Westminster Hall Sitting of 5 March 2002

Preamble
SIR ALAN HASELHURST[SIR ALAN HASELHURST in the Chair]

National Institute for Clinical Excellence
Motion made, and Question proposed, That the sitting be now adjourned.— [Mr. Heppe.]
9.30 am
Angela Watkinson: I am grateful for this opportunity to discuss an important subject that touches the lives of many different people: patients, their families, health professionals and managers and those in the pharmaceutical industry. The setting up of the National Institute for Clinical Excellence as a central body for the investigation, appraisal and recommendation of drugs, treatments and technologies was well intentioned and welcome. It offers an opportunity to obtain value for money in research through economies of scale and to make the best use of scarce national health service resources. Health authorities and primary care trusts can rely on the efficacy, safety and quality of NICE-appraised drugs and ensure that they are available to the patients who need them and who will benefit from them.
However, it is unclear who decides on the priorities for investigation and how much influence cost-effectiveness has on the institute's decisions. There is a general lack of openness and transparency about the process, methodology and criteria that are used to determine whether a treatment is effective. Realistically, the cost of the treatment should be set against the benefits of an individual restored to good health and able to work and lead a normal life. For example, it is estimated that rheumatoid arthritis costs the country £1.2 billion a year in benefits and lost income. Similarly, multiple sclerosis sufferers could be helped to lead a healthy life if beta interferon were available to them. Appraisal teams rarely include specialist clinicians in the particular field under investigation, yet such investigation would surely benefit from their detailed knowledge and experience. Perhaps the Minister would be kind enough to comment on those points in her summing up.
In theory, NICE should lead to faster take-up of clinically effective and cost-effective new treatments. There have already been many benefits. Since the institute was established less than three years ago, it has published clear and authoritative guidance on the use of more than 30 treatments, including new cancer drugs and treatments for coronary heart disease, asthma in children, diabetes and dementia. The duty of health authorities to implement NICE guidance within three months and make new treatments available should, in theory, eliminate the postcode lottery and make access more equitable. Regrettably, in practice, the variation in patient care that is so counter to the fundamental principles of the NHS persists, for two main reasons.
The first reason is funding. Funding for new treatments is not ring-fenced but is simply included in health authorities' global budgets. Health authorities
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must plan ahead, and if a NICE-appraised drug is unexpectedly introduced halfway through a budgetary year, they have serious difficulties in making funds available for the treatment. The absence of ring-fencing can lead to robbing Peter to pay Paul, with no net gain for patients. It is also difficult for large organisations that serve many commissioners, such as my own Barking, Havering and Redbridge Hospitals NHS trust, to ensure that all populations have equal access.
The second reason is delays. The process of appraisal is far too slow, and some health authorities are using NICE delays as a reason for not prescribing desperately needed treatments. That has become known as NICE blight. For example, following an appraisal process that started in August 2000, NICE has still not published guidance on the use of campto and other treatments for colorectal cancer. Negative NICE guidance would leave patients in Britain with no freedom of use of drug therapies. They would be in a similar position to those in Korea, Russia, Poland and the Czech Republic.
The United Kingdom lags behind many other countries in the uptake of innovative medicines, a situation exacerbated by a paucity of NHS drug funding. The NHS drugs budget allocation in 2000 for all anti-cancer drugs, for all cancers, was only 6.7 per cent. Only one in five eligible patients currently receives campto. The appraisal on its use in the first-line treatment of advanced colorectal cancer has taken far too long, which has serious implications for those already ill.
The condition is reaching epidemic proportions. The results of a second appeal against NICE refusal of campto—a drug of proven efficacy—bring into question the influence of cost on NICE decisions. There is similar concern over the availability of the breast cancer treatment herceptin, often the last resort for patients for whom other treatments have failed. Too many patients die while crucial decisions are awaited.
Implementation issues are causing difficulty with some areas of NICE guidance. Guidance on drugs for Alzheimer's published in January 2001 recommended that only specialists such as old-age psychiatrists and neurologists initiate and establish the maintenance dose for treatment. In many localities, there is a shortage of available specialists. A larger role for general practitioners who have specialist knowledge of not only the patient but the caring spouse would facilitate the wider availability of those treatments.
I recently received an answer from the Minister to a question about NICE guidance on fertility treatment. That is of concern to a group in my constituency, Couples Having Infertility Problems Solved—or CHIPS—which is eagerly awaiting the outcome of the NICE investigation. The Minister said:
"NICE has not yet published a timetable for development of these guidelines."
Although not a life-endangering condition, infertility causes extreme distress to couples. The delay has particular relevance because the biological clocks of the women concerned are ticking away; for some, it will be too late. Without the necessary treatment, those women could remain childless, with devastating results on their future emotional well-being.
The Department of Health placed 240 target areas for improvement on my local health authority last year, which was very challenging. Those used up the lion's

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share of the authority's budget, leaving only £6 million for the many non-target areas, including fertility treatment. There were £20 million-worth of bids for that £6 million, so the amount available for fertility treatment was, necessarily, extremely small. I urge the Minister to ask NICE to give greater priority to that important area of health care.
Over the years, a plethora of health-related bodies has grown up, including NICE, the Commission for Health Improvement, the National Clinical Assessment Authority and the National Patient Safety Agency. On 10 January this year, the chief medical officer announced a new committee, the National Infection Control and Health Protection Agency. We await the establishment of a new council for quality health care. All those organisations have to work closely with the social services inspectorate, the National Care Standards Commission and the Audit Commission. We seem to be overburdened with bureaucratic bodies. There is an urgent need for greater co-ordination and the avoidance of duplication of effort in the provision of quality public health services in the NHS.
A formal review of NICE has been expected for some time and there has been much debate about how and by whom it should be carried out. It is essential that that review is not concerned only with issues important to the pharmaceutical industry, which contributes so much to medical research in the United Kingdom and to the Government. It must also take into account the views and experiences of a wide range of health professionals, patients and patient groups on how treatments are used and how they work in day-to-day circumstances. More emphasis should be placed on the cost-effectiveness of medicines in terms of outcomes for patients and the implications for other elements of Government spending.
The impact of medicines on patients' quality of life is frequently overlooked, and it is more difficult to measure than cost. Reassurance is needed that NICE is not a cost-containment body. Who makes decisions on the affordability as opposed to the cost effectiveness of treatment is paramount. The success of NICE depends on how its guidance is implemented. Evidence of continued, or eradicated, postcode prescribing following NICE guidance needs to be collated with evidence of health authority and GP compliance with NICE recommendations. Unacceptable variations in care could then be challenged and all patients, regardless of their geographical location, would have equal access to treatment that best meets their needs.
9.40 am
Mrs. Cheryl Gillan: I congratulate my hon. Friend the Member for Upminster (Angela Watkinson) on a fine presentation of the case against NICE, and on securing a debate on a topic that has concerned many hon. Members, and many of our constituents, over a number of years. I saw the Minister make a face, and I hope that that will not be reflected in her response because I come to this debate with some constructive suggestions from the Multiple Sclerosis Society.
I should like to talk about the operation of NICE in conjunction with the investigation into beta interferon. Back in 1998, following investigations on behalf of some
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of my constituents who suffer from multiple sclerosis, I received some correspondence from a company called Schering, which had been trialling beta interferon. It stated that the
"effect of Betaferon on the condition"—
of secondary progressive multiple sclerosis—
"was so strikingly good that the Committee of International Trialists stopped this trial and offered Betaferon to those who were still on placebo."
In June 1998, the eighth meeting of the European Neurological Society in France concluded from an abstract of the trial that the study provided convincing evidence that treatment with the drug delays sustained neurological deterioration in patients with secondary progressive multiple sclerosis, which was reflected in the delay in their becoming wheelchair-bound.
To set the NICE investigation into beta interferon in context, I let the Minister know that I was receiving such papers in my office in 1998 and was passing them on to my constituents with multiple sclerosis. We started an investigation into the drug, and the Department of Health and the National Assembly for Wales asked NICE to appraise beta interferon on 6 August 1999. That appraisal did not happen in 2000, and it did not happen in 2001; it was not until 4 February 2002 that a final result came from NICE. That is an unacceptable length of time for anybody to wait for an investigation into a drug that has received the sort of reports that I have mentioned. Unfortunately, as the Minister knows, NICE was not able to recommend the drug.
At the same time that the Department of Health came out against the drug on the ground of cost-effectiveness, it leapt in to come up with a scheme to make the drug available to our constituents. I do not want to be curmudgeonly about that: we are extremely pleased that the scheme has been introduced, and many people are delighted to be included in it. However, it seems nonsensical that although NICE, which was set up by the Department of Health, opposed the use of the drug, the Department is spending its time finding ways around such decisions.
I agree with the Multiple Sclerosis Society, which has been absolutely fantastic throughout the debacle, supporting its members and providing information to Members of Parliament and other interested parties. The MSS wrote to me saying that it welcomes the Department's proposal but regrets
"that NICE itself has not been able to show the imagination necessary to resolve the issue. NICE has effectively said that because it cannot be sure about the long-term cost-effectiveness of the drugs people with MS should not receive them. The Department, by contrast, has said that the drugs should be prescribed in a manner which will allow this long-term cost-effectiveness to be properly assessed. The Department's approach turns on its head NICE's presumption of guilt until innocence is proven."
I want to reflect the concerns of the Multiple Sclerosis Society, which was involved in the appraisal of the disease-modifying drugs for MS for more than two years—twice the standard length of technology appraisals.
There is no doubt that the appraisal of the drugs was a challenge for the institute. The appraisal of drugs for MS, which is a long-term and complex condition, has certainly tested the robustness of the institute's approach to drug appraisals, but it has thrown into

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sharp relief several issues that need to be addressed if the institute is to meet the agenda set for it as a first-class service.
Mr. Oliver Heald: Does my hon. Friend agree that NICE faces the problem of deciding cost-effectiveness according to available resources? The Treasury decides how much money is available, and what is clinically excellent or cost-effective is decided in that context. NICE is not really considering matters with a blank piece of paper; it is forced to look at things from the Treasury viewpoint.
Mrs. Gillan: My hon. Friend is right, and he makes a good point. There is a straitjacket enforced on NICE that is not good for its investigations and operations. I have had constituents who were put on the drug and continued to work and contribute to society. The NICE appraisal does not consider the whole economic picture of how people continue their lives and are productive in society.
There is a gap between the institute's rhetoric about openness, transparency and the patient's perspective, and the actual nature of its structures and practices. That gap undermines the credibility of guidance from the institute among patients and patient representative organisations. The institute's approach is dominated by health economics and is characterised by a heavy reliance on results from randomised control trials. Such trials are necessarily short-term and cannot provide concrete evidence for the drugs, which will be used in the long term. The institute has not yet developed a suitable methodology for assessing the cost-effectiveness of longterm interventions.
I should like to put to the Minister a series of recommendations from the Multiple Sclerosis Society. I hope that when she responds she will do me, and the society, the courtesy of addressing those points. The society believes that a cultural shift is needed so that the critical nature of the institute's decisions and the resulting need to command the respect of the public are reflected in its structures, processes, and the way in which it conducts its day-to-day business. The society thinks that appointments to the institute's partners council board and appraisals committee should be advertised and subject to open recruitment processes. It thinks that the deliberations of the appraisals committee should be opened up by allowing patient representative organisations to observe discussions and by posting detailed notes of the committee's meetings on the institute's website. Those are not difficult recommendations for the Minister to consider. The appeal panel should be replaced with a lawfully constituted, independent body. I do not expect a knee-jerk reaction from the Minister, but I hope that she will give that recommendation long-term consideration and tell me, perhaps in a letter, how it is received.
There should be a public review of the institute's approach to the use of health economics which should examine, for example, the threshold of cost-effectiveness that has been set by the institute, the value of relying on the evidence of randomised, controlled trials, the costs and savings taken into account in appraisals, and the difficulties of assessing cost-effectiveness in the long term. I hope that my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) will accept from
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a humble Back Bencher that I hope that that should be supported across the board in our party. The institute should more actively support input from patient representative organisations and make the perspective of users who are affected by its decisions central to its decision-making process.
In conclusion, many of my constituents have gone to hell and back over the appraisal. They have had their hopes raised; they have had their hopes dashed. Some have amazingly poignant stories of people who have been unable to afford the drug and whose friends have gathered to raise the money for it and seen results. The Minister will have seen in the newspapers at the weekend the wonderful story of the lady who was able to become a fitness instructor following a successful course of the drug. I hope that the Minister will take the recommendations from the Multiple Sclerosis Society seriously. There has been a lot of pain in the operation of NICE and I hope that she will now learn the lessons from the mistakes and give us the assurance about the institute that my constituents and the MS Society deserve.
9.51 am
Mr. Mark Hoban: I congratulate my hon. Friend the Member for Upminster (Angela Watkinson) on securing this debate and opening it in such good style. NICE causes my constituents great concern in the prescribing of certain drugs and, in her opening comments, my hon. Friend referred to its lack of transparency. I want to illustrate that with two examples that I found on the NICE website.
One of the interesting features of the technology appraisal on NICE's website is that it states when the first, second and other appraisals committee meetings were held and the decisions reached, but it does not state when the appraisal process started. It states that assessment of the rheumatoid arthritis drugs etanercept and infliximab started before 6 February 2001, but not the firm date on which it started. It also states that the expected date of issue will be March 2002. One year seems a long time in which to appraise drugs that have already been assessed for effectiveness and safety and been approved and licensed. That is not the worst example of delays in the appraisal of drugs by NICE.
Asthma inhalers for older children are being assessed, and again no start date is published on the website, although those using the devices will be pleased to know that in March 2003, they will know which asthma inhalers are both cost and clinically effective. There has been a huge delay in reaching proper conclusions on drugs that have already been licensed as effective and safe. NICE's original remit was to speed up the availability of drugs and to assess clinical effectiveness, but the two examples that I cited fly in the face of that.
The area that causes me most concern is the change to NICE's remit in August 1999 to assess the cost-effectiveness of drugs within the Treasury's available resources. That sends a message to people awaiting evaluation of those drugs that once NICE has agreed that they are clinically and cost-effective, they will be available to those who need them. However, that is clearly not so, as an answer from the Department of Health suggested a few months ago. It stated that the Government will, in due course, announce plans to

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implement their manifesto commitment to ensure that local health authorities, primary care groups and primary care trusts are directed to prescribe those drugs. That hits at the crux of the problem that I have experienced in my constituency.
I would like to mention a case, but do not expect the Minister to reply to my comments on it, as I am using it purely as an illustration. One of my constituents, Michael Cooper, is hoping to be prescribed etanercept, a drug that relieves rheumatoid arthritis. That drug is being assessed by N ICE. Fareham and Gosport primary care groups sent me a letter to say that, even if NICE decides that the drug is effective, there is also a local process, led by clinicians, for evaluating the safety and effectiveness of new drugs. There is also a third layer of assessment, which takes advice issued by NICE into account. That is another delay in making the drug available to those in my constituency.
A further letter about Mr. Cooper's case was sent to me, and it raises the issue of what happens when NICE approves a drug, and how to fund the prescribing of it within the drug budget available to the local primary care group. I also have a letter from a consultant who works for Portsmouth City primary care trust, which says that we will have to consider carefully not just the benefits to patients from the drug, but what the rest of the population will have to do without in order to fund it—the drug is very expensive. Mr. Cooper hopes that it will deal with his condition effectively, but primary care groups say that they do not have the budget to enable the drug to be prescribed. That is remarkable, given that the Treasury laid down the basis on which the cost-effectiveness of the drug was to be assessed.
I worry about Mr. Cooper's condition. He has had many operations to replace joints and has taken a series of drugs, all of which have been rejected by his body. I spoke to him last night. He has been on morphine, and as his body did not accept the drug that he has tried most recently, he will have to go back on morphine. Etanercept has been licensed for use and is effective and safe, so why cannot his GP or consultant prescribe it privately while the NICE process is under way? That would be a sensible step. The drug must be safe and effective, as it has passed its licensing hurdles.
Mr. Cooper has generated a huge amount of correspondence on the subject, and makes some pertinent points. One letter to him contains the comment:
"You asked for guidance on the issuing of private prescriptions. A hospital consultant can not issue a private prescription and continue to see the patient under the NHS—it must be totally private."
A consultant in secondary care cannot prescribe the drug unless Mr. Cooper goes private. That is an odd state of affairs for someone who cannot have a drug funded from the local drug budget. Why cannot Mr. Cooper use his resources to meet the cost of etanercept? The letter goes on to say:
"Similarly, a GP would breach his or her terms and conditions of service if they issued a private prescription for a drug that they could theoretically prescribe on the NHS."
The word "theoretically" intrigues me. A GP cannot prescribe an approved drug if it is theoretically available on the NHS, even though the local primary care trust
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cannot prescribe it because it has not gone through the full local clinical effectiveness tests or the NICE tests. That puts us in difficult circumstances whereby drugs that are available theoretically, but not in reality, cannot even be prescribed privately for the relief of a very painful condition.
We are in an odd situation. We have drugs that are licensed as safe and effective. They are being appraised by NICE and by a local PCG. It is not guaranteed that they will be made available to patients because of the limitations on the drugs budget. At the same time, NHS rules prevent the consultant or the general practitioner from providing those drugs.
That is the crux of the problem. The system adds layer upon layer of control on the prescription of drugs. NICE is acting as a gatekeeper for cost-effectiveness within available resources, but it is still the PCG's responsibility to determine whether it is able, from its restricted drugs budget, to prescribe what can be very expensive drugs. Members of the PCG in my area—it is soon to become a primary care trust—will have to decide which drugs should be removed from the list and what changes in prescribing habits should be made in order to fund the availability of expensive drugs that have gone through the NICE process, which is intended to speed up the access and availability of drugs and to remove the postcode lottery.
10 am
Mr. David Tredinnick: I am grateful to be called to speak in this debate. It is astonishing that there is no Labour Member present beside the Minister. The Government's establishment of NICE has been attended by so much hope and expectation, and I cannot believe that they have received so little backing from their Back Benchers. My hon. Friends are nodding at that remark from our Back Bench, which is full, because the Conservative party recognises the seriousness of the subject under discussion. We wish to highlight some of the problems that we have encountered with NICE. I will not beat the Minister over the head about it—my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan) has used the word curmudgeonly—but several serious issues must be raised.
NICE was introduced to appraise new therapies so that it can provide the NHS with information to help it to achieve optimum clinical and cost-effectiveness from medicines and other treatments. Therefore, the concept of NICE is positive; it is important that research is carried out into different treatment options to determine whether they should be provided by the NHS.
However, we have heard about the problems of beta interferon and renal cancers, and I want to highlight one of the glaring omissions of NICE's work at present: it has missed the plot with regard to integrated health care. There is a growing movement in favour of embracing what used to be thought of as complementary therapies, and of offering a wide range of them. Sadly, the majority of the technologies that NICE has examined are what might be termed conventional medicine. Little or no time and resources are spent on examining other treatment options, such as complementary medicine.
That is strange given the current public demand for complementary medicine. About 5 million people use complementary therapies. Therefore, it is a serious

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shortcoming that NICE has not initiated any high-quality research into them. I hope that the Minister will address that point: I mentioned it to her before the debate, so I have given her a bit—a tiny bit—of notice.
Dr. Evan Harris: The hon. Gentleman has mentioned the shortage of high-quality research into some of the treatments that he is talking about, and he has stated that NICE is responsible for funding that, but I am unsure whether that is the case. I acknowledge that there is a call for such research. What role does he think the producers, manufacturers and prescribers of such treatments should play in providing the research base that is so urgently needed in that area of medicine?
Mr. Tredinnick: The hon. Gentleman has made a helpful contribution, as it is important to establish who will provide that research. We face a conundrum, because unless there is adequate research into a medicine, doctors such as the hon. Gentleman are not keen to prescribe it. I hope that I do not do him a disservice by saying that. Until we have a wide database of research, the medical profession will be somewhat sceptical. The Government must take the lead. I agree with him that there is an onus on the industry—those who produce pills and potions—to help, but the Department of Health has an overriding duty to provide information, which should be made available through NICE.
The issue must be examined in context. There are approximately 50,000 complementary practitioners in the United Kingdom. The Department of Health will not solve the health problems in the UK, with the exponential growth of demand on services that is in some part due to an ageing population, unless it brings in some of those 50,000 therapists.
The hon. Member for Oxford, West and Abingdon (Dr. Harris) may correct me, but I believe that there are approximately 30,000 health care professionals in the UK—depending on how they are added up—and 50,000 complementary practitioners, most of whom work in the private sector, although some acupuncturists work in the health service. Until the Minister and her colleagues instigate wider use of complementary therapies in the health service, the supply of practitioners will be insufficient to deal with the demand for services. That is a fundamental point.
Complementary therapies are often a fraction of the cost of expensive drugs. I do not suggest that such drugs are unnecessary, but we should not ignore less expensive remedies—a point that I will develop with regard to beta interferon.
Mr. Heald: Does my hon. Friend agree that in the treatment of mental health, a combination of treatments, such as the use of modern drugs with sport, reflexology massage or other such alternatives, provides the best way forward? Is he aware of MIND's "My Choice" campaign, which highlights the importance of the availability of a range of therapies to those with mental illness?
Mr. Tredinnick: My hon. Friend makes a valid point. He was at the recent King's Fund launch of that
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campaign and I pay tribute to him for the immense amount of work that he has done, as well as the personal time taken and dedication shown, to help those afflicted with mental health problems. He is right; it has been found most effective to embrace a range of treatments including acupuncture, homeopathy, higher vibrational energies such as Bach flower remedies, bush or North American flower essences and channelled energy.
When the House was not sitting the week before last, I visited a high-security prison in Hollesley bay, Ipswich, where I saw how a range of therapies are used on prisoners who have received life sentences—I met one whose sentence was 20 years. Reiki, the Japanese system of using symbols to stimulate people to channel energy, is effective. Whether one believes that energy to be from God or the universe or whatever, some people can channel energy through their hands. I met 10 prisoners, and every single one said of their own volition that they had benefited from such treatment and that, when they were locked up in their cells at night, it was the one thing that they could practise themselves.
The use of Reiki is an example of what my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) mentioned. It is effective for the treatment of mental health, especially in prisons. Most prisons in the midlands use a range of therapies to help reduce tension. Acupuncture is a key treatment. Indeed, I spoke to the deputy chair of the Hinckley magistrates bench on Friday about its effectiveness in prisons.
I remind the Minister that in mainstream complementary care there are approximately 2,000 acupuncturists, 7,000 aromatherapists, 16,000 healers, 800 herbal medicine practitioners, 2,000 homeopaths, 3,000 hypnotherapists, 8,000 massage specialists, 1,000 naturotherapists and nutritionists, 13,000 reflexologists, and 2,000 yoga practitioners. Will the Minister ask the management of NICE to investigate thoroughly such disciplines, which have existed for a long time? Traditional Chinese medicine and acupuncture have been around for 3,000 years.
In a Westminster Hall debate the other day, I pointed out that there are 60,000 hospitals in the People's Republic of China using Chinese medicine. We are told that we need more evidence to support such medicine, but it has existed for 3,000 years. Who are we kidding? The evidence is there, but the problem is that we have not looked for it. Much evidence that is published is often ignored. Masses of evidence exist about therapeutic touch and healing. Matthew Manning and others have written books and conducted surveys that are not considered. The Minister must consider such material.
Dr. Harris: I always listen to the hon. Gentleman with interest; sometimes he provokes me, although he does not mean to. Does he think that books on therapeutic touch and healing, which he described as research, meet the standards of research that pharmaceutical drugs must satisfy? Those drugs are tested by randomised, double-blind, placebo-based and long-term trials, in which many people are involved. Does he recognise that several of those qualities are required for research to be understandable, reproducible and valid?
Mr. Tredinnick: I do not know whether the hon. Gentleman is trying to help my re-election in a few years'

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time, but he has been helpful on this occasion. We are engaged in an important debate because a key issue is that one cannot use a traditional double-blind and placebo concept with many of these therapies. We must develop other concepts that take general well-being into account. We discussed that before the debate in connection with recent trials on homeopathy. A placebo trial may be more than that due to the energy of the person who is giving the placebo treatment. If that person is merely around another, that may increase the other's well-being. Additionally, complementary therapists can generally spend longer with their patients. The five-minute visit to the GP does not occur in the complementary world, in which a person would expect a first consultation to last for an hour.
The way in which the trials are set up is important and a matter on which the Government should expend time and energy. NICE may be able to interface with the database that was complied by the Research Council for Complementary Medicine. There are 75,000 research references for complementary and alternative medicine. I do not have the papers in front of me, but I am sure that I have written to the Minister, the Secretary of State or another Minister in the Department about the need for funding of that database. I have spoken in Parliament on behalf of the integrated health care movement for 15 years. The sums of money that would be required are small: £10,000 here and £100,000 there.
The Minister must address the regulation of complementary therapies—NICE may wish to take that on board. Osteopathy and chiropractic are in mainstream medicine. There was a big worry about the cost of regulation to the practitioners. That worry is approaching for traditional Chinese medicine and western herbal medicine—phytotherapy. Professor Pittillo is on the new committee that the Department of Health set up to sort this thing out. The Minister should talk to him because his life will be much easier if the Government find £1 million to help people pay for the regulation.
If any of my colleagues think that I am taking up too much time, I hope that they will interrupt me, but I understand that I have a little leeway this morning. That is unusual because one is usually under considerable pressure in this Chamber.
The Minister's life would be easier if she considered the wheels of regulation, which doctors such as the hon. Member for Oxford, West and Abingdon are keen on because they like regulated complementary practices. If the Minister wants to reach that point, she must help people through the hoops by providing a few pounds to lubricate the wheels. I am not talking about multimillion pound trials, but £10.000 here and £100,000 there. We must bear that in mind in the context of the massive budgets of the Department of Health.
Mrs. Gillan: I am listening carefully to my hon. Friend. His argument comes down to the input to appraisals of voluntary organisations that represent a substantial transfer of funds from the charitable to the statutory sector, and that should be recognised by the Department. The institute should possibly extend to voluntary organisations that are involved in technology appraisals the practical support that it intends to offer to
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organisations participating, for example, in its guidelines-development process. Thereby, funds would not go from the charitable sector to the statutory sector on such a profligate basis.
Mr. Tredinnick: My hon. Friend has done tremendous work on multiple sclerosis with the Multiple Sclerosis Society. She speaks with eloquence and has great knowledge of the subject. She is right to look at other aspects. We are in a new health paradigm. People are going to doctors, such as the hon. Member for Oxford, West and Abingdon, saying, "Doctor, I want to try homeopathy." It is no good doctors saying that, although they do not know anything about that treatment, it will probably not do any harm. Patients now demand that doctors know about different therapies. My hon. Friend's point about the transfer of responsibility for such practices from voluntary organisations to the Government again illustrates the need for the Government to take the whole range of services very seriously. We are talking about service providers coming into the health service.
The Government need to focus on the fact that a vast number of doctors do not have much idea of how to refer patients to other practitioners such as those that my hon. Friend the Member for North-East Hertfordshire mentioned when he spoke about mental health. They must take on board the fact that many treatments are multi-treatments. Most of the people working in complementary, integrated medicine, which I understand best, are multi-discipline practitioners. Homeopaths are often experts in Bach flower remedies, which work at a mental level. They tend to help people with depression or those who have difficulties in managing their lives. For example, oak or olive may be taken to give strength to someone who is run down. The high levels of the bush and American flower essences are all valuable tools. However, far too few, if any, medical colleges offer courses for doctors so that they can understand how to interface with this world.
Many years ago, I did a masters degree in business administration, which some think makes people a master of absolutely nothing and an understander of little. I can see hon. Members smiling at that description. Hopefully, I gained some understanding from such studies. Having spent a few weeks studying a range of subjects, I did not necessarily become a great expert. However, that does not matter. What people need to know is where to look when they need help. I shall never be an expert on economics. I do not speak in the House about economics, but I know when to contact an economist.
Doctors need to be able to say, "We cannot fix this skin problem. We have tried steroids, but the patient has not responded." That certainly happens at the George Eliot hospital, a massive national health service hospital in Warwickshire. It has brought in a homeopath, who specialises in skin conditions. He is not getting the easy patients, but those whom no one else can treat. There are worries about steroid creams, but homeopathy and traditional Chinese medicine, in particular, deal effectively with skin conditions. I could give the Minister chapter and verse about such matters.
We need to consider a new health paradigm in this country. That is the strategic thrust of my argument. We must take patient experience into consideration much

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more. That is something NICE could do: it could collate patient experience and anecdotal evidence. We are told that anecdotal evidence is not enough, but if one collates enough anecdotal evidence, it is pretty powerful. If 25 people came into the Minister's advice surgery in the run-up to the next general election and told her that they were unhappy about the ring road around Salford, I bet that she would not say that that was just anecdotal evidence, and that a double-blind, consumer-driven trial was needed. When people come to see me about the Earl Shilton bypass in Hinckley, I do not say that their comments are not representative because they are not statistically sound. Instead, I say that I am going to listen like blazes, and ask them to sit down and tell me about the problem because my job is to represent them.
We must not get fogged by the terminology. We have intuition, which derives from the right side of the brain. The left side of the brain deals with thinking clearly. We have lost much of our right-side intuition, which can be observed in animals sensing fear. A very effective way of preventing deer from eating roses, if anyone ever has that problem, is to put lion dung in the beds. Deer, who have not seen lions in England for 1,000 years, know if they smell a lion that they have to get away. That is intuitive and instinctive. We have lost that and we need to return to it.
My hon. Friend the Member for Chesham and Amersham, who has carried out so much work on multiple sclerosis, referred to beta interferon, as did my hon. Friend the Member for Upminster (Angela Watkinson). NICE's decision on beta interferon is very controversial. What is just as controversial is the failure to investigate the effectiveness of acupuncture in relieving the condition. That is not some crazy moon therapy of which no one has heard. The therapy has been around for 3,000 years and is practised in 60,000 hospitals in a country that comprises a fifth of the world's population. We are not considering it, and we must.
We have referred to costs, which are crucial to the national health service. We have already been told that new Labour has blown it on its existing budget, and is returning to tax and spend. That is now Labour's policy. It cannot fix the health service. It has tried to, but will have to spend more of people's money. The Minister would not have to spend quite so much if she considered other treatments. Acupuncture treatment is incredibly cheap. All one needs is a set of 14 to 20 needles per patient. They are terribly cheap; one uses them once and then throws them away. The expense lies in training the practitioners, although even that is cheaper. NICE should consider that.
The cost-effectiveness of medicines and the outcomes for patients, to which my hon. Friend the Member for Upminster referred, represents another straw in the wind. The Government must consider the cost. I am minded to table questions to the Chancellor of the Exchequer asking whether he has investigated the cost comparisons of the different medicines. Perhaps the Public Accounts Committee should consider that. I may ask my right hon. Friend the Member for Haltemprice and Howden (David Davis), who chairs that Committee, to consider it. The costs are completely different, and out of line. We ignore that and we should consider it: it is terribly important.
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Last week, we launched the parliamentary group on integrated and complementary health care, which replaces the one on complementary and alternative medicine that was set up in the 1970s by my hon. Friend the Member for Stone (Mr. Cash) with the former hon. Member for Erewash, Peter Rost, in order to create awareness. People are now very aware. A vast amount of the population is using such therapies and the Government are lagging. They need to wake up because we are undergoing a seismic change in health care in Britain as primary care trusts take over from the old health authorities. Many of the novel therapies offered under the old system have been done away with as the new system tries to bed in. More information provided through NICE and a greater number of inquiries would go a long way towards alleviating such problems.
It is rare that one gets a chance to say more than one hoped to in a debate. I hope that I have not monopolised the available time too much. I am grateful for the indulgence that my hon. Friends and hon. Members have shown in listening to me for so long.
10.24 am
Dr. Evan Harris: It is a privilege to be here to discuss such an important issue. I see that the Minister is on her own on the Labour Benches, but she makes up for her isolation with her enthusiasm, and we look forward to her contribution.
It should be pointed out that the Select Committee on Health is, or has recently been, abroad. That is why many people who might otherwise be present, including Government Members, are not. My hon. Friend the Member for Romsey (Sandra Gidley) would almost certainly have been here and might have been speaking were it not for the Select Committee's travels. It is particularly appropriate that we have in the Chair a distinguished former Chairman of the Select Committee, the hon. Member for Macclesfield (Mr. Winterton). He can see that we are discussing things that that Committee has discussed over many years.
It is appropriate to put on record that I am an Industry and Parliament Trust fellow with what is now GlaxoSmithKline—it has gone back and forth through several name changes. I also went on a national health service study trip, funded by the company then called Rhône-Poulenc Rorer, to the American Society of Clinical Oncologists some years ago, to examine rationing of health care treatments.
We have had a fascinating debate. The number of treatments spoken about demonstrates the pressure on NHS budgets. We have heard calls for more spending on and funding for treatments for rheumatoid arthritis, multiple sclerosis, infertility and cancer, to name but a few. Those calls are all appropriate, but involve saying that greater priority should be given to those conditions. Politicians must realise that, when there is a limited budget, a call for priority to be given to certain treatments or alternative treatments is by definition also a call for less priority to be given to something else. We must be careful about falling into that trap.
Mr. Heald: Does the hon. Gentleman agree that it is necessary to look far more widely at the cost savings made by the implementation of guidance? For example,

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in the mental health field, if modern drugs were made available, the effects would be felt not only in the Department of Health but in a range of Departments. Mental health is a condition that affects not only health but the issues covered by other Departments.
Dr. Harris: Of course I accept the hon. Gentleman's point and shall deal with those issues when I discuss how to measure cost-effectiveness. However, it would be difficult, and a dangerous policy, to rely on increased spending on effective treatment and on the identifiable release of funds in order not to put pressure on the budget when more spending in one area is called for. The corollary of that would be that we could only spend more on certain drugs when they could be shown to release funds, although there might be arguments to spend more on treatments and drug therapies when that did not release funding elsewhere. Meeting unmet need is something that we do not do well. I suspect that much Government policy is designed to ensure that we do not identify unmet need in case that requires funding for which savings cannot be made from existing treatments because there are none.
Mr. Heald: Has the hon. Gentleman read the interim Wanless report? That makes the point that there could be
"a 5 per cent. reduction in the societal cost of mental illness, for example through lost days at work or the loss of employment",
and even a reduction in the cost of crime, if modern treatments for mental health were available.
Dr. Harris: I understand the hon. Gentleman's point that investing in modern treatments and early intervention can cause long-term savings. I do not dispute that. However, if he is saying that we should give extra resources only to areas, such as the one that he mentioned, where that might cause the release of funding not just in the health service but elsewhere, he is on tricky ground. It is often hard to prove that that release of funding will happen, and one should not have to go as far as that hurdle. I hope that he will recognise my point that increased priority for treatment for certain conditions within existing budgets will create pressure because health authorities cannot grab Home Office or Department for Work and Pensions budgets and the savings therein.
The other temptation that we must avoid is engaging in NICE bashing. A number of public submissions to the Health Committee inquiry into NICE said that it is a reasonably well run organisation, and those submissions came from people who might have had an axe to grind. I am certainly not going to indulge in NICE bashing; politicians' behaviour, and particularly Ministers' policies in that area, makes them far more eligible for bashing.
I congratulate the hon. Member for Upminster (Angela Watkinson) on her speech introducing the debate, and I thank her for bringing the issue before us. If she does not mind my saying so, she should be congratulated on identifying many key issues that we have to—and want to—discuss, such as who appraises what goes forward, the lack of transparency on cost-effectiveness, how we can measure cost-
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effectiveness more widely than at present, and the lack of ring-fenced funding to implement NICE guidance. She also mentioned so-called NICE blight, which was discussed by other hon. Members.
The hon. Member for Chesham and Amersham (Mrs. Gillan), who is no longer in her place, has done sterling work with the Multiple Sclerosis Society, to which I also pay tribute. It is a fantastic campaigning organisation which has kept the issue of the appraisal of beta interferon in the public domain to a greater extent, in terms at least of numbers, than might otherwise have been so, given competing priorities for media attention. That has put pressure on the Government, who responded with a quasi-trial, a quasi-subsidy and a quasi get-out arrangement—a sort of sale or return scheme.
I should be grateful if the Minister answered the following question, and I should like an undertaking from her that she will do so either in her response or in correspondence. She announced a proposal to make beta interferon available, where it had been shown to be effective, on a reimbursement scheme. What negotiations had she had with the drugs companies that would supply the drugs, and had they reached a conclusion when she made that announcement just before the Friday on which the NICE verdict on beta interferon was announced? I question whether she was able to gain maximum value for money in subsequent negotiations if she had committed the Government to that policy.
I am glad to see the hon. Member for Chesham and Amersham back in her place. I was just appraising her contribution and asking whether the Minister can be sure that she got maximum value for money from the drugs suppliers given that she announced the scheme before it had been agreed with the pharmaceutical industry. Was the Minister not over a barrel having made that announcement—which I suspect was made in order to pre-empt what she might have considered to be bad news on the NICE finding?
The hon. Member for Fareham (Mr. Hoban) gave a perfect example of NICE blight in the field of access to anti-rheumatoid arthritis drugs. That such drugs were under appraisal gave greater cover for those who look after tight budgets in resisting their wider prescription. Furthermore, because those treatments are available to the better off who can buy them privately if they have their whole treatment privately—a distinction that the hon. Gentleman was careful to make—and given that NICE has ruled that some drugs should not be available on the NHS or there is a policy not to prescribe such drugs until the information is available, there are issues of equity to consider.
The Government entitled—I think satirically—the White Paper in which they introduced the concept of NICE, "Faster Access to Modern Treatment". Whether it is a good thing or a bad thing—I say that it is a bad thing—most people in the field recognise that, effectively, the Government have delivered slower access to modern and effective treatments, which they must recognise as a tool of rationing.
As usual, we had a welcome contribution from the hon. Member for Bosworth (Mr. Tredinnick), who ought to be treated with greater seriousness by hon.

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Members when he asks questions in the House of Commons. Ministers should, and probably do, recognise that he speaks for many people in making the case for alternative therapies. I know that he does not mind, but I regret the fact that people are amused that he makes the same point in an effective if different way time and time again. The key point about his contribution is the question of evidence. Even though I am sceptical about some of the alternative therapies that he promotes, I am not of the view that there is not a powerful effect from such treatments. However, I question whether such effects are greater than the placebo effect that he mentioned.
As I have said before, the placebo effect is important in medicine and worth buying. Indeed, much of what the NHS provides through what may be called the white-coat effect is a placebo. However, there are ethical difficulties in saying that something has a pseudoscientific mode of working when all that one is generating is, in fact, a strong placebo effect. If one explains that the treatment is a placebo, one undermines its effectiveness but at least one is being honest. There is a difficulty with treatments that have an effect but for which the mode of working is, clearly, scientifically nonsensical. A balance must be found between achieving the effect that one wants and being honest with the patient, particularly if one is taking their money at rates that presumably support the industry. At some point, the hon. Gentleman must recognise and address the need for that balance. One could say much more on the subject; undoubtedly, we will return to it in future debates.
I should like to use my remaining limited time to discuss three issues: effectiveness, cost-effectiveness and affordability. The National Institute for Clinical Excellence was set up to consider the effectiveness of treatments. I do not question whether that is appropriate. It was also set up to consider cost effectiveness, which is a question of rationing. I am aware that the hon. Member for North-East Hertfordshire (Mr. Heald) is concerned about the time. I will finish soon, although I have taken several interventions, including his.
I do not think that there is any doubt that NICE should consider cost-effectiveness, as long as it looks at it in the round and not narrowly in terms of health budgets only. We must get a handle on some of the longterm measures of cost-effectiveness that the hon. Member for Chesham and Amersham mentioned, and drug companies have a duty to ensure that their trials consider long-term effects on health economics.
However, I disagree with the Government's imposition of an affordability test on NICE. I first raised the matter in 1999, when the Government snuck through an amendment during the recess to the statutory instrument that set up NICE. They argued that NICE had to take affordability into account. However, it is not for NICE but for politicians who raise taxes for and from the health service to say what is affordable. Unless the Government recognise that they are, effectively, approving a way of rationing, they cannot escape the charge of blame shifting, especially if they urge and force health authorities to fund treatments approved by NICE without providing sufficient funds. They are robbing Peter to pay Paul.
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In getting rid of what the hon. Member for Upminster called a postcode lottery, we may end up, in the words of Dr. Mike Dixon,
"replacing it with something worse".
We may end up with a tyranny of the appraised, in which medicines and other treatments that have been appraised by NICE get all the funding at the expense of other effective and important treatments. Those are the key issues that we must address when discussing NICE. I look forward not only to the Minister's response but to what I expect will be the even more balanced approach of the Select Committee.
10.38 am
Mr. Oliver Heald: I agree with the hon. Member for Oxford, West and Abingdon (Dr. Harris) that describing the work of NICE using the words "faster access to modern treatment" is ironic at best.
I congratulate my hon. Friend the Member for Upminster (Angela Watkinson) on securing this important debate. She launched it by referring to her constituents' concerns about the delays in introducing infertility treatment and colorectal cancer drugs. We have been waiting more than a year for determination of the appeals.
My hon. Friend the Member for Chesham and Amersham (Mrs. Gillan), who has a particular interest in multiple sclerosis and beta interferon, said that some of her constituents had been "to hell and back" over the issue.
My hon. Friend the Member for Fareham (Mr. Hoban) spoke about his constituent, Mr. Cooper, who has rheumatoid arthritis. He described the operations to replace joints that his constituent has had while waiting for drugs that should be available but are not because of NICE procedures. His constituent is frustrated that he cannot even pay privately to receive the treatment that would ease his condition.
My hon. Friend the Member for Bosworth (Mr. Tredinnick) described in his important contribution the benefits of integrated health care. Although it does not relate solely to NICE's work, it is important to note that in the treatment of mental health, as with other conditions, one treatment may not be the answer and a range of treatments may be necessary. A choice should be available. I make no apology for again mentioning the MIND campaign, "My Choice", which is making the very point that, in dealing with mental health, modern drugs coupled with sport and other treatments such as massage, reflexology and so on often make the difference for patients.
The starting point for our debate must be to examine why as the most innovative country in modern medicine in Europe—we invent the most medicines—we are the slowest to allow patients to receive the benefits of those medicines. It is appalling that a country as innovative as Great Britain should be in that position.
We all agree that it is good to have a body that can describe excellence and that cost effectiveness should be part of that equation. However, as my hon. Friend the Member for Fareham said, when the Government decided that cost-effectiveness must be judged within available resources, as they did in August 1999, the pass

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was sold and from then on it was a question of what the Treasury was prepared to hand out instead of what excellence demanded.
I agree with the hon. Member for Oxford, West and Abingdon that NICE's work should be praised. The Royal College of Psychiatrists described it as a well managed organisation with capable officials—I agree with that—and talented staff. It referred to it as an
"organisation that exudes a sense of unity, cohesion and commonality of purpose"
and stated that it is good that it commissions work from other bodies and encourages excellence. None of us disputes that, but the fact that it is a rationing body is the nub of our criticism.
The Government have stated recently, in the light of the Bristol royal infirmary report, that guidance will be issued without Secretary of State approval. That is supposed to suggest a new independence for NICE, but the fact remains that it decides what is clinically excellent on the basis of how much money the Chancellor will allow to be spent. It is a corruption of clinical excellence to require decisions to be made on the basis of Treasury-led concerns.

My hon. Friend the Member for Upminster referred to beta interferon, which NICE was forced to conclude was not a treatment that should be made available. During the trials in Europe, it became so obvious that it should be made available that the trial was stopped and the drug was given to those who had been receiving the placebo. In the face of such evidence, NICE was forced to state that that important therapy should not be available here because the Chancellor had not allowed enough money to make it available. Only when the Government were desperate owing to the publicity—that is what matters to this Government—did they manage to cobble together a compromise that, if the drug companies would treat its use as a trial and risk could be shared, they would allow beta interferon to be made available for a limited period to see whether it worked. The Government were hoist with their own petard. They had insisted that NICE be a rationing body, and when it did the rationing, they were so shocked by the effect that they had to scrabble around to find a solution through the back door to enable people to receive the drug to which they were entitled. It is all very well and good talking about guidance issued without the Secretary of State's approval, but that depends on what the Treasury can afford.
It has been said that there will be a statutory obligation to make funds available. However, as my hon. Friend the Member for Upminster pointed out, a mid-year determination can create a difficulty for the health bodies. Much criticism has been made of whether the NICE guidance, even if coupled with a statutory obligation to make funds available, will be followed, because there are competing bodies in the area. The NHS centre for reviews and dissemination and the "Drug and Therapeutics Bulletin" are in the public sector and are capable of giving different advice on drug therapies—and they do just that. For example, they gave different advice on relenza. Ultimately, the buck stops with the clinician. The law is clear that it is up to
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the clinician to decide which drug to prescribe and, if he considers that the advice of NICE is wrong or that some other advice or opinion should be accepted, that is what he does. It is not simply a matter of NICE handing out its guidance and the money being available.
Many health authorities or trusts have no procedure whereby they can monitor the implementation of the guidance. Recently, CancerBACUP undertook a study that showed that only 47.5 per cent. of health authorities—as they then were—and primary care trusts have monitoring policy. Does the Minister accept that there is a need for a serious review of NICE? When I asked a parliamentary question about it in December, the answer was that the review that was promised in March 2001 would be considered in the light of the Bristol royal infirmary and Select Committee reports that were being undertaken. Will there be a full and proper review? If so, when?
Will the Minister confirm that the review will cover some of the important issues that have been outlined today? Will it deal with how cost effectiveness is quantified and measured? There is no doubt that, as the interim Wanless report made clear, a much wider assessment is required than that which is carried out by NICE at present. On mental health, the Wanless report estimates the cost of modern, world-class mental health services at £3.2 billion. It makes it clear that it is not unreasonable to set against that the
"5 per cent. reduction in the societal costs of mental illness"
that would be achieved as a result. Wanless highlights lost days of work, loss of employment, costs of crime and other issues. The report talks of an across-Government assessment.
Will the Minister confirm that NICE simply considers the drugs budget and the quality of life for the individual patient on the basis of QALYs—quality adjusted life years? If we can achieve from a treatment at a cost of less than £30,000 a quality adjusted life year, it passes the test. If it costs more than £30,000 a year, that is tough luck. Will she establish that that is how the system works at present and that it is as crude as that?
Will the review cover NICE blight and whether it should be merged with other bodies? Will it deal with the timing of appraisals? Who will decide when technologies will be up for appraisal? No one seems to know who makes such decisions. Will she comment on why her Department has published a report called "Faster Access to Modern Treatment" and has established NICE with the result, as I said at the start of my remarks, that patients in the most innovative country in Europe have the slowest access to modern medicines?
10.49 am
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I shall do my best to respond to all the issues that hon. Members have raised in the time available to me. If I do not manage to respond to some of the important and interesting detailed issues raised, I undertake to do so in correspondence.
I congratulate the hon. Member for Upminster (Angela Watkinson) on securing the debate. All those who spoke raised important and complex—not to say difficult—issues to be resolved. I am pleased that the debate is taking place in the context of the inquiry into

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the operation of NICE by the Select Committee on Health, because I believe that the debate and the inquiry address some of the same issues.
The hon. Lady said at the outset that the setting up of NICE was well intentioned and welcome. I was a little sceptical of the remark made by the hon. Member for Chesham and Amersham (Mrs. Gillan) that the hon. Member for Upminster had outlined the case against NICE; clearly, she had not. She voiced some reservations and concerns, but welcomed the establishment of NICE, and her comments were echoed by many other hon. Members who mentioned the way that NICE is run, the high quality of the people involved, and the way in which they are grappling with difficult issues.
The hon. Lady asked who decides the priorities and whether there are any specialists on the appraisal panels, before going on to discuss funding issues. The NICE process provides for expert views to be taken into account in many ways. The royal colleges and specialist associations make submissions to the NICE appraisal committee; those submissions provide the process with expert views. The appraisal committee also invites experts in technology to attend its meetings and give evidence. It is crucial that the best evidence is available to the appraisal committee during its consideration of such matters.
In the early days of NICE, concern was expressed about who decides the priorities and about the transparency of the selection process. That is one of the reasons for the launch tomorrow of a consultation paper on the process—how technologies are selected for appraisal, how they are considered, and who considers them. I urge the hon. Members who asked questions about the operation of the process to respond in detail to that consultation.
Mr. Heald: I am pleased to hear that, but will the Minister confirm that as well as the consultation exercise, there will be a full review of NICE and its operation?
Ms Blears: My understanding is that that review, which was originally referred to in January last year, was proposed in the context of the pharmaceutical industry competitiveness taskforce. The industry had voiced concern about the way in which procedures were selected and about the process for appraising them. The consultation to be launched tomorrow will pick up many of those issues.
The Bristol royal infirmary report raised different issues. It dealt not with competitiveness or the way in which technologies were selected, but with the independence of NICE and the way in which it interacted with the rest of the health service. Those issues, too, have been raised by hon. Members today, and they are picked up in the response to the Kennedy report. The review will be about the selection process, how the topics are considered and the sorts of evidence submitted.
The hon. Member for Chesham and Amersham raised a series of Multiple Sclerosis Society recommendations on cultural shift, the membership of NICE and, in particular. the involvement of patients' representatives and the perspective of users on the
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process. Those are extremely important issues, and I am sure that some of them are appropriate to the consultation process, but I undertake to raise them myself. It is important, not only for the Multiple Sclerosis Society but for the whole range of patient bodies, that the perspectives of users and patients are as much a part of the process as anybody else's perspective. If there is to be broad consensus about NICE's decisions, the whole community must have confidence in the process.
The hon. Member for Upminster expressed her worries about funding, and several hon. Members mentioned the possibility of mid-year determinations that could cause difficulty for primary care trusts and strategic health authorities when planning ahead within their allocations. Increases in the general allocations for health authorities and primary care trusts are occurring at a rate faster than any we have known before. Since 1997, health spending has increased by a third in real terms, and by 50 per cent. in cash terms. It is right that primary care trusts and health authorities that represent local communities are the bodies that plan ahead and decide how to meet the funding requirements for new treatments and technologies that emerge from the NICE process. It is fair to say that mid-year determinations and items coming out of the blue will be very rare. The processes are generally long term, involving research, licensing and the development of ideas. Most people involved in health will receive pretty good notice of what is to come on stream, and they should plan how to fund that with their partners.
It is the fair to say that mid-year determinations and items coming out of the blue will be very rare. The processes are generally long term, involving research, licensing and the development of ideas. Most people involved in health will receive pretty good notice of what is to come on stream, and they should plan how to fund that with their partners.
Several hon. Members mentioned so-called NICE blight. I assure them and the public that funding authorities are expected to use their existing prescribing arrangements and examine evidence of clinical effectiveness when considering the funding of any treatment being appraised by NICE, or of a treatment for which no appraisal has been commissioned. NICE should not be used as an excuse not to provide treatments. Health expenditure is rising significantly and procedures should be determined using the clinical views of GPs and those who are involved with their patients.
The hon. Member for Chesham and Amersham raised the issue of beta interferon. I am glad that she has welcomed the scheme that was set up to allow thousands of people to access beta interferon. The scheme is about creativity, imagination and taking an innovative and novel approach. That is in the best interests of patients in this country.
Turning to the comments made by the hon. Member for Oxford, West and Abingdon (Dr. Harris), I understand that negotiations with companies did not commence until after NICE had made its determination. That clearly answers the points that he raised.
The hon. Member for Fareham (Mr. Hoban) expressed concern about the three-month statutory period for the implementation of the decision set out in our manifesto to ensure that the system has teeth and that if NICE makes a decision, health authorities and primary health care trusts are obliged to implement it. I am delighted that that is now the subject of a direction

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and that there is a statutory responsibility for procedures to be funded within the overall increase in expenditure of primary care trusts' budgets.
Generally, I tell hon. Members that deciding what can be afforded and assessing the cost-effectiveness and clinical effectiveness of procedures are complicated matters for mature discussion among all parties. We live in the real world in which there are some financial constraints on health expenditure, but I am happy to say that under the current Government those constraints are much smaller than they were.
I come now to the points made by the hon. Member for Bosworth (Mr. Tredinnick). In principle, NICE may consider complementary therapies, provided they satisfy the criteria. The technology advisory group considers proposals, and anybody may submit ideas to that group: if the hon. Gentleman or those he represents wish to submit projects for appraisal, they can do so. We want the consultation process that will be launched tomorrow to make the selection process more transparent and open, to allow more people in different fields to submit ideas to NICE. The hon. Gentleman said that just being around some people increases our sense of well-being. Unfortunately, the opposite is sometimes true—but not of him.
The hon. Member for North-East Hertfordshire (Mr. Heald) asked about rationing and the budget. He must acknowledge that under the Labour Government health expenditure is increasing faster than ever before. Unless his party is prepared to match our health expenditure, it is pretty contradictory and an example of wanting it both ways to say that everything should be implemented with no limit on expenditure.
I am delighted that the hon. Gentleman welcomes NICE. It is not about reducing expenditure, because approximately an extra £300 million will be spent this year as a result of implementing NICE guidelines: for example, 9,000 women will get drugs for breast and ovarian cancer, 10,000 people will get drugs for cancer, 77,000 patients will get drugs for coronary heart disease, and 72,000 will get drugs for diabetes—
Mr. Deputy Speaker (Mr. Nicholas Winterton): Order. I regret that the Minister's time is up. We thank her very much for her reply to that important debate.

Political Participation (Young People)
11 am
Vernon Coaker: Today's debate is on one of the most important subjects for Parliament. The health of our democracy should be, and is, a real source of pride to us all. Hard-won freedoms such as freedom of speech and association, free movement, religious freedom and the right to vote are important principles, and they have all helped to create our democracy. However, there is a real sense of unease—a sense that all is not well and that something must be done. There is a feeling that alienation from the formal political process is growing, and nowhere is that alienation more acute than among our young people.
We must confront the context in which the debate takes place. The turnout in the 2001 election was appalling. Involvement in politics is not just about voting, but the record level of apathy, especially among young people, is a challenge to us all. Only 59 per cent. of people voted in the 2001 election compared with the 71 per cent. who voted in 1997, but that was 10 per cent. lower than at any election since universal suffrage was introduced in 1928. One cannot help comparing that figure with the number of people who voted in the "Pop Idol" competition. That may seem a trivial point, but it shows what can happen when people are motivated and interested. When it is easy to vote, people become more involved. I do not want to be a part of a democracy in which a minority vote in a Government; that is unhealthy for democracy.
What do some of those young people say? In a book published by Demos in 1999 called "The Real Deal", some disaffected young people gave their views. I shall quote some of them. A 21-year-old white British man said:
"I've got no plans to vote on any elections or anything. I don't feel that it makes much difference. I haven't noticed any difference in my life in the change of government. The only change of government that's been while I've been alive, I've not noticed any difference. I don't think that there would be any difference."
A black British woman said:
"No. Not really. I'm just not a political person. I don't really care one way or the other. Although some people get really upset when you say that, they think, 'Oh you should care, it's your world, your country too' but you know, I never think what I think is going to make any difference at the end of the day, I'd rather use my energies thinking about something else that matters for me."
We need to listen to what young people are saying. I reject emphatically the argument that young people are not interested in politics, that they are selfish and are therefore unconcerned about what is going on.
The word "apathetic" implies laziness. I believe that we, as politicians, need to ask why it is happening; we should ask whether we are to blame rather than trying to externalise the problem. We need to consider how we should respond to young people's disaffection. I believe that they are concerned and interested, but they want to feel that their voice, their vote, their view, can make a real difference to the decisions that are made. They want to feel that their involvement can change things.
We should consider the passion with which young people involve themselves in single issues. When we visit schools or youth clubs, young people tackle us about issues such as the environment, rights at work, poverty

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at home and abroad, animal welfare and drugs. They challenge us on the issues of fairness, equality and ethnicity—the whole range of social issues that confront us. Those young people have a real point to make about those issues, and we should listen to them.
The MORI poll cited in the "The Real Deal" states that 84 per cent. of young people consulted by MORI said that they did not trust politicians, and 70 per cent. said they had never been consulted about their needs by politicians. I tend to feel defensive when I read such statistics; my immediate reaction is, "Well, I do this and that, and I try to do my best"—but we should confront the issue and recognise that a real challenge lies before us. To overcome that apathy, disaffection and mistrust, we need much more direct contact between politicians and young people and more direct consultation on the issues. We need to break down the barriers. The media have a fundamental role in that, not only by holding us to account and but by concentrating on the real issues.
Mr. Andy Reed: My hon. Friend may be surprised to hear that when I consulted young people under 24 before the last election, I had a far better response rate from them than from the rest of the population. More than 33 per cent. of those who were asked questions responded, which shows that young people are interested in the issues. However, the most significant point that emerged was that they did not have enough information to make key decisions on the issues that we were trying to consult them about.
Vernon Coaker: My hon. Friend makes a valid point, and confirms my belief that when one has direct contact with young people, they have opinions to express. Young people simply want the opportunity to express their opinions.
My hon. Friend referred to the need for information, and I shall deal with the question of citizenship education later. It is important to ensure that people have information, but the key point of my argument is that young people's view of the political process and of politicians changes for the better whenever we consult and involve them directly. and make them feel that their voice is not only listened to but acted on, and that they are informing the decisions that are made.
The media have a role to play. A debate is currently taking place about the dumbing down of the media, which is an important issue. We would not want that to happen, but we should bear it in mind that the media play an important role in representing politics and providing a connection between politicians and the general public—not least with young people. The media's attempts to find new ways of programming, rather than defeating the desire of politicians to inform people, may have the opposite effect if they are successful in helping to engage young people. Although no one wants there to be any dumbing down, we need to consider how programming might help, especially with respect to young people. The BBC, independent television, radio and the newspapers are considering that issue.
To reinforce the importance of direct consultation, I shall quote the views of a young person who attended a consultation event in Cardiff. Some hold the view that we are not real people—to the extent that when we go
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out shopping in the supermarket, people say, "What are you doing here?" and we have to explain, "Actually, I'm shopping." Some people seem to think that we do not do normal things such as shopping. The young person in Cardiff said,
"Yeah. We've got this thing about politicians being all prim and proper, no family problems and when we was at one of the meetings we were saying, like we had to go round in circles saying something about ourselves and like who our idol was. And we had to say about our mothers and one politician turned round and said it would have to be my sister because she's a single parent mother and all her kids done really well in school and it made me realise it isn't two parent families and stuff like that. Which was good to realise."
That is an important point about a part of the process that somehow, when we talk about our democracy, we have to generate. We have to ensure that people realise that politicians are also human beings who live in society and the community, and use the hospitals and schools, as others do. Direct contact and consultation can help break down those barriers. However, young people will say that consultation must lead to action and change, and not merely be a talking shop.
As my hon. Friend the Member for Loughborough (Mr. Reed) mentioned, the introduction of citizenship education in our schools is crucial. It should not teach facts alone, although facts are important and people have to understand how Parliament works, how Members of Parliament are elected, what a council does and how councillors are elected. Young people must also be given a feeling of how the system can be used to try to change things. In their schools, they must be involved in decision making, so that they have real experience of democracy in action as well as factual knowledge about how it is supposed to work. Alongside citizenship education, the capacity of schools to change in response to what their young people say is important, as is the development of school councils and other such bodies.
The Government are to be congratulated on some of their actions to give young people a more effective voice locally and nationally, and the Minister will no doubt build on that point. For example, the UK Youth Parliament is an exciting initiative aimed at bringing young people into the heart of Government. I hope that we can build on it, and I shall speak more about it later. Youth councils are being established locally, and regional assemblies are linking up with the UK Youth Parliament. Sue Mansell, a citizenship co-ordinator, is working extremely hard to establish youth councils throughout my county of Nottinghamshire.
The children and young people's unit has been established and is encouraging Departments to consult and involve young people. Recently, the Department for Education and Skills held a consultation event with young people from all over the country. They spoke to the Government about what they thought should be in the Education Bill, what they thought was wrong with it, how they felt that it should be improved, and what differences they would make if they took the decisions. Those young people were invited to another meeting a week ago, and were met not only by Members of the House, including me, but by Members of the other House. We talked to them about some of the changes to be made in response to their comments. More such involvement is important. The Foreign and Commonwealth Office has organised many open days

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for young people, to encourage them to see it as an important part of Government and to encourage a wider diversity of applicants for jobs there. Across Government, changes are being made.
I recently visited the Monty Hind centre in Nottingham, which is the Nottinghamshire base for the National Association of Clubs for Young People. We need to ensure that all the changes that the Government make, whether in terms of resources or of policy consultation, reach down to the grass roots and the children at the sharp end.
You will know, Mr. Deputy Speaker, as will many of my hon. Friends and other hon. Members, that many MPs are trying new and exciting ideas to involve more young people in their constituencies. They are meeting young people and setting up websites and e-mail addresses, among other things, to try to engender links. However, we also have to recognise that the disengagement from the formal political process is real, and that there is a growing demand by young people for quicker decision making, faster change and more direct access to the process.
It was interesting to note that a poll conducted by Charter 88 in conjunction with the YMCA in August 2001 stated that a significant number of 16 and 17-year-olds—47 per cent.—said that voting could have a lot of influence, but that the figure for 20 to 22-year-olds dropped to 35 per cent. I do not think that 47 per cent. or 35 per cent. are necessarily significant figures for those who say that voting can make a difference. They do show, however, that we have an awful lot to do, and that an awful lot of change needs to take place.
There are a couple of issues that we need to consider. We must continue to think about the modernisation of Parliament. In the 21st century, we are still bound by tradition and forced to use antiquated language and procedures, which many young people see as irrelevant. I do not want change for change's sake, but Parliament must modernise itself if it is to be more relevant to the young people whom we represent.
Another important point is that Parliament should not be unnecessarily confrontational. The introduction of debates in Westminster Hall has resulted in an important change: some of the unnecessary party politicking has been taken out of our debates, which have sometimes been of a much higher quality as a result. Young people, in particular, are turned off by party political points being made just for the sake of it, rather than to advance a good argument. People understand that there are sometimes difficult issues, but Members of Parliament should seek solutions, not score party political points for no apparent reason.
We should also examine electronic means to enable young people to express their views directly to Parliament more easily. I am no great wizard with such things, but we should consider introducing interactive websites and chatrooms. We should explore the whole range of opportunities.
We must consult young people more widely on policy initiatives. We have heard practical ideas about how to make voting easier, and that will be important. I have said before that we need a debate about the age at which people are entitled to vote. We should change the
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suffrage, and the voting age should be reduced to 16. The age at which people may be elected should be reduced to 18, and the Electoral Reform Society and children's organisations such as Save the Children have supported a campaign to achieve that. Hon. Members will have heard it argued that although 16-year-olds can do a variety of things, such as joining the armed forces, marrying, and paying tax and national insurance, they cannot vote. We should deal with that anomaly.
We should also consider giving the UK Youth Parliament a budget. We can argue about the amount, but why not tell the young people involved, "We will consult you, and you will have a budget to spend." Why not give them £10 million and say that they can spend it as they deem appropriate? Why not give the Parliament's youth committees a budget to spend? Why not make councils establish youth committees and give them budgets that they must spend? There would be real decision making, real responsibility and real money to spend. Of course, those involved will waste money, but we ourselves cannot honestly put our hands on our hearts and say that we have never spent a few pounds that, in retrospect, we know could have been spent more wisely.
We should see young people not as a problem, but as a solution to many of the problems that we face. We have problems with crime on the street, drugs and poor behaviour in schools; indeed, there are a host of problems right across society. Why do we not involve young people by asking them, "What solutions can you suggest?"? If our young people were more involved in developing policies to deal with problems, we would make better policy changes.
There can be no greater challenge confronting individual Members of Parliament, or Parliament itself, than to rejuvenate and regenerate our democracy; it is crucial to re-engage the many young people who have lost confidence in the formal political process. The question is whether we are brave enough to make the decisions that need to be made.
11.20 am
Mr. Jonathan Shaw: I begin by congratulating my hon. Friend the Member for Gedling (Vernon Coaker). I have shared an office with him for nearly five years—although I have not been shopping with him—but this is the first time that I have taken part in a debate alongside him. Many hon. Members will know that he has been consistent in speaking and listening to young people, both in the House and outside. He has taken part in a number of initiatives, to which he has referred, and he and I are well acquainted with Save the Children.
What motivates people most strongly to participate? It is when they feel that they are going to lose something, or are going to have something imposed on them—that is a psychological motivator. Leon Festinger talked about the cognitive dissonance theory: if we feel that a force is threatening our balanced view of the world and what we perceive to be right, we will act. However, if we feel that our participation will have no effect, it is likely that we will not engage. An example of that would be compulsory voting. If any political party said that if it were elected it would impose compulsory voting, turnout would rise; people would not want to have that imposed on them and any political party that suggested it would be either voted out of office or not elected.

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Many hon. Members see that involvement at local level, particularly over controversial planning applications—mobile phone masts are topical for all of us. The community comes alive when people, young, old and middle-aged, want to resist something. They work hard for their communities and put in a lot of time and effort because they feel that they can affect something that matters to them. If we try to galvanise the same level of support, volunteering and community action for an environmental project, people are not so forthcoming or eager.
Consider the 1992 general election, when participation was higher than in the subsequent two elections. People felt that there was a real competition, and that there was something to lose if they did not vote. In 1997 and in 2001, particularly 2001, the press told us that the result was a foregone conclusion. How many doors did we all knock on to be told, "They're going to win anyway," even if we eagerly spoke of our majority and urged people to go out and vote? That is part of the equation.
I agree with what my hon. Friend said about the press dumbing down. We also heard at the last election that it was fashionable not to vote; people said, "Don't bother." That does not necessarily have an impact on which party people support, but it does affect whether they participate. People have argued about whether there was a golden age of participation and turnout, and from the 1920s until 1997. the percentage turnout was in the mid-70s, so the golden age, if there was one, ended in 2001.
The issue is important for my constituency, which is the youngest in Kent in terms both of its creation and of its population. It might surprise hon. Members to know that it also has the youngest Member of Parliament in Kent. Time has not been that kind to me, but even more depressing than my hairline is the fact that my constituency also had the lowest turnout in Kent. Although it is not the most affluent area in the country, it is far from being the kind of deprived inner-city area normally associated with low turnout.
All the political parties try to portray themselves as youthful organisations. Tune in to the party conferences and the leaders come on, the camera pans round, and—funnily enough—the two or three front rows are full of young people. The average age at the Labour party conference seems to be about 19 or even younger—although at the Tory party conference it is about 90. We have tried text messaging. birthday cards and first-time voter cards, but those measures have not had much effect.
Although young people's voting participation has gone down, as has that of the rest of the population, it is a question of more than just apathy and disillusionment. We need to recognise the potential seriousness of the situation, as my hon. Friend said. However, the news is not all bad—there have been advances in involving young people in politics, which will not necessarily increase participation, but will lead to the better formulation of policy.
Before my election to the House I was a social worker working with young people leaving care. For me, one of the proudest achievements of the Labour Government is the assistance that we have given young people through the quality protects programme. That
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programme involved a huge and worthwhile consultation process right across the country, which culminated in the Children (Leaving Care) Bill. There was a great campaign among young people and interested non-governmental organisations to raise the statutory age for leaving care to 21. That was implemented, and the Government went further, ensuring that if young people were in education or training, they could stay on until the age of 24.
That was an example of cause and effect. Young people were involved in consultation, had their say and affected the outcome. Directness is the key. If there is a clear relationship between cause and effect, young people will engage—as will the rest of the population.
The youth parliaments are an excellent example of the involvement of young people in politics. My hon. Friend referred to his, and I am bound to refer to my own in the Medway towns. The Ofsted report on the local education authority in my constituency reported that
"The youth parliament is an impressive organisation for involving young people directly in good citizenship. It is rapidly gaining respect for its contributions to the social debate. It includes representatives of all the schools and other organisations for young people".
Patrick Gearey, the public relations member of the cabinet drawn from the youth parliament, sent me that passage from the report. He seems to be getting his act together very well. The council has provided the parliament with £20,000, and it takes care of its own administrative costs with that money.
As my hon. Friend said, if we want young people to be involved, we should make it real by giving them money to make decisions about. They should have to tackle the sort of tough decision that we wring our hands about, such as those we have to make when trying to find solutions to the problems presented by young people.
The citizens curriculum is long overdue. School life has been dominated by academic performance, and although that is important, it has not assisted young people to cultivate ideas about the community and the wider society. We need thinkers as well as people who can pass examinations.
I took part in an exercise with sixth formers, talking about the events of 11 September. Half of the group took the part of George Bush and the other half played the role of our Prime Minister. They elected spokespeople and I presented them with budgetary issues. A £1 million extension was being built at the school and I suggested that they should give that money to our armed forces instead. "We don't want that," they said. By giving people finance, rather than merely making them discuss abstract issues, we make the situation more real.
Focusing on academic performance alone has led to the sanitisation of education. I have great hopes for the teaching of citizenship. I left school in the 1980s. My hon. Friend the Member for Gedling has referred to pop idols, and in the 1980s, pop bands were singing about unemployment: "I am the one in 10." I will not rehearse all the lyrics, but pop bands were talking about social issues and there was a rawness, which, like my hairline, has receded, so we must find new solutions.
I endorse the point about giving 16-year-olds the opportunity to vote. My hon. Friend referred to several things that people can do at 16 and 17. We are giving out

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mixed messages and we must be bold. My hon. Friend talked about entering the armed forces and getting married, but at 16 a young person can also enter and live in a brothel—I did not know that until I did some research. We allow people of that age to take considerable risks, and surely if we would allow them to live in a brothel, casting a vote for a Member of Parliament will not be beyond them.
It would be wrong to introduce such a measure without having a national debate. Young people's participation almost needs electric shock treatment. I suggest that we should have a referendum, which would bring alive young people's issues as never before. Unless we reverse the apathy we shall have minority elections, as my hon. Friend said. None of us wants that. For the sake of the institutions that make up our democracy, which we cherish, we must find bold solutions. I congratulate my hon. Friend on raising the issue today.
11.32 am
Ms Meg Munn: I, too, congratulate my hon. Friend the Member for Gedling (Vernon Coaker) on initiating the debate. I know that he has a long-standing interest in issues that affect young people. Much of what I want to say will illustrate the points that he has made.
During the recent parliamentary recess, I visited two schools in my constituency, Easthill and Newfield. I met groups of about 12 young people between the ages of 14 and 16 of varying abilities and, no doubt, varying interest in political issues. The issues that they raised were of great interest to me. They ranged from the role of a Member of Parliament—one young person asked, "What time do you finish work at night?"—to general questions about fundamental issues. I was asked, "What are taxes for?" and "Why can I get my glasses free until the age of 18 but have to pay for them after that?"
Some of those young people were beginning to link up the elements of what it means to be an adult, such as paying taxes and receiving services, with issues such as why young people get certain things free while others do not. They were also interested to know what the Government were doing about the theft of mobile phones. There was a lovely moment in the discussion when the teacher in the group confessed that he did not quite understand what the young people were talking about, because he was not familiar with the things that were important to them, such as SIM cards. That was an opportunity to ask young people for their ideas about how to reduce the problems that they face every day after school and when they are out with friends.
The young people also raised many current issues that we debate here and on the Floor of the House, such as the MMR injection. They wanted to understand why the Prime Minister took the stance that he did about his family. There was an interesting debate about the change of classification of cannabis, with people saying, "I won't get into trouble if I've got cannabis. I can't sell it or acquire it from anyone, but if I'm carrying it, I'm only going to get told off." The participants were trying to work their way around those ideas and to raise some of the issues that affect young people today.
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It will not be a surprise that student grants were discussed. So was the royal family and my views about it—and why, given those views, I was not prepared to do something about them. Foxhunting was of course discussed. The issues raised were those that were on our own agenda last week and will be there for months to come.
I was impressed by the fact that each group had been well prepared for the event. They had been well prepared by their teachers, but they had also prepared themselves. One group had spent the previous afternoon using the internet to research statistics, using them effectively and investigating the background of issues. They talked from a position of strength, having marshalled their facts. Some of them could give Jeremy Paxman a run for his money. If I am ever invited on "Newsnight" I shall definitely ask those young people to put me through my paces beforehand, because I am sure that his questions would be no tougher than theirs.
As part of my campaigning as a politician, I enjoy running street stalls, even in cold weather. People often say, "I'm not interested in politics," which is not the sort of thing that politicians want to hear. However, by that people often mean that they are not interested in us or what we do, and do not feel connected to it. They are not interested in what is written about in the newspapers, and strangely, they—unlike us—do not want to spend large parts of their lives attending meetings and sitting around talking about issues or leafleting. It may seem odd to us, but that is not the life that most people choose.
People are, however, interested in the stuff of their own lives. Just like young people in schools, they are interested in issues that affect them, such as their children's schooling. We have all experienced the phenomenon mentioned by my hon. Friend the Member for Chatham and Aylesford (Mr. Shaw): when something is about to be taken away from people, they turn out to meetings. There is no doubt that a proposal to close or merge a school will result in a room full of parents—and sometimes a room full of children and young people. People are interested in everyday issues, such as who is collecting the rubbish, but they also care about other issues, such as the wider environment, cruelty to animals, war and poverty.
It is up to us to engage with people about the issues that we care about—but we, and the institutions of politics, are often seen as not relevant or not accessible. I agree with my hon. Friend the Member for Gedling that politicians are not seen as real people. It makes a real difference if a Member of Parliament has the opportunity to meet people and tell them, for example, "I used to come and play hockey at this school when I was your age," and to explain that their backgrounds are perhaps not dissimilar—perhaps there may be a connection with parents, or some other connection.
People feel disempowered and unable to influence policies or decisions. Changing those feelings is not easy. If we had the answer, we would be busy providing it already, but today we have heard good examples of what can be done. Real opportunities exist now to start work with young people. Citizenship education is being introduced. However, I also agree with my hon. Friend that it is crucial that young people should be involved from an early age in influencing their own lives and that they should be consulted about what affects them.

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Where better for that to happen than in school? We have heard examples of school councils, and other mechanisms are available too.
Meersbrook Bank primary school in my constituency has a school council. I recently worked with several schools, inviting them to collect old European coins that were no longer of any value, and give them to Save the Children. We raised several hundred pounds from that. When I went to the school to pick up the coins, I found out that the issue had been put to the school council. I was relieved to learn that the council had voted that it was a good thing to do; the children had decided that they wanted to take part. Children as young as five, six and seven were making decisions. Four members of the school council gave the coins to me and I asked what they talked about in the school council. They told me that it was problems that were experienced in the school—whether with teachers, with the tuck shop, or with running in the corridor. Young people were involved at an early age in helping to resolve issues, and I thought that that was an excellent example.
We have to make the issues relevant. We should make an effort to meet young people from an early age and should encourage our colleagues in local councils to go out and do the same. Young people might not have the vote, but they are still citizens and members of the community in our constituencies. We should encourage schools to involve pupils in appropriate decisions within their schools so that they learn about discussion and compromise, about the art of the possible—as we should perhaps call politics—and about democratic processes.
There are real opportunities in councils and there are good examples around the country of councils that involve young people in best value reviews and in looking at the development of local plans. That practice should be spread. The UK Youth Parliament is a good place for young people to pass information among themselves. They might say, "We are doing this in our area, why not get in touch with your council and ask to be involved as well?"
We should involve them, as my hon. Friend the Member for Gedling has said, in consultation on legislation and Government guidance that affects them. Politics is about people's daily lives; they need to know how to have their say—it can and does make a difference. One way for us to help with that is to engage with children and young people outside the voting system as well as encouraging them to take part in that system when they reach 18.
11.42 am
Mr. Hilton Dawson: It is a pleasure to take part in what has not yet become a debate—the excellent contributions from my three esteemed colleagues have been along largely the same lines. However, this is a vital issue and I congratulate my hon. Friend the Member for Gedling (Vernon Coaker) on securing the debate. He will remember—neither of us will ever forget it—our trip to Angola in September. In the desperate circumstances of one of the most difficult places on earth for children to grow up in, some of the most powerful messages that reached us came directly from young people—astoundingly, from members of the Angolan youth parliament. That country, which has
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had one election in the past quarter of a century, manages to sustain a youth parliament, and I received an e-mail from one of those young people the other day.
I had an excellent evening on Saturday. I was put through my paces at a regional meeting at Charnock Richard of all the newly elected members of the Youth Parliament from the north-west, from Cheshire to Cumbria. Their contributions were polite, extremely articulate, well formed, challenging and to the point, and came from a perspective that no one in this Room has. They talked knowledgeably and passionately about the problems of education, access to public transport and young people living in rural areas. We discussed a range of issues and one speech was about care.
I am delighted to follow my hon. Friend the Member for Chatham and Aylesford (Mr. Shaw), as he and I have shared many moments in this Parliament of good discussion with young people on the all-party group on children and young people in care. Any Member can join the group and come along, generally on the third Wednesday of the month at 6 pm, to be challenged by young people whom many in the House and the country would, to be frank, patronise.
Those young people have missed out on educational opportunities and had dreadful life experiences. Regrettably, their peers often end up homeless, in prison or in other bad circumstances. Those who come along to meet young people in care, who often make journeys of hundreds of miles to reach this place, find that they know the subjects that they are talking about better than we do. We know that from debates with all young people. They are strong, powerful, articulate, intelligent, have important points to make and want action from Members of Parliament.
My hon. Friend the Member for Gedling was right when he described how we should try to attend to issues about which our young people are passionately concerned. We should afford them the opportunities to use discrete and realistic budgets, and have the confidence to allow them to make the mistakes that everyone makes in handling money and other such matters.
The Youth Parliament is extremely important, but we should avoid any sense of tokenism. It is in the hands of every Member of Parliament to build good links with their local Youth Member of Parliament. If my local YMP wants to be part of my constituency team and share office resources in order to carry out his work, there is no reason why he cannot do so. He could shadow me as I engage with local issues and, as a quid pro quo, he could help me enormously in engaging with the local youth forum and local young people on the issues that matter to them. The contribution of YMPs and young people in general can enrich the work of MPs and the way in which the House operates in terms of the interests not only of children and young people, but of our whole society.
I do not completely buy into the argument that we should have voting at 16, as it could be tokenistic. We must enrich and deepen our political culture so that the engagement and participation of children and young people is much more fully developed. Why should we talk only about 16-year-olds? I vividly recall a visit to a local primary school on which a boy aged nine—chronologically, at least—looked over the top of his

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spectacles and solemnly asked precisely what were my party's recycling policies. Let us not be ageist; many children have important points to make.
Before we change voting ages, we must appoint a children's rights commissioner. He would be known to children and be appointed and involved at the highest levels of government. He would embody and promote a culture in which children's voices were heard in every Corridor in this place, in every corridor in Whitehall and in local government. It is important that a commissioner is appointed along the same lines as in Wales, and I sincerely hope that there will be commissioners in Northern Ireland and Scotland, too.
I commend the Government's work on children in care and helping children and young people to participate: the children and young people's unit is doing exciting work; the Department of Health has played a vital role by bringing in young people to work on issues such as the quality protects programme and the new standards for children in care; and the Government have set up the children-led organisation, A National Voice. That is another major development, but we must extend such initiatives and build on the efforts to which my hon. Friend the Member for Gedling referred.
I refer hon. Members to the work of the all-party group on children, which I chair jointly with my noble Friend Baroness Massey. We are working with the Youth Parliament on ways to enable a discrete group of trained and supported YMPs to take a full part in all our meetings. Again, I recommend that hon. Members come along, because those young people have important points to make, know a great deal and are extremely challenging. The whole process is very enjoyable.
The participation of children and young people in the work of government is the next big idea, and this country must take it on board. Only when we fully listen to and engage with young people and act on their needs and wishes, and only when they see developments taking place, policies being promoted and resources going into the aspects of life that they regard as important, will we start to build the strongly participative culture that our democracy needs.
11.54 am
Ms Claire Ward: First, I congratulate my hon. Friend the Member for Gedling (Vernon Coaker) on securing a debate on this important issue, which politicians must tackle. One of the greatest difficulties for politicians is that many young people see us as on the outside and not connected to the issues that concern them in their everyday lives. I refer to a recent Centrepoint survey in which young people were asked why they see no reason to vote. Some said that it is because they are not registered to vote. Others did not know how to register and were not registered at their current address—the mobility of young people causes problems with voting. Young people also felt that their vote was irrelevant and would make no difference to what happened. That is one of our biggest problems. We need to tackle it in terms of the whole community, but especially in terms of young people.
How do we make the connection between young people casting their vote and what is delivered and makes a difference to their lives? We could all name
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initiatives that we know to have made a major difference in our communities, but our problem is that we do not get that message across enough. That is not a question of party politics and whether Labour or another party is in power; it is about ensuring that people feel a real connection and know who is responsible for what. That is why citizenship studies are crucial.
We have lost a generation of young people who have little interest in the political process. I do not say that they have little interest in politics—the real issues that affect their everyday lives—but they are not interested in party barracking, whether a Minister is in trouble or whether someone has resigned. They want to know what we are doing that will affect their everyday lives. We need to examine how Parliament and the Government can devise a process of education that empowers young people.
Young people do not want to express their opinions, whether in debate or through voting in elections, because they do not understand what difference it will make. They do not understand who is responsible for what. How many times have Members of Parliament been confused with local councillors? How many of us deal with issues that are the responsibility of local councillors? The difference between those responsibilities is misunderstood not just by young people, but by the population in general. We need to get more information about the system across, so that people feel empowered to make their voices heard.
We also send out confusing messages about young people. We say that we want them to participate in the political process, but we also see them as the problem. When we talk about crime, we often refer to young people, but in the vast majority of cases they are the victims. They are more likely to be attacked, whether in a mobile phone theft or an assault, than people from any other section of the community, but we see them as the problem because some hang around estates in the evenings and are considered a threat. We need to engage to find out what we can do to help them to gain some control over their lives.
The opportunities available to a young person of 20 have expanded and are much more advanced than those available to someone of similar age 20 or 30 years ago. A 20-year-old is now likely to be better educated and to have more disposable income and more employment opportunities, but although they have all those material things, they often lose community and family support and the sense of knowing where they fit in. We need to tackle that issue.
The all-party youth affairs group wants to involve more young people in the parliamentary and political process on the issues that concern them in the manner used by my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) in the all-party group on children. We want them to be able to make a difference. Recently, my hon. Friend the Member for Corby (Phil Hope) and I were involved in taking a group of young people from a YMCA around the House of Commons on an interactive tour. Instead of us dictating to them what we thought they should know, they were asked what they wanted to hear about the House of Commons, the workings of Parliament and the work of a Member of Parliament.
Mr. Reed: Rather than engaging a small number of people in the current process, do we not need to change

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our politics? We want to encourage young people to get involved, but the current process turns off young people and other constituents. Do we not need to modernise the way in which we do things?
Ms Ward: My hon. Friend is right. I hope that more hon. Members come up with ideas about how to engage young people's interest and listen to what they have to say.
Time is moving on, so I commend my hon. Friend the Member for Gedling for obtaining this important debate. We need to begin talking to young people, not just in our constituencies, but as a Parliament and a Government. I fully support my hon. Friend's idea that the voting age should be reduced to 16. I realise that it is not universally popular, but it sends out the message that we are interested in young people voting. We know that Members of Parliament spend time with pensioners because pensioners vote, so perhaps politicians would be more interested in listening to young people if they voted in greater numbers.
12.2 pm
Matthew Green: I, too, congratulate the hon. Member for Gedling (Vernon Coaker) on obtaining the debate, not least because it gives me the opportunity to make my first speech as Liberal Democrat youth spokesman.
At 23, 1 was elected and became the youngest ever member of South Shropshire district council, having become involved in politics only 12 months before. I contacted someone with whom I had been at university. She shared a house in a different part of the country with another girl, with whom we had also been at university. After our conversation, she said to her friend, "Matthew's just been elected a councillor." Her friend, a graduate and an intelligent young woman, said, "But I thought Matthew was honest." That is an aspect of the problem: the perception that we change as soon as we enter politics and are no longer ordinary members of society. We need to go some way to break down those barriers.
I have noticed, as I am sure other hon. Members have, that people who turn up to surgeries tend to be older. Indeed, when I take up an issue for a younger person, even someone in their 20s, it is often because a parent has visited me. Such a parent might say, "My daughter lives in a council house that is not up to standard. Will you try to sort it out?" That is part of the issue that we have to deal with. Young people do not even see us as a potential solution to individual problems.
Why has this state of affairs come about? We are too keen to blame young people, but the blame really lies with us. Rod McKenzie, editor of BBC Radio 1 news, says:
"Radio 1 believes that its target audience of 15–24 year olds are not disinterested or depoliticised. But they are fed up with the sterile and formulaic Westminster political coverage—men in suits"—
I am guilty of that—
"shouting at each other in parliamentary jargon across the dispatch box. Every time we ask for their opinions online on paying higher taxes to fund the NHS, tuition fees or foxhunting, we get a massive, passionate and thoughtful response. So this isn't about de-politicised youth—it's about Westminster not being relevant."
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For a long time, young people have thought that we do not discuss their issues. For instance, the biggest step forward in debating the problem of drugs was taken by the previous shadow Home Secretary who, in what may have been a moment of madness, suggested even tougher penalties for cannabis use. The result was that half the shadow Cabinet suddenly spoke up to reveal that they perhaps had somewhat different experience of cannabis. That freed up the political debate on cannabis, which young people have been discussing for years, believing that we are completely out of touch. The House was afraid to discuss the issue as it is discussed on the street, but ironically, the previous shadow Home Secretary took a significant step forward.
We must accept that although some solutions are in the Government's control—I am keen to hear the Minister's response on those—some are not. I am afraid that we are all guilty. There is a tendency to patronise young people and the attitude is that we know what is best for them. We should be asking them for their views, and in the case of 16-year-olds, their votes.
We have heard about making voting easier by allowing it at supermarkets or on the internet. Those suggestions may be welcome and sensible, but they will not solve the problem, because they are window dressing. The difficulties go much deeper. We have also heard about better education. I welcome that and the teaching of citizenship at schools. I particularly welcome the Youth Parliament. I have been invited to join the board of trustees, and I am delighted to do so. The Youth Parliament is a key to increased youth involvement in politics.
Organisations such as the YMCA have undertaken a number of interesting initiatives that try to get young people to debate the issues, and at the last general election it was able to increase young people's participation in voting. I must praise other initiatives such as the Westminster day, which is a cross-party event organised by Liberal Democrat Youth and Students that took place a few weeks ago. I was delighted that the Prime Minister, who was joined by the Conservative and Liberal Democrat leaders, became the first Prime Minister to speak at the event. That shows that they are perhaps taking the issue more seriously and highlights the fact that the Prime Minister's response to my question on votes at 16 was surprisingly out of touch.
The key is making young people respect society more so that they want to be involved in it, and we can generate respect for our society and our system by respecting young people more. I am afraid that we tend to patronise them. We must reduce the voting age to 16. I shall not bore hon. Members on the point—I hope that they were in the Chamber when I introduced my ten-minute Bill before Christmas—but I must draw out a couple of points.
The Charter 88-YMCA poll result was referred to by the hon. Member for Gedling, who cited two figures, but did not give the age bands. The 47 per cent. figure is for 16 and 17-year-olds and the 35 per cent. figure for 18 to 22-year-olds. Interestingly, people aged 16 and 17 think that voting is more important than do those aged 18 to 22.
Liz Blackman: Does the hon. Gentleman agree that, allied with what he has just said, introducing

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citizenship teaching is crucial? If we introduce structure and coherence to young people's curriculum diet and then tell them that they must wait until they are 18 to put it into practice, the impetus will be lost.
Matthew Green: I agree entirely. The hon. Lady must have read my notes, as that was my next point. Perhaps as a sign that we are not the only ones who patronise young people, after I put my question to the Prime Minister, "Westminster Live" decided to do a vox pop in my constituency—a bit of a sting to show that my constituents are not interested in votes for 16-year-olds. The most interesting vox pop came from an 80-year-old woman, who said that 16-year-olds should have the vote, but that she could think of a few 80-year-olds who should not.
There is an idea in society that young people do not have views or that their views are not properly formed and that they are insufficiently educated. With citizenship teaching, they will be educated about how to vote and about other aspects of politics, but then there will be a two-year gap, which makes nonsense of the whole idea. If the Government are serious about it, they should also be serious about giving 16-year-olds the vote. I hope that the Electoral Commission makes a positive announcement about that in the next week or two.
We do not give 16 and 17-year-olds full benefit entitlements, but we should either treat people as full members of society or not. One element of getting young people more involved in the political system is treating them as full adults at 16. However, the single-room rent restriction reduces their housing benefit entitlement. That restriction should be ended for people over 16, and I entirely agree with remarks made earlier about the mumbo-jumbo that we speak in Parliament. That must change.
One solution is not in the hands of the Government, but in ours: personal contact with Members of Parliament to show that we are human and interested. Recently, I went out with young people from Ludlow youth forum and held a surgery in a pub on a Friday evening. I did not dress down, but went in my suit. I did not turn my cap around or drink 14 pints, but young people raised all sorts of issues with me, such as skateboard parks and other matters. Using such methods, the issues are just as much in our hands as in the Government's.
12.13 pm
Mr. Charles Hendry: I congratulate the hon. Member for Gedling (Vernon Coaker) on securing this important and timely debate, and the extent of the media coverage in recent weeks shows that he picked the subject of the moment. I agree with his assessment of the problem and that of other hon. Members. I also agree about the seriousness of the problem and with most of the hon. Gentleman's conclusions, although I disagree on lowering the voting age. I agree with the hon. Member for Lancaster and Wyre (Mr. Dawson) that it smacks of tokenism and takes our eye off the real challenge, which is how to get more young people who are already able to vote to participate in the electoral process.
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Excellent research by MORI, in conjunction with the Adam Smith Institute, and by the BBC into why people do not vote makes stark reading. Only 60 per cent. of those aged between 18 and 24 are registered to vote—when one takes into account low turnout, the figures are even worse—and of those, fewer than 30 per cent. of first-timers voted in the last election. The researchers investigated what percentage of 18 to 24-year-olds participate in local elections: 12 per cent. said that they always participate, 13 per cent. that they usually participate and 8 per cent. that they sometimes participate. That is a third of that electorate, which means that two thirds of first-time local election voters rarely or never vote.
Some 51 per cent. of 15 to 24-year-olds said that they were not interested in politics at all. That gives some indication of the problems that we must address, but none of those people would be helped by reducing the voting age. That distracts us from our task of getting people to turn out when they are entitled to do so. The book "Political Systems of the World" says that the voting age is lower than 18 in only seven countries, including Iran, Cuba and North Korea. The message in those countries is that people are allowed to vote at 16, but only for the one party that is allowed to stand. Changing the voting age does not, therefore, necessarily advance the democratic process.
Only 6 per cent. of young people said that they did not vote because voting was inconvenient. So, what are the reasons behind the disillusionment and apathy? The first is a lack of understanding of the key issues. Four fifths of young first-time voters said that they knew hardly anything or nothing about Parliament, the work that we do or the work of European Union. That figure rose to nine out of 10 when they were asked about the role of local government. That lack of understanding is, therefore, a key issue.
The second issue is trust. According to a BBC survey of younger voters, only 16 per cent. trust politicians to put the needs of the country before those of their party. That is down from 39 per cent. 30 years ago, so there has been a dramatic decline. When asked, "What does politics mean to you?", 39 per cent. gave negative answers, using words such as crooks, criminals, corruption, boring and liars. When people say that they will not tolerate lying by those in ministerial positions, the lesson that we in politics must draw is that something must be done if young people are not to become even more disillusioned.
The third point relates to changing attitudes. Only half 26 to 35-year-olds felt that they were neglecting their civic duty by not voting. That shows how attitudes have changed, and we must urgently tackle the issue. As the hon. Member for Chatham and Aylesford (Mr. Shaw) noted, people said that they would not vote in the last general election because they could see no difference between the parties. That issue came up on doorsteps, where people would say, "You'll win anyway" or "I can't really see the difference between your parties." We must make the differences between us clearer.
There is also a feeling of disempowerment, because younger people do not feel that their votes will count. There is a general indifference to the political process.

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We must make sure that 2001 is an exception, not part of a downward trend, and we must consider how to change things.
Young people can be given a positive attitude towards voting. An analogy was made with "Pop Idol", although it is not totally relevant. Nine million people voted in that programme, which is more than voted for my party and the Liberal Democrats combined in the general election. Some 10,000 people applied to be considered for the programme, which is three times the number of election candidates. That shows that young people love to vote when they are enthusiastic.
Another lesson that we can learn from "Pop Idol" relates to the fact that it was a positive programme. The contestants did not argue with each other and the negative contributions were made by a panel of judges, whom one was free to despise. The contestants kept it positive and spoke about their strengths and the strengths of the others.
I agree that our job as politicians is to enthuse young people, and we cannot expect them to find politics interesting if we do not change some of the ways in which we address issues. We must show them that we are dealing with their concerns. It is easy to take a patronising view and say, "Young people are only interested in drugs, music and clothes." As the hon. Member for Sheffield, Heeley (Ms Munn) made clear, they are interested in issues across the board. If one talks to them in depth, one finds that they have strong views over the range of issues that we discuss in the House.
When I became my party's youth affairs spokesman, I was slightly dismayed by the number of television and radio interviewers who told me that, because I was representing young people, I would have to know who was No. 1 in the charts, who would get a Brit award and who played the lead in a particular film. Fortunately, I knew the answers, but I was disappointed that those commentators trivialised young people's views on important issues by saying that we must talk to them about pop music or films.
When we talk to young people, we find that they have concerns about education, transport and housing. They are worried about crime, and, as the hon. Member for Watford (Ms Ward) said, they are often the victims rather than the perpetrators. They are concerned about the environment and even about taxation. Some students who were here recently said that they could not believe how much tax they pay on the wages that they earn to pay their way through university. We should take more account of young people's views on the range of issues that we deal with in the House.
Barclays bank recently surveyed younger self-employed entrepreneurs aged under 24. The main frustration cited by 40 per cent. of them was "not being taken seriously"; we must take that into account. Young people starting out in work are not the only ones who find that they are not taken seriously. The young want account to be taken of their views, but often we follow rather than lead. Younger people's views on the environment are often well ahead of those of Governments, politicians and international organisations. We should listen to them more—our policies on the environment, above all, determine the sort of world in which they will live.
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We must also show that Parliament can do more to deliver genuine outcomes. First-time voters are an immediate generation—they are used to getting things done quickly, they go on the net to buy things, they have instant access to information. We must show that we can deliver outcomes as well as talk. Too often, they hear people say that, for example, it will take 20 years to sort out the health service. If they have only been alive for 20 years, they cannot relate to that time scale. We in Parliament must be concerned less about the spin and the politics and more about the substance.
Young people belong to a confident generation. They are entrepreneurial, they believe in themselves and they are outgoing. They do not like red tape and they are fed up with the idea of a nanny state telling them how they can and cannot live. As politicians, we must react to that. We must show that we are in tune with their ideas—first, to win their trust and, secondly, to get them to play a greater role in the political process. I congratulate the hon. Member for Gedling on securing the debate and on the way in which he opened it.
12.22 pm
The Parliamentary Secretary, Cabinet Office (Mr. Christopher Leslie): I, too, congratulate my hon. Friend the Member for Gedling (Vernon Coaker) on securing the debate and on so ably setting the issue in context.
The participation of young people in politics is fundamental to the central tenets of democracy. Participation in the democratic process not only legitimises governance and the rules by which we live, but enriches civil society. It connects citizens to the wider community and gives the individual a sense of his role in determining outcomes as well as in the mechanics of decision making.
We had a useful debate on similar issues in Westminster Hall in November, but it is useful to focus on the role of young people. We are discussing not simply voting and membership of political parties, but increasing regular, active participation. Our core principles are to engage and involve the public, particularly young people, through better and more thorough consultation processes and by modernising and reforming the ways in which we interact and communicate with the public.
I do not have time to comment in depth on many of the points that have been raised. My hon. Friend the Member for Chatham and Aylesford (Mr. Shaw) spoke passionately about particular matters. I had not realised that he shares an office with my hon. Friend the Member for Gedling, who talked about shopping. Judging by the shirt and tie combos that they are wearing, they went together.
The hon. Member for Wealden (Mr. Hendry) touched on statistics and gave turnout figures from the general election. Of course, they are disappointingly low. There are no definitive data on age differentials, not least because of the secret ballot, but MORI estimates that the turnout of 18 to 24-year-olds was about 39 per cent. Too many young people say that it is likely that they will never vote. A high proportion of younger people have no party identification and 40 per cent. of 18 to 24-year-olds stated in a recent survey that they knew hardly anything about the way in which Westminster works.

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The Department of Local Government, Transport and the Regions, which has sponsored research, is examining participation at local government level, young people's views and attitudes on local councils and their images and perceptions of local authorities generally. The Department's study is considering what initiatives are likely to have the most effect on encouraging participation, and I understand that the work will be published shortly.
I congratulate my hon. Friend the Member for Watford (Ms Ward) on her work in the all-party youth affairs group. As she said, we should not get too depressed about the issue. Like her, I believe that young people are as naturally inclined to take an interest in the state of the community around them as those in any other age group. The challenge is to relate the decision-making processes more readily to those young people and to help younger people to appreciate the fact that, even as individuals, they can make a real impact on the direction that society takes.
On voting processes and mechanisms, the Government are undertaking a series of activities to consider the questions of e-voting and electronic democracy, as we want to harness the power of new technologies to strengthen the democratic processes. Young people are those most likely to be online, but least likely to vote, so my right hon. Friend the Prime Minister has established a new Cabinet Committee under the leadership of my right hon. Friend the Leader of the House to examine the issue in much more detail. The Committee will be helped by the office of the e-envoy in considering not only voting processes, but how generally we may increase public participation through new technologies.
As my hon. Friend the Member for Watford and others said, the Electoral Commission, as an independent body established by this Administration, is doing its own research into reasons for low turnout. It is working with the Hansard Society to consider the effectiveness of election literature and researching the accuracy of electoral registers.
Colin Burgon: It is appropriate that my hon. Friend the Minister is responding to the debate, because many of us consider him to be the Pitt the younger of the 21st century. Is there not a danger that we have left the world of work out of our discussion of this complex subject? Mr. O'Brien, who is sitting on my hon. Friend's left in more ways than one, was socialised through the National Union of Mineworkers, which gifted a generation of young people an attitude to politics and socialisation. We need to widen the debate to be able to
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understand why whole sections of young people are becoming atomised, individualised and depoliticised. Does my hon. Friend agree?
Mr. Leslie: What an intervention! I am not sure whether to take my hon. Friend's comments as a compliment or an insult, but if I can live up to Mr. O'Brien's esteemed reputation, I shall have done very well for myself.
The Electoral Commission is doing good work, but the children and young people's unit should be mentioned, too. It was referred to by my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) and the hon. Member for Ludlow (Matthew Green), who is also involved in the issue and whom I congratulate on his new Front-Bench post.
The unit focuses on encouraging young people to engage in the democratic process, and my right hon. Friend the Minister for Police, Courts and Drugs, who is responsible for young people, is involved in a democracy project entitled "Y vote, Y not?", which promotes a young person's agenda for democracy and which young people helped to formulate in a series of workshops throughout the country.
My hon. Friends the Members for Gedling and for Lancaster and Wyre and others referred to the United Kingdom Youth Parliament. It is an independent, nonparty organisation, but the Government are keen to support its activities. My right hon. Friend the Minister with responsibility for young people has responded to the organisation's agenda and the Government have given core funding for its activities, for the next financial year at least. We also welcome the work being done on the local parliament.
James Purnell: Will the Minister consider, as part of the reform of the House of Lords, a quota for young people, so that they are represented just as the White Paper suggests that women and people from ethnic minorities should be represented?
Mr. Leslie: Our constitutional arrangement needs to include young people much more. I shall certainly pass those comments on to my colleagues.
Citizenship education is crucial, and I am glad that this fantastic piece of work will be in the curriculum from the new school year. Many other activities are taking place, but the issue involves not only Government services, but Parliament. We must focus on the role of MPs in reaching schools and ensure that we listen and evolve our political structures. Change must come from the grass roots as well as from the top down. That is a constant challenge, but one on which there is a rare all-party consensus. We need a step change in our efforts to increase the participation of young people.

Age-related Macular Degeneration
12.30 pm
Mr. Paul Burstow: I am grateful for the opportunity to raise a matter that affects my constituents and people throughout the country: eye care in general and age-related macular degeneration in particular.
In the U K, about 500,000 people are legally registered as blind or partially sighted, but the true number, if it could be discovered, is probably much higher—perhaps as high as 1 million, or even more. Nine out of 10 such people are aged over 65. The Royal National Institute for the Blind estimated a few years ago that about two thirds of visually impaired people do not register their condition with social services and are not formally logged in the system. We do not have information about the real scale of the problems of sight loss and low vision in this country. In my local authority, the London borough of Sutton, slightly fewer than 1,000 people are on the register, and about 100 are added each year, but in 1997 the RNIB estimated that there were probably about 3,170 visually impaired people in my local authority area.
Each year in this country 16,000 people aged over 50 are registered blind as a result of AMD, or macular degeneration. As many as 500,000 people suffer from AMD. Estimates suggest that the number of cases has doubled since the 1950s and, because of the growing elderly population, is likely to treble during the next 25 years. Macular degeneration is this country's leading cause of sight loss among those aged over 50, but most people do not know that, or have not even heard of the condition. That must change, because knowledge is the first step towards preventing needless blindness and helping those with sight loss to adapt and cope more effectively.
Macular degeneration causes the progressive irreversible loss of central vision in an older person. It leaves peripheral vision intact, but causes profound visual disability. Everyday things that we take for granted such as reading, watching television and driving are no longer possible. Sufferers can no longer see the face of a loved one or anyone else. Most people with AMD-85 to 95 per cent. —suffer from what is known as the dry form of the condition, which progresses slowly but eventually results in the outcome that I have described. There is no treatment for the dry form of AMD, although research is being undertaken.
In the less prevalent wet form of the condition, a change in the blood vessels at the back of the eye causes scarring, which leads to the loss of central vision. It is far more aggressive than the dry form: sufferers can lose 75 per cent. of their vision in just 6 months. Early diagnosis is therefore important so that steps can be taken to give assistance. There are treatments that give some respite to people with the wet form.
Mr. David Heath: I congratulate my hon. Friend on securing this important debate. Does he agree that the most important elements in dealing with people with AMD are early diagnosis at primary care level, access to ophthalmological
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specialists, and the adequate provision of rehabilitation and of low-vision aids, which is currently very patchy across the country?
Mr. Burstow: My hon. Friend makes some important points, which I shall develop in my speech, and 1 look forward to the Minister's response to them. I am aware of my hon. Friend's considerable interest in the matter, both professionally and as the chair of the all-party eye health and visual impairment group, which was established recently and has attracted a good deal of support from all parties in the House.
I mentioned that 75 per cent. of a person's sight is lost in six months with the wet form of AMD. As my hon. Friend says, early diagnosis, timely treatment, and good aftercare and rehabilitation can make a significant difference. In some cases, they can save sight; in others, they can help people to cope better with loss of sight. Regular screening is therefore vital. Promotion of awareness of eye care needs and eye health is also important. The campaign launched by the Guide Dogs for the Blind Association, the RNIB and others to raise awareness will make people more conscious of the importance of getting one's eyes checked. Not only are checks important in terms of enabling people to see by using glasses and changing their prescription, but they provide other health care benefits—for example, screening for glaucoma or diabetic retinopathy is vital, because those conditions do not manifest symptoms until it is too late: when they have had an effect, the harm has been done.
Last week I was pleased to have the opportunity to chair a seminar in the House on behalf of the Patients Association, in which it presented the findings of a comprehensive survey of ophthalmology services throughout the country. The report covered 76 health authorities, and health boards in Scotland, and achieved a 64 per cent. response rate. The survey discovered much that is important. It found that only half the health authorities believe that their current provision of eye health services is adequate, and that almost one in four health authorities do not offer any treatment for macular degeneration.
The survey found that only 1 per cent. of health authorities can offer a routine appointment with an ophthalmologist within a month—that is critical time lost, which can result in permanent loss of sight. It revealed that the average waiting time in health authorities throughout the United Kingdom is between three and six months. That is long enough for people to lose their sight, but not quick enough to ensure that steps are taken to save people's sight, or to help them to cope better with the consequences of losing their sight.
Only one in four English health authorities have done anything to get a grip on their current provision. As my hon. Friend the Member for Somerton and Frome (Mr. Heath) says, provision is patchy throughout the country, but only one in four English health authorities either have carried out or are planning to carry out some sort of audit of their existing eye health service provision as part of the implementation of the national service framework for older people. A more worrying figure is that 37 per cent. of health authorities do not know whether they are going to carry out audits and are not planning them. The failure of some health authorities to know even whether they plan to conduct an assessment of current provision is extraordinary.

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There are a couple of treatments available to deal with the wet form of AMD, although I do not want to portray them as a panacea or magic-bullet solution. Hot laser treatment is a cure that can be worse than the condition. Cold laser treatment works through a process known as photodynamic therapy or PDT. The latter, more recently introduced therapy—it was licensed in August 2000—is based on the use of a light-sensitive drug which targets abnormal blood vessels in the back of the eye and enables a cold laser to remove them and stop their growth. The treatment can have a substantial beneficial effect on the progression of the wet form of AMD, although not in every case: not every person is a suitable candidate. However, it can only halt the process, not reverse it.
I hope that the Minister will address a concern shared by many that was clearly stated in the Patients Association survey, which is that a blight has—perhaps inadvertently—been cast on that treatment by the ongoing National Institute for Clinical Excellence evaluation. A blight is suggested by the results of the Patients Association survey, which found that 73 per cent. of English health authorities had received funding applications for photodynamic therapy, but 67 per cent. of them had turned those applications down. Clinicians had recommended those applications—they were not turned down on the grounds that a clinical assessment indicated that they were not worth having. They were turned down because clinicians were waiting for NICE guidance. Ministers have made it clear that that is not an acceptable excuse.
I hope that the Minister will reconfirm that the Government's position is that NICE should not be used as a reason to exclude the possibility of, at the very least, access on a named basis to such treatments. Since the treatment was licensed in August 2000, 9,000 patients have been denied the opportunity to try it. In 2001 alone, 7,000 eligible patients were not given it, and only 500 patients got it on the NHS—despite the fact that more than 100 hospitals across the country have the necessary equipment. I hope that the Minister can comment on that.
The debate is not only about access to treatment, but, as my hon. Friend the Member for Somerton and Frome mentioned, about dealing with the consequences of losing sight and the provision of low-vision services. The Macular Disease Society published a survey of its members' concerns, views and hopes for the future. One story that emerges is of its members' experiences of inadequate information being provided to them at the point of diagnosis—in some cases, the diagnosis was not explained at all. Because there were no care pathways that patients could be sent down, they were sent home to cope in complete ignorance of their condition.
Only one in four health authorities plan any form of improvement to visual rehabilitation services. Much could be done to raise the general standard of low-vision services to the best standard in this country: measures include providing greater access to sophisticated reading aids, taking more care and providing more information at the point of diagnosis by eye care specialists, increasing awareness of where to refer people in terms of support and counselling and providing more training and support in the use of low-vision aids.
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Low-vision experts can advise on basic, practical matters, such as appropriate lighting in a person's home, which can make a significant difference to their ability to use the sight that they still have. They can also advise on rehabilitation training and access to rehabilitation officers, who can recommend the best ways in which to use and adapt domestic appliances.
I end by asking the Minister a few questions and drawing his attention to the recommendations in the Patients Association report, which provides a good basis for taking that service area forward. First, will he consider asking health authorities or the new strategic health authorities and those responsible for implementing the national service framework for older people to undertake audits of their existing services, so that we have a baseline against which we can evaluate progress? Secondly, will he look at current best practice in terms of the information provided to service users? That is particularly important at the point of diagnosis, because it raises awareness of eye disease and the importance of screening.
Thirdly, on the issue of equal access, the survey shows that services are a lottery. Those with the good fortune to live in one part of the country can get a speedy diagnosis and access to treatment and a range of support services; those in another area do not get those things and go blind never knowing that something better could have been available. Fourthly, we need clear referral patterns and pathways between opticians, who should be trained, and ophthalmologists. When the conditions I have mentioned are detected, speedy referrals can be made, which enable prompt action to be taken that in many cases may save a person's sight.
Finally, although the national service framework for older people rightly refers to the need to target the problem of falls among older people, many health authorities do not make the link between visual acuity and falls, despite the fact that it costs the national health service £1.7 billion a year just to cope with the hip fractures and other injuries that are the consequence of falls. The cost would probably be considerably greater if other costs were added, such as those for social services.
Losing sight can imprison a person just as effectively as putting bars on their windows. Taking steps to ensure early diagnosis, prompt treatment and good aftercare and support could be the decisive intervention that prevents a person from finding him or herself on the slippery slope to dependence. I hope that the Minister will assure us of a positive response to the Patients Association's recommendations and to the issues that I have raised.
12.45 pm
The Minister of State, Department of Health (Mr. John Hutton): I welcome the opportunity that the hon. Member for Sutton and Cheam (Mr. Burstow) has provided to discuss these important issues. I congratulate him on the generally sensible and effective way in which he presented his arguments, but unfortunately I do not agree with every point that he made. The Liberal Democrats talk about a new style of politics. I hope that one day we will see evidence of it in their presentation of their arguments and their opposition to the Government. It is easy to present a position as uniformly bad, and generally speaking that

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was the hon. Gentleman's starting point today, but I take issue with that. It is not a fair or reasonable description of the national health service today or the progress that we have made during the past four years. I shall return to that as I respond to his four points.
The hon. Gentleman spoke of the need for improvements to local services. He said that there is a need to raise awareness of age-related macular degeneration and visual disease generally, and I agree with him on that. He expressed concerns about equal access, about which I have strong views. I think that his position and mine are probably not too dissimilar. Finally, he called for clear national standards. To be fair, the current Government have probably moved more substantially in that direction than any previous Government. I am not trying to evade the hon. Gentleman's points—I will deal with them shortly—but first I want to provide some context in addition to that which he has already provided.
AMD affects one in 100 people aged over 75, with some 100,000 people overall affected. It is the main cause of blindness in people aged over 50. I agree with the hon. Member for Somerton and Frome (Mr. Heath), who said that our priorities should be centred, first, on promoting the earliest possible diagnosis of illness—and its prevention, if possible—and, secondly, on ensuring the most effective treatment and cure. Treatment must be accessible and convenient to patients and must incorporate the latest available technology.
I take issue with the assessment that the situation is universally bleak. The Government clearly demonstrated the priority that they attach to the issue when they reintroduced free sight tests for everyone aged 60 or over from April 1999. That costs the NHS £50 million a year, but it is money well spent. The measure reversed restrictions introduced by a Conservative Government 10 years previously. Older people are most vulnerable to eye disease and stand to benefit most from regular eye examinations. I am glad to say that in 1999–2000 there were more than 2 million more NHS sight tests.
However, we must also ensure that the NHS stays sensitive to new advances in the treatment of eye disease and can quickly identify the people who might benefit from them. AMD is the most common cause of sight loss in people aged over 50. It is severely disabling, although it seldom leads to complete sight loss. Only the central vision is affected, so most people with macular degeneration should retain enough side vision to maintain a degree of mobility and independence.
There are two main types of AMD: dry and wet. The dry form of AMD is more common: we estimate that it affects almost 90 per cent. of those with the condition. The onset of the condition tends to be slow. As macular degeneration is an age-related process, it often involves both eyes, although they may not be affected equally at the same time. People are often not aware of loss of vision if only one eye is affected, noticing the condition only when it affects the better eye. Cases in which one eye is affected and the patient is not aware of the sight loss are often picked up at an eye examination by an optometrist as part of an NHS sight test. I hope that removal of the charging restrictions will aid better diagnosis, prevention and cure. Other people find that their visual cells simply stop working, with an effect
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similar to colours fading in an old photograph. That is known as dry degeneration, as the hon. Member for Sutton and Cheam rightly said.
In cases of dry AMD, vision tends to deteriorate gradually and the loss is not always severe. The worst effects can be alleviated with low-vision aids such as magnifiers, telescopes and, increasingly, closed circuit television cameras that project an enlarged image on a display in front of the patient's eyes. Better lighting and large-print books can also be helpful.
Although research is under way, it remains a sobering fact that the great majority of AMD cases—patients with dry AMD—are not treatable. Those patients are equally deserving of support and I pay tribute to the work of many voluntary organisations such as the RNIB, the Guide Dogs for the Blind Association and the Partially Sighted Society, who do so much to improve our understanding of the needs of people with visual disabilities.
The Government are continuing to provide extra financial support to the voluntary sector. We have recently made a grant of £130,000 over three years from October 2000 to a consortium of voluntary organisations, including the RNIB, Guide Dogs for the Blind Association, Action for Blind People and Sense, to develop low-vision services and improve co-ordination between health and social services and the voluntary sector. The hon. Gentleman identified that as an area on which the Government should focus their attention, and we are trying to do so.
Valerie Davey: Will my right hon. Friend include the Macular Disease Society in future considerations? It is doing a very good job.
Mr. Hutton: We shall certainly consider that. We want to work openly with the voluntary sector, and no one disputes the society's expertise. I strongly agree with the hon. Member for Somerton and Frome that nothing can do more to improve the quality of life for people with visual handicaps than prompt, effective collaboration between the various agencies—health authorities, social services and others. That is the road that we want to travel.
Wet AMD, as the hon. Member for Sutton and Cheam said, is the most aggressive form of AMD but is less common, affecting around 10 per cent. of patients. It tends to have a more severe and rapid effect on the central area of vision. Blood vessels from one layer at the back of the eye start to grow into the central part of the retina—the macular area—and may leak or bleed, causing rapid and significant reduction in central vision. It tends to affect one eye at a time, but there is a risk of degeneration in the other eye in ensuing months.
Laser treatment was considered suitable for some patients with wet AMD, but only a very small proportion of all AMD sufferers might be considered suitable candidates for such treatment of the retina. It is normally successful only if the condition is picked up early, and even then not all patients are likely to be suitable. Furthermore, there is a risk associated with laser treatment that lesions may continue to progress after laser treatment and vision may even become worse. In most cases, therefore, the only existing treatment is to reduce the effects of any other eye condition, such as

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cataracts—I am pleased that we are doing significantly more cataract operations than ever before—so that artificial and natural light can be used more effectively. Patients may also be helped with the use of improved lighting, optical and other devices, and training.
The hon. Gentleman focused on the potential benefits of photodynamic therapy, which offers some exciting prospects. PDT offers a genuine prospect of increasing the accuracy and effectiveness of laser treatment for wet AMD. This treatment uses a photosensitive dye which, when activated in the back of the eye by a light source, closes abnormal retina blood vessels. The underlying abnormal blood vessels are then easily identified and selectively destroyed without damaging the overlying sensory retina.
The National Institute for Clinical Excellence is evaluating this treatment. Its appraisal committee will meet on 7 March to produce draft guidance. The committee will have a second meeting on 15 May and guidance on whether the treatment should be generally available on the NHS is expected in July 2002, subject, of course, to any appeals. The hon. Gentleman asked what happens in the meantime, which is a reasonable and fair question. He asked the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), that question on 10 January. As an assiduous collector of information through parliamentary questions to the Department of Health, the hon. Gentleman will be aware that my hon. Friend set out the procedures that we expect NHS bodies to follow while they await NICE guidance. We expect them to take into account the available evidence and to assess patients in the light of it. Awaiting NICE guidance is not an excuse for NHS bodies to fail to get on with the job that they are supposed to be doing.
At this stage, we do not know what the NICE guidance will be. If the treatment were endorsed by NICE, the next step would be to ensure that the people who might benefit from it are identified and referred as promptly as possible. The measures that we took in April 1999 to extend eligibility for free NHS sight tests to people over 60 will have helped to prepare the way. Optometrists can identify the signs of AMD and, with additional advice and training, they could identify the cases of wet AMD that might be susceptible to the new treatment. A system of local protocols with hospital ophthalmology departments could be developed to ensure that patients are referred promptly for treatment. As the hon. Gentleman has said, there are already examples of such protocols for some other eye conditions, and we welcome those sorts of initiatives.
Concerns have been expressed about the capacity of ophthalmology departments to deal with referrals. The hon. Gentleman referred to a recent survey by the Patients Association that suggests that there are wide regional variations in ophthalmic services. That survey is accurate. Action must be taken to address those problems, and we are doing that. We have allocated an extra £20 million over two years to fund the capital costs of 60 schemes to improve treatment facilities. The NHS is providing more cataract operations than ever before: 236,000 operations were carried out in 2000–01, compared with 170,000 in 1998–99. That additional investment—which is part of a broader and deeper
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investment in the future of the NHS—will improve the standard of eye care for older people and greatly enhance the quality of their lives. There has also been an increase of about 4 per cent. in the number of ophthalmology consultants in each of the past four years. That trend is set to continue, so that the number of such consultants will rise from 651 to 895 by 2010.
The hon. Gentleman mentioned raising awareness. That is important, and I agree with his comments. I welcome the recently launched FOREsight initiative, which is backed by the AMD alliance of the RNIB, the Macular Disease Society and Age Concern. I hope that the campaign will be successful in raising awareness of AMD among the over-50s, and in encouraging people to visit their optometrists—especially if they suspect that they have the symptoms of AMD. The information booklet for the campaign includes an Amsler grid for self-testing to highlight visual distortions that might be symptomatic of AMD, and information on what to do if AMD is suspected. That might be helpful to some people, but regular eye tests should ensure that any signs or symptoms are picked up in the early stages of the disease, when treatment might be more effective in preventing sight loss.
In 1999, we collaborated with the RNIB on the "Half an hour could save your sight" campaign. Posters and leaflets describing the full range of health benefits from the eye examination were distributed to general practice surgeries, hospitals, public libraries and other public places. The Department helped with the costs of the campaign—I think that we provided about £40,000. I understand that the RNIB is planning a further campaign, drawing on the lessons of the earlier one. We await the outcome of that with interest. I cannot give a commitment to support a new campaign at present, but we will consider whether we can contribute to the initiative when we know more about the proposals.
Mr. Burstow: I am grateful for the Minister's response. Are the Government minded to extend the national service framework for older people? Will he examine ways in which the best practice that was discovered by the Patients Association can become the norm? As he has acknowledged, there are still too many places where services are not up to scratch, and where people do not get access to services as quickly as they need to.
Mr. Hutton: We have no current plans to modify the national service framework for older people, although we keep an open mind about such matters. That is the straight answer to the hon. Gentleman's question. However, all the national service frameworks are kept under close review. They are never the last word on any subject. They are beginning the process of achieving national consistency, for which he and many other people have long called. It is likely that the national service framework on diabetes—and especially its focus on diabetic retinopathy—will be perceived as helpful in dealing with some of the problems of inconsistency across the country. Furthermore, the Government are investing about £600,000 in research that is directly relevant to macular degeneration, as the hon. Gentleman knows because he asked a parliamentary question about it—a question which, I am glad to say, we answered.

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The hon. Gentleman raised important issues, and I have tried to respond fully to the points that he made to reassure him that the Government are strongly committed to improving eye health. We have demonstrated the priority that we attach to it by introducing free NHS sight tests—the over-60s are the most vulnerable to eye disease and stand to benefit most from regular eye examinations. We have begun to tackle the variations in ophthalmology services, for example, through the "Action on cataracts" campaign, and we will respond appropriately to advances in the treatment of AMD.

Mortgages (Regulation)
1 pm
Mr. Barry Gardiner: The capacity of Members of Parliament for self-delusion is considerable and widely remarked on by press and public. We are infinitely capable of taking credit for a rise in consumer spending as much as a drop in inflation, or for the building of a new road as much as a reduction in carbon monoxide emissions, and we will do it without blushing. We are oblivious to the fact that some of the things that we claim to have championed would have happened anyway, and we are positively dismissive of anyone who dares to suggest that the events of which we claim to be the sole and proximate cause are in any way mutually contradictory.
When it comes to delusions of grandeur and self-importance, my own talents are no less than those of my parliamentary colleagues, but even I hesitate to claim that it was my visit to the Speaker's Office on 14 February to secure today's debate on mortgage regulation that set in motion the extraordinary events in the mortgage industry over the past three weeks. The debate was originally entitled "Standard Variable Rates in Mortgages", but that was amended to the more prosaic "Mortgages Regulation" under pressure from the Table Office. I would dearly like to think that it was a leak of Sixsmith proportions about the original title that prompted the Nationwide building society to announce nine days later that it would abolish its higher standard variable rate and compensate its customers. In a similar vein, I trust that the Economic Secretary to the Treasury will be pleased to confirm this afternoon that it was the bleak prospect of responding to this debate that prompted her to rush to press the long-awaited Treasury consultation document "Regulating Mortgages".
After chalking up two such clear evidences of the power of the Adjournment Debate to initiate preemptive action, who could doubt that yesterday's announcement by the Halifax about compensation to some of its standard variable rate customers is also a direct consequence of its fear of oratory in the House of Commons? In truth, I doubt it, but in my defence, I am yet young in the House. Given a few more years by the electorate and under the tutelage of my senior colleagues, I will probably arrive at that happy state wherein all good things can uniquely be attributed to my initiative.
"We could do the right or the wrong thing. We chose to follow the principles of fairness and fair play."
So said Philip Williamson, the head of Nationwide building society, commenting on his company's decision to abolish its higher standard variable rate and actively seek out and compensate customers who had suffered by having their mortgages pegged to it since 1 March 2001. With such a talent for self-delusion, Mr. Williamson is eminently suitable for the House of Commons. The only reason why Nationwide is now doing the right thing is that on 1 March 2001 it did the wrong thing. The Minister will be pleased to hear that I will not catalogue the details of cases on which the Financial Ombudsman Service has made a ruling on dual variable mortgage rates since the beginning of this year. I will, however, clearly outline the common elements of those cases and why I believe that the mortgage lenders acted wrongly.

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In each case, the borrowers had taken out their mortgage at a time when the lender had only one standard variable rate. The lender in each case promised borrowers a special deal of a discounted or capped-rate mortgage that would use the SVR—standard variable rate—as its reference point. The lender in each case introduced an additional variable rate and claimed that the reference point for the deal was the higher of the two variable rates. Each lender tried to dress up its new rate in a different name. Halifax had "Halifax variable rate 2" and Nationwide had the "base mortgage rate".
The ombudsmen rightly ruled that in each case the new, lower rate was fulfilling the function of the standard variable rate that the parties had agreed would be the yardstick for their contract. Any reasonable borrower wishing to take out a discounted or capped mortgage would have been entitled to take comfort from the fact that the standard variable rate would respond to the Bank of England base rate in such a way as to attract new borrowers or to retain existing ones. However, the Halifax variable rate 2 was 0.75 per cent. lower than Halifax variable rate 1, and Nationwide's base mortgage rate was 0.5 per cent. lower than the so-called standard variable rate. The higher rates were, in effect, used only by customers who the companies could claim were locked into them. New borrowers took the lower rates. The lenders had held out the prospect of real financial benefits against a known standard—the standard variable rate—but that standard proved to be illusory when they introduced the lower rates. In effect, a mammoth fraud was perpetrated on the customers, which is only now being set right, and that reluctantly and partially.
Let no one be under the blissful misapprehension that Nationwide realised its mistake and happily rectified it. It lost the original complaint to the ombudsman last year and appealed against it. Only when it lost that appeal did Nationwide decide to make a virtue of necessity. It contrived to use the decision to turn back the clock and indemnify all the customers that it had so badly wronged as a strategy to rubbish its competitors. Of course, today we can be thankful that it did, because if Nationwide emerges rather badly from the affair, Halifax—or HBOS—has truly earned its dreadful reputation as the villain of the piece, and not just among taxi drivers and market stall owners. Instead of conceding gracefully after losing its appeal, Halifax publicly insisted that each and every person who considered that they had been similarly wronged and disadvantaged would have to lodge a separate case to the financial services ombudsman.
The Minister knows well that Halifax had at least 500,000 people linked to its old standard variable rate. She must ask herself whether everything stands well with the process of mortgages regulation in this country, when mortgage lenders can cock such a snook at their customers, insisting that justice be dispensed only after submitting to the bureaucratic nightmare of 500,000 separate cases to the ombudsman. It is disgraceful that Mr. Ian Beggs, the senior media officer for Halifax, sought to dismiss the ombudsman's report by claiming that it was only
"a decision in an individual case. It is not just about the product but also about letters and conversation"
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with customers. That is spin worthy of Jo Moore or Martin Sixsmith, and I hope that it will be dealt with in a similar, if swifter, manner.
Yesterday, Halifax was forced into a partial climbdown. Instead of following Nationwide's lead and indemnifying all its affected customers, Halifax has said that it will compensate only the 10,000 customers who had formally complained between 1 March 2001 and 31 January 2002, when variable rate 2 was imposed and withdrawn respectively. Another 20,000 customers who complained after 31 January will not be compensated but given a £100 ex gratia payment. Those who suffered in silence are to be given nothing. At first, quite shamefully, Halifax put out a statement yesterday saying:
"The ombudsman has confirmed that any customers who contacted Halifax for the first time since February I are not eligible for a refund."
The emphasis, I would stress, is that of the Halifax and not my own. The statement was instantly rebutted by the ombudsman, who stated:
"That is not our position, it is Halifax's interpretation of the ruling. We have asked them to withdraw it immediately."
I am confident that Halifax will ultimately be forced to give way and to compensate all its affected customers. That may cost as much as £200 million, which the company is trying to retain for its shareholders, not its policyholders. At this point, it is right that I pay tribute to journalists such as Richard Dyson and the campaign by the financial section of the Daily Mail which, with the Consumers Association, have brought customers as far as they have got today in obtaining redress.
Mr. Gareth R. Thomas: May I draw my hon. Friend's attention to a parallel case and invite him to ask the Economic Secretary to consider the implications? Higher rates of interest were charged by Paragon Finance on a mortgage book that it took over from National Home Loans in the 1980s. Two sets of National Home Loans borrowers challenged Paragon's higher rates of interest under the Consumer Credit Act 1974 and the Unfair Contract Terms Act 1977. Both arguments were struck down by the Court of Appeal in October, despite considerable sympathy from Lord Justice Dyson, who said:
"Borrowers have suffered serious hardship as a result of the increases in interest rates charged by Paragon Finance."
Mr. Gardiner: I am delighted that my hon. Friend has made that intervention. So much scamming goes on in the mortgage and consumer credit markets that he does his constituents a service in highlighting the problem today. I am sure that the Economic Secretary will be able to investigate the case that he raises.
It is one thing for consumers to fight against mortgage lenders in this country and to have to go through the ombudsman's procedures to secure justice. It is another thing to see the way in which the Building Societies Association has responded to that. Adrian Coles, the director-general of the Building Societies Association, has accused the ombudsman of introducing
"regulation by the back door."
He adds:
"Some of my members are beginning to call the ombudsman an unaccountable, price-fixing regulator."

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If the fact that the ombudsman is calling for justice for millions of people in this country is regulation by the back door, we are left to wonder what regulation by the front door might be. The answer is currently contained in the mortgage code, which is a voluntary code entered into by mortgage lenders. Two of the key promises it contains are:
"We, the subscribers to this Code, promise that we will: act fairly and reasonably in all our dealings with you;"
and
"correct errors and handle complaints speedily".
Anyone who has followed the saga of dual standard variable rates over the past year cannot believe that the mortgage lenders involved have been complying with the mortgage code.
The Economic Secretary is probably as avid a reader as I am of Building Society News, the newsletter of the Building Societies Association. She will therefore have read February's edition. It makes salutary reading, because it contains a major attack on the ombudsman's powers, stating that
"firms are bound by FOS decisions (as you would expect) but have no way of taking the matter further if they feel an injustice has been done, and therein lies the problem. As the FOS leaflet for complainants, Your complaint and the Ombudsman, says: 'If an ombudsman makes a formal decision on your case, this will be final. Firms have to accept our decisions. But you don't. You are free to go to court instead.'
Firms can ask for, but not demand, a hearing in front of the ombudsman if they are unhappy with a provisional decision, but how fair is a hearing where the FOS ombudsman makes a determination on the decision of the FOS adjudicator? It is not an independent process. The final decision (so far as the firm is concerned) is for the ombudsman to make, and there is no provision for a hearing after that. The only course of action open to firms is to seek judicial review, but this process is not an appeal in the proper sense of the word. Rather, in a judicial review, the courts look at the process through which a decision was made, instead of the decision itself.
In the end, to preserve competition for the benefit of the consumer, firms may have no alternative but to turn to the human rights legislation."
That is an extremely sinister development in the regulation of mortgages in this country. The Building Societies Association is, in effect, laying down a marker, saying, "If we don't like the decision of the financial services ombudsman, we may take it to the Human Rights Act 1998." That entails all the costs of a legal process—currently avoided under the ombudsman system—which each individual complainant would have to fight. That is an absolute disgrace, and I look forward to the Minister commenting on the BSA's position.
I am disappointed that the consultation document produced by the Treasury on 28 February indicated that the regulation of mortgages through the Financial Services Authority is to be put back from 1 September 2002 to the second quarter of 2004. That is something for which we have been waiting for a long time, and it is sad to see it receding into the distance. I remind the Economic Secretary of the position adopted by her predecessor, my right hon. Friend the Member for Airdrie and Shotts (Mrs. Liddell), who said of the mortgage code:
"It is too soon to decide whether the Code, on its own, is capable of protecting mortgage borrowers to the standard that the Government are determined to see achieved."—[Official Report, 7 April 1998; Vol. 310, c. 152W.]
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The events of the past year mean that it is no longer "too soon." It is absolutely vital that comprehensive regulation is introduced as soon as possible.
1.20 pm
The Economic Secretary to the Treasury (Ruth Kelly): It is a pleasure to serve under your chairmanship, Mr. O'Brien. I congratulate my hon. Friend the Member for Brent, North (Mr. Gardiner), who takes great interest in these matters, on securing the debate. It provides me with an opportunity to respond to his specific points and to outline the Government's underlying approach to mortgage regulation.
The idea behind the Government's approach is to secure a fair deal for the consumer, while acting in a proportionate manner. We do that by creating an environment in which the consumer is able to make informed, intelligent decisions about financial services, and by ensuring that there are appropriate redress mechanisms in place if a problem arises, whether it is a generic issue affecting a large group of people or a specific issue affecting one or more individuals. Regulation plays an important role, but it is not the only tool in our toolbox. It is certainly not the first thing that we think of when we consider how to make markets work more effectively. There are many other things that we can do: improve the information available to consumers, improve consumer education, promote sharper competition among product providers, encourage the development of voluntary industry codes, set benchmarks for products and so on.
The creation of a single regulator, the Financial Services Authority, is the centrepiece of our policy. As a single regulator, it is in a much better position to respond to a financial services sector in which firms and intermediaries operate in several different markets, in which products are bundled and in which innovations in products, design and marketing occur at an ever-increasing pace. A single regulator also creates a regulatory system that is easier for consumers to understand. Firms and consumers no longer have to deal with an alphabet soup of different regulators, each with different rules and approaches.
The creation of a single ombudsman service is another crucial development. The Financial Ombudsman Service is a one-stop shop for redress when a firm authorised by the FSA is unable to resolve a consumer complaint, and it can step in as an independent, informal and user-friendly alternative to court action for the consumer. The FOS is an important part of the overall consumer protection provided by the Financial Services and Markets Act 2000. It is free to consumers, and its decisions are binding on authorised firms, including mortgage lenders.
In that context, toward the end of last year I examined the general regime for mortgage and general insurance regulation. Specific events had occurred since the original decision to regulate mortgage lenders was taken in January 2000. For example, about a year ago DeAnne Julius was asked to chair an independent review of the banking and mortgage codes to examine the benefits they delivered to consumers. Her report raised the issue of mortgage advice regulation and argued that self-regulation was not a sufficiently strong regime for mortgage service standards. I shall take my hon. Friend's comments today as giving added impetus to that recommendation.

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I also received strong representations from consumer groups and industry that mortgage advice and advisers should come under the FSA umbrella. In the light of those representations, and taking into account regulatory and market developments, I concluded that there would be significant benefits to consumers from regulating the quality of advice and the qualifications of advisers. Although there is already much good practice, I expect that there will be a higher standard of advice available across the board. Consumers will have to deal with only one agency for compensation and redress, whatever their financial services problems.
To respond to the intervention of my hon. Friend the Member for Harrow, West (Mr. Thomas), episodes such as the Paragon Finance home loans example are one of the reasons why we have found it necessary to take further steps to regulate the mortgage market more generally. The decision not only benefits consumers but streamlines regulations for brokers who already deal with the FSA in other lines of business. Mortgage regulation is expected to come into force during the second quarter of 2004 alongside that of general insurance.
I shall explore some of the recent events outlined by my hon. Friend the Member for Brent, North. He is particularly concerned that in the light of an FOS decision on a specific case, banks and building societies should be required—I take it that this was his suggestion—to put right all similar cases instead of doing so only in response to individual complaints. I shall stand corrected if his meaning was different.
I understand why my hon. Friend finds that idea initially attractive, but it would blur an important distinction that is central to the way in which we regulate. To tamper with that distinction would be detrimental to consumers, bad for the industry and would risk creating two separate regulators operating with different remits. We try to maintain a clear distinction between complaints handling and regulation. The FOS is available to consider individual complaints, whereas my hon. Friend's argument relates to regulation.
The prudential regulation of banks and building societies—ensuring that they maintain sufficient resources and appropriate systems and controls—is the
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responsibility of the FSA. Standards relating to conduct of businesses for mortgages are currently set out in the mortgage code. It is the role of the Mortgage Code Compliance Board to ensure that personal customers receive a fair deal from the banks and building societies that subscribe to the code. As I said earlier, the decision has been made to transfer mortgage advice and intermediaries to the FSA in 2004.
In practice, the distinction between regulation and complaints handling works well and in the interests of consumers. It enables regulators and ombudsmen to concentrate on their core tasks and avoids their diluting the authority and expertise of one another.
Mr. Gardiner: I appreciate the distinction and I am cognisant of the dangers that would arise if every complaint to the FOS were decided generically and applied to every other case. However, my hon. Friend should take on board the fact that as soon as the lower variable rates were introduced by companies, a whole category of contracts into which those companies had entered were effectively rendered fraudulent. At the moment, the only redress has been through the FOS, but consumers are entitled to regulation that stops such wholesale abuse by companies. I urge her to meet the mortgage lenders involved and encourage them to sort out the problem now. I believe that some arse-kicking now by my hon. Friend will speed up the process.
Ruth Kelly: I thank my hon. Friend. Our diagnosis of the problem is somewhat different. As I understand it, the ombudsman has criticised the information provided to consumers at the point of sale and the ability of lenders to differentiate the rates at which they provide loans to their customers. The core criticism is of the information provided rather than of the system. The FSA is considering how to define and operate its new system of treating consumers fairly and I am sure that it will examine that, but it is for the FSA, not the Treasury, to decide. However, I am certain that it will hear the concerns that my hon. Friend has outlined and consider them seriously.
I thank my hon. Friend for his interest in these issues. Consumers throughout the country will want to follow the debate. He has raised important matters that he should also take up with the Financial Services Authority.

Greater Manchester Police Funding
1.29 pm
Mr. Graham Brady: I am grateful for the opportunity to raise matters of utmost concern to my constituents and all other residents and businesses in Greater Manchester.
The Minister will be aware that there are serious concerns about police funding. For instance, the chief constable has long highlighted the anomalous impact on Greater Manchester police of the funding of police pensions. The cost of funding the pensions of the force is £67 million per annum, but the Home Office funds only £60 million of that each year. In comparison, the pensions bill of West Midlands police, a similar size force, is £50 million, but the Home Office funds £52 million. Greater Manchester police force has a £7 million shortfall that must come out of its operational budget, whereas West Midlands police force is, in effect, given a £2 million windfall towards its operational budget.
It must be remembered that the Greater Manchester force faces demands imposed by a crime rate that is 41 per cent. above the national average. It also has to meet some major exceptional costs. The Home Office has met two thirds of the cost of last year's Oldham riots, but a major additional cost is left for Greater Manchester police. The biggest exceptional item, on which I will focus, is the cost of policing the Commonwealth games, which are due to open in Manchester in less than five months time. That cost is estimated by Greater Manchester police and the police authority to be £7.88 million. I believe that that cost should be borne by the nation, not only by the people of Greater Manchester.
The Commonwealth games are a major national and international event that will bring more than 5,000 athletes from 71 nations to Manchester and the United Kingdom. The games will bring thousands of spectators and dozens of heads of state to Manchester. We in Manchester are proud to host the games, and proud that Her Majesty the Queen will visit twice in her jubilee year to open and close the event, which will be the largest and most spectacular multi-sport event ever hosted in the UK. I am confident that the games will be a huge success and that the Greater Manchester police will do the most professional job possible to ensure the safety and security of all involved.
It is intolerable that the Government should make the people of Greater Manchester suffer as a consequence of hosting the games. Councillor Stephen Murphy, the chairman of the police authority, warned on 18 January:
"The absence of funding support will result in either a significant increase in the precept or a deterioration in policing standards across Greater Manchester with a probable escalation in crime rates … to make further savings to meet the cost of the Games would have a major impact on policing and likely impact on the numbers of police officers".
I raised the matter in the House on 24 January. On that occasion, the Leader of the House made it clear that Greater Manchester and its residents should bear the cost. He replied:
"I remind the hon. Gentleman that Manchester sought to hold the Commonwealth games and, indeed, fought hard for that. I congratulate it on its success. Naturally, there are consequences of Manchester's success in securing the Commonwealth games."—[Official Report, 24 January 2002; Vol. 378, c. 1024.]
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At that point, we were not hopeful that Manchester would receive support for the policing of the games, but matters had improved by 29 January, when the Home Secretary wrote to the police authority to promise to fund £3 million of the £7.88 million requested. None the less, that leaves almost £5 million to be met, perhaps by increases in council tax. My constituents have already suffered a 47 per cent. increase in council tax since Labour took control of the borough of Trafford six years ago. Alternatively, the cost could be funded by cuts in policing.
The Home Secretary has said that officials and Her Majesty's inspectorate of constabulary will carry out a rigorous appraisal of the remainder of the bid. I am sure that the Minister will re-emphasise today that the door is not closed. I am also sure that the rigorous appraisal of the cost of policing will ultimately endorse the Greater Manchester police estimate of the cost of security for the games. The residents of Greater Manchester and I want an absolute commitment today from the Minister that the full cost of policing the games will be met by the Home Office.
The Minister may not accept the estimate for the cost of policing the games, but whatever the ultimate cost of policing them is, it should be the responsibility of the whole nation, not only of the people of Greater Manchester. What I want today is not a commitment to find £7.88 million for the costs of the Greater Manchester police, but an absolute guarantee that the full cost of policing the Commonwealth games will be met by the taxpayer nationally, not dumped on the taxpayers of Greater Manchester.
I remind the Minister of the warning given by the chief constable in the Manchester Evening News on 21 January. He wrote:
"We are in a desperate situation, and if I introduce cuts and we don't get funding for the Games, it will have a massive impact on policing in Greater Manchester."
Mrs. Lorna Fitzsimons: Will the hon. Gentleman give way?
Mr. Brady: The hon. Lady is in the nick of time, because I was about to conclude my remarks.
Mrs. Fitzsimons: Will the hon. Gentleman accept a comment from a fellow representative of Greater Manchester and taxpayer who takes a keen interest in these matters, having taken part in the parliamentary police scheme this year with Greater Manchester police? To some people, the claim made by the chair of Greater Manchester police authority and the chief constable that the huge increase in their budget this year will result in fewer police officers seems incredible. I have only a simple abacus; how can it be so?
Mr. Brady: I have focused today on the cost of policing the Commonwealth games. I am sure that the hon. Lady will accept that since 11 September, the cost of providing security and guaranteeing safety for a major international event such as the games has increased. It is perfectly reasonable for the view of the police authority and Greater Manchester police to reflect that.

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I do not want to get involved in squabbles between Labour party members, whether they are Members of Parliament or Greater Manchester local authority members. My request today is that the Minister guarantees not a specific sum for the funding of the policing of the games, but funding in full. That is essential. The hon. Member for Rochdale (Mrs. Fitzsimons) and the Minister cannot get away from the fact that if the cost of policing the games is not met by the taxpayer nationally in recognition of the fact that the responsibility is a national one, the burden will fall on the people of Greater Manchester—on the hon. Member for Rochdale, on me, and on all the people whom we represent. Their taxes will rise, or their policing will decline, or a combination of the two will happen.
We face a serious choice. I call on the Minister today to provide certainty and confidence to the organisers of the games, to those who police Greater Manchester, and to the people whom I represent, that the cost will not be imposed on the taxpayers of Greater Manchester, but will be met as a national responsibility, as should always have been intended.
1.39 pm
The Parliamentary Under-Secretary of State for the Home Department (Mr. Bob Ainsworth): I congratulate the hon. Member for Altrincham and Sale, West (Mr. Brady) on securing a debate on Greater Manchester police funding. It is a useful opportunity to air some of the funding issues currently affecting Greater Manchester and to discuss what the Government and the police are doing to increase resources and reduce crime. I was surprised that the hon. Gentleman did not use the all the time available to him to discuss some of the broader issues involved in policing and police funding in Manchester. He effectively raised only two issues: pensions and the Commonwealth games. I accept that both are substantial issues that need to be talked about, but I intend in my response to range more widely than he did.
Mr. Brady: I will be delighted if the Minister deals with some of the other concerns about funding for Greater Manchester police, but for the purposes of this debate I would be happy with a simple, short assurance from him that the cost of policing the games will be met by the Government. Were he to give that assurance now, I would be happy for the debate not to take up the rest of the time available. We could all go away happy.
Mr. Ainsworth: I intend to go wider than the hon. Gentleman did. I am only surprised that he, as a Greater Manchester Member of Parliament, has not used the time available to him to discuss more his broader concerns about other issues that affect Greater Manchester police authority and policing in Manchester. I will respond to the Commonwealth games issue, but I want to talk about broader issues as well.
It is appropriate to thank all those front-line officers in the Greater Manchester police force who have worked tirelessly in recent months to protect the public
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in difficult circumstances—policing the disturbances in Oldham, then meeting the heightened security requirements in the aftermath of the terrorist attacks of 11 September. They have been working under real pressure and we should take our hats off to them. I hope that the hon. Gentleman agrees that they have done a magnificent job in providing the maximum protection to the people of Greater Manchester in such difficult circumstances.
The funding increase for Greater Manchester police this year is in line with the average increase for England and Wales. The authority received an extra £9.5 million from the funding settlement. The force will also benefit indirectly from the additional funding provided by the Government to the National Crime Squad and the National Criminal Intelligence Service, which comes out of the police grant before it is divided among local police authorities.
When Conservative Members suggest that police funding is not adequate for the task, it is appropriate to remind people that until the Government established one, this country did not have a national crime squad. We had regional crime squads, but the funding was far less and was of an altogether different order to that which we provide to NCS. NCIS, too, did not exist under the previous Government. This country had the fourth largest economy in the world, a sophisticated modern society, but no national criminal intelligence service. In this debate, we should accept that it is not only money that helps, but the assistance given by NCS and NCIS. Such assistance is of some importance in helping police in Manchester and elsewhere to tackle criminality.
Turning to the main topic of the hon. Gentleman's speech, we are helping Greater Manchester with the cost of policing the Commonwealth games. As he said, in the police grant debate on 30 January we announced that we have decided to make an initial grant of £3 million toward the cost in view of the substantial policing costs faced by Greater Manchester police. We have asked officials of Her Majesty's inspectorate of constabulary to examine closely the estimates that the Greater Manchester police authority has made of the overall costs that it will face. On the basis of that further assessment, we will consider the extent to which we are prepared to make further grant available to the authority.
The original estimate was £3.9 million, but it has now doubled. The circumstances have changed and there may he considerable justification for changing the figures, but if the hon. Gentleman thinks that the Government can simply accept changes of such magnitude without asking someone to examine whether they are justified, he does not live in same world as me. We will ask HMIC to examine the estimates rigorously, and when we have its report we will announce the extent to which we can help Greater Manchester police authority with the costs that arise from the games. I will not make that announcement in response to this debate.
Mr. Brady: Of course it is reasonable to examine the estimates in detail, but is the Minister saying that he will not fund the whole cost of policing the games even if

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HMIC and officials in his Department find that the estimates are accurate? Will he not give me the assurance that I requested?
Mr. Ainsworth: I have said what I have said. We will examine the estimates that we have received. We have agreed to £3 million, and there is an estimate that is well in excess of that. We must properly evaluate any estimates before we can give any commitments, and we are doing that. We have given the job to HMIC, and we shall consider the issue when we have its report. There are other pressures —
Mr. Brady: Will the Minister give way?
Mr. Ainsworth: I cannot keep giving way to the hon. Gentleman. He had plenty of opportunity to make his case before I stood up.
The Greater Manchester police authority faces other pressures, and the hon. Gentleman will be aware that on 30 January I also announced special grant of £1.44 million towards the additional cost of policing the riots. That was paid to the authority on 8 February. Funding for special grant is limited, and we had to consider demands from other forces that have also experienced riots. Each application had to be treated fairly, and that is what we did.
The hon. Gentleman raised some issues, but not others. My hon. Friend the Member for Rochdale (Mrs. Fitzsimons) mentioned some of the money that has gone into crime reduction in the Manchester area in recent years. I shall run through some of the statistics so that the hon. Gentleman can see that those funds are not inconsiderable. I do not know whether, like me, he believes that partnership is the key to reducing and keeping crime figures down, but we have invested more than £17.2 million in projects in Greater Manchester under the crime reduction programme. Greater Manchester police made successful grant applications for £1.25 million of that. In addition, the Department for Transport, Local Government and the Regions has provided more than £3.3 million for neighbourhood and street warden schemes.
The £17.2 million has been distributed as follows: more than £9 million has been spent on 41 closed circuit television schemes; £3.2 million on 10 schemes under the communities against drugs programme; more than £1.7 million on reducing burglary initiatives; £1.3 million on targeted police initiatives; and £471,000 on 33 partnership development fund projects. Some £380,000 has been spent under the violence against women initiative to reduce domestic violence, rape and sexual assault by known perpetrators; £153,000 has been spent on small retail projects; and £100,000 has been spent on projects to tackle prostitution.
In the hon. Gentleman's constituency, £31,000 has been allocated to a reduced burglary initiative on the Racecourse estate in Sale. The Department for Transport, Local Government and the Regions has provided £242,000 for two neighbourhood warden and street warden initiatives in Sale, West. That is a significant investment in extra resources. I will give way to the hon. Gentleman so that he can tell me whether he welcomes the money that has gone into his constituency and the rest of Greater Manchester.
Mr. Brady: The Minister will not be surprised to hear that I welcome any money that goes into my constituency. I am delighted that help has gone to Sale, West. However, I have a straightforward question for him and I hope to receive a simple answer. Does he believe that the policing cost of a major national and international event should be met by the nation or by local taxpayers in the city that hosts the event?
Mr. Ainsworth: The funding formulae used to decide who funds what and to what extent in relation to events such as the Commonwealth games are not new—they were not invented in the past couple of years. We will consider in detail the costs that Manchester is likely to incur as a result of the Commonwealth games. When we have a detailed report and can see how robust the figures are, we will make a decision on whether we can contribute more than the £3 million that we have already allocated.
The hon. Gentleman identified the problem of police pensions without telling the House that it has existed for many years and that Governments of different party political complexions from those currently in power did nothing about it. We accept that pensions costs represent an increasing burden on many police authorities. The overall police settlement includes provision for expected further pensions costs, but the incidence of such costs is bound to be uneven. As we both know, individual cases and pressures will arise in different years.
A review of police pensions by Home Office and Treasury officials is nearing completion. The views of police authorities, including that of the hon. Gentleman's area, will be taken on board with those of other key stakeholders. We must also consider the impact on Government finances, as we are doing. We want a modernised pension arrangement that is more flexible and affordable for future entrants to the police service. We must have a system that gives greater certainty about pensions obligations of individual police forces. A report on the alternatives available to change the way in which we fund pensions is expected very shortly. The issue is important, but I ask the hon. Gentleman to accept that the Government are trying to tackle some difficult issues that were not tackled for many a long year when perhaps they ought to have been.
Mrs. Fitzsimons: Will my hon. Friend hear some concerns from another Member of Parliament for Greater Manchester? Important though it is to deal with the one-off funding of the Commonwealth games, as the hon. Member for Altrincham and Sale, West (Mr. Brady) suggests, the funding formula itself is important. There is a disparity between the metropolitan boroughs and rural areas. I do not want to denigrate any rural areas, but the increased cost of policing a metropolitan area such as Greater Manchester must be accepted.
I fear that scaremongering in this financial debate will affect the people of Rochdale, even though crime in Rochdale has decreased significantly and police numbers have increased significantly since Labour took power. There is a great deal of concern that the comments made by the chief of police and the chair of

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the police authority in their budget debates with the Government are having a detrimental effect on the public and obscuring the facts.
Mr. Ainsworth: My hon. Friend is absolutely right. I was just about to say something about police numbers. Crime overall, as well as many categories of crime, has decreased in Greater Manchester, as it has in the rest of the country. However, fear of crime is a real issue. People's perception of the problems of crime and their vulnerability to it has not changed in line with the actual crime figures. Those who unnecessarily alarm people are adding to the fear of crime.
Police numbers are important as part of a comprehensive package of measures to ensure a modern and efficient police service. The public rightly feel reassured by the sight of police officers on our streets. That helps to reduce the fear of crime. It is for the police authority and the chief constable to determine the resources, the precise composition of the force, and the distribution of officers. On 30 September 2001, Greater Manchester had 7,036 police officers, 114 more than in March 1997 and the same number as in March 1995. Although there is more to be done, we have effectively restored the cuts to police numbers in the Greater Manchester area that occurred in the last two years of the Conservative Government. Civilian staff numbers have increased by 415 since March 1997, an increase of 6 per cent, to 3,027 on 30 September 2001.
Mrs. Patsy Calton: I hear all that the Minister is saying and I believe that the number of police officers has increased, but last Sunday I visited the Twining Brook road area of Cheadle Hulme in my constituency, where I met people who told me that women were afraid to go out at night or to let their children play outside during the early evening. How does that square with what the Minister is telling us? Is
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the distribution of police officers throughout Greater Manchester such that there are more in some areas than in my constituency? I simply do not understand what he is saying, and neither will my constituents.
Mr. Ainsworth: It squares precisely with what I have said. This is an important issue, so I ask the hon. Lady to think seriously about it, leaving aside party politics. Police numbers are not the whole issue. I mentioned the increase in civilian staff, because how on earth are police constables to do the job that only they are capable of doing and only they have been trained to do if we do not give them the back-up necessary to enable them to spend more time out on the streets?
That is part of the reasoning behind the proposals in the Police Reform Bill that we have introduced. We want police officers to be used much more effectively out on the streets of Greater Manchester and elsewhere in the country. That is what the hon. Lady's constituents and the Government want. I hope that our proposals, currently in Committee in the House of Lords, will receive the support of the Liberal Democrats, so that we can increase police numbers along the lines that we promised and ensure that the police are more effective, more visible and can use their time more efficiently.
Mr. Brady: I am sorry that, despite giving the Minister a clear indication at the start of the debate that I wanted an answer and a promise that the Government would meet the full cost of funding the Commonwealth games, and despite his long, meandering contribution to this short debate, the Minister has refused to do what I asked. He says that HMIC officials would reconsider the estimates, but he has not given a commitment that if those estimates are found to be accurate, they will be fully funded by the Government—
Mr. Bill O'Brien: Order.
Question put and agreed to.
Adjourned accordingly at Two o'clock.