evidence to support his hypotheses?
Miss Kirkbride: I am sorry to disagree with my hon. Friend in answering his concerns. Andrew Wakefield is not alone in raising the matter; doctors in America and Dublin have questioned whether there is a cause for concern. I have not spoken to the MRC panel, but I would be interested to hear my hon. Friend's remarks should he be lucky enough to catch your eye, Mr. Deputy Speaker.
I am grateful that my hon. Friend raised the Finnish study, which looked at 1 million children and claimed that there was no link between MMR and autism. The problem is that it found not a single case of autism, which, in 1 million children, is statistically inconceivable. I am greatly concerned about the veracity of the study and its conclusions. The affliction of autism is so great in our society that to find not a single case is most unlikely; according to the most recent figures the incidence is six in 10,000, so there is likely to be a case of autism in 1 million children.
Another problem with the Government's statistics relates to the Japanese experience, which the Prime Minister raised on the Floor of the House. I am sad to say that when Ministers refer to such a case, it makes one wonder what they have to hide. The Japanese experience is wholly different from that portrayed by Ministers. Japan had a genuine problem with the mumps component—the urabe strain—of MMR, which was causing encephalitis and killing children. That rogue strain was not used elsewhere, so there is no comparison to be made with the strains of MMR used elsewhere in the world. The Japanese Government covered up the problem for a long time, and then introduced single vaccines having withdrawn the MMR vaccine. In those circumstances, it is hardly surprising that the Japanese public said that they would not accept any vaccine because they no longer trusted the Government.
The British Government say that Japan has single vaccinations, some 80-odd children have died of measles there, ergo single vaccines cause a problem for children

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and are dangerous. That is a completely fallacious conclusion. Children are dying of measles in Japan because they are not being vaccinated at all, which has become part of the problem here. When Ministers use that example, I am concerned that they feel the need to misinterpret data. That causes great concern for all of us.
There is a case to be made for single vaccinations. I was grateful to learn a few weeks ago that the Government are to spend more money—an extra £2.5 million—on looking at the causes of autism. That money is welcome. Will the Minister clarify whether any of the money will be used to consider the findings of Dr. Andrew Wakefield and Professor John O'Leary, and to address the issue that is causing public concern? Speculation in the newspapers has been that the ostracism of Dr. Andrew Wakefield will not continue and that greater dialogue may be achieved between him and the Department of Health. That would be welcome, and would give parents less reason for concern.
I would be grateful if the Minister would clarify, openly and honestly, Government plans for the MMRV—measles, mumps, rubella and chicken pox—vaccine to be included in a quadruple jab. When I asked recently, I was told that there were no such plans, but I have seen newspaper speculation that scope may exist for introducing a quadruple jab. If we are to deal straight with parents, we should know whether the Department of Health genuinely has such plans. We need clarity and certainty about what is being considered and what has been ruled out.
Will the Minister comment on allegations in newspapers—I do not know whether they are true—that the reason for the removal of the availability of single vaccinations on the national health service and the introduction of the MMR jab was that the patent on single vaccines was running out? Does the same reason apply to the prospect of introducing MMRV, and the MMR patent? Is that why the new quadruple jab is being introduced? I hope that that is not true, but it has surfaced in newspapers so people would like clarification.
Another allegation that has surfaced in newspapers is that doctors are dropping children from their lists if parents refuse to let them have the MMR jab. Does the Minister have any reason to believe that? If it is true, can she clarify the attitude of the Department of Health towards such doctors, who would be behaving disgracefully by not allowing parents the right to choose what is best for their children?
Lynne Jones: Does the hon. Lady think that parents would conclude that separate jabs would be best for their children if equal prominence were given to the adverse effects associated with not having the triple vaccine as that given to the unquantified and probably unassociated effects of autism?
Miss Kirkbride: The hon. Lady makes a relevant point. However, hon. Members who disagree with me have a problem with the difference between the desirability of achieving wider public health goals and the inevitable feelings that parents have towards their children; they want to do the best for them, and are not
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as worried about the wider public health consequences. That is the inevitable conclusion that most parents rationally reach.
Lynne Jones: Will the hon. Lady give way?
Miss Kirkbride: No. If parents believe that MMR is a problem, but do not have access to single vaccinations, they will make a choice between having MMR with its potential link to autism, or not having it and accepting that their child may get measles. The hon. Lady's experience may be different, but I had measles, as did my brother, sister, mother and father. We have all had it, and for most people the experience is not life-threatening. However, it is for some children, which is why the public health argument is more important. We need to protect those children who are likely to be damaged by measles, which is why we want more parents to give their children measles mumps and rubella vaccinations. However, when one considers one's own child, the considerations are slightly different from those surrounding the wider public health. Labour Members must bear in mind that difference in attitude.
I shall comment on the Prime Minister's refusal to say whether his young child has had the MMR vaccine. It was not an issue of privacy. All parents talk about whether their child is having the MMR vaccine; it is no big deal and much like asking which school a child will attend—it is part of the common currency of conversation between parents. It is also relevant to point out that when there was concern about the whooping cough vaccine, Prince Charles made it known that his children had had the DPT—diphtheria, pertussis and tetanus—vaccine to prevent whooping cough. The Queen also let it be known that Prince Charles and Princess Anne had had the polio vaccine when concern arose about that. The Prime Minister therefore stands somewhat accused of causing the problem.
If we are to believe the story in The Independent at the beginning of February, the Prime Minister had not given his child the MMR vaccine when I asked my question. That is surprising because children are called for vaccination after they are a year old; little Leo was a good 18 months, if not older, by that time. I do not believe that this is a privacy issue, and it is a shame that the Prime Minister sought to make it one. That has not helped his Government's policy on the matter. I know that the Minister and other hon. Members will accuse me of undermining public confidence, but such accusations are wrong and false. The Minister has undermined public confidence by not allowing public choice. Choice is fundamental to people's lives and they are entitled to have it.
We pay for the national health service. Research has left queries in some people's minds about MMR, and rightly or wrongly—we all hope that the research is wrong—they will be swayed by it. No amount of bullying by the Minister's Department and officials will make any difference to public attitude. People want choice and it is about time that the Government gave it them.
Several hon. Members rose—
Mr. Deputy Speaker: Order. This is an important issue. We normally commence winding-up speeches

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30 minutes before the end of the debate, which would mean that they would start at 12 noon. The three Front-Bench spokespeople have sent me semaphores by various means to say that they want 39 minutes in total. That means that, to get the official responses to a serious issue, it shall be very difficult to fit in everyone. At least six hon. Members indicate that they want to participate, some of who have not taken the trouble to inform the Chair beforehand, which makes it difficult for the Chair. I appeal to all hon. Members to bear in mind the paucity of the time available to us, make their points pertinent and clear and accept as few interventions as possible. So far, there have been far too many.
11.31 am
Peter Bradley: Thank you, Mr. Deputy Speaker. I shall do my best to be brief. It is my susceptibility not to measles but to high blood pressure that has put me at risk in recent weeks. Nothing has enraged me more—the hon. Member for Bromsgrove (Miss Kirkbride) has done nothing to diminish my outrage—among what passes for news in this place than the so-called controversy about MMR.
What makes this issue different from others, and the reason that I am angry not just as a politician, a Government supporter and a Member of Parliament trying to represent the best interests of my constituents, but above all as a parent desperate to protect my children and those of others from killer diseases, is that this is a matter not so much about choice—as the hon. Lady suggested—as about public health. I believe that, in this important case, some elements of the press and some Opposition Members have lost sight of their responsibilities as shapers of public opinion and the public agenda. They ought to know, if they do not already, that their actions and words in this place and elsewhere have consequences. It is a shame that others might be asked to pay the price for their irresponsibility.
I understand parents' anxieties. We live in an age in which we demand certainty but cannot have it; in which we want to live risk-free lives but cannot do so; in which we expect definitive advice from the experts whom we then distrust, and against whom we reserve the right to litigate when they get it wrong; and in which we are too often unprepared to take decisions for ourselves, or to take responsibility for those decisions when we do. In such circumstances, it is crucial that information on life-and-death issues—that is what we are discussing—such as MMR should be objective, balanced and, far as possible, politics-free.
That has not been the case in the debate. In the face of overwhelming evidence that MMR is safe and that the alternatives are less so, some papers have sensationalised the largely refuted research of just one doctor, and some Opposition Members, I regret to say, have jumped on the bandwagon. Together, they have sought to make political capital out of a public health issue. By design or default, they have collectively undermined confidence in MMR, contributed to a reduction in its uptake and thereby placed children at risk from the diseases that MMR had all but eradicated since its introduction into this country in 1988. The Public Health Laboratory Service now warns of an epidemic among four-year-olds beginning school, as mine will be after Easter.
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What are the facts? I shall abridge them because I am sure that others better qualified will spend more time on them in the debate, but 90 countries, 35 of them in Europe, pursue a policy of MMR vaccination. They include all members of the European Union, Australia, New Zealand and the United States, where some states do not accept admissions to schools of children who have not had MMR and other vaccinations. No country recommends three single vaccines in preference to MMR and 500 million doses have been issued since 1972.
The studies that have been referred to in the United Kingdom, the United States, Sweden and Finland have found no proven link between MMR and autism or Crohn's disease. The British Medical Association, the Royal College of Nursing, the Royal College of General Practitioners, the Royal College of Paediatrics and Child Health, the Community Practitioners and Health Visitors Association, the Faculty of Public Health Medicine, the Royal College of Midwives, Unison, Sense, the Royal Pharmaceutical Society, the Public Health Laboratory Service, the Medicines Control Agency and the Department of Health have all advised that MMR is safe.
Where, then, did this controversy come from? There was no new research at the beginning of December, no new evidence to launch the story into the headlines. Someone in a newsroom on a slow day just decided to turn up the heat under a trusted old potboiler—this is not the first time that the controversy has hit the newspapers. There is nothing like a health scare story to bide the press over a slack couple of weeks, not least because, as the hon. Lady conceded, there is no certainty in science. We can spend days, if not weeks, wringing our hands and agonising over what is true and what is not true, what is fact and what is not fact, what is trustworthy advice and what is a conspiracy of silence.
I make one crucial point about press responsibility. It was not what was said about MMR that caused the problem. The fact that the issue had been raised at all precipitated the controversy and, inevitably, parents' anxiety. A Daily Mail headline on 13 December said, "High rate of autism increases fears about jab". There was no report of new evidence, new research or a new study but simply "fears about jab". No attempt was made to link MMR with autism or the identification of autism. Three days later, Lauren Booth, writing in the same newspaper, said that
"the weekly flood of speculation on the subject is making us wary",
thus adding her own bucketful. Nothing was substantiated. The celebrities and influential people to whom the hon. Lady referred—[Interruption].
Mr. Deputy Speaker: Order.
Peter Bradley: Some newspapers had an almost dismissive attitude to truth, facts and standards of objective reporting. The Sunday Telegraph on 9 December, referring to a Department of Health report not yet published, headlined its story, "Studies fail to disprove autism link to MMR jab". Three days later, the headline in its sister paper The Daily Telegraph was, "Autism and MMR link not proven, say experts". By that time, the damage was done.

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We then had, as the hon. Lady mentioned, the case of Leo and the relentless crusade of the Daily Mail and other newspapers against an 18-month-old infant. It is as if all the medical evidence to which I have referred should be put aside and the only authority in this crucial public health issue be the man whom the Daily Mail most despises—the Prime Minister. On 23 December, Amanda Craig headlined her article in The Sunday Times, "Privacy be damned, Mr. Blair, parents are afraid."
Who is responsible for that fear and anxiety, and the risk under which they place parents and their children? I suggest that some elements of the press and some hon. Members search their consciences. There have been so many scoops about the incidence of Leo's jabs—the hon. Lady referred to some of them—that the poor child must feel like a pin cushion, if not a political football.
The press has not been the only example of the exercise of freedom without responsibility. The story has been politicised by the press and by some Opposition Members alike. I tabled an early-day motion on MMR on 13 February, which I hoped would be an all-party one. The first signatory was a Conservative, the hon. Member for Esher and Walton (Mr. Taylor). I pay tribute to his courage because so far he is the only Conservative MP to have signed it.
On 30 December, the shadow Health Secretary said that
"all the evidence suggests that it"—
that is, MMR—
"is the safest thing to do."
Unfortunately, by 6 February, he found it expedient to say:
"In the circumstances, I think that reluctantly we have to accept that single jabs may be the only way of giving children protection",
irrespective of the evidence that we have about pertussis, about what happens when children do not have their jabs and about the difficulties of administering six jabs instead of two.
The hon. Member for Bromsgrove said much about choice, which is one of her party's favourite issues. The issue is not about choice but about public health. We have responsibilities to each other in our communities, and the issue goes beyond party political doctrine. We know the risks of single jabs, and we know that we must balance the relative risks of MMR, such as they may be, with the known risks of improper immunisation. Some influential people in the newspapers and in this place have exercised their choice, but they have put children at risk thereby. I deplore that and find it deeply depressing.
Mr. Graham Brady: Will the hon. Gentleman give way?
Peter Bradley: No, I will not.
I shall finish with an anecdote. A researcher for one of the more influential Radio 4 news programmes phoned me not long ago and asked me to comment on a Standards and Privileges Committee report that I had not seen—nor had the researcher—about my hon. Friend the Member for Leicester, East (Mr. Vaz). When I declined, the researcher asked me whether I knew of anyone who "hated Keith Vaz" and who would comment. The question was chillingly but refreshingly
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frank, in an ironic way. I then said that I thought I had been phoned about the early-day motion on MMR that I had tabled the day before, and the researcher said that that was yesterday's story. Yesterday's story—until the next time that it is convenient to raise a scare in the media and in this place. I sincerely hope that we can find a way of immunising ourselves against a recklessly irresponsible press and a cynically opportunist Opposition.
11.42 am
Mr. Andrew Lansley: I shall be briefer than the hon. Member for The Wrekin (Peter Bradley). I should hate to be seen as sharing any of his views. I shall make my own arguments and not share any of his, which will ring hollow with the pharmaceutical industry, given the occasions on which he has attacked it.
I understand the points made by my hon. Friend the Member for Bromsgrove (Miss Kirkbride). However, I have considerable concern about one of them. I believe that previously she had not argued against the effectiveness of the MMR vaccine but had accepted that it was effective for its purpose. I am glad to see that she is nodding, because I would like to put that question to one side. The vaccine is effective: one has only to consider the reduction in measles, mumps and rubella in the population as a consequence of the introduction of the vaccine in 1998 to agree that it is effective for its purpose. The question that all hon. Members and I wrestle with is, what should be our response to concerns that are expressed by parents in our constituencies? What response should we give, not as scientists but as Members of Parliament?
I come from a constituency in which the worth of science is taken to heart, and I have the opportunity to speak to people in my own constituency who have undertaken research in precisely the area that we are discussing. I am convinced that the situation is not like others in which people have doubted the value of science. If one includes the word "Government" as an adjective to describe the scientists, it is even worse. Government scientists and medical advisers are not operating on the basis of supposition or presenting a hypothesis about the effectiveness of MMR or even a hypothesis about the lack of a link between MMR, inflammatory bowel disease and autism. They are working on the basis of substantiated trials and research that sought specifically to identify such a link but did not find one. As such, my conclusion is that a responsible public policy would proceed with, and sustain, MMR as a safe vaccine without proven side effects that question its safety.
The issue that the Government must contend with—perhaps the Minister might consider this briefly, even if he does not refer to it in detail—is that there must come a point at which parents' concerns about MMR reduce compliance with it to the extent that it is not a viable policy. I do not think that we have reached that point in my area, and I shall certainly continue to do everything that I can to sustain the take-up of MMR.
However, the hon. Member for The Wrekin is wrong: the issue is raised with me, as a Member of Parliament, expressly on the basis of choice. Although the great majority are opting for MMR, a small number of

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parents exercise their choice—privately, at present—to opt for the single vaccine. In effect, their children are protected in the intervals between vaccines by the herd immunity that is the result of parents opting for MMR.
That raises a serious issue. How ethical is one's choice if others, by virtue of the choices that they make, provide protection for one's children? The Government would move to difficult ground if they were to decide that, as a matter of public policy, we should make choice available. Such choice may mean that some people gain protection because of the right choices of others or, alternatively, it may lead to a much worse public health outcome. It has been clearly proven many times around the world—it is not a matter of patronising people—that asking parents to comply with six rather than two inoculations for three separate diseases leads to lower compliance than has been the case with the MMR.
There must come a point at which it would be right to make the single vaccine available, but we have not yet reached it. It is responsible of the Government to sustain MMR, and it is responsible of me, as a Member of Parliament, to encourage parents in my constituency to accept it. It is incumbent on all of us to debate these concerns; however, if science points to a conclusive position in support of the MMR vaccine, we have a responsibility to reflect that in what we say and do.
11.47 am
Dr. Stephen Ladyman: I will also try to be brief. I believe that I can safely say that, during my work for the all-party parliamentary group on autism, I have met, and discussed the issue with, all the leading experts in this country, corresponded with many of the leading experts around the world, read the vast majority of the research on the subject and given the matter considerable thought. We are not dealing with an open-and-shut case. I would not pretend for one second that we are, because that is not the nature of science. However, I could take hon. Members through the list of evidence that indicates that MMR is the right policy but, as it would probably take much longer than a one-and-a-half-hour Adjournment debate to do so, I shall touch briefly on only a few studies, ones at which hon. Members who have raised the question should take a long, hard look.
One is the Finnish study, rightly challenged by the hon. Member for Bromsgrove (Miss Kirkbride). It is only a small piece of the picture, but it provides strong evidence that MMR is safe. There are other studies, such as the one by James Kaye, which was reported in the British Medical Journal last year. It included a time trend analysis that looked for a correlation between the increase in autism and immunisation rates. It found that the levels of autism increased four times in the population during a period when the levels of immunisation with MMR were constant; there was no correlation between MMR and autism. In 1999, The Lancet published a study by Brent Taylor et al, which showed no evidence of temporal clustering in the north-east Thames region.
Each study in itself is not a complete answer. They are not proof positive, but they comprise very strong evidence supporting the case for MMR. Each can be
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taken apart by those campaigning against MMR because such people fundamentally misunderstand the process of science.
The process of science is to set up a hypothesis and test it. It is like building a big jigsaw puzzle: one has a small piece of the jigsaw in the corner and tries to find another piece that will fit. The question that one tries to answer is whether the pieces fit together. Sometimes the answer is yes, sometimes it is no. One cannot predict the shape of the next piece, the piece after that, or the full picture, simply because the answer is occasionally yes. Each study is only a small part of the total package. One cannot criticise individual studies for not being a total answer to the question.
I bring the attention of Opposition Members to two types of study that have produced strong evidence against MMR being the causal agent for most cases of autism. Research was carried out on thalidomide, examining the relationship between thalidomide damage and autism. A strong correlation was shown during the tragic experience of thalidomide. We know that thalidomide acted in the first three months of embryological development. There is strong circumstantial evidence that whatever causes autism happens during those first three months.
Other scientists have been looking for metabolic markers of autism. In the United States, several scientists believe that they have identified potential chemical markers that are present in babies shortly after birth and are a strong indication that that baby is going to develop autism later in life. Those scientists have described the chemical markers as the smoking gun that points to the development of autism. If the chemical markers are there immediately after birth, that child will have autism. Nothing will happen later in that child's life to trigger autism: he or she already has it, but it will take time to develop.
Those are important parts of the total evidence, but no one part is the complete picture. I acknowledge that, based on the evidence of Wakefield and others, a very, very small sub-group of children may get autism as a result of MMR. That cannot be disproved, but it is a long way from being proven. That sub-group consists of a tiny proportion, which did not show up even in the large studies that have been undertaken.
Ms Drown: Will my hon. Friend clarify whether it is the measles component or the MMR that is responsible for the effect on that group?
Dr. Ladyman: Based on Andrew Wakefield's research, if the effect is there at all, it is caused by the measles component. There is no reason to say that a measles vaccination would be any more or less safe than MMR.
However, Andrew Wakefield's research can be explained by other means. The findings of measles virus markers can be explained in some children on the basis of the immunological memory that one would expect immunised children to have. I can tell the hon. Member for Bromsgrove that many of Andrew Wakefield's co-workers do not agree that there is a link with MMR. I have discussed that with them, and they believe that there are other, equally valid, explanations for his findings, distinct from the one the hon. Lady advances.

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Even if we accepted that there was, in a small number of cases, a risk of a link between MMR and autism, I put to the hon. Lady the argument of herd immunity. Herd immunity is, as she knows, the phenomenon whereby one creates resistance to an epidemic throughout a whole community. If an infectious agent of a disease passes it on to another person who is susceptible to that disease, the level of the infection in the community is maintained. If the disease is passed on to more than one person, the level of infection increases towards epidemic proportions. If a high proportion of people are immunised against a disease, the whole population is partially protected. The 10 per cent. of the child population who have an injection but do not develop immunity are protected by herd immunity. When the hon. Member for Bromsgrove makes the choice not to immunise her child, she does not make it just for herself, but for my child also. She is taking away my choice in the matter: my child will lose herd immunity because she made a personal choice. [Interruption.] I shall not give way: the Deputy Speaker has ordered against it.
There is no such thing as choice in matters of public health. Whether we like it or not, we have to weigh the balance of the risks, consider the evidence and take a public health decision for the whole population. On that basis, I say that the Government have struck the right balance and made the right decision. It is inappropriate for the hon. Lady to suggest that we would maintain herd immunity with a single choice immunisation programme. She still questions my analysis, but most parents of boys do not believe that they need the rubella injection, so boys would not receive it under a single choice system. Most parents of daughters do not believe that they need the mumps injection, so girls would not receive it under a single choice system. In both cases, we would lose herd immunity if the single vaccination approach were adopted.
We have the experience of the pertussis events, where we exchanged a multiple injection for a single choice system. We found that the level of immunisation went from 80 to 30 per cent. That is the reality we shall have to deal with if we adopt single vaccines. We would lose herd immunity, and the hon. Member for Bromsgrove, by making a choice for her child, would damage the children of everybody else in this country.
11.56 am
Dr. Evan Harris: Let me start by saying that I do not think that the hon. Member for Bromsgrove (Miss Kirkbride) is being irresponsible. If she were open-minded, that would be a responsible attitude: I hope that she is. I do not think one should blame Back-Bench politicians for raising concerns on behalf of themselves and their constituents. That is, after all, what this place is for. It is more consistent for her to express doubts about the safety or effectiveness of MMR than for people to profess that they have no doubts about the safety of MMR and call for single vaccination. Conservative Front Benchers have done that, despite knowing that the evidence suggests that that would damage public health. There are people in my party, whom I respect, who take the view of the hon. Lady. I do not think that her scepticism about MMR is unique to her party, but the position of Conservative Front Benchers is harder to sustain.
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Our approach is based on several principles. We believe in sceptical scrutiny of the Government. I am dubious about almost all Government policies, including those in the arena of public health. They have failed on tobacco advertising and delayed and dallied on sexual health strategy. However, after careful scrutiny, we are prepared to back the Government's policy on childhood vaccinations. An approach that we commend to other parties is one of evidence-based policy making. It is hard for an Opposition party to sustain a position that Government should take a view contrary to that recommended by its expert medical and scientific advice. The Conservative party has to defend its view.
One must avoid bandwagon politics while being sensitive to parental concerns, which Conservative Front Benchers have not managed. I recognise that there are genuine parental concerns: I have never told any of my concerned constituents to have the MMR because I say so. I have always told them to talk to their GPs: it is more sensible for people to have a discussion with a doctor or health care professional than with a newspaper editor or a politician. We must be realistic about media behaviour. I agree in broad terms with the hon. Member for The Wrekin (Peter Bradley). Sadly, a story titled "MMR Proved Safe" would merit fewer column inches than "Health Scare on Immunisation". We therefore have to be careful about that.
On reading the evidence—I initially considered it with scepticism—my position is that MMR is safe and the most effective way to protect children from serious diseases. I criticise those who take a different view on some of the issues for being blasé about those diseases. Dr. Carol Vorderman, whom I had previously respected and, dare I say, admired, stated in The Independent that the vaccination
"was introduced only 10 years ago; what happened before? We didn't all die—we had a mumps inoculation, rubella and you just got the measles."
Dead children do not tell anecdotes. Such an approach is highly irresponsible for someone who is perceived to be an oracle on scientific issues, however rightly or wrongly.
The hon. Member for Bromsgrove said that we were concerned about such a full-frontal attack on the immune system, and that we knew or suspected that toxins in the brain were responsible for autism. I would be interested to know whom she meant by "we". Such an approach, with a pseudo-scientific justification for genuine concerns, takes people down an unhelpful avenue. It is almost certain to be a blind avenue unless the approach is based on scientific evidence. It does a disservice to autism, which is a devastating illness that is worrying in its incidence and prevalence. I am concerned that the focus on MMR will detract from other more fruitful and long overdue research into the disease.
Issues have been raised about general practitioners suspending patients from their lists to achieve immunisation targets. Will the Minister now abandon the immunisation target payments for GPs? They corrupt the system, are a conspiracy theorist's paradise and pollute the doctor-patient relationship. How can one have an open approach—how can patients believe that they are to be given independent advice from their GPs—when the spectre of financial incentive hangs over consultations? The Government did not introduce the policy, and they would do well to remove it.

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Similarly, it is wholly unacceptable for GPs to remove or suspend patients from their lists to gain immunisation target payments. While those payments exist, there will always be worry about that. I urge the General Medical Council and primary care trusts, the bodies that control the conduct and contracts of GPs, to clamp down severely on any suggestion that even temporary suspensions with no treatment implications have taken place to remove patients from lists.
It is appropriate to speak about the Prime Minister and his son. I have absolute sympathy with Leo Blair and limited sympathy with the Prime Minister. Politicians must be careful about parading their children in any circumstances and then claiming privacy. I urge all hon. Members to withdraw the subject of their children from the debate, and to stick to the facts and their opinions. Where would it end if practice in relation to our children were to become important in terms of the subject of public health? If there were a contraceptive pill scare, would people be asked what their spouses or young daughters used? I do not think that we want to go down such a path, and I cannot see the ethical difference between the two subjects.
Dr. Andrew Murrison: Does the hon. Gentleman agree that he is being a little hysterical, and that it is incumbent on the Prime Minister to show leadership in this country, as abroad? Had the Prime Minister done so on whether his son had been immunised, we might not face a measles epidemic on the scale that we do.
Dr. Harris: I asked people who are concerned about MMR whether their views would change if they knew that Leo Blair had had the vaccination, and the answer was that they would not. A change is worth making only if it will change one's practice, as I learned from my work in medicine. There is a fatal flaw. When Leo Blair was rumoured to have been vaccinated, the shadow Health Secretary said:
"If the reports are true, it is an astonishingly cynical move designed to deflect criticism from the Government's abject failure of policy".
In some people's eyes, it seems that the Prime Minister cannot win.
The Government have some difficulty on single vaccines and choice, but my view on the subject echoes that of the hon. Member for South Cambridgeshire (Mr. Lansley). They are right to accept that if MMR is the safest and most effective way to protect people from serious diseases in childhood, it is not appropriate to offer on the national health service something that is known to be less effective and could be less safe. Would that be appropriate in the name of choice? I hope that the NHS does not generally offer treatments that we know are dangerous to children simply because patients want the choice. Indeed, we should not offer a treatment that we know is in the worst interests of patients simply because they want it, and there is no ethical duty to do so.
If one knows that the rates of coverage will drop below their already low rates if the policy is changed, one also knows that it will mean more outbreaks of
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serious diseases and more deaths. The hon. Member for Bromsgrove did not have an answer on that. A change in Government policy would make that likely because there would be a loss of confidence in vaccination in general. People who would currently use MMR would abandon vaccination altogether.
Mr. Bill Wiggin: Will the hon. Gentleman give way?
Dr. Harris: In a moment.
When I suggested that to the hon. Member for Bromsgrove, she said that the situation was hypothetical. Her whole case is predicated merely on the hypothesis of a link between MMR and autism. At best, it seems inconsistent for her to refuse to engage with hypothetical questions when challenged.
The hon. Lady said that one could not apply the lessons of one vaccination to another when I pointed out that coverage fell by a further 30 per cent. when single vaccinations were offered during a whooping cough scare, and that there were thousands of cases and more than 70 deaths from the disease. However, the hon. Member for Woodspring (Dr. Fox) stated in a Conservative press release on 3 March 2001:
"It is therefore vital that we apply the conclusions drawn from the meningitis campaign to boost our MMR programme before unnecessary tragedies occur".
Many of the hon. Lady's colleagues do not seem to be unwilling to accept my proposition.
Mr. Wiggin: I was concerned by the hon. Gentleman's comment that coverage had already fallen. In my constituency in Herefordshire, there has been a 6 per cent. fall in coverage, from 93 to 87 per cent. We are debating not whether MMR is good or bad, but whether we can give people a choice. While coverage continues to fall, lives will be put at risk.
Dr. Harris: That is a fair point, and one that I can answer. The lessons of history advise us that to switch to something that the Government know to be less effective and possibly less safe—there is less evidence of its safety—would make levels fall further. That would expose more children. It would affect not only the children of parents who would currently give their children MMR, as they would lose faith and not vaccinate, but put at risk the babies of parents who still supported MMR but whose children were too young to be vaccinated.
I would not go so far as the hon. Member for South Thanet (Dr. Ladyman), who said that there was no free choice in public health. It is more reasonable to say that there are limits on choice in public health, and that we should strike a balance. Those on the Conservative Front Bench must explain how the Opposition can be the first in history to urge the Government not only to ignore all their medical and scientific advice, but also to go against it. If the then Government had done so on BSE, we would be in an even worse situation than we are in relation to that disease.
12.8 pm
Tim Loughton: I congratulate my hon. Friend the Member for Bromsgrove (Miss Kirkbride) on raising the subject,

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which is topical and heated, as she said. The strength of feeling is clear from the number of hon. Members present. She is well known for her personal interest in the subject, as a Back Bencher representing her constituents and as a mother of young children. I disagreed with some of her points, although I respected her for making many of them and agreed with many others. She is right to say that the key issue is one of public confidence, or rather lack of it, and specifically diminishing public confidence in the immunisation programme.
We are short of time today because the Government have not had a debate on MMR in their own time. If they are keen to reassure people, perhaps they should give up some of their own time rather than dealing with the matter at the fag-end of a debate initiated by a private Member.
The comments made by the hon. Member for Oxford, West and Abingdon (Dr. Harris) were, as usual, extraordinary. I am sure that the Government will be enormously relieved that the Liberals are supporting them on MMR, although, apparently, half the hon. Gentleman's party are not—but that is the usual situation. This is nothing to do with bandwagons. There has been more jumping on bandwagons in Liberal party circles than at the OK corral. It is a matter of public confidence and that is what we should be concerned with. We are all concerned with our children's health and we have a dual responsibility both as parents and as representatives of our constituents.
Let me repeat that the Conservative party remains absolutely confident that MMR is the safest form of vaccination available. It is not 100 per cent. safe—nothing is—but we think that it is the most effective way of vaccinating and protecting our children. However, we are not the ones who need convincing. People have lost confidence and in parts of London, in particular, the vaccination rates have fallen below 70 per cent.
I ask the Minister to give us the latest, up-to-date figures. She keeps telling us that the figure is only 84, 85 or 86 per cent. In a written answer to me yesterday she was unable to give the last quarter figures for 2001. The Government are basing their pronouncements on last September's figures, and a lot has happened since then.
I welcome the study performed by the Royal Free and University College medical school in London, with the Public Health Laboratory Service, which has been publicised by the British Medical Journal. The study followed 473 children with autism born between 1979 and 1998 and found that the proportion who showed decline in intellectual performance at the onset of autism was no higher after the introduction of MMR in 1988 than before. The study concluded:
"These findings provide no support for an MMR associated "new variant" form of autism with developmental regression and bowel problems, and further evidence against involvement of MMR vaccine in the initiation of autism."
As hon. Members have said, the royal colleges, GP organisations and all the other major medical bodies have given their vote of confidence to MMR. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley), in a very intelligent and useful contribution, mentioned the Finnish study, which started in 1982. Finland is the only country in the world to be documented as free of indigenous measles, mumps
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and rubella. The United States has been giving MMR vaccines since 1972 and before MMR was introduced in this country in 1988 some 30 different studies took place.
I welcome the extra £2.5 million going into autism research. I speak as vice-chairman of the all-party group on autism, of which the hon. Member for South Thanet (Dr. Ladyman) is chairman. He made some interesting comments about chemical markers that may affect the onset of autism before birth. However, we do not know for sure, and the public are increasingly sceptical about pronouncements from Ministers and from medical officers acting under instructions from Ministers. The vaccination rate has been falling and continues to fall.
This debate is about choice. The choice between MMR and no vaccine at all is not a choice. It is certainly not a choice that I recommend to any of my constituents, because measles is not a soft option—it is a killer. Getting rubella during pregnancy can lead to deafness, blindness and heart defects. We need more publicity about the deadly effects of catching those diseases, as well as mumps. The lack of confidence has been growing for months.
The hon. Member for The Wrekin (Peter Bradley) thinks that the Conservatives, in cahoots with Lauren Booth, the sister-in-law of the Prime Minister, have cooked up the controversy, as if people had not lost confidence until the Conservatives and Lauren Booth started saying things. Coming from a Labour Member, the suggestion that the Conservatives are using Leo as a political football really takes the biscuit.
For all those reasons my hon. Friend the Member for Woodspring (Dr. Fox), the shadow Secretary of State for Health, took the right decision earlier this month in saying that, because of the alarming fall in vaccination rates, the Government should now make the choice of single jabs available to those parents who refused MMR for their children.
Ms Drown: Will the hon. Gentleman give way?
Tim Loughton: I do not have time to give way—I was very generous in giving way in a previous debate.
People have been losing confidence. We have all heard anecdotes. We have all been rung up by constituents who say that they are scared stiff about the prospect of MMR. One of my constituents—Mrs. Lewis from Worthing—was quoted in the local paper two weeks ago. She said:
"I think parents should be given the choice".
Her older children were vaccinated 10 years ago. She went on to say:
"At the time, we were just told the vaccines had been combined. As mums we thought it was great because we didn't have to put our kids through three injections. But there has been a lot of data since then."
She criticised the lack of information available to parents about MMR and the possible side effects, and went on to say:
"There will be some parents who don't have their children vaccinated but the majority of parents—99.9 per cent. of parents—just want their kids immunised. That's the most important thing."

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The bottom line is that, if the rate of vaccination falls across the country from the 95 per cent. required to 70 per cent., as it has in parts of London, that could leave 148,000 children without immunisation, out of a total of 591,000. That would have the makings of a grave epidemic. The loss of confidence is desperate. The Minister herself said a week ago in The Guardian:
"The public no longer accepts Government reassurances about health risks."
She is dead right and she must take some of the blame for that. A poll conducted by ICM for The Guardian two weeks ago showed that 75 per cent. of people want the Government to provide free separate jabs. Only 73 per cent. of those with young children would choose MMR and 19 per cent. were so worried that they were prepared to pay for separate injections themselves. Only 20 per cent. said that they trust advice from politicians and officials "a lot". Some 47 per cent. trust such advice "a little" and 30 per cent. disregard it altogether. Unsurprisingly, only 6 per cent. trust "a lot" what journalists have to say, so the Government cannot pin all the blame on what people read in the papers.
A poll published in The Telegraph on 9 February said that four out of 10 parents with small children—this is contrary to the claims of the hon. Member for Oxford, West and Abingdon—said that the Prime Minister's equivocation about his son's treatment had dented their confidence in MMR. What has been the Government's response? Apparently, they are going to launch an advertising campaign. We would like to see the evidence of its effectiveness, because Roger Hayward, the chairman of the Public Relations Standards Council, warned that such a campaign could backfire. He told the "Today" programme:
"The public are very canny and they know that anyone who is advertising on an issue as significant as this is really admitting, `I'm sorry, we can't convince the journalists, so we are going over their heads to try to reach you directly.'"
There are several important questions with which I hope the Minister will deal. People are choosing single jabs for their children and the Government are doing nothing about monitoring the effectiveness or the regulation of those jabs. One in 70 of the licences for vaccines being imported from France is for a single jab—a ten-fold increase on the previous year, according to the Medicines Control Agency. However, in a written answer to me yesterday the Government revealed that they have no idea how many people are having single jabs.
The Government need to do some research. Are they monitoring who is giving those jabs? A private clinic in Lincolnshire said that it received 10,000 calls a day inquiring about single jabs. Are the Government monitoring charges? We are now hearing stories of people paying anything from £240 to £560 for a set of three single jabs in different parts of the country. Such people are voting with their feet and paying out of their own pocket because they do not trust the advice that the Government have been giving. Are we monitoring those health authorities taking action against individual GPs who want to give single jabs?
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I have also been told that the waiting time for single jabs is going up because of the lack of vaccines. Those are all questions that the Government cannot ignore, because many thousands of parents are opting for that course of action because, for them, MMR or nothing is not a choice. That is what the debate is about.
It was irresponsible of the chief medical officer to say that taking a single jab was like playing Russian roulette. That undermines enormously the confidence of those many thousands of parents who have taken the desperate action of getting single jabs for their children. The debate is not about the Prime Minister and the Government proving that they are right and that the wicked Tories are wrong. It is about treating the genuine fears of ordinary parents with respect and giving them a choice rather than no choice. Concerned parents have now been added to the ranks of "wreckers". However much the Minister may disagree with them, they have genuine fears and are exercising their power to opt out if they see fit. The Government urgently need to restore confidence; until they can take every step to increase coverage, they should offer choice.
12.20 pm
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I congratulate the hon. Member for Bromsgrove (Miss Kirkbride) on securing this debate. MMR is an extremely important issue which affects the lives of our children even before they are born, and I know that she feels strongly about it. However, I deeply regret the climate in which the debate is taking place and the opportunism that has been shown by some Opposition Members in discussing something that is so important to our children's health.
In the limited time available, I want to deal as fully as possible with the serious issues that have been raised: the safety of MMR, the worth of separate vaccines and the question whether government policy should change.
Concern has been raised about whether MMR causes autism. As my hon. Friend the Member for The Wrekin (Peter Bradley) has said, it is used in 90 countries. It is recommended not only by the Government, but also by a series of independent bodies including the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the Royal College of General Practitioners and many of their counterparts in other countries, as well as the World Health Organisation and independent bodies around the world. In this country, the Committee on Safety of Medicines and the Joint Committee on Vaccination and Immunisation have reviewed all the evidence concerning autism. The Medical Research Council has now reviewed MMR, bowel disease and autism three times. All the organisations that I have mentioned have stated their full support for the present policy and for the overwhelming conclusion that there is no link between MMR and autism.
In the United States, the American Academy of Paediatrics and the Institute of Medicine have also undertaken huge reviews of MMR and have come to the same conclusions. All the expert bodies have been very clear and their advice has been strong: plenty of evidence shows that there is no link between MMR and autism and we should continue with a programme offering MMR, not separate vaccines.

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My hon. Friend the Member for South Thanet (Dr. Ladyman) gave examples of evidence. I should like to highlight further examples of the research that medical experts tell us is so important. For a start, a study of all children in the North Thames area found no impact on levels of autism when MMR was introduced. In 1988–89, most under-fives were vaccinated with the MMR jab. Before 1988 there was no MMR jab; after, it was almost universal. Was there a step increase in autism? No, there was not. No impact on the level of autism could be found, because it had been increasing before 1988, and it continued to do so after 1988. Other studies, both here and abroad, have found similar things.
In addition, there is evidence of regressive autism not having been affected by the introduction of MMR in 1988. Many individual cases have been studied. In 1998, the Committee on Safety of Medicines set up an independent group of experts to examine 110 cases, looking at reports from the families, the GPs, and the specialists looking after the children whose parents feared that their autism might have been brought on by MMR. The written records of nearly 40 per cent. of the children showed that health professionals had already had concerns about their development before they had MMR and nothing in those detailed investigations implicated the MMR vaccine.
The hon. Member for Bromsgrove raised the issue of Dr. Wakefield's research and the recent research statements that he has made. Independent experts have serious doubts about the validity of Dr. Wakefield's methods and his results, as well as about the design of the study. For example, Dr. Bellini, head of the measles laboratory at the Centres for Disease Control and Prevention in Atlanta in the United States, said that there was
"gross overstatement of the results and impossibility of interpretation of their findings."
None of the research by Dr. Wakefield implicates MMR. The latest study does not even mention whether the children studied had had an MMR jab, a single measles jab or any jab at all—or had had measles.
On Radio 5 earlier this month, Dr. Wakefield said that some of the children in his study had had the single vaccine and that the virus was present there. That is one of the key issues that the chief medical officer raised in his letter to Dr. Wakefield, in order to try to ensure that the statements made receive proper academic and public scrutiny. The evidence on MMR is clear. Experts advise us that there is plenty of research that finds no link between MMR and autism.
The hon. Member for Bromsgrove is pushing the view that single jabs are somehow less risky and represent a precautionary approach. All parents want to do what is safest for their children; they want to take the fewest risks. There is no evidence that single jabs are less risky or less likely to cause autism or anything else. Parents have been misled.
Mr. George Osborne: If a parent decides, however irrationally, not to give his child the MMR vaccine, would the Minister recommend that that parent arrange for the child to have three vaccinations or for it to have none at all, leaving the child unprotected?
Yvette Cooper: The clear recommendation of all medical experts in the field is that parents should arrange for the MMR jab. Parents are being misled by statements like that made by the hon. Member for Bromsgrove, about the protection afforded by single jabs, and are led to believe that the single jabs are somehow less risky. That has arisen due to the hon. Lady's confusion over technicalities, which I shall be happy to write to her about. However, she is wrong and is misleading parents as a result. There is extensive evidence about the problems and the risks that would be posed by introducing single vaccines on the NHS.
Andrew Selous: Will the hon. Lady give way?
Yvette Cooper: No, I do not have time. The hon. Member for Oxford, West and Abingdon (Dr. Harris) clearly stated the problems involved in introducing six separate vaccines. Recent research in Chester has suggested that two thirds of children currently going for separate jabs do not complete their courses. The advice that we have received is clear: coverage would fall if we introduced separate jabs, not only because people would be less likely to complete the course but because children would be unprotected between injections—Dr. Wakefield recommended having a year between them—and because of the impact on confidence of introducing separate jabs.
The hon. Member for Oxford, West and Abingdon mentioned the impact of introducing separate jabs for whooping cough in response to similar anxieties. That led to substantially lower coverage and lower coverage of all other vaccines also. In that case, many thousands were admitted to hospital and around 100 died. The clear conclusion from the medical experts is that introducing separate jabs would make things worse. It would lead to lower coverage than at present, not higher, and would leave many more children exposed to deadly diseases. That would mean more cases of measles and of mumps, more pregnant women exposed to rubella and, ultimately, more children dying as a result.
I do not see how any Government could responsibly listen to all that medical advice—knowing that if we introduced separate jabs we would put the health and lives of more children at risk—and choose to ignore it because it was politically easy to do. Of course it is politically the easy thing to do, but it is morally the wrong thing to do. The advice to us is clear. I do not see how we could look those parents in the face, either. Parents are deeply concerned because they want to do the right thing for their children. Opposition Members are asking us to implement a policy that would put children across the country at risk. What do they say to the royal colleges, to the nation's top children's doctors, to all the medical experts who have told us that that would put the lives of more children at risk? It would be deeply irresponsible to do so. Those on the official Opposition Front Bench hide behind all kinds of weasel words, saying that they have only just called for single jabs and that that is only because the levels of coverage are falling.

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Last year, the hon. Member for Woodspring (Dr. Fox) said that his party would introduce separate jabs if coverage did not rise. At the time, a parent said, "Well, I saw that Conservative on telly saying that we should have single jabs. He's a doctor; he should know." Yes, he should know. He should know better and he should listen to the medical experts and medical bodies that are advising us that to do that would put children's lives at risk. Parents want information. They have a right to information and they want their questions answered. We must find more ways to give them answers to their questions. We do not want to put their children's lives at risk.

Redundancies (Receivership)
12.30 pm
Mr. David Miliband: Judging by the number of hon. Members who were in the Chamber, I thought that there had been a sudden outbreak of interest in the position of workers who are sacked by companies in receivership. I am sorry to see Opposition Members leaving the debate.
The Government committed themselves in their 1997 manifesto to significant measures to ensure fair treatment at work. I am delighted that, since then, those aspirations have become legislation on the minimum wage, the rights of trade union recognition and more rights for part-time workers. Those measures are an important down payment on our vision of economic renewal that is based on partnership at work.
By contrast, today's debate focuses on a group of workers for whom the burden of insecurity and risk remains unfair. I am talking about employees who are sacked by companies in receivership. I want to stand up—as do my hon. Friends—for that group of workers, draw out the Government's thinking on such an important matter and find out how such an injustice can be remedied. For reasons that I shall explain, 350 sacked workers in south Tyneside have a particular interest in the debate. They are looking to the Government for help. Their cause is just and I look forward to the Minister's comments.
In September last year, 1,150 people producing printed circuit boards for a parent company called ViaSystems Ltd., based in the United States, were told that the company that employed them had gone into receivership. A second plant located north of the river Tyne was closed. The announcement raised a host of difficult issues, not least those concerning the good faith of the parent company and its use of public funds. But that is not my main interest today. The debate is about the human misery that arises from a loophole in the law as it affects sacked workers.
For 11 weeks after the receivership was announced, there followed a tense—not to say hair-raising—period of intensive activity to save the South Shields plant. I am delighted that the management buyout team was given outstanding support by public bodies in the region and, ultimately, by Ministers in the Department of Trade and Industry. The employees are highly skilled and the plant had been the subject of enormous investment, which made a new start possible. In early December, I was privileged to help launch a new company, Circatex, with the chief executive, Charles Brooks. We are hopeful that it will become Europe's leading PCB manufacturer.

However, we learn that with every silver lining comes a cloud. Within days of the announcement of the receivership in September, 350 workers had been sacked. They included people such as Selby Armstrong, a chemist with 33 years' service at the plant; Susan Feasey, a production worker with 21 years' service; Marjorie Joseph, a printer with 26 years' service, and Val Smith, a supervisor with 33 years' service. Although the launch of Circatex saved 800 jobs, I am sorry that it could not get their jobs back for them.
I do not need to explain to the Minister what it means to people to lose their jobs in an area of high unemployment. They were committed workers with

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precious manufacturing jobs, who had years of service and genuine skills. Expert and active support from the Employment Service has ensured that about 120 of the sacked workers have now found alternative employment, but for all the workers concerned, the original redundancy announcements were only the beginning of a longer nightmare. Most importantly, key rights—above all, to redundancy pay—lost the vast bulk of their worth.
The legal position for workers in companies that go into receivership is complex. I shall outline it briefly. Payments owed under employees' contracts are treated as unsecured claims. The Insolvency Act 1986 gives employees some preference in the restoration of those claims for back pay up to £800 and for holiday pay, but redundancy pay has never been given that degree of preference, so many employees are left with redundancy entitlements that are not worth the paper on which they are written.
Mr. Bob Blizzard: I wish to bring to my hon. Friend's attention an example from my constituency that supports his argument. I refer to Zephyr Cams, a company in Lowestoft. Its 100 employees knew from the accounts department that any income that the company received was transferred immediately from it. They watched while bailiffs removed machines from its factory to pay off debts. When the company eventually went into receivership, the employees were owed wages and redundancy payments. To their horror, they found that the American owner of the company, Mr. Kenny Joseph, had taken the same action with companies in Weston-super-Mare and has now transferred the assets of Zephyr Cams to a company up the road.
Mr. Miliband: I am grateful to my hon. Friend for bringing that example to my attention. I do not know the details of the case to which he referred, but it seems that sacked workers in his constituency have been left with worthless redundancy and contractual entitlements.
The Redundancy Payments Act 1965 tried to plug the gap. Under the Act, the Government offer a safety net for employees. In respect of a maximum of 20 years' service, ex-employees are now entitled to a maximum of £240 for each year worked between the ages of 22 and 40, and £360 for each year worked between 41 and 64. The maximum statutory redundancy payment is £7,200. Thanks to the Employment Relations Act 1999, that figure is uprated annually in line with inflation.
However, the tattered nature of that safety net becomes evident when we consider the contracts that the ex-employees at ViaSystems had signed. The contracts of the most experienced workers, which dated back to when the site was owned by Plessey, guaranteed them four weeks' pay for each year worked. So, instead of my constituents receiving £7,200 from the Government, they should have been entitled to much more. According to his contract, Mr. Armstrong was entitled to £46,000 in redundancy pay, but he received £7,200. Susan Feasey could have expected £25,000, but received £6,500. Marjorie Joseph has lost out to the tune of £32,000 and Val Smith has lost £51,000. That toll of misery goes way beyond the trauma of life without work. It puts at risk a life's work.
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I know of a constituent of my hon. Friend the Member for Jarrow (Mr. Hepburn) who, according to his contract, should have received £170,000 in redundancy pay for a career of service. He received £7,200 instead.
Mr. Stephen Hepburn: I congratulate my hon. Friend the Member for South Shields (Mr. Miliband) on securing this important debate. It is noticeable that the Tories and Liberal Democrats are not present and I hope that that fact is remembered. I pay my hon. Friend specific tribute for saving hundreds of jobs by launching the firm that has taken over ViaSystems. He should be praised for his great work. I am sure that he agrees that we should applaud the attitude of the work force he represents. They have endured injustice, but they bear no animosity. We have a Government who listen. We have seen that happen in cases that involved miners and in asbestosis cases. My hon. Friend will agree that the Government must listen to the redundant workers.
Mr. Miliband: My hon. Friend makes a powerful point. By any standards, what has happened in south Tyneside—an area that covers both our constituencies—is worse than rough justice. Our constituents feel let down by the system. They feel battered through no fault of their own. They have paid into the national insurance fund, but then found that the insurance policy had holes in it. Now they want reform.
We must discuss two aspects of reform: first, the legal position and, secondly, the safety net. The Government recognised some of the legal dilemmas in their White Paper on insolvency entitled "Productivity and Enterprise—Insolvency: A Second Chance", which was published last year. It highlighted the sole accountability of the administrative receiver to its appointer and the desirability of creating a system under which all creditors have a duty owed to them. The White Paper also signalled a willingness to follow Germany and Austria in abolishing Crown preference—to the benefit of unsecured creditors.
However, the White Paper did not consider workers who expected redundancy pay. I hope that the Minister will set out today the Government's thinking on how to treat redundancy pay in the future. Why should it not have the same preferential status as back pay? It is anomalous that employees' rights to redundancy pay are stuck at the back of the queue while holiday entitlements are paid. It is a matter of fairness in the division of spoils from failed companies. I do not envisage public spending implications, and I believe that justice should prevail.
A second aspect goes beyond the legal position. It relates to the operation of the Government redundancy scheme. The latest Library figures, which relate to 1999, suggest a net outlay of some £150 million on the scheme—£170 million paid out, and £20 million received in return. However, if the original maximum compensation of £40, introduced by the 1965 Act, had been uprated in line with inflation since 1965, it would today be worth not £200 or £300 but £460, almost doubling the £7,200 maximum to which former employees are now entitled.

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Similarly, the Government payment was designed originally to equate to a weekly wage but no longer does. The average weekly wage today is slightly more than £400. The Minister may correct me, but I believe that it is about £409—much higher than the £240 currently paid.

In addition to considering increasing what is effectively a flat-rate benefit, we should consider alternative methods of proceeding, such as relating statutory redundancy pay to contractual entitlement and/or length of service. I should like the Government to consider the feasibility of a graduated scheme. Statutory redundancy pay could be linked to contractual entitlement. The fundamental unfairness of the ViaSystems case relates to the gap between expected payments under contract and actual payments under the statutory scheme. It is simply not right that someone with a contractual entitlement to £50,000 receives the same as someone with an entitlement to £10,000. The latter receives 70 per cent. of their contractual entitlement; the former not even 15 per cent. Reform is, therefore, essential.
Entitlement under the statutory scheme could be specified as a percentage of the contractual entitlement, or the state minimum, whichever is higher. That would at least mitigate the catastrophic loss that redundancy currently represents. If it were set at, for example, 50 per cent. of entitlement, my constituents would take a hit from their redundancy, but they would not lose everything, as happens at the moment.
My second idea complements the suggestion that payments should be related to expected entitlement. Redundancy pay should be linked more closely to length of service. The current approach of paying more for years served by older workers is a nod in that direction, but in other countries and parts of the private sector, it is a clear principle that long service should be rewarded. A statutory formula based on length of service is used in Austria, Portugal and Spain; in France, the Netherlands and Germany, social compacts agree payment, and length of service comes into play. The Library reports that, in the private sector, companies as diverse as Lloyds TSB, Johnson Wax and Matushita (UK) relate redundancy payments to length of service. Ideally, those two elements of graduation—relating payments to entitlement and to length of service—could be combined. For example, those with 20 years' service could be guaranteed 50 per cent. of their contractual entitlement; those with 10 years' service 30 per cent., and so on.
Obviously, those ideas need work. I do not expect the Minister to announce today that he has turned Government policy on its head. However, I am hoping for a commitment from the Government to consider the principles underlying a revised scheme, to accept that more work is needed on the subject and a willingness to work with all interested parties for reform. The matter may not be front-page news and may not affect the majority of people. However, I believe that British people have a strong sense of fair play. The scheme currently goes against fair play and should, therefore, be reviewed and reformed.
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The tragedy in my constituents' case is that a change in the law would not help them. Former ViaSystems workers realise that it would not change the position. However, they believe that others should be protected in future, and that is why they came to London to present a petition to the Prime Minister two weeks ago.
The pain of redundancy is harsh enough. It should not be combined with the theft of livelihood. It is time for a change, and I look forward to the Minister's reply.
12.44 pm
The Parliamentary Under-Secretary of State for Trade and Industry (Nigel Griffiths): I congratulate my hon. Friend the Member for South Shields (Mr. Miliband) on securing a debate on this important subject and for his efforts in pursuing the interests of his constituents who were formerly employed by ViaSystems Tyneside Ltd. I add my voice to that of my hon. Friend the Member for Jarrow (Mr. Hepburn) and congratulate my hon. Friend the Member for South Shields on his vital role in securing the management buyout of the south Tyneside plant by Circatex Ltd., which meant the continued employment of hundreds of his constituents. For that he deserves the highest praise.
It is always regrettable when employees lose their jobs through no fault of their own, such as through an employer's insolvency. However, such circumstances are commercial matters for the parties involved and are not open to direct Government intervention. Our role is to provide help and support for business when appropriate and to ensure that employees have a framework of minimum safeguards through employment rights legislation.
The DTI has in place a toolkit to help employees of companies that are in difficulty and close. When redundancies are inevitable, we do everything possible to help people find new jobs and, if necessary, acquire new skills. The job transition service can provide an intensive and personalised response to large-scale redundancies and work with local partners, and has a good record of finding new employment for people affected by major job losses.
We actively support manufacturing jobs in the region and the creation of strong regional economies. We pledged £1.2 billion, which will rise to £1.7 billion, to regional development agencies to support innovation and enterprise, and in raising the game in every region RDAs are working in partnership with the public and private sectors, businesses, universities and local authorities.
To summarise employees' statutory entitlements on the insolvency of their employer, the Employment Rights Act 1996, which consolidates earlier legislation and implements the European Union insolvency protection directive, allows for certain debts owed to former employees of an insolvent employer to be met up to statutory limits by the Secretary of State from the national insurance fund. Such debts include not only statutory redundancy payments but also arrears of pay, holiday pay, compensatory notice pay and basic awards of compensation for unfair dismissal. Claims for such payments are processed on the Secretary of State's behalf by the DTI's redundancy payments service. I understand that claims received from former

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employees of ViaSystems Tyneside Ltd. have been processed and paid by the redundancy payments service under those provisions.
Mr. Russell Brown: Matters are often not as clear as the Minister describes. I have some experience, with a knitwear company in my constituency that went into liquidation some 15 months ago. The employees are still awaiting redundancy payments, as the DTI declared, I suspect rightly, that the company re-started five days after the doors closed and was operating again. That is an issue. A safety net is provided, but the matter is never as straightforward as is sometimes portrayed.
Nigel Griffiths: Indeed. My hon. Friend fought hard to raise the issue at the time on behalf of his constituents, for which they were especially grateful.
When the Secretary of State makes payments on an insolvent employer's behalf, she becomes a creditor in the insolvency proceedings in the employees' stead, and the national insurance fund can thus recoup a portion of money paid out. The portion recouped obviously depends on factors such as the value of assets remaining in the insolvent business, the level and type of debts owed to other creditors, and the respective preferences accorded to those debts under insolvency legislation.
Although my hon. Friend the Member for South Shields did not mention it in his speech, I am aware that some comment has been made about the sale of part of the ViaSystems parent company to a new owner registered in the Cayman Islands in 2000. It may be helpful if I explain that that has no bearing on the former employees' entitlements. Their contracts of employment were with the ViaSystems subsidiary in Tyneside not the parent company. In any event, provided that former employees of an insolvent company worked in Britain, it makes no difference to their insolvency payments whether the company has a Britain-based or overseas owner.
Hon. Members may like to know that a proposal to revise the European Union insolvency protection directive is currently under negotiation in Brussels. It is designed to take account of changes in insolvency practice and law that have taken place in member states since the original directive was adopted in 1980, and other factors, such as the dynamism of the internal market and the need for consistency with other Community directives on labour law.
The Government support the Commission's proposals in principle and expect the revised directive to be adopted later this year. That will afford us an opportunity to update our domestic implementing provisions and ensure that they are operating as effectively as possible. We will, of course, carry out full public consultation before making any changes to legislation and I am sure that hon. Friends who take an interest in the issue will want to make their views known at that stage.
On employees' rights on redundancy, in cases in which employers propose to make collective redundancies—20 or more at one establishment within a 90-day period—they are required to inform and consult the affected employees through representatives and notify my right hon. Friend the Secretary of State.
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Those requirements are contained in the Trade Union and Labour Relations (Consolidation) Act 1992, which implements the EU collective redundancies directive and applies to insolvent employers exactly as it does to solvent employers.
The main thrust of the speech made by my hon. Friend the Member for South Shields concerned redundancy rights of employees, especially the amount of statutory redundancy payment for which they may qualify and which he considers inadequate. Unlike insolvency payments, statutory redundancy payments are not currently covered by European law, nor has any formal proposal yet been made that they should be. The entitlement of employees working in various member states is therefore determined by the law and practice of the country in which they work.
The purpose of the United Kingdom's statutory redundancy payments scheme is, as my hon. Friend suggested, to provide a minimum safety net for compensation for redundant employees for the loss of expected continued employment. It leaves employers and employees or their representatives free to negotiate more favourable severance terms on a contractual basis according to their priorities, needs and circumstances and what the business can afford. In many cases, that is what they do, and the Government welcome that.
My hon. Friend suggested that the amount of redundancy payment payable from the national insurance fund to former employees of an insolvent employer ought to be linked to their contractual entitlement rather than limited to the statutory redundancy payment amount. We do not agree. It would significantly increase the costs falling on the national insurance fund and, ultimately, on the taxpayer. Moreover, it would benefit the relatively well off, with generous terms and conditions, and do nothing for those on lower contractual entitlements.
My hon. Friend suggested that the calculation of statutory redundancy payments ought to take more account of length of service. However, length of service is already an important factor in the calculation. I will explain the formula used in the calculation, which may illustrate the point. The amount of the lump sum statutory redundancy payment depends on three things: how long the employee has been continuously employed by the employer; how the employee's years of continuous service relate to a particular age band; and the rate of weekly pay at the time of dismissal, up to a weekly limit.
For each complete year of continuous service between the ages of 18 and 21, former employees receive half a week's pay. For each complete year of continuous service between the ages of 22 and 40, employees receive one week's pay, and for each complete year of continuous service between the ages of 41 and 65, they receive one and a half weeks' pay. Over the age of 64, the amount is halved and is extinguished at the age of 65—the underlying aim of the scheme is to compensate for the loss of expected continuous employment and, as retirement age is reached, that expectation diminishes.
The maximum number of years' continuous service that can be counted for statutory redundancy payments is 20. The length of continuous service is counted backwards from the relevant date—generally that on which the notice of dismissal given to the employee ends.

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If the employer gives less than the legal minimum notice, the extra notice that should have been given is added. If the employee is entitled to a longer period of notice under the contract of employment, and the employee received the notice but did not work it, the date up to which continuous service is counted may be later still. Certain absences such as sickness, pregnancy or temporary shortage of work can count toward continuous service even if the contract of employment is suspended during that absence.
I hope that hon. Members will agree that length of service is already accorded a great deal of importance in the calculation of statutory redundancy payments. It may also be helpful to mention the statutory limit on a week's pay used for such purposes. As my hon. Friend said, section 34 of the Employment Relations Act 1999 abolished the previous requirement to conduct an annual review of award limits and established a revised mechanism for annual changes in award limits in line with retail prices. The Secretary of State is required to change the limits accordingly by order.
To bring hon. Members up to date, the most recent uprating took place this month, when the limit on a week's pay was raised from the £240 mentioned by my hon. Friend to £250. The Government consider that the mechanism put in place in 1999 constitutes a suitable and effective means of ensuring that the limit on a week's pay remains fair and appropriate. I take my hon. Friend's point that in earlier years the levels of the limits may have been eroded in real terms, but I take no responsibility for the decisions of previous Administrations.
My hon. Friend mentioned the White Paper on insolvency, which will be followed up in our enterprise Bill. The White Paper afforded us the opportunity to undertake a wide-ranging review of corporate and personal insolvency issues. As my hon. Friend suggested, important proposals were put forward, including the abolition of Crown preference, which
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would leave more assets remaining in an insolvent company for distribution to other creditors, including any employees owed money.
We have it in mind to introduce a ring-fence mechanism to ensure that the benefits of abolishing Crown preference flow to unsecured creditors. That will benefit people after payments have been made to preferential creditors and for administration costs. A proportion of the money available for distribution will be ring-fenced for unsecured creditors, and employees may benefit in that capacity for the part of the debt that is not preferential.
I note my hon. Friend's suggestion that redundancy payments should be accorded the same preference as debts such as pay arrears. Although not specifically mentioned in the White Paper, I can confirm that we are giving further thought to that point. However, the preferences set out in the insolvency legislation were carefully considered when they were originally introduced and the need to examine them in the round rather than in a piecemeal way must influence the way in which we approach the issue.
I hope that I have answered my hon. Friend's key questions. I have every sympathy for former employees of ViaSystems Tyneside Ltd.—especially those who have yet to find alternative work—and for redundant employees of the other businesses. I am grateful to my hon. Friend for raising an important issue. I repeat that thanks are due to him for his sterling efforts to secure employment for those made redundant who are now re-employed. I commend that model to all hon. Members who might be confronted with similar circumstances with regard to companies in their constituencies that face the terrible plight of insolvency. The work of the regional development agencies, and the other mechanisms that the Department of Trade and Industry has established, place us in the forefront of the drive to ensure that employees who lose their jobs have the chance to secure comparable employment and to learn the new skills that they require. I thank my hon. Friend for raising this important matter.

RAF Lyneham
1 pm
Mr. James Gray: I have not secured the debate to seek to discover the outcome of the study that the Ministry of Defence is undertaking, or to hasten its publication. The Department's officials hope to submit the study to their Ministers by 18 April, and the Ministers hope to produce an outcome based on that report by the summer. That timeframe is acceptable to those of us who live near RAF Lyneham and who seek ways of ensuring that the base remains open, and as profitable and active as it is at the moment.
The purpose of the debate is not to hasten the outcome of the study, but to have some input into it. Wiltshire county council, North Wiltshire district council, and local parish councils such as Calne, Lyneham and Wootton Bassett, are keen to play an active part in consultations during the preparation of the report rather than after its publication.
With regard to that matter, I take great encouragement from a written reply that I recently received from the Minister. I asked what discussions the Ministry of Defence has with other Departments when it considers the closure, partial sale or relocation of a military base. He answered:
"Officials are fully aware of the impact of such changes on local communities and it is the MOD's policy to initiate an early and close dialogue with the local authorities and the regional government offices concerned."—[Official Report, 18 December 2001; Vol. 377, c. 175 W.]
So far, that does not seem to have been the case with regard to Wiltshire county council and North Wiltshire district council. A recent meeting that they held at RAF Strike Command led them to form the impression that they would be consulted only after the report had been produced, merely about the effects and consequences of its recommendations.
I wish the Minister to take the opportunity to re-confirm that he will make active use of the expertise of Wiltshire county council and North Wiltshire district council—and of myself—during the remainder of the period for preparing the report, although I accept that that cannot be done with regard to strategic and secret matters. If the Minister states that that will be the case, I will pass on that glad news to my colleagues in Wiltshire.
With the intention of informing the report, an ad hoc committee in my constituency—whose members include several retired RAF officers and representatives of all the local authorities—has composed a detailed and technical report in the past few months. I handed a copy of it to the Minister before the debate. We hope that he will take it fully into consideration when he reaches conclusions on the Department's report.
The ad hoc committee's report sets out the severe economic effects that the closure of RAF Lyneham would have on my constituency; it would do, wouldn't it? There are 2,500 RAF personnel at the base, and 750 civilian employees. Assuming that most of those people have families, it is fair to estimate that about 10,000 people in my constituency owe their livelihoods directly to the RAF—and we must also remember the schools, shops, entertainments, churches and other services and organisations that cater for them.
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Wiltshire county council's economic appraisal study, which is appendix 1 to the report, concludes that the local economy would lose about £75 million per annum if the base were closed. I acknowledge that, if the Hercules fleet were withdrawn, something else of greater economic benefit might replace it. However, one merely needs to glance at similar places where a large military base has closed to see that it might take several years of extreme economic hardship before the area recovers. Corsham in my constituency is a good example of that. After the Army pulled out, it suffered great social deprivation and hardship for approximately 10 years. The economy of the town is now picking up again, partly because the Defence Communications Services Agency is based there. Nobody—including the Minister's hon. Friends who represent the town of Swindon—would want the Corsham experience to be repeated around Lyneham.
We appreciate that, although the Minister wishes to take such economic consequences into account in coming to his conclusions, his role is to address the strategic issues involved in deciding where the plane should be based. The report that I handed to him this morning attempts to do that. There is no point in us simply saying, "If you close our base, it will cost us thousands of jobs," because the response would be, "Well, you would say that, wouldn't you?" Therefore, our report seeks to make a useful and dispassionate contribution to the strategic considerations of the debate.
There are several important strategic issues that the Minister should take into account. He is aware that the airmen and airwomen of RAF Lyneham play an outstanding and crucial role in the defence of the nation. The modern, manoeuvrist expeditionary type of warfare, which was highlighted in the strategic defence review, would not be possible without the unsung heroes of our military transport fleet. They are involved in conflict of every kind, and they pride themselves on being the first in and the last out. We salute them.
We are proud of the eight Hercules planes that are serving in Afghanistan, and I hope that the Minister will ensure that they always have the best possible equipment for such deployments. I am also proud that the first Lyneham airman was recently awarded the DSE for his outstanding heroism.
The new plane—the C130J—is settling in extremely well. Recently, I tried out its simulator. My constituents, including those who live directly under the flight path, are proud of the contribution that they make to the defence of the realm. Every air base is subjected to criticism from a few local people about aircraft noise, but most of my constituents would say, "We are used to the Hercules planes, we are comfortable with the noise that they make, and we are proud that our area is able to make that contribution to the defence of the realm." Remarkably little fuss is made about aircraft noise in the area—even in the village of Bradenstoke, which is directly under the flight path.
Local people would welcome it if the A400M fleet were housed at Lyneham—although that would depend on the German Government being able to sort out the current difficulties about its procurement. We hope that, by the deadline of 31 March, we will hear that we are to buy it—and that the 8,000 or so jobs in the west country that depend upon that are secured.

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If Lyneham were to get the A400M—or whatever might replace it—we would welcome that. We have had detailed consultations with its manufacturers, and other oganisations, and we believe that RAF Lyneham is ideally suited to accommodate the A400M.
Recently, there have been strange briefings that the runways at Lyneham are 10 m or 20 m too short for the A400M. Airbus has assured me that, not only is the main runway entirely suitable for all take-offs and landings under all conditions irrespective of how heavily the plane might be laden, but, crucially, that the second runway at Lyneham is equally strategically usable for the A400M under all circumstances. Lyneham has two runways from which the planes can take off and land, but Brize Norton has only one. Hangar space, married and single accommodation, and other aspects of the infrastructure at Lyneham are also suitable to accommodate the A400M fleet, although they could do with upgrading.
Another strategic consideration is that it would be foolish to locate all our air transport assets at one base. That would present a marvellous target to an enemy state, or to terrorists—about whom we are currently very concerned. If we house all our strategic tanker aircraft, the A400Ms, and the Hercules fleet at Brize Norton, it would become an extraordinarily attractive target. From that point of view, and that of interchangeability with regard to weather conditions, it is sensible to have two transport air bases rather than one.
We are concerned about the environmental impact that would result if Lyneham closed and the planes went to Brize Norton. In recent written answers, the Minister has acknowledged that there is no spare accommodation for either single or married people at Brize Norton. Many Brize Norton airmen are not housed in RAF accommodation. That also applies at Lyneham, where many RAF staff are housed in local private accommodation.
If Lyneham were to close and roughly 10,000 people were redeployed to Brize Norton the effect would be something like a new town being built, presumably on greenfield sites around Brize Norton. I suspect that my hon. Friend the Member for Witney (Mr. Cameron), who is the Member of Parliament for the area, would not be happy with that proposal. There would also be a marked increase in road traffic in the narrow lanes around Brize. Road and rail communications to Lyneham are by comparison very good; it is near not only railways but also the M4. There would also be a huge increase in aircraft noise around Brize, and aircraft movements would more than double. Currently there are about 33,000 air movements a year from Brize, and about 36,000 from Lyneham. That would make a total of 69,000 air movements a year—230 take-offs and landings a day—from Brize Norton. I am certain that the inhabitants of the area would not be happy about that.
On the financial attractions, the only reason for making such a closure—I do not say that it will take place—is for the Treasury to gain financial benefits from it. The operational savings implied in concentrating two bases in one would be relatively marginal and would
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certainly be offset by the huge capital cost of the move. Building the 2,000 or 3,000 houses needed would cost an enormous amount of money, and it would cost a fortune to move Lyneham's five air simulators. The Army might try to take over the redundant RAF base, in which case there would be no capital gain for the Treasury anyway. There would be huge daily costs for the RAF but no gain. We believe that the financial benefits to the Treasury are largely illusory, or at least extremely marginal. The economic and social impact on my constituency would be huge.
We are as dispassionate as we can be in our report, but we believe that there are powerful strategic and environmental reasons for opposing an amalgamation of our transport fleet and the closure of RAF Lyneham. Of course, I do not expect the Minister to give us any assurances today. It would be wrong for him to do so. I am sure that he will be careful in his response and tell us that he is looking into the matter and that it is extremely interesting. That is as it should be; I do not want to force him into a premature announcement.
I hope that the Minister will reflect on our report—a detailed, careful work in which we have tried to avoid special pleading on behalf of RAF Lyneham. It is intended to be a balanced consideration of all the issues that he will have to think about in the next month or two. I hope that he will consider all my points, and take action to ensure that local people, the local councils and I are fully involved in that consideration.
We do not pretend that we do not want the Minister to conclude that the A400M should be based at RAF Lyneham. If he does not come to that conclusion, we hope that he will at the very least decide that the remaining C130J fleet should continue to be based there. We want him to agree that there is strategic importance in having two tactical transport air bases, and that having one would be a huge strategic error. We hope that he will listen to what local people have to say in the report, and that when he considers the matter in the next month or two, he will conclude that, setting aside the economic consequences for my constituency if the base were to close, there are overwhelmingly important strategic reasons for keeping both bases open and basing the A400M at Lyneham. We accept that the strategic tanker aircraft will be based at Brize. We hope that he will decide that the nation should have two transport air bases. By that means, it can avoid setting an obvious target for enemies of the state, including terrorists.
1.14 pm
The Minister of State for Defence (Mr. Adam Ingram): I congratulate the hon. Member for North Wiltshire (Mr. Gray) on securing a debate on a matter that is of considerable importance to the community around Lyneham. I welcome the opportunity to pay tribute to the work of the station and to set out in more detail the background to, and the way forward on, the strategic review on the future use of three airfields, RAF Lyneham, RAF Brize Norton and RAF St. Mawgan.
I am grateful to the hon. Gentleman for his comments about RAF Lyneham's current role and join him in paying tribute to the station. RAF Lyneham has a long and illustrious history and was established in May 1940. There is little doubt that the units at RAF Lyneham

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make a considerable contribution today. It is currently home to the entire RAF Hercules force, which presently comprises five squadrons, 54 aircraft and approximately 2,500 service and 760 civilian personnel. Lyneham is also the base of the Hercules reserve aircrew, No. 47 Air Despatch Squadron of the Royal Logistic Corps, the United Kingdom Mobile Air Movements Squadron, No. 4626 Aeromedical Evacuation Royal Auxiliary Squadron, and the tactical medical wing, which provides primary medical and dental care to deployed RAF units.
My colleagues and I are aware of the contribution that the station makes to the defence of the country. My right hon. Friend the Secretary of State for Defence visited Lyneham last month to meet the personnel who work there. He was impressed by all that he saw. I know that the station is held in high regard by the local community and, in turn, greatly appreciates the support that it receives in the area. However, life moves on, and if we are to deliver the best defence available within our resources we must constantly review and revalidate our assumptions and change when necessary to reflect new situations. The strategic review on the future roles of RAF stations Lyneham, Brize Norton and St. Mawgan, which I announced on 9 November, is one strand of that approach.
The RAF is undergoing its most comprehensive aircraft re-equipment programme for decades. Some 25 Hercules C130J aircraft have been introduced at RAF Lyneham in recent years, and in the next 10 years the future strategic tanker aircraft, the Nimrod MRA4, the Eurofighter Typhoon, airborne stand-off radar—ASTOR—and the A400M, which has already been mentioned, will be introduced into service.
As I announced at the time, the strategic review is driven by the anticipated arrival of new aircraft for the air-to-air refuelling and air transport fleets. At the end of the decade, the VCIO and TriStar based at Brize Norton are due to be replaced by the future strategic tanker aircraft private finance initiative service. The Hercules C130K based at RAF Lyneham and the C17, also based at Brize Norton, are due to be replaced by the A400M. In both cases, the introduction of the new aircraft will result in smaller but more capable fleets, and modern best practice maintenance arrangements mean that fewer ground crew will be required. It makes sense for us to review our present arrangements, given that changing profile. St. Mawgan has been included in the review because it has spare capacity and it is appropriate for us to consider that at the same time.
Let me lay a couple of ghosts to rest. Contrary to what some people may claim, the review is not a Treasury-driven cost-cutting exercise, although I appreciate that that was not the thrust of the hon. Gentleman's argument; nor are we seeking to identify the most expensive base to close it down. We are ensuring that the basing arrangements for the arrival of the new aircraft make the best and most cost-effective use of available resources. The House would expect no less and all colleagues who have an interest in the delivery of the defence of the realm will recognise that that is the way forward. I appreciate that the hon. Gentleman acknowledged the need for that approach.
As I said in November, the strategic review will take into account the decision that I announced earlier this month to base a future strategic tanker aircraft at RAF
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Brize Norton. To put that in context, both bidders for the prospective private finance initiative programme proposed the continued use of RAF Brize Norton as a main operating base for the FSTA. On this occasion, my Department accepts the industry's best commercial judgment. Brize Norton has the appropriate facilities including, uniquely, a fuel hydrant system, which is essential to run an efficient air-to-air refuelling operation, and the appropriate expertise in the field.
The strategic review has a long way to go before any final decisions are reached, probably early in the summer. In that context, it would be helpful if I set out the review's terms of reference, so that they are well understood. The review is being carried out by RAF Strike Command, which is looking at the optimum basing solution for the A400M aircraft and for the Hercules C130J that will remain in service alongside the new transport aircraft. It will examine the provision of collective training for deployed operations currently based at RAF St. Mawgan and the benefits of wider commercialisation at all three stations. It will also look at the best location to base the search and rescue force headquarters, currently sited at RAF St. Mawgan. Finally, following from that work, the review will make a recommendation on whether there is a continuing need for all three stations. I state categorically that it does not follow that RAF Lyneham's future is in doubt just because a decision has been taken to base the future strategic tanker aircraft at Brize Norton.
The review is divided into two phases. The first phase involves collecting information on the current tasks undertaken at each station and their associated costs; establishing the irreducible or other spare capacity that might exist; looking at the current planned future use for each base; identifying the potential commercial interest in each site and establishing the optimum base for the A400M.
Phase two comprises the analysis of the data gathered in phase one, taking into account the decision taken to base the future strategic tanker aircraft at RAF Brize Norton and whatever recommendation the review may reach on the basing of the A400M aircraft. Phase two will seek to identify the most cost-effective basing solution for the Hercules C130J fleet, the benefits of wider commercialisation at each station and the future roles of each unit. The study began on 15 November 2001. I hope that phase one will be completed within the next few weeks, with the final report due in early summer.
To inform the review, full economic and investment appraisals are being undertaken. They will identify the economic situation around the unit, assess, as closely as possible, the amount of income the unit provides to the local economy and, in the case of the investment appraisal, look at the current and probable future costs of the options available. Before the debate, the hon. Gentleman passed me a copy of a detailed report published by local interests, for which I am grateful, as the analysis will help the assessment that is being undertaken.
The three options before the review apply equally to any of the three stations, the first being to maximise the military use of the station. If a station is adjudged to have, or to be likely to have, spare capacity, it would involve the relocation of units from other bases with the possible disposal of all or part of another site. However,

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there is always a case for keeping a judicious amount of spare capacity available somewhere in the defence estate to provide flexibility for contingency operations.
The second option is commercial exploitation. The irreducible spare capacity, essentially the spare capacity to which I referred, can be marketed either by direct contacts with organisations or through a strategic partnership. The aim would be to maximise revenue to the benefit of the public purse while retaining primacy over the airfield, so that civil activity could be suspended to allow full military use if necessary. The third option, which is very much last on the list, is disposal of all parts of a site. Such a move would follow only a full review of the options for the site, including the possibility of use by another service.
I know that the hon. Gentleman appreciates that what I have outlined represents a substantial piece of work. He is right to say that it would be wrong to expect me to give him an answer today; this is not the forum in which that is normally done. It would also be wrong of me to prejudge conclusions on the basis of our short examination of the subject today. However, I want to make it clear that we are a long way from making a decision to close a station. A decision has not yet been taken on where the A400M will be based, but even if that were not RAF Lyneham, it would not automatically follow that Lyneham would close. As I outlined, many other factors would have to come into play before such a conclusion was reached.
Understandably, there has been much public interest in the study that we are undertaking. The report reflects that. That is why the Department is committed to engage stakeholders in the review, including local
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authorities, civilian and military station personnel, and the trade unions that represent civilian personnel at a station. That consultation is well under way. In the past fortnight, personnel from RAF Strike Command who are charged with undertaking the review have visited all three units to talk to station personnel and trade union representatives. Those events were well attended.
The hon. Gentleman talked about consulting wider interests. On 29 January, review team members met local authority and regional development agency representatives from all three areas where the stations are sited. The aim of that consultation was to allow local authorities to highlight any issues or concerns about the review. If authorities have suggestions for a station's future use, including opportunities for commercial exploitation, they will be most welcome with regard to our assessment of the way forward. A further round of consultations with local councils will take place next month.
I was a little perplexed when the hon. Gentleman said that councils and other interests felt that they were out of the loop or pushed aside when it came to the early determinations. I hope that I have reassured him that we are taking a detailed consultative approach. I will take on board his concerns and ensure that what I am saying marries up with what is happening on the ground.
We do not underestimate the review's importance to communities around the stations, including Lyneham. I am happy to assure the hon. Gentleman that the review will take full account of the representations that have been made, not least those set out in the report that he passed to me. We plan to continue the review in a spirit of openness and in that spirit I am grateful for the opportunity that this debate has afforded me to set out the Department's position. It is a strategic review, which it is right to have at this time.

Queen Elizabeth Hospital, Gateshead
1.28 pm
Joyce Quin: I welcome the opportunity to raise a matter of considerable local interest and concern in my constituency and the surrounding area. It relates to the grave failures and mistakes in the treatment of women over a long time in the gynaecology and obstetrics department of the Queen Elizabeth hospital in my constituency.
My hon. Friends from neighbouring constituencies have taken a great interest in the matter. My hon. Friends the Members for Jarrow (Mr. Hepburn), for Blaydon (Mr. McWilliam) and for Tyne Bridge (Mr. Clelland) have represented their constituents' concerns to my hon. Friend the Minister, the hospital and the local health authority.
Before coming to the substance of my remarks, I want to make it clear that I recognise the great improvements that have been made in my local hospital in recent years. Changes in management have been beneficial and the hospital has many excellent consultants who are supported by dedicated staff. The hospital is also a centre of excellence for some women's diseases. It offers screening services and carries out work on breast cancer. There is also a regional gynaecological oncology service. The issues are serious, but I do not want previous appallingly bad practice to undermine or tarnish the excellent work that is being done in many areas, or the progress that has undoubtedly been made.
I am glad that the Minister will reply to the debate and I know that she and the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith) took an interest in the petition that I presented to Parliament on behalf of my constituents. My constituents and those of my hon. Friend the Member for Jarrow have not had full or proper answers to their many questions over the years. My principal request is for some mechanism—ideally a public inquiry—to tackle those concerns.
As the Minister knows, Dr. Janusz Wszeborowski and Mr. Peter Silverstone have been struck off. Most of my constituents' grievances related to those two consultants. She will also know that the General Medical Council considered three cases, but not those under discussion; nor did it consider the eight illustrative cases that the current management of the Queen Elizabeth hospital submitted to it. I had hoped that the need for an inquiry would be removed if the GMC could consider those cases. The women concerned understandably feel cheated and let down by the fact that the GMC took action against the main doctors concerned, but did not examine their grievances and appalling experiences.
The transcript of the proceedings of the GMC against Mr. Silverstone relates to operations that he carried out in 1995 and 1998. Those operations were not carried out at the Queen Elizabeth hospital. What strikes me about the transcript is that the criticisms about how he carried out the operations are eerily similar to the complaints that my constituents made about operations that were carried out in previous years. That prompts the obvious question: why were the earlier complaints not investigated more fully and why was appropriate disciplinary action not taken then?
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The transcript refers to failures to record adequate medical histories of patients at pre-operative and postoperative stages and to arrange adequate assistance for a complicated operation. It also refers to the failure to provide appropriate medical aftercare and to recognise the limits of Mr. Silverstone's skill and professional competence and work within them. The conclusions show that those failures put patients at risk and justified his being struck off.
The Minister of State stated in a letter to me of 18 February, and in a letter of 29 October 2001 to my hon. Friend the Member for Jarrow, that there was a confidential inquiry into the workings of the obstetrics and gynaecology department. In April 1993, that inquiry concluded that there were no clinical issues that warranted formal action. She also stated that five complaints were received about Mr. Silverstone following the inquiry and between 1 April 1993 and 10 December 1993, that all were investigated and that none warranted formal action against him.
Some clear questions arise from those statements. Why was no formal action taken, especially since I understand that specific complaints led to compensatory out-of-court settlements in several cases? Was it not a matter for concern that, no sooner had one confidential inquiry been concluded, the hospital continued to receive similar serious complaints about the department in the months immediately following? I wonder how much compensation has been paid out over the years to women who complained about their treatment. I have a feeling that considerable sums have been involved. It would be good to have an answer to that question.
I could quote many distressing letters that I have received from the women concerned who, obviously, are very keen to ensure their anonymity, which I respect. Not all ' of them refer to treatment at the Queen Elizabeth hospital. Some refer to operations conducted in local private hospitals, and the concerns of those patients should also be addressed in an inquiry. One letter concerned a hysterectomy. The patient said:
"Mr. Silverstone performed a hysterectomy on me…a few days later I noticed a dreadful smell which was subsequently traced to the wound…the contents of my bowel were oozing through the stitches…I had emergency surgery performed by another doctor to repair the damage to the bowel which had happened during the hysterectomy…The resulting scars are horrendous and caused me problems which contributed to the break up of my marriage…I have also had to have subsequent surgery on both my bladder and bowel".
Another extremely distressing case concerned the death of a baby, caused by cerebral birth injury. An investigation was carried out into the case in 1992, a year before the inquiry mentioned in the letters sent by the Minister of State to me and my hon. Friend. Although it declared that the standard of care had fallen short of what was required, once again, astonishingly, no question of serious professional misconduct seemed to arise.
Mr. Stephen Hepburn: I congratulate my right hon. Friend on securing the debate and taking the lead on a very important subject—gross injustice to people in our area. I support her call for a public inquiry.

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If the Minister put herself in the position of the people in the cases that my right hon. Friend outlines, I am sure that she, too, could do nothing but support that call.
Joyce Quin: I am grateful to my hon. Friend. I welcome the interest that he has shown in the matter on behalf of his constituents. Like me, he has had many female constituents affected by the problem, going back a number of years.
The numbers involved are considerable. When the trust set up a helpline in the wake of Mr. Silverstone's initial suspension by the GMC, some 85 women contacted the hospital complaining of their treatment. At about that time, several of them organised a support group and held meetings. They were surprised at the large numbers who attended. With the publicity given to the activities of the support group, the presentation of the petition and even to this debate this week, even more women have come forward and contacted me, my colleagues or the support group.
I pay tribute to the support group, its secretary, my constituent Debra Wilson, and her fellow members. Forming a group and putting forward concerns to the authorities has not always been easy. Many group members did not want to be in the public eye and were people not normally keen to complain. However, they have approached their task with purpose and determination and have been prepared to revisit experiences that they would otherwise have wanted to put behind them, to get concerns addressed.
I also recognise the efforts of the local newspaper, the Evening Chronicle, which has consistently backed the support group and its demands. In recent years, changes have taken place in the national health service that I hope will make a recurrence of such a situation. unlikely. The culture in which doctors and consultants are perceived as gods, never to be questioned, has diminished. It is also recognised that whistleblowing is necessary in certain circumstances, and should be welcomed, not condemned. It is accepted that the performance of individual consultants must be properly monitored. The culture of the royal colleges has changed—they perceive themselves less as protectors of members of their clubs and more as protectors of the public, which is what they should be. However, I would welcome comments from the Minister about any further measures to ensure that the failure to deal with such serious issues cannot recur, as well as to explain how the remaining unanswered questions can be properly addressed.
We are talking about a huge degree of physical and emotional pain. We are discussing the cases of women who have lost babies who might otherwise have survived. Some women are unable to have normal, satisfying physical relationships with their husbands and partners because of the physical damage that they have experienced. We are considering appalling mistreatment that should never have occurred, which should have been exposed and stopped much earlier. My constituents want answers and justice. As Members of Parliament, my hon. Friends and I are determined to see justice done, however belatedly. I urge the Minister to respond positively today.
1.41 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I congratulate my right hon. Friend the Member for Gateshead, East and Washington, West (Joyce Quin) on securing the debate and raising an issue that is important not only to her constituents, although the graphic illustrations of the damage caused are hugely moving, but to everyone who wants to ensure that patients get the highest possible quality of care from the NHS. I also recognise the concern and interest shown by my hon. Friend the Member for Jarrow (Mr. Hepburn) on behalf of his constituents. It is important that such matters are raised in Parliament so that they are properly aired and addressed by all of us. They are important to us all.
I am aware of the petition that my right hon. Friend presented to Parliament on 18 December, which highlighted the mistreatment, negligence and misconduct of consultant Peter Silverstone and Dr. Janusz Wszeborowski and alleged a subsequent cover-up by the Queen Elizabeth hospital authorities. Those are very serious matters. I hope that I can deal with them and outline some of the improvements made in my right hon. Friend's local hospital—as she has generously acknowledged—as well as some of the national steps that the Government are taking to ensure that examples of poor practice are caught early and do not recur.
When such events occur, it is crucial that we learn lessons from them. We must ensure that systems are put in place to ensure that other people do not suffer the sort of damage that may have occurred. Although Dr. Wszeborowski was struck off the medical register by the General Medical Council in January 2001 and Mr. Silverstone was struck off in August 2001, the events that led to today's debate go back as far as 1993. The matters in question have been the subject of concern for many years.
Joyce Quin: It is true that inquiries relating to those two doctors took place in 1993, but the Minister should consider that some of the cases brought to my attention go back as far as 1979. We are actually considering a period of about 20 years.
Ms Blears: I am grateful to my right hon. Friend for clarifying the matter and illustrating how long it has been causing concern to her constituents and other members of the public. I highlighted the length of time during which it has been investigated to show how long it has taken—in the past rather than now—all the regulatory authorities to deal with it. It is not satisfactory when that takes years and years. Many of our reforms of the way in which the GMC operates are designed to speed up some of the processes so that an inordinate length of time is not taken to deal with poor practice. My right hon. Friend now tells me that the matter goes back even further than 1993, which adds to our concern about the length of time such matters are allowed to drag on.
Mr. Silverstone worked at the Queen Elizabeth hospital as a consultant obstetrician and gynaecologist for 17 years before retiring in 1993. While employed by the trust, he was part of a team of doctors working with Dr. Wszeborowski. The trust received five complaints

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about Mr. Silverstone between 1 April 1993 and 10 December 1993 when he retired and those are some of the complaints to which my right hon. Friend referred. All the complaints were investigated. Two were upheld and related to Mr. Silverstone's rudeness—he was brusque and abrupt with patients. He denied that he had been, but offered personal apologies to the women concerned and also offered to meet them. Those were the sort of complaints involved and it is important that my right hon. Friend is aware that those that were upheld related to his lack of personal skills in dealing with people and his attitude rather than to clinical incidents.
Of the three remaining complaints, two concerned Mr. Silverstone's attitude and one related to treatment he had performed, but they were not upheld. The complaints that were upheld concerned attitude and behaviour rather than treatment, which is why it was decided that none warranted formal action. Like my right hon. Friend, I was concerned that there had been five complaints and no formal action to implement disciplinary procedures. I am informed that the complaints that were upheld concerned rudeness and brusqueness in Mr. Silverstone's attitude rather than treatment.
Joyce Quin: It is true that the complaints that were upheld related to behaviour rather than clinical practice, but other complaints made by women, many of which have been settled out of court, concerned appalling clinical treatment that resulted in physical injury and sometimes the loss of a child's life. Those complaints were also dealt with much later by the GMC and there are serious question marks about the clinical treatment that was administered as well as the behavioural offences to which my hon. Friend referred.
Ms Blears: I am certainly not trying to minimise the impact of the clinical or behavioural incidents on my right hon. Friend's constituents. They are serious and if she wants to raise any matters that remain of concern to her constituents I shall be happy for her to raise them individually with my Department. She has referred to clinical issues that resulted in compensation and it would not be appropriate in this forum to go into the details of legal cases and levels of compensation, but I would be happy for her to contact me about outstanding matters of concern and to provide further information so that we may examine them again.
After the inquiry into the complaints that were made about Mr. Silverstone, he was retired in December 1993. It was only in January 2001 that the GMC's interim orders committee suspended him
"in the interests of public safety"
pending an investigation relating to the circumcision of babies. He had been carrying out that work in a private capacity after his retirement from the Queen Elizabeth hospital and it did not relate to his activities in the trust. He was struck off the medical register by the GMC on 24 August 2001. As the investigation dealt with offences that were committed during his private practice after he had retired from the trust, there was not an opportunity for matters relating to particular women patients to be fully explored and considered.
In 1996, colleagues in the trust's department of obstetrics and gynaecology raised questions about some aspects of Dr. Wszeborowski's work. The investigation
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that followed revealed a history of patient complaints about rough handling during examinations and deliveries. He was suspended from duty in September 1997 pending action by the trust under its disciplinary procedures. He reached retirement age and left the trust's employment in December 1998, but following a referral to the GMC's fitness to practise directorate by the trust, he was also struck off the medical register.
The time that it takes to deal with those matters in disciplinary terms and through GMC procedure is an issue because it allows people to retire from service. It is difficult to explore such people's actions because time, in a sense, overtakes events. In that case, Dr. Wszeborowski left the employment of the trust in December 1998, some years prior to being struck off by the GMC.
Following the GMC's decision to strike Dr. Wszeborowski off the medical register, the Gateshead health trust set up a telephone helpline for patients who were worried about treatment they had received from him. The line was subsequently extended to former patients of Mr. Silverstone after he was suspended by the GMC, to ensure that as many women as possible were contacted and offered support and counselling.
As my right hon. Friend said, 85 women called the helpline to discuss their concerns. After those initial calls, obstetricians, gynaecologists and senior midwives reviewed their cases and every woman was called back within three weeks. Everyone was offered an opportunity to meet with a consultant and a senior midwife, who was the trust's service manager for obstetrics and gynaecology. The consultant and senior midwife met with 36 women, a further 10 women discussed their cases with the consultant over the telephone and three received advice from him by letter. Fast-track appointments were made for 13 women who needed further treatment.
The trust also allowed those women immediate access to their medical records without having to follow the formal process and five women took up that offer. It also offered independent counselling and support to all the women, although in the event only one woman took that up. It took a number of wide-ranging steps to ensure that as soon as it was alerted to the problems that those women had experienced, they were offered not only counselling and support, but the option of further treatment and a proper review by other consultant obstetricians and gynaecologists.
As my right hon. Friend acknowledged, the trust has made substantial improvements in recent years to its obstetrics and gynaecology services. There is a new consultant, Mr. Mani Das, and five more consultants have joined him since he was appointed. A number of new services have also been introduced. Now, a multidisciplinary clinical audit process that involves all staff regularly reviews their practice to ensure that there are no further examples of poor practice. There are new guidelines and protocols for the treatment of all pregnant women, including a fast-track, one-stop service for women with menstrual problems and an early pregnancy unit to deal with any abnormalities. There is also a robust risk management structure. All clinical and non-clinical incidents are thoroughly investigated and any improvements are immediately initiated. Those innovations have been well received by patients. The

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obstetrics and gynaecology department was ranked highly when assessed last year and is an example of good practice.
Teaching and training systems in the hospital were reported to be "excellent" following a visit by the Royal College of Obstetricians and Gynaecologists in 1999. That demonstrates that women can be assured that under the new team in the Queen Elizabeth hospital they will receive the best treatment and care during pregnancy and the delivery of their children.
The women who have been affected have been through a distressing time. The vast majority of staff in the NHS do a first-class job and this is a rare case of poor practice. It is vitally important that we have systems to pick up such cases quickly, which can act to stop them from happening. That is why on 1 April 2001 we introduced annual appraisals and work reviews for all doctors. They will ensure that doctors meet the high standards of their profession. The Government have new powers to enable the GMC to suspend doctors immediately when serious concerns arise about their performance. We are also introducing a mandatory reporting system for failures in the NHS, so that lessons are learned and mistakes not repeated.
We want to establish fast, fair and effective procedures to resolve problems of poor or unsafe practice and to avoid situations in which patients are left unprotected because no intervention is made to stop a doctor practising until a case is investigated. In the past, cases dragged on for a long time and doctors were allowed to continue practising while investigations took place. We want to ensure that that does not happen in future. We also want further to reform the way in which the GMC works to ensure that it is fast, fair and effective and puts the interests of patient's first.
We have established the National Clinical Assessment Authority, which is a central element of our work on quality. It will provide advice to employers in cases in which they are concerned about the clinical practice of doctors. It will not be an employer or regulator, but will help employers to assess doctors by
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carrying out an objective assessment of a doctor's performance. That is an innovation to address the performance of doctors. Following such assessments, the NCAA will advise the trust or health authority on appropriate courses of action. That should speed up the system quickly to deal with poor practice.
For the first time, we are involving lay people in such procedures, which will give patients a real voice in ensuring that doctors meet the highest possible standards. We will provide support for doctors who are ill, suffering stress or whose practice has deteriorated owing to the pressures on them. We want to support them to allow them to continue to care, while also protecting the interests of patients.
We are issuing guidelines on gynaecology and obstetrics to ensure that every trust in the country provides high quality services. I acknowledge that those new improvements do not address the deep concerns of the women in the cases that were described by my right hon. and hon. Friends. Those cases, particularly those described in the extracts read by right hon. Friend, are incredibly distressing and moving and indicate her severe concerns and those of other hon. Members.
I have seen no evidence of a cover-up by the trust, however, and have been informed that detailed investigations of complaints and subsequent determinations were made. Steps were taken to ensure that all the women who had been involved in allegedly poor treatment had access to a helpline, counselling and further treatment. If my right hon. and hon. Friends remain concerned, I would welcome further details being sent to my Department, so that we can take another look at the matter. I recognise that the cases are of extreme concern to the women involved.
I emphasise that we are ensuring that doctors provide good quality services throughout the country to all patients. We are determined that the procedures and systems will be fast, fair and effective for everyone. Patients must be protected and I welcome further information from my right hon. Friend.
Question put and agreed to.
Adjourned accordingly at one minute to Two o'clock.