Westminster Hall Sitting of 20 March 2002

Preamble
[SYLVIA HEAL in the Chair]

Walsgrave Hospital, Coventry
Motion made, and Question proposed, That the sitting be now adjourned.—[Mrs. McGuire.]
9.30 am
Mr. Jim Cunningham: First, I thank Mr. Speaker for granting me this debate, which is the third on Walsgrave hospital. I know that a number of hon. Members wish to speak, so I shall try to get through what I want to say as quickly as I can. My hon. Friend the Member for Coventry, North-West (Mr. Robinson) has been held up because of a road accident, but he is definitely on his way here.
The debate has cross-party support and there is nothing political about it, as it involves the welfare and well-being of the people of Coventry. I shall be jumping in and out of the Commission for Health Improvement report; hon. Members will not want me to go through the whole thing and bore the heck out of them. We welcome the management and personnel changes and the management restructuring that have taken place at the hospital. We also welcome the fact that steps have been taken to implement the CHI report.
The impression has been given from time to time that we have been critical of the hospital staff. To the best of my knowledge, no hon. Member has criticised them. Indeed, we believe that they have done an excellent job in difficult conditions. According to my postbag, the public have always praised the medical treatment they received from the staff.
I ask my hon. Friend the Minister, why has there been a delay in publishing the CHI implementation report? We expected it in January, but it was not made available until March. I am at a loss to understand the reasons for that delay. Why was there a delay in signing the contracts for the new hospital? There might be a perfectly logical reason for that, but the people of Coventry would be worried if the project were delayed, because they are anxious to have a new hospital.
Hon. Members are aware that a number of concerns about the hospital have been raised over the years. For example, the style of management and the relationship between consultants and management is highlighted in the report. Another worry is the suspension of consultants, the cost of those suspensions and the loss of the consultants' skills for long periods. Legal redress has a financial cost. That money—thousands of pounds—could be recycled into the national health service, rather than being spent on long-winded procedures that try to gain someone redress and justice.
Then there is the general cost to the trust of the loss of good will. The CHI report touches on that when it mentions the relationship between consultants and previous management. Next is the question of how long it takes to deal with the suspensions. For example, not too long ago, in the case of a consultant in Coventry, it took up to two years. Those are long-winded
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procedures. There is also a cost to individuals—to their self-esteem and pride. More important, the families also suffer, whatever the outcome, and they are often innocent. I hope that the Minister studies those procedures and speeds them up.
Over the past few weeks, another consultant has been suspended, although we cannot judge why. Again, however, the trust and the hospital have been denied the services of a top consultant in his field. There is concern about what is happening. The previous management suggested that they could not deal with some problems at the hospital because planning and programming the new hospital diverted their attentions. I do not know how true that claim is, but I certainly question it.
About two years ago, we had a problem with bed blocking. I became involved during the parliamentary recess. I readily acknowledge that we cannot simply blame the trust, because three agencies are involved, but the issue requires more attention. The three agencies cooperate as best they can on a problem that creates anxieties among families who, because of lack of cooperation or of social workers, must wait for relatives to be discharged from hospital. It is a difficult issue, but we must nevertheless tackle the concerns.
There has been a lack of consultation between the trust and local MPs about not only the new hospital, but matters of common concern, so I hope that efforts are made after the debate to involve local MPs much more. People know that we are in the business of trying to help the NHS, not of knocking it. My hon. Friends and I are concerned to work with the trust and the management locally to provide the best health service for the people of Coventry. That is what this is all about and why we have constantly raised those issues over the past two or three years.
I hope that my hon. Friend the Minister responds to another concern about consultants. When does whistleblowing become serious misconduct? I know one or two consultants who blew the whistle in the best interests of their hospital or trust, but found themselves charged with misconduct. I am sure that my hon. Friends know of similar instances. Where the charge is not misconduct, employers have invented a new charge of bullying. My hon. Friends know that the trade union movement has pushed for several years for something to be done about bullying, certainly in the classroom and the workplace. I have no evidence of this, but I would not like to think that employers are using the charge of bullying as a catch-all, just as some employers charge individuals with gross misconduct, which is a catch-all and very serious. We must give a lot of thought to the charge of bullying.
I recently introduced a ten-minute Bill based on the Kennedy report about Bristol. I thought that it would be useful to include two aspects of the report in my Bill, which is still proceeding through the House. For example, it provides for trusts to have two additional members or for two members to be designated with responsibility for upholding the public interest, regardless of what the trust may do. As I am sure my hon. Friends know, trusts have a dual function, which I want to remove. Again based on the Kennedy report, the second part of my Bill would allow facilities to be provided for staff to upgrade their skills after two or three years. I know that my hon. Friend the Minister is considering that issue.

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I welcome the CHI report's recommendations. CHI initially became involved as part of a routine review of the hospital's facilities between February and July 2001. The findings were published in September 2002. So far, I welcome the action taken by the trust to implement the CHI report, as I am sure my colleagues do, but there are still two areas of concern. Before I come to them, it is worth reminding the House that there were five initially: the practice of putting five beds in a four-bed bay, the high death rates for non-emergency admissions, the organisation of the emergency departments and the emergency assessment unit, the relationship between some consultant medical staff and senior managers, and the need to address current service problems.
Satisfactory progress has been made with the bedding bays, death rates for non-emergency admissions and the service problems, but progress on organising the accident and emergency departments is limited. The relationship between some staff needs improvement, a subject that I touched on earlier.
Outstanding problems are still to be resolved. Although progress has been made by the trust to ensure patient safety across the split site services, the agreement and implementation outlined in September has not occurred. Will my hon. Friend the Minister comment on that in her winding-up speech? The trust has stated that it intends to implement one of the three structural solutions proposed by the external review, but CHI is concerned that the proposals are costly and that no priorities have been identified.
No contingency plans are in place should full funding for the changes not be available and CHI remains worried that only limited progress has been made between consultant medical staff and senior managers. Two clinical service teams have been found to have significantly dysfunctional working practices and some senior staff remain disengaged from management colleagues. The trust has proposed a new management structure to strengthen the role of clinical staff and has employed external teams to change management and build teamwork, but it is too early to evaluate the possible impact of that.
I welcome the changes made in the trust, especially the appointment of the new chairman, with whom I look forward to working, as I am sure my colleagues do. We should learn lessons from the CHI report, and I hope that there will be no need for more debates on Walsgrave hospital. We have never tried to tell anyone how to run a hospital, but we are certainly interested in the well-being of the hospital staff and consultants and, ultimately, the service delivered to the Coventry public. We should draw a line under the past and make a fresh start, so that we can all work together to provide the best medical facilities for the people of Coventry.
9.42 am
Mr. James Plaskitt: I am pleased to contribute to the debate, as I was regrettably unable to attend when Walsgrave was discussed in this Chamber previously. Although Walsgrave is not my local hospital—Warwick has a different district general hospital—what happens there is of considerable concern to my constituents and to me, as many of them are treated there.
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I endorse what my hon. Friend the Member for Coventry, South (Mr. Cunningham) said. I have not had occasion to deal with complaints from my constituents on the clinical care that they have received in the hospital or the quality of work from its staff, but plenty of casework about what goes on at Walsgrave has been brought to me over the years and all the issues raise questions about management.
I use Warwick hospital in my constituency as a benchmark. It has had several management problems during the past few years, including considerable turbulence in management personnel, and we recently lost the chief executive as a result of questions about the management of figures supplied to the Department of Health. That turbulence has created great difficulties for the hospital but, throughout the period, not one clinician has said that they have lost confidence in its management.
In contrast, I received a petition signed by more than 80 clinicians at the Walsgrave, telling me that they have lost confidence in the management of the hospital. Clearly a serious state of affairs has been reached. I have received evidence not only from constituents, but in the form of the petition signed by clinicians, and I know of the concern of my colleagues who represent Coventry constituencies. I hear whispers and comments in the health community.
That is the background, but as a responsible Member one looks for objective assessment of what is happening. The report by the Commission for Health Improvement provides that, and it puts the problems into sharp focus. As colleagues have said, most alarm bells rung in the report are relevant to the way in which the place is being managed and run, but less relevant to the standards of clinical care. Yet although it is, in essence, a management issue that we are dealing with, there are clinical consequences and my concern is focused on that aspect.
By way of illustration, I want to raise the case of Mr. John Clifford, a resident of Lapworth in my constituency. In July 2000, he attended the surgery of his GP, who detected heart problems. Mr. Clifford was examined and it was discovered that he had a faulty aortic valve. He and his family were told that a replacement operation was required and that such operations have a 95 per cent. success rate. They were told of the importance of the operation being done within, ideally, six months.
Mr. Clifford was placed on a waiting list and he and his family were told that hopefully—that was the expression used—the operation would be done in or before April 2001. During 2001, Mr. Clifford's condition deteriorated. His GP contacted the hospital several times to urge that the operation be brought forward. The April 2001 deadline passed without a date for surgery being offered. In despair, the family contacted the Walsgrave again in October 2001. The consultant told Mr. Clifford that he would be seen within the next three to four weeks.
In November 2001, the family remained very concerned about Mr. Clifford's condition and contacted the hospital again. Because of their concern and the urgency of the case, they said that they would contemplate private treatment, only to be told that there was no point. Nothing would be gained by securing

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private treatment, as Mr. Clifford was third on the list and his operation imminent. Yet by January 2002 a date for treatment still had not been given.
Mr. Clifford was very ill over Christmas and new year. Eventually, on 26 January, he was admitted as an emergency case to Warwick hospital. On 4 February, with Mr. Clifford in Warwick, the family received a letter signed by Mr. Loughton of the Walsgrave:
"I am pleased to inform you Mr. Clifford will be called to come into hospital for his surgery within the next few weeks. If for any reason this does not happen, Mr. Clifford will then be given the opportunity to utilise the private sector".
That came after the family had been told that there was no point in going private because he was third on the list. On 6 February, in a worsening condition, Mr. Clifford was transferred back to the Walsgrave hospital, where a consultant examined him, said that he was too ill to be operated on and told the family that he had missed his "window of opportunity". On 13 February, Mr. Clifford died.
The community health council is investigating the case, at my encouragement, and I understand that Mr. Richardson, head of communications at Walsgrave hospital, has told a local newspaper that an internal review of management procedures has taken place in order to examine what happened in Mr. Clifford's case. However, he has told us that the results will not be published. Will my hon. Friend the Minister tell us whether that is a common procedure, whether, in her view, it is acceptable and whether the Department can obtain the findings of that important inquiry, which the hospital seems unwilling to share?
I cite the tragic case of Mr. Clifford as an example of what can happen when a hospital has dysfunctional management. I therefore read the March update from CHI with considerable concern. It reviews progress following its earlier report, but still finds:
"Limited progress has been made by the trust to build effective working relationships between doctors and managers".
The clinical governance review found that
"relationships had broken down between some consultant medical staff and senior managers. In particular, some doctors did not feel safe to raise concerns about clinical risk."
It continues:
"CHI remains concerned about the limited progress in the area. CHI was particularly concerned that some senior medical staff remain disengaged from management colleagues. CHI found further evidence of two clinical teams with significantly dysfunctional team working."
Those are serious findings, and to have them reiterated in a follow-up visit by CHI is worrying. CHI says that the role of the trust board is vital in correcting the problems, and I am sure that we agree. It also says that the board has been strengthened by new members since the CHI clinical governance review, adding:
"There needs to be an ongoing commitment and recognition by the Board that these issues should he tackled."
That is an understatement—dysfunctional management and the breakdown in the relationship between management and clinicians contributed to the tragic outcome for my constituent, Mr. Clifford.
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I cite a press release issued by the hospital on 11 March. It indulges in an element of self-congratulation based on Dr. Foster's independent hospital guide, which is available on the web and which I have checked. Walsgrave hospital receives a five-star rating—apparently not a bad evaluation—but even that guide points to problems in the cardiothoracic service and the high death rates at the hospital. I conclude by mentioning the guide and the Walsgrave's interpretation of it because Mr. Loughton concludes his press release by saying that my right hon. Friend the Secretary of State for Health has said that
"no chief executive should be 'looking for the excuse book'".
Indeed they should be looking for the excuse book, given what has happened and what is still happening. There should be no hiding place. Will the Minister comment on what she thinks should happen to chief executives who have such a record on leaving their post? Should they pop up in due course, elsewhere in the national health service?
9.55 am
Mr. Geoffrey Robinson: I am grateful for an opportunity to take part. I congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing the debate and on introducing a ten-minute Bill. I also welcome the Minister, who is attending for the first time, I believe, one of our three Adjournment debates on matters relating to Walsgrave hospital. We are sure that she will give a lucid and serious reply to the deeply worrying concerns that remain in our minds despite the enormous step forward that has taken place since our previous meeting in this Chamber, when the Minister of State promised to take on board what we said. Since then, Mr. Loughton has handed in his resignation. Without any personal animosity, and respecting the proper limits on our privileges in this House, we regard that as an important step forward. However, ahead of that suspension, a further suspension took place, which is a cause of grave concern to us all. Let me say why.
In none of our criticisms in any of our Adjournment debates have we sought to speak other than wholly positively about the nurses and support staff at the hospital. This is purely a management issue. We believe that the performance of some consultants at Walsgrave has not been up to the standards that the national health service or the Department of Health would allow to continue if they knew the full facts.
In its second report, CHI emphasises that one key area in which great improvement is still necessary is working relationships between consultant staff and management. Now there has been a further suspension, that of Dr. Mattu, which is bound to be, at the very least, a setback to any improvement. We already know that there has been an initial meeting of the consultants at which a wide range of concerns were raised. The necessary signatures for an emergency debate were forthcoming and we shall be plunged back into exactly the same destabilising process that applied in the case of Mr. Barros D'Sa, which lasted over 20 months. Later, I shall say something about the time that suspensions take, because I am sure that the Minister finds that as unacceptable as I do, and I know that the Government are taking steps to accelerate the process.

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The problem with the suspension of Dr. Mattu is that it is following exactly the same lines as that of Mr. Barros D'Sa. There is no hint of criticism of his professional competence. On the contrary, he is the top man in his field and he has an international and national reputation. I believe that he has given papers in north America, which, by any standard, leads in virtually all aspects of coronary care, diagnostic and surgical. In fact, Dr. Mattu is giving a paper there this very week.
We have a major national shortage of surgeons and doctors and the distinguished surgeon Sir Magdi Yacoub is scouring Europe and north America to recruit top surgeons and consultant cardiologists, but we, in our wisdom, have managed to suspend probably our top man in the field. That is worrying.
The same applied with Mr. Barros D'Sa. There was not the slightest hint of professional incompetence in his case. In addition, the charges are exactly the same—harassment and intimidation. I cannot take a view on those charges, and I do not expect the Minister to give us her view this morning, but I hope that she gives the matter her attention, because that would mean a lot to us in the circumstances.
The charges come from a junior doctor, who worked for Dr. Mattu and made a series of recriminations that, frankly, if boiled down to their essence, do not amount to much more than self-interested tittle-tattle motivated by the fact that he did not get everything that he wanted. There is a childish quality to the charges, which hardly merit a suspension when we so desperately need people such as Dr. Mattu.
One cardinal sin may have been committed: the complainant attacking Dr. Mattu alleges that he said that the incident might bring about the suspension or dismissal of Mr. Loughton. If that were a hanging charge, all the MPs here today would be suspended. Having some experience in such matters, I could advise my hon. Friends on how to handle it.
Dr. Mattu was one of 80 people involved. He did not simply say, alone in conversation with one of the junior staff, that there was a move to secure Mr. Loughton's resignation. Eighty people went public in a debate or ballot, and many of them went public outside the secret ballot to make it clear that they had no confidence in the chief executive. There was an open movement, backed by most of the surgeons, to achieve that very end. Therefore, the charge has no significance or seriousness.
There is another similarity with the whistleblowing incident in the case of Mr. Barros D'Sa. There was a terrible record of colorectal perinatal death rates at the Walsgrave, but that was not accepted. We raised it with the hospital management—I did so myself at a very early stage—but no action was taken until we received the Commission for Health Improvement report. Two steps have been taken since: a new colorectal specialist has been recruited and the surgeon whose performance was unacceptable no longer does that job, but it took us two years to get to that point.
Finally, thanks to CHI, we have eliminated the problem of having five beds in a four-bed room. Dr. Mattu made that point to me nearly two years ago, but nothing was done. I wrote to the management and I
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wrote to David Loughton personally at least twice, telling him that the practice must change. Dr. Mattu was so forceful and confrontational on the subject that I felt that the very least I could do was write a letter, or he would perceive the fault as mine.
Dr. Mattu is that sort of person— he cares deeply, and I can see how that might upset people, but that is no reason for suspension. He may be a little to blame for the fact that personal relationships between him and his staff in the department are not perfect, but knocking heads together—including Dr. Mattu's, if required—is the right strategy. We should not have to go through a lengthy and costly suspension procedure that also seems to me, although I pass no final judgment on it, to be of questionable necessity.
In passing, I address the question of Mr. Loughton's resignation. I ask respectfully what the redundancy arrangements will be. Will there be severance pay or will he move to another position in the NHS? The Minister may not be able to give an answer this morning, but the people of Coventry have a considerable interest in knowing what is going to happen.
I address two other aspects of the suspension procedure in respect of Dr. Mattu. I am not sure what guidelines are set down by the Minister or the NHS executive, but the process followed in this case is unacceptable and smacks of the arrest procedures characteristic of a communist or fascist dictatorship. The Minister is bound to refer to the fact that the relevant letter was signed by the medical director, but it would be naive of any of us to imagine that the hand of Mr. Loughton was not behind it.
I can assure the Minister that Mr. Loughton has been boasting to other senior consultants and consultant representatives, some of whom he probably thought would be favourable to Dr. Mattu. Mr. Loughton has assured them that the matter has gone to the highest level in the national health service—my right hon. Friend the Secretary of State on the one hand and the chief medical officer on the other—and that everyone is wasting their time opposing it, almost as if the outcome is prejudged and the suspension not a neutral act as it was meant to be.
David Loughton is leaving now and we can speak with a frankness that may not have been possible before. At public meetings, he let it be known to consultants and others in the hospital that he had a hit list of five people whom he was going to get rid of before he left, by suspension or some other method. We have all heard that and we believe what we hear when it comes from reliable sources who have heard it from the horse's mouth. Perhaps that was his parting shot. Nothing that can be said about the action in question will do other than convince me and, I think, my hon. Friends that it was inspired by David Loughton.
The manner of Dr. Mattu's suspension is unacceptable. Two people—the medical director and deputy personnel director—banged on his door and demanded entry. He let them in and they made it clear what they were about. He said that he had the right to be represented, but they questioned the need for representation. Dr. Mattu had no forewarning. There was no prior discussion, airing of grievances or attempt at conciliation with the parties involved. It is almost as if people wanted to provoke the incident. Dr. Mattu was

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shown to the door and marched off the premises. He was not allowed to take his computer, which was his own. The locks on his door were changed and the details on his floppy disk, or whatever was in the computer, impounded by NHS staff, who I understand had nothing better to do than start transcribing the whole lot to see what they might find out about him.
That gives my hon. Friend the Minister an idea of the way in which the process can be conducted and the military behaviour of the management, and I hope that she is reassured that the steps that we have taken—bringing those matters to this place three times—have not been taken lightly. We are pleased that the chief executive has gone, but, following his last throw of the dice, we must pick up the pieces.
Another important point is the sheer length of these suspensions. I know that the Department has published a new notice, probably at the Minister's initiative, insisting that dealing with such cases should be speeded up and suggesting the manner in which that could be achieved. I raise the issue because another surgeon at the hospital, Miss Briony Ackroyd, has been suspended for, I think, more than two years. It is not acceptable that suspensions are allowed to last so long at enormous cost. That is the bizarre aspect. I believe that it costs the best part of £400,000 or perhaps £500,000 to deny the people of Coventry the services of such a good surgeon.
Similarly, Raj Mattu is a top-flight surgeon—the best in his category. There is great need and we are trying to recruit people from abroad, but he may be out for up to two years for harassing or having a set-to with some of his junior staff. We all have those problems, but we sort them out. I can remember similar incidents in the Department where I worked. We had rows and yelled at one another, but we knocked heads together and solved the problems ourselves. That is what this is about.
When the Minister reads the charges levelled at Raj Mattu, she will see that this is nothing but a case of people falling out and saying things in the heat of the moment that they should not have said. The top man has been suspended, however, which is nothing short of crazy.
I hope that my remarks are sufficiently clear, and I would be grateful if the Minister considered the overall issue and where the case of Briony Ackroyd stands. I know that Miss Ackroyd would like the matter to be resolved. There are too many questions for the Minister to deal with today, but I have utter confidence that she will answer them. We are pleased to see her in her place.
10.9 am
Mr. Mike O'Brien: I congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing the debate about the situation at Walsgrave hospital and on gaining Mr. Speaker's consent to another discussion of a subject that so concerns us.
This is the third debate on Walsgrave. The last one involved seven hon. Members in an unprecedented display of concern following publication of the initial Commission for Health Improvement report. The situation is not new. It did not suddenly develop last year after publication of the report, but has been developing in the management and the culture of the hospital for probably more than a decade. In recent
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months, especially following publication of the report, the public and hon. Members who represent them realised that they could not allow the culture that had developed in the hospital to continue to cause these problems. Public confidence in the delivery of NHS services in our area was being increasingly damaged, and the CHI report was the last straw. All the MPs who represent constituencies in the area had to take a stand.
The problem at Walsgrave is clearly dysfunctional management. The clinical staff, senior consultants, nurses and those who support them have all worked enormously hard to deliver good quality medical care to patients, but they have been handicapped by the quality of organisation that is supposed to run the hospital. We must restore public confidence and make it clear that the staff have been doing a tremendous job, despite the handicaps that they face.
It is time for a new start and a new culture. We no longer need the Thatcherite approach to management, if I may describe it like that—management by diktat from the top, whereby an individual decides to run things as he thinks appropriate without consulting others who work with him. For a time, a weak management board allowed the chief executive, David Loughton, to carry on in such a manner, but we have the opportunity to make progress with the public-private partnership that the Government have approved and prospects at the hospital are brighter.
The new culture, the new hospital building that the public-private partnership will produce and the development of the new teaching hospital plans will all enable us to paint a bright picture for the future of Walsgrave. That should start to restore confidence that not only are there good workers at the hospital, but there is the prospect of good management and delivery of a first-class service.
The most recent CHI report still fills us with concern. On the five key issues, the action plan shows some improvement in some areas. On reducing the number of beds in bays from five to four, the first CHI report expressed concern that five-bed bays put patients in danger, despite the hard work that the staff put into caring for them. Some problems have been addressed and the response in the new report is satisfactory. Satisfactory progress has been made on analysis of death rates, but more work needs to be done.
Some progress has been made on organising care in the two accident and emergency departments and the emergency assessment unit, although it is unsatisfactory and more work must be done there. Inevitably, progress on rebuilding working relationships was limited while the chief executive, David Loughton, was in post. I hope that his decision to go enables those working relationships to be improved. Like my hon. Friends, I am concerned about references to the two clinical teams with significant dysfunctional teamworking, which the management must tackle.
There has been some satisfactory progress in dealing with the serious service problems, but, as my hon. Friends said, until there is a new building and better facilities can be provided to deliver services, the longterm problems will remain and will need constant vigilance by the new management. However, a new chief executive and the current chairman, Mr. Stoten, should be able to create a new culture and start to deliver further improvements.

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I share my hon. Friends' anxieties about the disciplining of consultants at Walsgrave hospital, which must change. There must be a more sensible, and faster, approach to the matter, but it is not the consultants' job to run hospitals. NHS management is given the responsibility of running hospitals on behalf of the public. However, it is the responsibility of those who provide patient care to inform their Members of Parliament and other public representatives if problems arise, and they must be able to do so.
I want the Minister's assurance that if consultants have serious anxieties about care in a hospital such as Walsgrave, they will be able to take that concern to their Member of Parliament. There should be no restriction on them doing so, such as a disciplinary obligation on consultants to go through a certain procedure before talking to their MP. The NHS is a public service and Members of Parliament are responsible for ensuring that it is delivered. If there is a concern, I should be able to bring it to the Minister's attention and consultants should be able to talk to their MP.
Mr. Robinson: May I reassure my hon. Friend that in my experience of dealing with consultants, none of them wanted to run the hospital? They wanted the hospital to be run properly and in respect of clinical care, for example, they did not want five beds in rooms designed for four. They felt that surgeons whose perioperative fatality rate was far too high should not be retained and they were worried that in a four-year period Coventry had almost the worst record in artery and valve heart surgery. Those are the concerns that consultants brought to my attention.
Mr. O'Brien: I accept what my hon. Friend says. Consultants do not appear to be seeking to run the hospital, but it is right to make it clear that a public service must be delivered, and managers are employed in the NHS to do that. Consultants should also look to themselves and develop a culture in which they can work with the new management at Walsgrave hospital.
I do not want to have to go to the electorate in three or four years and face public expressions of concern about how the hospital is run. The problems must be sorted out now. I hope that everyone at the hospital pulls together and I am sure that they will. I am pleased that the new chairman is prepared to come to grips and I hope that he continues to address the issues seriously.
The Government's decision to franchise the chief executive's post struck me as odd. I can see why a Minister might decide to franchise the whole team, but I cannot understand the decision to franchise, from within the NHS, only that one post. Why was it taken? I am not sure what difference it will make, as it only delays the appointment of a chief executive by obliging a franchising procedure to be carried out, although there may be a good and logical reason for doing so.
Why was the team not franchised? I am not advocating franchising, however, as I do not think it necessary. The best approach would have been to carry on and appoint a new chief executive from within the NHS. A limited number of people can apply, as probably only a handful have the necessary experience
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of running a very large hospital. Considering the numbers, I do not think that franchising will make a difference.
No doubt the Minister has a reason for taking that course of action; I am merely curious about it. Perhaps it is a way to express concern that things have reached a pretty bad pass in the management of the hospital and to show that she wants fundamental change. If that is the case, I accept it. The board, by and large, is new. Many senior management posts in the hospital are acting or are held by new people. We are getting a new management team in anyway, which is good. The objective must be to restore confidence, and I am sure that we can do that.
10.20 am
Andy King: I shall keep my remarks brief because, as my hon. Friends have pointed out, we have been here three times already.
The people of Rugby feel that Mr. Loughton should not have been allowed to resign, but should have been removed much earlier. They, and the people of Coventry, would have suffered far less if that had happened. The report points out some improvements. There certainly have been some improvements since the arrival of the new chairman, and I feel much more positive about the future, especially since we heard the good news of Mr. Loughton's departure. What concerns the people of Rugby. however, is that he seems to be hanging around for a considerable period. We want him to go as soon as possible. As my hon. Friend said, the people want to know that he will not walk away with some handsome package into another top job somewhere else. We must not be seen to reward someone who has not done the job that he was paid to do—delivering the best quality services.
CHI is doing an excellent job. The whole purpose is to ensure, through clinical governance, that people receive the highest possible quality of service. I am sure that my hon. Friends have shared my experience. Constituents come to me regularly, with details that defy belief and reason, about the way in which they have been treated when they have gone to Coventry and Warwickshire hospitals.
The following examples date from after the first CHI report. In November a constituent took his wife, who was 23 weeks pregnant, had stomach cramps and was bleeding, to Walsgrave hospital. He said that the labour ward could only be described as prehistoric. It was cold and dirty, the wallpaper was peeling and the floor coverings were taped together.
Another constituent with varicose veins was seen by four different consultants. Some were in the same department; others were in different departments. On every occasion her notes were missing. Staff had no idea why she had been referred. Internal communications between departments were non-existent.
When another constituent took her son to Walsgrave, he was moved to 10 different beds in 15 days. To add insult to injury, when he returned to St. Cross in Rugby by ambulance, the staff did not know that he was arriving. That tells a terrible tale of incompetent management in life-threatening situations, which must not be allowed to continue.

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The second CHI report called for significant improvements in those five areas. I am delighted that it found it impossible to paper over the cracks and give the impression that those significant improvements had taken place, because, as was rightly pointed out, the core of the problem was poor management and the dreadful culture that persisted in the hospital. As the report said, that problem must be tackled and those cultural changes must take place. We know that it takes time to change a culture, but unless that happens, we will be in the same cycle in the years ahead. As representatives of the people of Coventry and Warwickshire, we cannot stand by and watch. The future is positive, and I look forward to seeing the new chief executive in post. I wish him well—[Interruption.] I apologise; I wish whoever is in post well. be it him or her. Whoever it is, they will need all the support that can be given to them.
I have already arranged a meeting in May with staff representatives and the chairman, and I intend to ensure that such meetings take place regularly. I have met several consultants and found them to be committed people who are determined to deliver the best quality services that they can. I appreciate the hard work that the Minister has done to help, especially those in Rugby, as we were taken over by the Walsgrave hospital. I thank her for her assistance in ensuring and safeguarding the local hospital services for my constituents in Rugby.
10.28 am
Mrs. Caroline Spelman: Thank you for allowing me to make a brief contribution, Mr. O'Brien. I am not, I believe, the only speaker not to have been present from the start of the debate, and I have been present at every stage of the battle to get justice done for our constituents. My constituent, Simon Standley, alerted me to the problem after he suffered a failed renal transplant at the Walsgrave hospital, and I speak with him very much in mind. He was there for four and a half months, and was able to observe at close quarters the profound problems that were later identified in the CHI report.
At Mr. Standley's request, I shall return to the issue that was raised by the hon. Member for Coventry, North-West (Mr. Robinson). Something is awry in the unfair way in which the whistleblowers were dealt with at the hospital. I speak with the consultant Mr. Barros D'Sa in mind, and also on behalf of the cardiologist Mr. Raj Mattu. When the whistle was blown, the management wanted to suspend Raj Mattu, who had been brought in to solve the problems in the department. Ultimately, the suspension was dealt with by the medical director, which is the correct procedure. However, his suspension will be overseen by the chairman and chief executive who originally called for that suspension, which represents a conflict of interest. The cardiologist holds strong views, as one would expect of a person brought in to troubleshoot a department and get things done. I wished to raise that issue with the Minister, and I shall confine my remarks to that remaining injustice. I look forward to her comments in response to the wider issues raised by colleagues.
10.30 am
Dr. Evan Harris: This has been a serious debate and has raised serious issues. Although some hon. Members are veterans on this
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subject, this is my first venture into it, so I will be cautious. My experience is of management and consultant conflict in the cardiac unit at the John Radcliffe hospital in Oxford, which has experienced similar problems, although not as deep as those at Walsgrave hospital.
The problem has been going on for a long time, and hon. Members with local constituencies have deeper knowledge of the situation, so it would be inappropriate for a Front-Bench spokesman such as myself to go into such detail. Hon. Members have demonstrated that when seven or eight of them act in concert—they have been able to have three debates on this subject so far—they can bring a great deal of experience, wisdom and insight to an issue, as well as bringing pressure to bear on their local trust in order to effect change. Both the hon. Member for Coventry, South (Mr. Cunningham), who secured the debate, and the hon. Member for Meriden (Mrs. Spelman) deserve praise and applause for their assiduousness in bringing forward such matters.
I wish to draw out some of the questions regarding the wider issue of performance indicators, and how useful they are compared with Commission for Health Improvement reports. I shall also comment on the franchising process mentioned by the hon. Member for North Warwickshire (Mr. O'Brien), and discuss whistleblowing.
The hon. Member for Coventry, South rightly struck a positive note when introducing the debate by welcoming the role of the Commission for Health Improvement, as well as its involvement and follow-up report, and the management change. He was at pains to point out that he and many other commentators on this subject are not generally criticising the staff at any level, which is important to mention. Although some appraisals of hospital performance are valid, I contend that some are not, and they may have a negative impact on morale at a time when retention and recruitment are critical in terms of capacity and quality of care.
Among his concerns, the hon. Member for Coventry, South identified management style—a point that has resonated throughout the debate—and the relationship between consultants and managers. It is important to make clear, as did the hon. Member for North Warwickshire, that consultants do not, and should not, want to run hospitals. The hon. Member for Coventry, North-West (Mr. Robinson) said that, in his experience, the consultants in his area did not wish to run hospitals. However, in my experience, people with a lifetime involvement in a hospital do not necessarily embrace changes that may weaken their power. That is not always a bad thing, although some may describe it as a wrecking attitude. Nevertheless, we must recognise that the balance of power should shift away from senior consultants in hospitals. Most of them understand that, although of course we should note that some do not, as the hon. Member for North Warwickshire pointed out.
Mr. Geoffrey Robinson: I would not like the idea to get around that any of the three consultants mentioned in my contribution had that sort of problem. They are certainly not resistant to change. They have problems

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because their changes are resisted by management—changes that would be wholly to the good in terms of improving health care.
Dr. Harris: I accept what the hon. Gentleman says, and stress that my remarks are general.
The costs incurred through the loss of consultant input from those suspended, the number of consultants suspended and the time for which they are suspended have been raised many times. This is a further reminder that procedures must be speeded up. It is difficult to say that no people who are under investigation should ever be suspended, because if a complaint is made, it is difficult for someone to come out as a whistleblower if they must work with the person against whom serious allegations have been made. Speed of process will be important.
The hon. Member for Warwick and Leamington (Mr. Plaskitt) said that he had heard no complaints about clinical care per se, and that complaints were mainly about management. It is important to stress that—although the two things are connected.
The hon. Gentleman also drew attention to a petition from 80 clinicians. We must be careful about sacking by petition, because many politicians—and, indeed, Governments—would be in deep trouble on that basis. He was right to say that the Commission for Health Improvement report—an independent report following an in-depth study—was helpful. The inspection was routine, and it was fortuitous that it happened. Going back was also important.
The hon. Gentleman related well the striking and tragic case of his former constituent, Mr. Clifford. Although it is difficult to draw conclusions without hearing the other side of the argument—there usually is another side—one cannot get away from the fact that that gentleman was first told that he needed a relatively urgent operation in July 2000, yet more than 18 months later he still had not had it. The point is that he needed his operation within six months. If patients who have waited longer but whose cases are less urgent are prioritised, which is the risk with maximum waiting times, there is a danger there will be less political focus on others. Mr. Clifford had been waiting almost 18 months when he underwent his tragic emergency admission. A lesson must be learned about the need for admission to be governed by clinical priority—and, of course, about the need for sufficient capacity.
The hon. Member for Coventry, North-West made a refreshing speech; characteristically, no holds were barred, and he spoke with his usual candour. He gave his view on the allegations against the suspended consultant, although he was careful to say that he was not making a final judgment. There is an issue about temptation, because we know that people might give a view that did not take account of the junior doctor's difficulties in the case in question. I do not want to be drawn on details because I accept that the hon. Gentleman's knowledge of them is greater than mine. However, speaking generally from my experience as a spokesperson for junior doctors, I know the number of times that I was approached by junior doctors who said that they were terrified of making any complaint
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because they feared that it would be seen as a spat between two equals. The power structure between a consultant and a junior is very different, because a junior doctor relies on a consultant for his or her reference. The sooner we move to a system of open references, the better.
As the hon. Member for Meriden said, there is a balance between whether there should be maximum freedom for whistleblowing from the outset or whether trusts are right to have procedures whereby people approach problems internally first. In the Labour Government's first term, they said that they would get rid of gagging clauses. However, my experience—and, I think, that of other hon. Members—shows that staff are still scared to speak to their Members of Parliament. That point was made by the hon. Member for North Warwickshire.
The hon. Member for North Warwickshire asked a good question about why franchising, rather than advertising, is being used for the post, given that the Government are restricting applications to those from within the NHS. I suspect that that is because franchising is a new policy for which the Government can take credit, by definition, because they invented the term. Hospitals that are doing badly can only do better. When they do better with a new manager, the Government will say that that is a direct result of franchising, rather than of the new manager.
Finally, I must mention performance indicators. The Sunday Express set out the position by pointing out that there are three sets of performance indicators in use at once. The star rating system was slammed by health service journals and others as irrational and subject to fiddling. It causes the distortion of resource allocations and clinical priorities, and measures such things as capacity, over which hospitals have little control. Further indicators are the Dr. Foster ratings and the CHI report. All the indicators drew very different conclusions about the hospital. John Richardson, a spokesman for the University Hospitals Coventry and Warwickshire NHS trust, said that the naming of the hospital as a poorly performing trust was catastrophically damaging to its staff and unduly worrying to its patients.
That was not said about the CHI report, which allows the press to go into the detail of the specific allegations and to see that the concerns are not mainly clinical but are about some of the broad-ranging performance indicator systems that are being used, such as the Government's performance indicator. There is an element of blame shifting in the system; we must be aware of that.
Someone referred to the Secretary of State's comment that no chief executive should be looking for the excuse book. That message could come back to haunt the political chief executive of the NHS, because in the end, the proper performance of hospitals is a matter for the politicians.
10.40 am
Mr. Simon Burns: Like other hon. Members, I begin by congratulating the hon. Member for Coventry, South (Mr. Cunningham) on bringing this important debate before the House of Commons yet again. Its importance is highlighted by the presence of so

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many Labour Members who represent constituencies that are directly affected, and of my hon. Friends the Members for Meriden (Mrs. Spelman) and for Solihull (Mr. Taylor). The debate is important because—not unnaturally or unreasonably—hon. Members want to secure the best health care for the communities in their constituencies.
In Walsgrave hospital, we have seen the high standards of health care that we and our fellow citizens expect unravel for far too long, and now they have completely collapsed. It is important to repeat what many hon. Members have said: we are not criticising the dedicated staff who work in that trust and that hospital. What has happened in that hospital has been described by many hon. Members both in this debate and in the past: the trust has a dysfunctional management team, and that has caused many critical problems with the provision of health care in what should be a first-class hospital offering first class patient care to the people of Coventry and the surrounding area. For far too long, it has been blighted by a series of ongoing disputes. They have torn the hospital apart. Consultants have, in effect, been at war with the senior management, and especially with the chief executive. That has resulted in a dismal level of health care and patient care, which led the hospital to receive a zero star rating in the league tables issued in late 2001.
The hospital has been riven by suspensions of consultants, resignations, bullying, low morale and a desperate atmosphere of suspicion, tension and recrimination. In short, the atmosphere and conditions in which people have had to work, and which patients have had to put up with, are poisonous. That has led to low morale among the patients and the staff, who have had to do a very difficult job in very difficult circumstances.
Nowhere is that more apparent than in the damaging CHI report, which makes for shocking reading. Its criticisms of the hospital—which should be a centre of excellence for local health care—are convincing and damning. It states that the trust scores significantly higher than the national average for the percentage of patients readmitted within 28 days of being discharged, and for the percentage of non-emergency admissions who die within 30 days. Overall, the hospital's comparative death-rate score is 14 per cent. higher than the national average for emergency admissions, and a staggering 60 per cent. higher for non-emergency admissions.
Many critical areas of the hospital have suffered from overcrowding. We have heard from hon. Members the example of the five beds in the four-bay wards. The CHI report also condemned the level of cleanliness; it said that some areas were dirty, unhygienic and unkempt. That is in a hospital, where one would expect cleanliness to be so good that one could—metaphorically—eat off the floor. That was not the case at Walsgrave.
The CHI report contains 68 individual criticisms or areas in which action is called for. Perhaps the most important, in the context of the breakdown of confidence between the consultants and the chief executive, is about the relationship between senior management and staff—that senior staff felt isolated, disempowered and undervalued.
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CHI's action plan says:
"Clinical Risk Management is seriously undermined by some senior clinical staff feeling intimidated and threatened by senior managers when reporting concerns about clinical practice".
I find that a staggering complaint to be levelled at the management of a national health service hospital in this day and age. The report continues:
"Confidence, communications and relationships between some senior medical staff and senior managers need to be restored in order to develop effective working relationships."
That is an equally damning indictment, but what I find worrying is that CHI's follow-up comments about areas in which there is a need to restore trust and heal the breach between consultants and management make it clear that not enough is being done fast enough to allow the hospital to move forward rather than be constantly tainted and affected by what has happened in the past.
With that breakdown in communications, it is hardly surprising that 66 per cent. of the senior medical staff have, in effect, passed a motion of no confidence in their chief executive. Looking at that fairly superficially, I would think that it is unheard of in the NHS, and must be a key indicator that something is very wrong. The situation has been going on far too long; it is a total mess.
The chief executive, David Loughton, seems to have been the cause and catalyst of many of the problems that have emerged in the hospital, through his management style, his high-handedness and his actions. His suspension of surgeons such as Mr. Barros D'Sa and Mr. Raj Mattu seems incomprehensible, and gives credence to the accusations that his management style was based on bullying and intimidation. That is a deeply flawed management style that is not needed, and should not be welcome, in the national health service.
Mr. Loughton has now announced that he is leaving the post, although I understand that he may not do so for up to six months from 6 March, when he made that announcement. In the light of that, I have several questions for the Minister, and I would appreciate it if she could give specific answers—if not in this debate, by writing to me.
Did Mr. Loughton genuinely resign, or was he pushed? Why has he been allowed to remain in post for such a long time, given what we have seen, given the zero rating of the hospital under the Government's system of tables, given the damning indictment in the CHI report and the criticisms that hon. Members have made to Ministers over a long period? It was quite clear that something was wrong with the hospital and the trust. When Mr. Loughton had lost the confidence of a significant number of the medical staff with whom he had to work, and the trust's performance was so poor, why was he able to survive for so long, when such positions as his are critical in assuring the highest performance of this country's trusts and hospitals?
Can the Minister provide a financial figure for what the suspension of consultants, which carried on for so long because the system to resolve the problems that caused them was long-drawn-out and complicated, has cost the health service, and thus the provision of health care?
I should also be grateful to know why Mr. Loughton remained in post once the CHI report, which damningly highlighted many problems and showed the need for

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action, was published. In other parts of the world, such as business—although I accept that a hospital is not a business—if the chief executive were presiding over such calamity and failure they would have gone long ago. I should also be interested to know what the Government and the Department of Health have been doing about that sad saga, and why they did not do more to bring those problems to an end.
Finally, with the departure of Mr. Loughton, I too should like to know whether he is to be moved on to another job within the health service. To be fair, that has been common practice in the health service by Governments of all political parties, regardless of how poor performance has been. Will he leave the health service—which would be a blessing for it—and be paid off with a financial package of cash and pension rights? If someone is responsible, or seemingly responsible, for completely ruining a trust and the provision of health care in an area, it adds insult to injury for the patients and staff who have had to put up with and work in those conditions if the person who seems to have caused them is handsomely rewarded financially.
10.51 am
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): I, too, congratulate my hon. Friend the Member for Coventry, South (Mr. Cunningham) on securing a debate on the progress in implementing the clinical governance action plan at the University Hospitals Coventry and Warwickshire NHS trust, and in particular on the issues at the Walsgrave hospital.
My colleagues and I are fully aware of the concerns that have been raised locally and the issues highlighted in the CHI report. Those issues are of great concern to people in the area who need to use health care services in Coventry. Obviously, I appreciate how strongly hon. Members in that area feel, and over time they have raised those issues in Parliament and with Ministers. All the hon. Members who have spoken have made clear their support for both the excellent work being done by many of the clinical staff at the trust, and the care that is very often provided for patients. As we discuss the concerns that have been raised, it is important to acknowledge that.
The Commission for Health Improvement's rolling programme of clinical governance reviews began in 2000, and it examined the University Hospitals Coventry and Warwickshire NHS trust in February 2001. During the review, CHI examined the clinical governance structure within the trust, taking the views of patients, staff and local partner organisations. As hon. Members have mentioned, the report, which highlighted five areas requiring immediate attention, was published last September. The areas requiring attention were the practice of placing additional beds in bays not designed for that purpose; the need for a review and analysis of mortality rates for non-emergency admissions; the organisation of care between the two accident and emergency departments and the emergency assessment unit; the relationships between some consultant medical staff and senior managers when concerns about clinical risk were raised; and the need to address current service problems.
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Hon. Members will be aware that as a result of the CHI report the trust was awarded a zero star rating in the NHS performance ratings in September 2001. Accordingly, the trust's chief executive was given three months' notice to achieve satisfactory performance improvements in those five areas. It is worth pointing out that that is the first time we have had a proper procedure that flags up such problems and provides both an independent external assessment and a proper process for developing action plans. Where such problems are not likely to be dealt with, they can be turned round by new procedures for bringing in alternative management and arrangements. Those sorts of procedures are now available in the NHS for the first time. They are extremely important, and have been critical in handling the issues at Walsgrave hospital.
The trust's work in developing its action plan was extensive. Its staff have worked hard, not only in the areas identified by CHI, and on 22 and 23 January this year CHI assessed progress against the five major areas of concern. My hon. Friend the Member for Coventry, South asked whether there was a delay in the implementation of the report. I understand that the report was always intended to be issued about eight weeks after the visit, so it was always expected in March.
CHI observed that some progress had been made, especially on problems such as a fifth bed in four-bedded bays. Satisfactory progress has been made in analysing mortality rates and identifying a programme of developments, although, as my hon. Friend the Member for North Warwickshire (Mr. O'Brien) said, more work needs to be done. Some progress has been made to accident and emergency services, limited progress has been made in addressing poor relationships between medical staff and managers. and satisfactory progress has been made on current service developments.
In summary, the trust has made satisfactory progress in three of the five areas, but limited progress in two areas. The commission noted some improvements but, as hon. Members have made clear, it continued to raise concern about the working relationships between some doctors and managers of the trust, and in some teams. As a result, it was decided to franchise the management of the University Hospitals Coventry and Warwickshire NHS trust. An advertisement will be placed next week to seek a high calibre chief executive to take the agenda forward, with the continued support and direction of the chairman.
My hon. Friend the Member for North Warwickshire asked why we are using franchising instead of reappointment. The process of franchising is only for trusts that are zero rated, to signal the need for broad and substantial change to solve their problems. It builds change into the process of appointment, with the development of action plans to turn the trust round, and franchise plans on how the key issues will be addressed by an incoming chief executive. Trusts can appoint experienced NHS leaders who have already been appointed elsewhere in the service. There are various differences, and I shall be happy to write to my hon. Friend about the significance of franchising.
Several hon. members have spoken about the suspended consultants. They will be aware that it is difficult for me to comment in detail on individual cases. My hon. Friend the Member for Coventry, North-West (Mr. Robinson) referred to Miss Ackroyd, whose case is

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awaiting the outcome of an inquiry by the General Medical Council. Other hon. Members referred to the recent case of Mr. Mattu, which is being examined internally by the trust. It is important to say that the suspension of an employee is a neutral act and does not prejudge the outcome of a case. All the cases are subject to detailed procedures under health service guidance issued in 1990, and employment law. I share the concern that the procedures take too long. It is not acceptable for cases to drag on, often at great cost to employer, employee and the health service.
Mr. Geoffrey Robinson rose—
Yvette Cooper: I am tight for time, so I shall not take interventions.
We are introducing improvements to speed up cases, including the establishment of the National Clinical Assessment Authority, and an extensive review, involving medical and professional organisations, to try to speed up the processes and improve the care of patients.
Hon. Members have also expressed concern about whistleblowing. All trusts are required to introduce procedures so that staff at all levels can raise matters of concern without fear of retribution. It is critical that they should be able to do so through existing line management. If necessary, however, they should be able to bypass management arrangements. It is also important that people should be able to talk to their Members of Parliament. As so many hon. Members have raised that matter, I shall examine it further in the local area.
I shall also examine the tragic case of Mr. Clifford, which my hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt) raised. Obviously, it will be little consolation to the family to have the matter investigated now, but I am keen to look into it further and get back to my hon. Friend.
Hon. Members have also raised a series of further questions to which, unfortunately, I have not had time to respond. I hope that I shall be able to reply to them later, and I undertake to write to all hon. Members about the additional points that they have made. I understand the concerns that have been expressed, and, like other hon. Members, I strongly want improvements to be made in their local trust. We now have in place a system to deliver those improvements, and to flag up problems when they arise. That is right. As hon. Members have said, we can now move forward, improve care and look to a new future for the local community.

Age Discrimination
11 am
Hywel Williams: I am grateful for this opportunity to debate age discrimination. This is a timely debate, particularly given that the Government are consulting on the equal treatment directive. That consultation will conclude at the end of this month.
Last Saturday, at Plaid Cymru's spring conference, I chaired a meeting with Age Concern Cymru at which the latest version of the pensioners' manifesto for Wales was launched. Hon. Members will not be surprised to know that the fourth of 12 points in the manifesto is a call for legislation to make discrimination on the grounds of age illegal. That is a live and important issue for older people, as it should be for us all as we face the prospect of growing older—some more than others. I was proud to associate my party and myself with that call for an end to age discrimination, particularly given the salience of the issue in Wales, where a large proportion of the population is over retirement age, and in some areas the figure is extremely high.
I am gratified that hon. Members from other parties who have a long-standing interest in this matter hope to speak in the debate. I supported the Age Equality Commission Bill, which was introduced by the hon. Member for Falmouth and Camborne (Ms Atherton). I am glad to pay tribute to her hard work on the issue, and, like others, I was disappointed when the Bill was withdrawn.
Yesterday, I was glad to associate my party and myself with a ten-minute Bill on age discrimination, which the hon. Member for Sutton and Cheam (Mr. Burstow) introduced. Both he and the hon. Member for Falmouth and Camborne are present, and I trust that they will elaborate further on their arguments with their usual eloquence, should they be fortunate enough to catch your eye, Mr. O'Brien.
As someone in the middle years of life, I am beginning to understand the Welsh adage: yr hen a wyr, yr ifainc a dybia—the young suppose, the old know. What is it that the old know? They know that age discrimination is an all-too-real aspect of their everyday lives. An ICM poll for Age Concern found that nearly one person in three knows someone who has been the victim of age discrimination at work. Seventy per cent. of the population believe that ageism still occurs, and the public overwhelmingly believe that it should be illegal to discriminate against someone on the grounds of their age.
I know that other hon. Members will discuss other aspects of age discrimination, but I shall make some general comments before moving on to employment issues.
In preparing for the debate, I asked a few constituents for examples of age discrimination. They readily responded, and just a few examples will suffice. As regards health, a patient was told that she was too old to have cervical screening, even though she had specifically requested it. Someone who was recovering from a heart attack said that she was not given access to the rehabilitation services, including dietary advice, that a younger person would have received. She was told off the record that resources were rationed by age, and that was her perception.

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As regards the provision of care, it is too easily assumed that residential care is the appropriate response to the needs of the older person. From my experience in social work and in social work education and training, I know full well that there is a strong move towards care in the community for older people. I am also aware that young people might be maintained in the community as a common-sense strategy, while older people might be admitted to residential care as a matter of common sense. I also have family experience of the value of the independent living fund's support in maintaining younger people with a disability in the home—with the valuable help of the social services and of the voluntary organisations. Would that that support were available to the same degree for older people for whom, too often, the assumption is that residential care is the proper option. We need to shift from this common sense of what is appropriate care to assessing individuals and their needs.
In many areas of Wales, health and care services are not available through the medium of Welsh. That is significant, given the greater proportion of older people making use of such services. For example, the Stroke Association points to the effect of a stroke on language ability; people might lose their ability in their second language. Services in the medium of Welsh might not be available in southern and eastern urban areas, even though the person has no choice but to use his or her first language. That counts as indirect discrimination.
I have a further short example. Last week, I met someone who had applied for motor insurance. She faced a 400 per cent. increase in the cost of her premium. The reason that she was given for the jump was her age—she is over 75. She is a very active person and a student in higher education—so much for assumptions about the capacity of older people—and I understand that she is also a very good driver.
Turning to employment issues, older employees are valued by far-sighted and clear-thinking employers for their commitment. their experience and their skills with people.
Mr. Elfyn Llwyd: When I was a youngster, I was an articled clerk to a person of retirement age. He taught me everything that I know about being a lawyer.
Hywel Williams: I thank my hon. Friend for that point. I have met his former colleague, who is as spry as he ever was, and now in his 90s, I understand. Older employees are valued by their employers for their commitment, skills and experience. It is well known that B&Q employs older people—the effect of that policy has been to reduce its staff turnover by 60 per cent. and absenteeism by 39 per cent., so continuing the employment of older workers can be good for employers. However, employers often assume that age implies the existence of other characteristics—it is a proxy for poor health and the lack of flexibility in the workplace, or a lower capacity for work. Those assumptions are not based on the individual's health or work record, nor even on the record of older workers as a group, but they are influential assumptions.
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I hope that the House will forgive me for introducing this thought about assumptions. It has stuck with me since a friend inflicted it upon me and I cannot shake it off. To assume something is to be in danger of making an "ass" out of "u" and "me". The message is that we should assume nothing. People should not be treated as asses; certainly the law should not be one.
The age discrimination that is faced by many workers often leads them to feel that their right to work is less certain than that of other employees. Their commitment might be sapped, their experience disregarded and their skills with people undervalued—those are real problems for older workers. However, the Employers Forum on Age reports that 55 per cent. of managers admit to using age as a criterion for recruitment, and a third have not heard of the voluntary 1999 code of practice on age diversity in employment.
During a debate on the Employment Bill, I raised a point about the unfair dismissal of people aged over 65. Many people find retirement to be a time of freedom and opportunity. Their right to choose to retire should be protected. Others, however, want to work into later life. That is an entirely laudable desire; they want to maintain their networks of colleagues and friends and they want, and need, to maintain their incomes by earning money for work done. That, too, is laudable. An increase in the percentage—8 per cent., according to the labour force survey in spring 2001—of people over 65 continuing to work, perhaps part-time, makes a lot of plain common sense. It can be good for employers and employees. Is it therefore reasonable to maintain a mandatory retirement age. and is it not unacceptable to remark on the financial burden that older people allegedly present while insisting on a mandatory retirement age? Older people should have a proper choice to continue working if they want to.
Mr. Simon Thomas: Is it not ironic that this House, which legislates on matters such as a mandatory retirement age. benefits most from the contribution of people who have passed that age?
Hywel Williams: I thank my hon. Friend for that interesting point. I have been impressed, as I mentioned earlier, by the clarity and incisiveness of the contributions of people who might in other situations be regarded as beyond working age—or perhaps even as being on the scrap heap.
A significant aspect of age discrimination is the age limit of 65 on protection from unfair dismissal. I tabled a new clause to the Employment Bill on Report with the aim of removing the age limit. That would have ensured that an older person would be able to claim for unfair dismissal, just like any other employee. It would have brought that right into line with a great many other employment rights, which are not subject to an upper age limit, such as the right to paid leave and the right to a minimum wage. The right would be consistent with the right to claim unfair dismissal for specified reasons that are automatically regarded as unfair, such as trade union membership.
It was a disappointment, therefore, that there was only the briefest opportunity to discuss the new clause. The hon. Member for Runnymede and

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Weybridge (Mr. Hammond) said on Report that he had much sympathy with the aim of the new clause, and that he looked forward to
"a constructive discussion on how to protect the rights of older workers … when the consultation in which the Government are engaged is discussed".—[Official Report, 12 February 2002; Vol. 389, c. 159.]
I look forward to the hon. Gentleman's remarks this morning.
As we know, the Government confront an equal treatment directive. The short guide to their proposals puts matters succinctly, stating that
"it is wrong for people to be singled out for different treatment, merely because of personal characteristics."
As far as I can see, the age limit on protection from unfair dismissal singles people out on the basis of their personal characteristics—their age. However, I understand that the Government are not asking a direct question in the consultation about employment rights for people over 65. I accept that another broad question—question 15.20—might elicit views on that issue; but only indirectly.
I note that the equal treatment directive allows the Government to justify some differences in treatment on the ground of age, such as when there is a genuine occupational requirement. Different treatment can be justified on the basis of employment policy, and relevant differences in treatment may include dismissal conditions. However, I cannot see why the attainment of the age of 65 should be the point at which people automatically lose the employment right of protection from unfair dismissal.
Ms Candy Atherton: The hon. Gentleman will be aware that one of the problems that employers and employees face is that of obtaining insurance at the age of 65. That applies in volunteering as well. Will he comment on that?
Hywel Williams: That is a salient problem. I referred earlier to difficulties in that respect in obtaining motor insurance. Clearly, the availability of insurance would facilitate the employment of people over 65.
The bad effects of age discrimination may deprive employers of some of their most valuable employees, at a time when they are most needed. I referred earlier to B&Q's experience of the value of older workers. Losing older employees because of age discrimination can therefore be bad for employers and, in turn, the economy in general, because of lost production, extra benefits paid and lost taxes. The performance and innovation unit report "Winning the Generation Game" estimated that the cost of lower economic activity among the over-50s was £16 billion in lost GDP and between £3 billion and £5 billion in lost taxes.
Discrimination may also undermine older employees' ability to choose to continue working, because their position seems less certain and valued than that of younger employees.
Mr. Philip Hammond: I accept entirely that the main thrust of the hon. Gentleman's argument relates to older workers, but would he acknowledge that age discrimination operates at the other end of the age spectrum?
Hywel Williams: Certainly, and Plaid Cymru has taken a petition on such matters as the minimum wage for younger workers.
Age discrimination also affects people over 50. The Government have said that they intend to introduce new legislation to prohibit discrimination in work on the grounds of age, but they want to take the fullest period available for consultation on the age strand of the equal treatment directive, up to December 2006. It has been pointed out in earlier debates on an age equality commission that the Government have had commitments to end age discrimination for at least six years, since 1996, which is the year before they were elected. Many older people have the potential of years of work before them. They should not have to wait until 2006 for protection from age discrimination and unfair dismissal.
We are given to understand that the Government's preference is for a single equality commission. Other hon. Members will no doubt speak on that matter, but I shall pose a few questions before finishing. Will such a commission address a broad range of discrimination issues, or will it concentrate on employment questions? Clearly, it should consider discrimination broadly. The establishment of such a commission may be some way off, so what will happen in the interim for the rights of older people? Will the commission be established through primary or secondary legislation? Will we have to wait for a body of case law to be developed?
Will the Minister note my general concern about the danger that issues of age discrimination, so long unregarded, will not have a sufficiently high profile when struggling for attention with other important aspects of discrimination? There should not be a competition between the different "isms"—between issues of discrimination on the grounds of ageism, racism, sexism or disability. Alas, that competition sometimes seems to exist.
In conclusion, by 2006 I shall be in my early 50s and we shall have had another general election. I have every faith in the support of the good people of Caernarfon, but I admit to having a personal interest in the matter.
A debate on age discrimination should cover aspects of discrimination addressed by other equality legislation on employment, access to goods and services, buying and renting property, and so on. No doubt, other hon. Members will address some of those issues. I look forward to the Minister's response.
11.17 am
Ms Candy Atherton: I congratulate the hon. Member for Caernarfon (Hywel Williams) on securing the debate. Age discrimination is fast becoming a major issue of political activity and debate. Yesterday we had a ten-minute Bill on age discrimination and I attended a conference on older people in the media, at which my hon. Friend the Minister was the keynote speaker. Recently, we debated my private Member's Bill and Help the Aged launched its On the Scrapheap campaign, which helped to raise the profile of the issue still further. All that is good news for tackling age discrimination across society. In addition, the Government have adopted article 13 of the equal treatment directive and are consulting on how to implement it.

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The hon. Member for Caernarfon referred to the problems faced in the world of work. I could wish that the wholescale discrimination that people faced was to be found only in the workplace. Sadly, the workplace is just the tip of the iceberg, and the iceberg is rather large.
I am a member of Equal Rights on Age, which comprises national organisations such as Age Concern, Help the Aged, the Association of Retired and Persons over 50, the National Pensioners Convention and a handful of hon. Members, such as myself. We have come to some conclusions on how we believe the Government might tackle age discrimination and, as we reach the end of the first round of consultation on age, it seems appropriate to explain our point of view.
We all know the statistics that show that age is becoming the social issue of our time. We are being urged daily to consider working longer, even into our seventies, in order to provide financial security for the future; yet, at 47, I am deemed to be an older worker, as are most hon. Members. The House is one of the few places where a 40-something, as I am, can still find herself referred to as a young thing—one of the great ironies of life. Older people are more likely to watch television, an argument voiced at the Independent Television Commission and Help the Aged conference yesterday, yet older people rarely appear on television and then only in caricatures such as Victor Meldrew, or in parts such as Prunella Scales' role as a somewhat daffy older shopper in Tesco's advertisements. Older people do not appear in the main stream, and they know it.
It is clear that the Government need to set the agenda, and that it must be secured by primary legislation. Regulation provides no legal statutory power, and it has been shown that voluntary codes of conduct are ineffective. Indeed, age equality should be treated in the same manner as sex, race and disability. It will not be enough for legislation to cover only employment. It must cover access to goods, facilities and services, and the management, buying or renting of land or property. The ERA group, not unnaturally, believes that people should not be treated less well than others purely because of their age. The Government and public bodies should, of course, take the lead with positive images.
If age is to be treated equally, there should be an enforcement body, which should work to eliminate age discrimination, promote equality of opportunity, encourage good practice and advise the Government on age discrimination. The Government could even adopt a template from those commissions that deal with race, gender and disability. The commission could help people who have been discriminated against, such as the vet in Cornwall whom I have mentioned before, to secure their rights. The House might be amused to learn that my vet, Noel Stewart, has now leapt to fame. From being excluded as a vet working on foot and mouth, he has been nominated as the sexiest man of the year by Radio Cornwall, which shows how life can move on.
A commission could provide information and advice to individuals, employers and service providers, prepare new statutory codes of practice and offer practical guidance. It could provide a conciliation service, investigate the many cases of discrimination, monitor
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the law and initiate judicial action where necessary. All the organisations campaigning for older people's rights believe that those issues could be secured through an age equality commission—and, to coin a phrase, we want it now. Age equality requires that a commission should be created as soon as possible. In the minds of employers and among society generally, a recognition of ageism lags behind that of other forms of discrimination. In order to catch up, it is vital that the Government create a commission to focus on age. Later, the commissions could be melded together, with the different strands of discrimination all being represented in one body.
At the moment, legislation to tackle age discrimination is the great omission. That makes remedial work all the more urgent. Age discrimination must be treated in the same way as the other areas of discrimination. It would be wrong for the message to go out that the Government somehow feel that it is okay for ageism to be treated differently from other forms of discrimination. Older people need to be a visible part of the commission, and it should be sufficiently resourced to serve the millions of older people in this country. It would be wrong on all counts for age to be linked to disability, as has been suggested for the structure of discrimination commissions in future.
The Government should legislate to give employees flexibility on when they retire. By adopting that position, they might show enlightened self-interest. One in four older people say that they have been affected by age discrimination in the workplace, so if we presume that we all have two sets of grandparents, every family in the land has been affected. I urge the Minister to think how warmly those people might take to a Government who effectively and efficiently introduced comprehensive legislation on age discrimination, and who recognised that age discrimination in the workplace cannot be tackled if people cannot get insurance to enable them to work. The Government have tackled pensioner poverty, for which I applaud them, and they could tackle all aspects of age discrimination. Older people are more likely to vote, hence the enlightened self-interest.
The Government could recognise that older people are sometimes the only people who can deliver what is required. For example, 87-year-old Dr. James Van Allen is apparently the only person in the world who can analyse data sent from Pioneer 10 in deepest space to the National Aeronautics and Space Administration in the United States. Let us celebrate the contribution that older people make and want to make. Let us enable them to participate by removing the barriers in services. Let us end discrimination that means that the older people are, the more they are seen and treated as second-class citizens.
11.26 am
John Barrett: I congratulate the hon. Member for Caernarfon (Hywel Williams) on his interesting remarks, and my hon. Friend the Member for Falmouth and Camborne (Ms Atherton) on hers. Like me, she is 40-something and feels relatively youthful in this place. I am not sure who first replied, when asked what they felt about getting older, "Not bad considering the alternatives."

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Like many other people, I have noticed that newspapers tend to give numbers after people's names. At the conference organised by Help the Aged, Kate Adie, 56, talked about the marginalisation of older viewers of television. Reference has been made to the fact that, when considering equality, we should take care to think about age separately from gender, race and disability. The work of the equality commission must not be a battle between those who consider such issues. When legislation is being drafted, we must ensure that those who feel that race, gender or disability has caused a problem for groups in society understand that various problems in relation to age must also be tackled.
Mr. Hammond: The hon. Gentleman referred to the apparent obsession of newspapers with people's ages. Does he suggest that they should not publish the age of the people to whom they refer? When they do not, I confess that I ask myself how old the person is. Whether someone is 18 or 68 makes a difference to how I read an article.
John Barrett: I have no objection to newspapers including an individual's age, but it tends to slant the news coverage if a newspaper names someone and then mentions his religion immediately afterwards. It may be of general interest to know the age of the person speaking, but what if newspapers then mentioned that he was disabled? I would not urge newspapers to stop the practice, or try to legislate against it. I was pointing out why they used it in the first place.
As the hon. Gentleman said, age discrimination is an issue for younger members of society as well as its older members. I want to raise two issues; voting rights and the national minimum wage. On 5 March, voting age was debated in Westminster Hall, so I shall not dwell on that subject for too long, but I should remind hon. Members that we are happy to collect tax from people at 16. I am the parent of a teenage daughter, and when she was 16 she reminded me that she was old enough to get married in Edinburgh. Although she was prepared to help in the campaign, she was not old enough to vote. At a time when our forces are being deployed abroad, we should remember that young people can join the armed forces and the Government can make important decisions about where those forces are deployed, but some members of the armed forces are too young to vote for the Government who will make decisions about where they should go and what they should do.
As the hon. Member for Falmouth and Camborne has already said, older people are more likely to vote. It is interesting to note that as many as 47 per cent. of 16 to 17-year-olds felt that voting was important and could have considerable influence, but that the figure for 17 to 20-year-olds dropped by 12 per cent. So as young people go into their 20s, they seem to think, for whatever reason, that it is less important to vote. They may change their minds later through self-interest, but the Liberal Democrats believe that if we are to encourage people to take an active interest in politics, the voting age should be 16.
The hon. Member for Caernarfon mentioned employment legislation, and there are real problems in relation to unfair dismissal, but I want to talk about the
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national minimum wage. The British Youth Council has been campaigning to end discrimination against young workers. It has said:
"Workers should be paid equally for work of equal value. Any lower rate to the National Minimum Wage should be assessed by training, not age. The most vulnerable 16 and 17 year olds in society have no safeguards against poverty if they have no wage protection rights or have no entitlement to benefits."
It goes on to say:
"The Secretary of State for Trade and Industry ends the current age discrimination in the National Minimum Wage…all workers from 16 years of age should be entitled to the same minimum wage rights as adult workers."
Other campaigners on that issue include the GMB.
If, when legislation is framed, the House can appreciate that age discrimination takes place at the younger as well as the older end of the spectrum, that will be a step forward.
11.32 am
Mr. Paul Burstow: I am grateful to the hon. Member for Caernarfon (Hywel Williams) for his initiative in securing an Adjournment debate on this subject. It is timely, not least because of the ten-minute Bill that I introduced yesterday. As I said then, about 15 pieces of private Member's legislation have been before the House during the past 5 years, attempting to nudge the issue forward, roll this large rock up the hill and persuade the Government that age discrimination requires more than just a voluntary approach; it requires a statutory approach. Perhaps as a result of the European Union directive on equal treatment in employment, there will now be some progress and legislation will be introduced by 2006. However, in common with others who have spoken today, I take the view that we need more comprehensive legislation that also addresses issues relating to the provision of goods and services.
The hon. Member for Falmouth and Camborne (Ms Atherton) was absolutely right when she said that we should celebrate the fact that people are living for longer. However, it is not always the case that extra life is added to those extra years, in terms of the quality of their experience, and that is a problem, but all too often, the language that we use to debate old age is ageist in its assumptions. We use phrases such as "the demographic time bomb" and "bed blockers", which suggest that age is some sort of problem, rather than an opportunity not just for the individuals, but for the wider community. That is why we need to look not just at the employment questions that the hon. Member for Caernarfon rightly tackled, but at the broader picture that he also touched upon. We need to address ageist assumptions, attitudes and practices. A comprehensive age equality Bill has a part to play in dealing with that.
There is a lot of research evidence, both domestic and international, about the extent of discrimination in the labour market. Far less research is available into the causes and extent of ageist assumptions and practices and the wider agenda of public policy and private practice. At the beginning of the month, Help the Aged published a useful and timely report on age discrimination across public policy. I make no apologies for the fact that I shall probably refer to much of its evidence. Help the Aged drew together the existing

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evidence. It looked at the problem and identified a series of age barriers. We often talk about age barriers in terms of access to health and social care, but they are much more widespread than that. In many cases they are being used as explicit devices to ration access to services and public resources. In other cases, they are implicit, but just the same they are used to ration resources.
There is a much bigger challenge than the direct discrimination issues. There is the challenge of how we address indirect discrimination, such as institutional ageism. Many organisations unconsciously discriminate on the basis of age. We need to think carefully about how we address that. Many organisations fail to include older people in the development of policy and the implementation of services. In terms of health, for example, old age is equated with illness and disability. That is wrong. The majority of us will probably not need any form of long-term care. We will pass on never having had to come into contact with social care or the health care services in our later lives. There is also direct discrimination. There are age limits on screening programmes such as for breast cancer. Older people are excluded from clinical trials and have to wait longer in accident and emergency departments.
There is age discrimination in social care too. As the hon. Member for Caernarfon rightly said, assumptions are made about where it is appropriate for an older person to be cared for. We cannot generalise about the care needs of older people. People take a journey through their lives, and part of that journey may entail them being cared for in their own homes. At some point they may need to be cared for in residential care. There are discriminatory elements there too. The maximum fee levels for care homes for older people are lower than the fees that are paid for younger people in care homes. Why? That needs to be looked at critically. Why does it take someone like Rose Cottle to come to Downing street to raise those concerns about underfunding of the care home sector? The practice of limiting expenditure for home care to equate to the cost of residential care is also widespread. Placing that cap denies that person the opportunity to live as independently as they can in their own home.
The same applies in the benefits system. Older people have longer waits for the disability fund. Only 10 per cent. of older people get money from the social fund, despite being poorer, often for longer, than younger people. The mobility component of disability benefits is another serious concern. In the 1970s, for example, people under 65 who qualified for the disability component for mobility, continued to receive it once they reached that age. Someone who becomes disabled after the age of 65 is no longer eligible for the mobility component, as if it is entirely appropriate for them to be stuck indoors, unable to get out. Such forms of discrimination in public policy show that we have a widespread problem of ageist assumptions and practice that need to be addressed.
I have four questions for the Minister with regard to how we can move the agenda forward, and they are not all about legislation. First, what is being done to tackle ageism in public policy? What steps have been taken across Government to audit public policy to get to the roots of where ageism exists? Through its national
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service framework, the Department of Health is at least beginning to do that and may provide a template that other Departments need to follow. Is the national service framework being followed up, and if so what lessons are being learned to ensure that staff are equipped with the tools to enable them to identify and tackle ageist assumptions and practices?
Secondly, we need a change in the law because, as the hon. Member for Caernarfon identified, the voluntary terms of practice for employment have not worked. Most employers do not know that they exist and those who do are confused about what they are for. As the hon. Member for Falmouth and Camborne and my hon. Friend the Member for Edinburgh, West (John Barrett) rightly said, however, we must go further than employment and have a comprehensive Act that deals with employment and goods and services, and places a general duty on all public bodies comprehensively to tackle age inequality and actively to promote age equality.
Thirdly, we need a mechanism to educate, inform, learn and enforce. An age equality commission is vital and I hope that the Minister will say something about that. We must avoid a situation in which age discrimination always ends up as the poor relation of all the other forms of discrimination. Can further thought be given to the time scales so that such a commission can be running, even if only in shadow form, before other changes take place? A body of skill, knowledge and experience could therefore be built up so that if and when we had a single commission, it would not be overshadowed by others that had been in place for much longer.
Fourthly, we must strengthen the evidence base. We need a series of data, the better to understand what is happening. We do not know the number of people in the work force who are past retirement age, nor do we know the differences in the experience of men and women past retirement age in respect of transport and health care. We do not have information about the interrelationship between age and ethnicity. It would be helpful if the Minister could say what research is in hand across Government to strengthen the evidence base so that there is more evidence to inform policy development.
Yesterday, I introduced a ten-minute Bill on age discrimination. The Press Association produced some copy about how it went and felt the need to describe me as "Paul Burstow (39)". My hon. Friend the Member for Edinburgh, West referred to that. It felt that it had to give my age, which is unnecessary and constitutes stereotyping. What on earth does a reader gain by knowing my age because I have an interest in ageism issues? It adds nothing to the piece and merely stereotypes still further.
We should be moving these issues from the margin to the main stream. I hope that the Minister will respond to my questions, because ageism is clearly a serious issue and a serious challenge for us all. It costs our economy £31 billion and it is time that we all said not only that we will no longer tolerate ageism, but that we will tackle it through legislation and concerted action across Government.
11.43 am
Mr. Philip Hammond: I, too, congratulate the hon. Member for Caernarfon (Hywel Williams) on obtaining the debate. I am

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genuinely delighted that he was successful, because he drew the short straw twice in the Standing Committee that considered the Employment Bill and on Report, when he tried to raise this important issue, but fell foul of the timetabling procedures. I am glad that he has had an opportunity to elaborate on the points that he was forced to make in 90 seconds on Report. I hope to have the chance to respond more fully than I was able to then, when I had the last 15 seconds before the guillotine fell.
I am glad that the hon. Member for Sutton and Cheam (Mr. Burstow) has clarified his status in the great age debate as someone rapidly approaching the 40 watershed. [Interruption.] The hon. Member for Falmouth and Camborne (Ms Atherton) referred to being one of the 40-somethings taking part in the debate, and the hon. Gentleman is shortly to join us.
Ms Atherton: I never referred to 40 as a watershed; I merely said what age I was. The problem with stereotypes—saying that a person is 40-something, or 30, and that it is a watershed—is that they perpetuate ageism.
Mr. Hammond: If we are to have a serious debate on the subject we must avoid political correctness for its own sake. People are interested in a person's age; it is a relevant piece of information. As I said earlier, when I read a newspaper report of a trial or criminal proceedings, knowing the age of the person involved helps me to form a mental picture of them. I want to know lots of things about them.
It is perfectly possible to address the issue of unjustified discrimination without going to the extreme of suggesting that it is always wrong, or always unjustified discrimination, to want, out of curiosity, to know a person's age. It tells me something about the person and I am not ashamed to admit that.
Mr. Burstow: Is there any other information that the hon. Gentleman would expect to have—for example, whether a person has a disability, and, if so, what it is? What does it tell him to know a person's age? What are the lessons to be learned from knowing a number?
Mr. Hammond: It depends on the circumstances. We have all sorts of information about a person if we are watching them on television because we can see them. When we read something in a newspaper we have to imagine what the person looks like and knowing how old they are helps us to build up an image of them. It is human nature to want to have that information. I shall say something about education versus legislation later.
If we set out fundamentally to change human nature it is likely to be a long haul. I hope that we do not attempt to do so as I have sensed a large degree of consensus in the debate about what needs to be done, which is relatively unusual in this place. We should exploit the benefits of that consensus and see what we can do with it, rather than trying to drive wedges between us by citing extreme examples.
It is a great pleasure to see the Minister in the Chamber; I am glad that the national minimum wage was mentioned because whenever I see the hon. Lady that subject inevitably comes into my mind. However many times I debate with her, I doubt that we shall have
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the pleasure of spending as many hours together as we and the hon. Member for Falmouth and Camborne did on the Standing Committee on the National Minimum Wage Bill. The debate, introduced by the hon. Member for Caernarfon, has focused on employment issues, which the hon. Gentleman raised in debates on the Employment Bill.
I was particularly pleased that the need for a flexible approach to health and social care for older people was raised. The hon. Member for Sutton and Cheam and I have discussed those important issues on many occasions. The hon. Gentleman was right to say that ageist assumptions lurk throughout the structure of society. In the late 1940s and 1950s, the age of 65 was a sort of magical marker which became institutionalised and it will take a great effort to shift it. Since then, especially in the last 20 years, the transformation in people's life expectancy and in their expectancy of a fit and active older age has made the watershed of 65 increasingly irrelevant and absurd. That is the underlying premise of the hon. Gentleman's remarks.
This debate takes place in the context of the European Union equal treatment directive and the obligation on the United Kingdom to legislate by 2006. The hon. Member for Falmouth and Camborne mentioned the distinction between primary and secondary legislation. Although 2006 is still a long time away, will the Minister confirm that there will be primary legislation to implement the directive?
The Government's preference so far has been for voluntary codes to try to achieve progress, despite the clear position set out by the right hon. Member for Makerfield (Mr. McCartney). As Opposition spokesman in 1996, he said categorically that an incoming Labour Government would introduce comprehensive legislation to outlaw age discrimination. The Labour party in opposition said many things that have not translated clearly and unambiguously into Government programmes, and that is certainly one example.
The Conservative party's position is clearly in favour of flexibility. I can tell the hon. Member for Caernarfon now, as I would have told him on Report had I had enough time, that the official Opposition will be supportive—
John Barrett: On the question of flexibility, should not the hon. Gentleman point out that the Conservative party's policy in Scotland, which is for long-term care for the elderly, is the exact opposite of that in England?
Mr. Hammond: I am certain that we do not have a policy in England against long-term care for the elderly. The approach of the Westminster Government is different from that of the devolved Government in Scotland with regard to the provision of so-called free long-term care for the elderly. Indeed, we have questioned the definition of free nursing care—as the Government desire to call it—on many occasions, but I suspect that we stray from the main theme of today's debate.
I should like to place on the record that we will support carefully thought out proposals to abolish blanket mandatory retirement limits in employment, so that people's individual circumstances can be properly taken into account. We believe in flexibility. It fits

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clearly with our core principles of flexibility in labour markets, the supremacy of the individual and a rejection of blanket, one-size-fits-all solutions.
The Government have also talked about flexibility in relation to retirement. They mention a flexible decade of retirement, but it is not clear what that entails. Perhaps the Minister will clarify the situation. Is the flexible decade from 65 to 75 or 60 to 70? Will she elaborate how the mechanics will operate in practice?
I am glad that the hon. Member for Falmouth and Camborne had an opportunity to speak this morning. The Opposition were anxious to see her Bill taken in Committee, because we could have had a genuine exploration of some of the issues needing further debate. Unfortunately, it was not to be.
There has been a good deal of consensus in the debate so far. However, legislation is always a blunt instrument. I realise that the EU directive requires legislation, so we will have it, but it does not automatically change people's attitudes. I urge the Minister to consider the educative process alongside the legislative process. The Government must be proactive in educating employers about the advantages of employing older workers and the disadvantages of an arbitrary, mandatory retirement age.
Mr. Burstow: Does the hon. Gentleman agree that, although legislation might not change attitudes, it provides a mechanism for challenging them? Does he also agree that we must ensure that the legislation that is on the statute book is sufficiently comprehensive to address not only employment, but the goods and services issues?
Mr. Hammond: The hon. Gentleman makes a good point. Legislation changes people's superficial attitudes. With regard to that, I offer the example of race discrimination legislation. It is relatively easy to put in place legislation that carts people off to court for overt racist behaviour, but it is much more difficult to change people's fundamental attitudes. That requires an education process—not merely the heavy hand of legislation.
I do not disagree that both approaches are needed, but I hope that the focus on legislation—and the European Union requirement for legislation—does not lead us to lose sight of the need for a parallel process of education because, particularly with regard to employers and employees in the workplace, there is a genuine win-win possibility here. To some extent, people are not exploiting that because they are not aware of it—they have not had the opportunity to understand the full possibilities that are available to them.
Ms Atherton: I am listening with great care to what the hon. Gentleman is saying. Does he agree that a commission would be able to spearhead the educative part of the process of tackling age discrimination?
Mr. Hammond: That is a responsibility of Government, and a commission is one way of achieving it. When the Minister replies, I would be interested to
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hear about what the Government are doing, not with regard merely to relying on future legislation, but to setting in train a process of preparing public opinion—of changing attitudes and educating people.
I return to the point that I was making. There is a job to be done in educating employers about the advantages of employing older workers. It is also important to overcome some of the stereotyping, to which several hon. Members have referred. There is also a job to be done in educating employees, by persuading them of the need continually to upskill, so that they do not inadvertently reinforce the prejudice that older workers are likely to have less relevant skills. It is clear that, as people become older, they must upskill and retrain themselves, to ensure that they have the relevant skills that are needed in the workplace throughout their working lives.
Fiscal incentives are always a good way for Government to persuade people. I notice that the Minister is smiling, and I remember that she was a Treasury Minister in the previous Administration. Nothing is as effective as a fiscal incentive in changing people's behaviour, as I am sure that she is aware. Fiscal incentives will be an important tool in ensuring extended participation in the work force, with a staged departure from it at a time that is appropriate to the individual's needs—rather than at a time that is imposed by an arbitrary limit.
I also urge the Government to lead by example. The Government are a large and, I suggest, a relatively rigid employer throughout the nation. When the Minister replies, will she describe how the Government are leading by example in addressing the question of fixed retirement limits in the public sector and other matters that have been mentioned in previous debates? As the Government are a large employer, they can lead by example on the issue, as is the case with regard to all employment-related matters. The probing of Ministers during the Standing Committee that dealt with the Employment Bill made it clear that although the Government were willing, in several areas, to lecture employers about the benefits to themselves of adopting more flexible and family-friendly employment practices, they did not always take the lesson of that lecture to heart by practising what they preached in their role as an employer.
The core of the point that the hon. Member for Caernarfon wanted to raise during consideration of the Employment Bill and today is compulsory retirement. I should be grateful if the Minister would clarify whether her interpretation of the European Union directive is that the Government would be required to outlaw blanket arbitrary and compulsory retirement at a certain age. May we address the practical concerns that would follow from that?
I hope and assume that all hon. Members agree that if people need to retire because they are no longer able to perform their role in the work force effectively, there must be a mechanism to achieve that. I argue—I am sure that all hon. Members in the Chamber agree—that a blanket age limit is a crude and ineffective way in which to achieve that. If we say that a person should not be required to retire at a certain age and we should instead examine their capability to do a job, is the Minister confident that we would not fall foul of another anti-discrimination provision? For example, if fitness and

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capability to do a job were the criteria rather than age, could we fall foul of anti-disability discrimination legislation? It is important that we look across the piece at the different anti-discriminatory provisions that are in place and ensure that there will be an effective way for employers to address people who no longer have the ability to perform the function that they have performed in the work force.
Mr. Burstow: I am listening closely to the hon. Gentleman's argument. He suggests that discrimination legislation on disability is framed to give an advantage to disabled people rather than requiring reasonable adjustments to allow them to use properly the abilities that they have.
Mr. Hammond: I was raising a genuine issue of concern. Presently, we have a crude and arbitrary test of fitness to continue work that is based on an age limit. All hon. Members will agree that that is pretty irrelevant. People do not become unfit to work in a certain role when they are aged 65 and a day if they were fit to perform the role two days before. There will have to be other tests, and I foresee that problems will arise from them. Although employer organisations are becoming more receptive to the increasing unsustainability, inefficiency and ineffectiveness of a blanket age limit on retirement, they are worried about how we will deal with future issues.
The Government's consultation document raises all those issues, but it does not suggest any answers. Responses to the consultation are due by the end of March, and I hope that the Minister will accept what hon. Members have said in the debate as a response to the consultation process and take that into account.
Perhaps unwisely, I confessed to my own weakness earlier in the debate by telling the Chamber bluntly that sometimes when I read about somebody in the newspaper, I wonder why it does not give his or her age. I make a confession of the latent ageism that I suspect we all have. As I have grown older, I look at people—especially professionals such as lawyers and accountants—and think, "Good God! He can't possibly be old enough to give me legal or financial advice."
Ms Atherton: I am listening with some interest to the hon. Gentleman. If he reads about a Sam Brown or a Leslie Brown representing a person, does he know whether that person is a man or a woman? Does that flavour his judgment about the person who makes a statement?
Mr. Hammond: That depends on the context, but there are certainly times when I am interested in someone's gender, when the name does not betray it. I do not feel in any way ashamed to admit that. I think that it is natural human curiosity. I am merely telling the Committee, in all honesty, what has happened as I have grown older and become 40-something—I am actually not far from becoming 50-something now.
Ms Atherton: Another watershed.
Mr. Hammond: As I have grown older, I have started to find, inevitably, that more and more people in positions of authority with whom I deal are younger
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than I when once they were older than I. That is a perfectly natural experience, and I find it interesting, in the context of this debate, to examine my own reactions and instinctive prejudices. We all have those, and to pretend that we do not is not a sensible starting point for the debate. I hope that we are all mature enough to recognise that they are largely irrational and absurd, part of the conditioning that all of us 40-somethings have because we grew up in a world where people were assumed to retire at 65 and cease to be economically effective or participate in the work force from then. That is the era in which we grew up, and it will colour us.
I have probably gone on for far too long already, but I have one or two more points. Whatever people think about the moral arguments against ageism, there is clearly an unanswerable economic argument against the current mandatory retirement age. As we all live longer, it is simply not an option for us to expect to work for 30 years and then live comfortably for another 30. The country cannot afford that and we as individuals shall not be able to afford it unless we are prepared to consume a very much lower percentage of our product during our working years, and I suspect that most of us are not willing or able to do that. We all face a private challenge as we examine the huge benefits of longer life expectancy. There is also a public challenge for the state, in examining how to encourage us to remain economically active and contributing for longer periods of our lives.
I urge the Government to lead by example and to recognise that, although legislation is needed to satisfy the requirements of the EU directive, that cannot be a substitute for education. The key challenge for the Government is to educate employers and employees in the concept of a flexible approach to retirement. If we are to have a mature debate, the Government should acknowledge that all forms of discrimination are not necessarily wrong. We are here talking about unjustified and irrational discrimination.
The hon. Member for Sutton and Cheam mentioned health care, and he and I have discussed that before. There will be cases when the clinically appropriate treatment for a person differs, depending on whether they are 18 or 80. It would be a great shame if, in trying to tackle inappropriate, unjustified, irrational age discrimination, we allowed the debate to be hijacked and lost sight of the fact that there are areas and issues where discrimination on age grounds is appropriate.
The hon. Member for Caernarfon cited the car driver who could not get insurance, or was charged a large sum for it, because she was over 75. There are many other car drivers who are grateful that their car insurance premiums are very low because they are over 50 or over 55. Those differences are actuarially justified.
My party and I have an instinctive sympathy with the position set out by the hon. Member for Caernarfon, which underlines the importance of individuals and of dealing with each person's position on the basis of their individual characteristics, capabilities and needs. The arbitrary blanket retirement age is the opposite of that.
We have here a rare, genuine win-win opportunity by which employers, employees and the public purse can all benefit from a change in attitudes, which can be underpinned, but not solely brought about, by

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legislation. I hope that when the Minister replies she will specifically address education and the Government's role as a major employer in leading by example.
12.10 pm
The Minister of State, Cabinet Office (Mrs. Barbara Roche): The debate has been extremely good. I agree that the time for this issue has come. There is a great deal of public interest in it, and there is certainly a great deal of interest in the House.
As my hon. Friend the Member for Falmouth and Camborne (Ms Atherton) said, the conference held yesterday by Help the Aged and the Independent Television Commission enabled us to consider in more detail the representation of older people in the media.
The hon. Member for Runnymede and Weybridge (Mr. Hammond) talked about general education, which is very important. I am pleased to see him opposite me again because our paths have not crossed since those heady days on the National Minimum Wage Bill. Indeed, there were heady nights as well; we spent not only days but nights on that Bill. We set the record, which was about 36 hours, for the longest sitting in Standing Committee. You will be relieved to know, Mr. Taylor, that given the limits of Westminster Hall I do not intend to repeat that today.
It is clear that unfair discrimination on the grounds of age is not tolerable. We need to counter the unthinking prejudice that blights not only people's lives, but our economy. Older people are a major and growing section of the population, and we need their skills, talents and contributions if we are to create a successful society and economy. Although it is right to say that the over-50s suffer most from age discrimination, it is not the exclusive province of older people. Younger people also experience ageist practices, as the hon. Member for Edinburgh, West (John Barrett) pointed out. We have all heard, for example, about whiz kids doing well in the City, but we have also heard about people who cannot get jobs in IT because they are over the hill at 30. The hon. Gentleman referred to training and to the need to keep skills up to date. Much of the research actually shows that older workers are the most assiduous in following modern technology and practices, and in making sure that their skills are competitive.
There has been a great deal of discussion today on the question of whether ageist employers miss out on the skills and experience of a diverse work force. Reference has already been made to the fact that the estimated cost of that is £31 billion according to the Employers Forum on Age publication "Ageism: too costly to ignore". The Cabinet Office report "Winning the Generation Game" discusses similarly large sums of money.
The Government are determined to tackle discrimination against older people. We are taking action for older people right across Government through legislation outlawing age discrimination for the first time, and in the Age Positive campaign initiated by the Department for Work and Pensions, the new deal 50-plus and the Department of Health's national framework for older people. Through our Age Positive campaign we are challenging ageist employment practices, and I shall speak about that legislation in a moment.
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Many employers are already committed to employing a diverse work force. As champion employers, they have shared their experience of good practice along the lines suggested by the hon. Member for Runnymede and Weybridge. There is good practice out there, and those employers who have good policies implement them not only because they are nice people, but because to do so makes economic sense and gives them a competitive advantage. Those employers are astute.
Through the new deals we are helping older people to find work. For the past four years the employment rate for the over-50s has increased faster than the overall employment rate. During the first 21 months of the new deal 50-plus, more than 61,000 people have been helped through the programme. That is a tremendous number of people.
Ms Atherton: Is my hon. Friend aware that even people who have found employment through the new deal are turfed out on certain dates because the employer or voluntary organisation to which they are offering their services cannot obtain insurance cover for employment or work undertaken in a voluntary capacity? If that barrier in the goods and services insurance industry is not tackled, there will never be a resolution to the problem.
Mrs. Roche: I know that my hon. Friend feels strongly about the matter. I understand why and will deal with it in a moment.
On education, learning can play a major contribution in helping older people to fight discrimination by giving them the confidence and skills they need to compete for interesting and rewarding employment.
I turn to the important matter raised by the hon. Member for Caernarfon (Hywel Williams), whom I congratulate on securing the debate, and by the hon. Member for Sutton and Cheam (Mr. Burstow)—health and social care. The national service framework directly addresses age discrimination against older people in accessing NHS or social care services. It sets out, for the first time, national standards for the care of older people and will ensure that older people are not unfairly discriminated against when accessing NHS or social care services because of their age. Action plans are being drawn up to deal with any unfair policies that have been identified as age based. Ageism is intolerable and NHS treatment should be based on clinical need, not age. We cannot say that too often because it is important to get that message across.
Age discrimination in the workplace has been the focus of much of our discussion. Too often in the past, older workers have been written off although they have much to offer. Nearly 70 per cent. of people between 50 and state pension age are in employment, but for the remaining 30 per cent. finding and retaining suitable employment can be a serious problem. We welcomed the employment directive because it is important in ensuring equal opportunities for all workers in this country and elsewhere in the European Union. However, legislating against age discrimination is not simple. The House knows that article 13 of the directive introduces some new strands.
Mr. Hammond: Can the Minister tell me what has changed since 1996 when her right hon. Friend the

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Member for Makerfield (Mr. McCartney), now the Minister for Pensions, said that an incoming Labour Government would introduce comprehensive legislation outlawing age discrimination? She is now saying that it is not so simple.
Mrs. Roche: There has been no change. We are absolutely committed to implementing the directive, which is what we shall do. Our consultation document highlighted some complexities and I shall deal with them now.
Legislating against age discrimination is not simple. Complex and sensitive problems must be resolved so that the eventual legislation is practical and helpful to employers and employees. For example, the directive recognises that differences of treatment are sometimes justified on the ground of age. The challenge for implementation is thus to identify which differences of treatment are acceptable, and which are not. That means that we must carefully consider the response to the consultation.
The consultation will be in two stages. The current consultation on equality and diversity seeks views on several broad issues. We want to discover what people think about mandatory retirement ages. That issue was raised by the hon. Member for Caernarfon who initiated the debate. With regard to justifications, we aim to find out what practices employers have, why they need them and why they need to retain them. The consultation finishes at the end of the month. We will then develop specific proposals in the light of the responses to it, and consult on them later in the year.
Mr. Hammond: While the Minister waits for responses to the consultation, what has she done to examine the way in which the Government treat their employees, and their view on mandatory retirement ages, especially in the civil service?
Mrs. Roche: The hon. Gentleman is more impatient than I remembered. He will have an answer if he can just contain himself a little.
Mr. Hammond: That is what Ministers always say when they are about to run out of time.
Mrs. Roche: I will return to that issue, if the hon. Gentleman can just contain himself.
The hon. Member for Caernarfon was concerned about the rights of older workers and the upper age limit for unfair dismissal in the Employment Rights Act 1996, as his amendment to the Employment Bill showed. We will consider that as part of our overall approach to the implementation of the directive.
There have been several questions about goods and services. On Second Reading of her private Member's Bill, my hon. Friend the Member for Falmouth and Camborne eloquently drew attention to the difficulties that some older workers experience. There should, of course, be no identifiable differentiation in the provision of financial services or credit. The banking code is voluntary, but it is followed by almost everyone in the banking industry; it includes undertakings on nondiscrimination. However, the directive applies only to employment and training, which is a major step in itself.
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We must resolve several issues before we can introduce the legislation, and it would not be sensible to be distracted at this stage by the further complexities that legislation on goods and services would pose. For example, should we outlaw 18 to 30 holidays because they are ageist? Should concessionary travel continue to be available to pensioners? What about other concessions, such as the television licence?
Demographic and economic factors will provide powerful incentives for shops and service providers to change their practices towards older customers. I use the phrase "demographic factors" positively, not as the hon. Member for Sutton and Cheam used it.
Mr. Burstow: Will the Minister at least reflect on the fact that there is rarely an opportunity for primary legislation, and that it would be a loss to pass up the opportunity to legislate on goods and services when the Government are legislating on employment?
Mrs. Roche: I will, of course, listen to what hon. Members have to say, as the House expects me to. However, I do not want people to underestimate the number of difficult and complex issues that we will have to resolve if we are to implement the legislation to which we are committed. That is our priority.
Hon. Members referred to an age commission. We are determined to put in place effective arrangements for advice, support and guidance for individuals and employers. Those will cover all the new discrimination strands in the directive—age, sexual orientation and religion. It is not clear that an age commission is the best way to proceed, and such a course could raise questions about cost-effectiveness and overall coherence. It is essential that the Government study the issue in the round, and it does not make sense to establish new single-issue arrangements before we have thoroughly considered the strategic and practical issues for all the new strands. It is important that we take the issue forward in that way.
The hon. Member for Sutton and Cheam asked about research, and officials at the Department of Trade and Industry are working with officials at the Department for Work and Pensions. DWP officials also work on the Age Positive campaign, which is led by my right hon. Friend the Minister for Pensions, and on commissioning research. I agree that it is important that we do that.
The hon. Gentleman also asked about tackling ageism in public policy. I take his point that we must look at the issue throughout the Government. The Cabinet sub-Committee on older people, which is chaired by my right hon. Friend the Secretary of State for Work and Pensions, is taking a close and active look at age issues across Government policies. It is also examining the Government's role as an employer, and the hon. Member for Runnymede and Weybridge is right that the Government should act as an exemplar on the issue.
The hon. Gentleman asked about the flexible decade of retirement. The current consultation seeks general views on the retirement age, and we shall consult on specific proposals later in the year.
The hon. Gentleman asked how we would incorporate the policy strands. The document said that we aimed to prepare separate items of legislation for

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each strand and to use regulations under section 2(2) of the European Communities Act 1972 to implement the directives where possible.
As regards the Government acting as an exemplar, the Cabinet Secretary has written to permanent secretaries about the need for the civil service to ensure that it takes that role seriously.
The hon. Gentleman asked about mandatory retirement ages. There is, of course, no legal retirement age, and employers are responsible for setting the retirement age for their employees. Through the document, we are consulting on whether there should be mandatory retirement ages. It is probably one of the most complex issues in the document and in the consultation process.
The process of developing legislation to outlaw age discrimination at work is nearing the end of its first stage as the consultation exercise draws to a close, and I look forward to considering the responses. That is why this debate, which was initiated by the hon. Member for Caernarfon, is timely. I undertake to ensure that I take account of the comments that have been made. I also look forward to consulting on the specific proposals later this year.
These are important issues, and this has been an extremely good debate. I look forward to working with hon. Members to take the agenda forward.

Car-jacking
12.30 pm
Mr. Tom Watson: I am grateful for the opportunity to raise the issue of car-jacking for what I believe is the first time in this House. May I ask my hon. Friend the Minister to pass on my congratulations and regards to the Prime Minister, who has pre-empted this debate and has set up a street crime and car-jacking taskforce to deal with the problems that I shall outline?
I hope that the taskforce will consider not only car-jacking but new measures to tackle the junior criminals who move from bullying in the classroom to taking part in antisocial behaviour on street corners. In West Bromwich, East, my neighbours are driven to misery by teenagers who create mayhem late at night. Although they conduct relatively minor acts of antisocial behaviour, they belong to the generation that can graduate to street crime and violent car-jacking. I hope that addressing persistent and defiant behaviour in very young people will be a core goal of the taskforce.
The Government have worked closely with the car industry in the past couple of years and have successfully introduced new security measures in vehicles. However, we now see the flip side of that. At the end of January, the violent stabbing to death of 25-year-old Timothy Robinson outside his home by a gang of suspected car-jackers brought this new crime to the attention of the public. Thieves often target motorists who have items on their passenger seats, such as a handbag or laptop computer, and in nearly all cases they strike when the vehicle is stationary at traffic lights. A common tactic is to force minor collisions and then to ambush motorists when they approach them to exchange insurance information. The most public case happened when Gloria Hamilton, a 41-year-old mother of three, was knocked unconscious by a gang of thieves who stole her vehicle in south London. While all motorists who are involved in accidents should report and pass on their details to the police, this kind of crime has prompted the RAC Foundation, on whose policy committee I sit, to encourage motorists to go directly to a police station if they are uncomfortable about a minor collision.
Because the crime is classed as robbery under UK law, few statistics exist on the extent of the phenomenon. Metropolitan police figures suggest that 1,200 car-jacking style crimes took place in London last year.
Mark Tami: Is my hon. Friend aware of an incident in Cardiff earlier this week in which a young man who stopped to answer his mobile phone was set upon by a gang of youths, who kidnapped him and took him for a hair-raising drive before stealing all the money that he had on him and taking his CD player? Car-jacking is often seen as a London crime—it is not; it is spreading to all parts of the country and we must address it in that light.
Mr. Watson: I thank my hon. Friend for bringing that point to my attention. Car-jacking is not countrywide but, like street crime, it has hot spots. There are certainly some in my region, the west midlands, and there are others in Salford, Bradford and West Yorkshire. Last

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week, a particularly savage attack on a young driver that took place just outside my constituency made the front page of the Great Barr Observer. In that case, the man was violently pulled over to the kerbside and attacked by two men who punched him to the ground and then stole his vehicle.
Many examples of such attacks in the west midlands illustrate the growing problem. In one case, a female motorist—female motorists are often targeted—was parking her BMW in her front drive. A man approached the car to ask her the time and she was assaulted with an iron bar and viciously dragged from her car. Luckily, the car was fitted with a tracker device and, although she was injured, the police were able to retrieve the car about eight miles from the incident and arrest the man. Will my hon. Friend consider how new technology might combat that crime? Will he tell the House how the Home Office pilot scheme in Northampton—the automatic number plate identification scheme—is progressing? It might deter further developments in that crime.
Although car-jacking is a relatively new phenomenon in the United Kingdom, it is far from new in other parts of the world. South Africa has suffered the crime since the mid-1970s. Until 1986, car-jackings were recorded as robberies, but the South African Government changed the law in 1986 to allow the specific offence of car-jacking. I am not saying that the problem is as bad in the UK as it is in South Africa, but a number of lessons could be learned from the way in which other countries deal with the crime. The number of violent car-jackings in South Africa has escalated to a horrific extent. Two years ago, more than 12,000 incidents took place; through the greater use of hit squads to target crime hot spots, that number has been reduced by 1,000 during the past 12 months.
I hope that my hon. Friend will consider introducing a new specific offence of car-jacking. It is my strong view that harsh and stern penalties should be imposed that truly reflect the terrifying and violent nature of the crime. We need to send to those dangerous and violent criminals the clear message that, when caught, they will go to jail for a long time. Introducing a specific crime of car-jacking with harsh minimum tariffs would also ensure that criminals who took part in that activity would not be let off as a result of legal ambiguities.
I refer my hon. Friend to some rather contradictory statements made by Lord Woolf during the past few months. In early January, he said that mobile phone muggers should be sent to prison for up to five years—I strongly agree with that sentiment, as do many of my constituents. Only two months later, on 6 March, The Guardian reported him as saying that the courts should think twice about sending criminals to jail. I want to make sure that when car-jackers are found guilty, the judges have no choice but to send them to jail. If the Government decide that that is not appropriate now, will they at least put pressure on police forces throughout the United Kingdom to record car-jackings and smash-and-grab attacks separately from robberies? With accurate statistics, we can properly assess the true extent of the crime.
The RAC Foundation is concerned that insurance companies have refused, or tried to refuse, to pay out money to motorists involved in car-jackings when the vehicle is stolen. Clearly, we cannot let that continue. The majority of car insurance policies say in the small
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print that claims are invalid if the key was left in the ignition or if the car was not locked. The Association of British Insurers said that insurance companies should always pay out on claims made as a result of car-jacking attacks, and I sincerely hope that all insurance companies will follow that sensitive approach. It will add insult to injury if those companies use the small print to shirk their responsibilities. In his deliberations with the insurance industry, could the Minister ask insurers to make a public statement to reassure car drivers that they will be able to achieve at least some recompense if they are victims of attacks?
In the Minister's discussions with police authorities, will he consider the possibility of issuing guidelines to drivers on how to avoid becoming victims of car-jacking attacks? The RAC Foundation has responded to this public information issue in its PR and marketing. It has issued helpful guidelines to its members and motorists in general, saying that thieves will be more tempted to target a vehicle if goods are visible, so drivers should ensure that valuables are not left on the passenger seat or dashboard when travelling. The RAC Foundation also says that car-jacking gangs are more likely to target motorists who seem unsure where they are going—when they look at maps at traffic lights, for example.
Such guidelines as planning a route before travelling should be handed down by a police authority. They should be a police force responsibility, not simply left to the motoring organisations, because they are an important part of crime prevention. I hope that the Chancellor's Budget will include greater funding for police forces, and I know that the Minister will be negotiating behind the scenes on that matter. When the Budget is known, some money should be spared for public campaigns, as they do so much to reduce crime. As everyone knows, crime prevention is better than law enforcement.
I welcome the opportunity to raise this matter in the House for the first time. It is of great concern to my constituents and of increasing national concern. I look forward to the Minister's comments.
12.42 pm
The Parliamentary Under-Secretary of State for the Home Department (Mr. Bob Ainsworth): I congratulate my hon. Friend the Member for West Bromwich, East (Mr. Watson) on securing the debate on an issue that relates to not only his constituents but people throughout the country. The Government share his concerns about this despicable crime. We need to be as tough and effective on car-jacking as we have been on tackling other vehicle crime offences.
Some terrible incidents have been reported in recent weeks, and we extend our sympathies to the victims of those crimes. The incident in Cardiff has been mentioned, but others have occurred throughout the country. The victims are not only the people involved in the incidents, but those who are instilled with the fear that the same thing might happen to them. My hon. Friend the Member for Alyn and Deeside (Mark Tami) is right in saying that the issue is not simply London based, as it is a problem in areas such as the west midlands and most other conurbations. We are determined to reduce violent crime by pursuing a concerted strategy of targeted policing, effective

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punishment and tackling the underlying conditions that breed violence. I welcome the opportunity to describe our strategies. The increase in violent theft of cars and burglaries in which car keys are stolen is possibly a result of the increased security for new vehicles that follows Government pressure on manufacturers to make cars more difficult to steal. The publication of the Home Office car theft index has helped to raise awareness of car security issues among motorists and encouraged manufacturers to raise standards continually. It is massively unfortunate that so-called "car-jacking" stems in part from our success, in that criminals have been forced to resort to more violent means of stealing vehicles. I do not underestimate the task ahead. We must deal with the issue, as my hon. Friend the Member for West Bromwich, East made clear, and we shall certainly do so.
My hon. Friend raised the subject of personal safety and some action that motorists could take. The Home Office has published a leaflet, "Your Practical Guide to Crime Prevention", which we intend to make available on our website. I shall ask officials to check that some of the advice that my hon. Friend mentioned is covered adequately in that guidance, as he was right to say that we could not class the issue simply with motoring offences. There is a role for the Government and the Home Office in ensuring that guidance is as comprehensive and effective as possible.
We support the use of tracking devices in high-performance and expensive vehicles, but recognise that in some cases those are beyond the means of the majority of motorists, especially those who drive older models of cars. An average price for the installation of a tracking device is about £400, and then an annual subscription must be paid. However, they are playing a part in discouraging vehicle crime.
My hon. Friend was right to point out that the police do not record car-jacking as a separate offence, nor is there a legal offence category of car-jacking. When there is a threat or use of actual violence, the offence is robbery, which carries a maximum penalty of life. He said that, in terms of the criminal justice system and sentencing, a separate offence of car-jacking was necessary. I am not convinced of that, as the problem has so many manifestations and different levels, as in other cases of robbery. I am broadly satisfied that the framework is adequate for the purposes of sentencing.
The other issue to which my hon. Friend alluded was that of reporting and whether, without a specific sentence, we have an adequate and accurate method of measuring the size and geographical spread of the problem. That point is well worth considering, so I give him a commitment that I shall consider it. Although we have statistics, we are not confident that they properly cover the size of the problem or measure the severity of individual instances. Sentencing capability is covered, but the issue of reporting is worth further examination.
It is important that the courts then treat the offences with the seriousness that they deserve. The Lord Chief Justice recently emphasised their seriousness when he gave a judgment on several cases that involved robbery of mobile phones from young people. One such offender
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received a six-year custodial sentence, and three young men convicted of car-jacking recently received custodial sentences of up to four and a half years.
The Lord Chief Justice's view accords with that of the Government, which is that those who prey on the vulnerable using violence or the threat of violence should expect a commensurate sentence. He is perfectly capable of defending himself. My hon. Friend said that there were contradictions in what he said, but I do not think that the Lord Chief Justice tried to suggest that custodial sentences were inappropriate in cases of robbery, especially the aggravated robberies and more serious car-jacking offences that have been highlighted in the press of late, to which my hon. Friend referred. We believe that the sentencing framework needs to be adequate and the courts need to take the matter seriously and respond appropriately to the severity of the crime. I hope that the comments of the Lord Chief Justice encourage that; we agree with them.
My hon. Friend alluded to the announcement by the Prime Minister and the Home Secretary this morning. We have made it clear that the whole of Government as well as other agencies should give the highest priority to tackling robbery and dealing quickly and effectively with offenders. Additional funds of £20 million have already been committed to tackling the robbery problem in the five forces with the greatest problem, including the West Midlands police force, which received an additional £3.3 million and has set a target of reducing robbery by 34.1 per cent. by March 2004.
The subject discussed this morning was stepping up action to deal with robbery. The robbery reduction initiative announced by the Home Secretary over the weekend involves a clampdown on all street crime, which of course includes the specific issue of car-jacking that my hon. Friend has raised. My hon. Friend will probably agree that knowing that one will be caught must be the biggest deterrent, particularly if that prospect is supported by an appropriate punishment regime. We must reclaim our streets for decent, law-abiding citizens, who want no more than to be able to walk or drive safely, to live peacefully and to go about their business freely and untroubled by the fear of attack.
The Prime Minister chaired the first meeting of the new cross-departmental street crime action group this morning. It is drawing together all the resources, expertise and initiative of Government Departments and all the relevant agencies, in a concerted effort to attack the problem. This morning's announcement contained five main strands relating to the police and criminal justice system. The police should step up operations against robbery by targeting hot spots—an issue on which I am encouraged by what my hon. Friend has said—making more arrests and ensuring that evidence is brought to bear swiftly and systematically to enable early charges to be laid; the Crown Prosecution Service should step up the priority that it gives to robbery case preparation, fast-tracking cases, deploying top-quality lawyers and working closely with the police.
The courts need to give priority to robbery cases, if necessary introducing extra sittings to deal with the increased work load that will arise from the initiative. Youth offending teams need to give priority to the work on robbery cases, including the preparation of pre-sentencing reports. The Prison Service and probation

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service will need plans to deal with what we hope, sadly, will be an increase in the number of robbery offenders to be brought to justice, who could be given prison sentences.
My hon. Friend rightly said that the matter needs to be tackled more widely than by the police and criminal justice systems, so I think that he will be happy to learn that a leading contribution to this morning's announcement was made by the Secretary of State for Education and Skills, who has been considering what schools can do to help to identify problems and to take early action. An example might be supporting the police in truancy sweeps. My hon. Friend mentioned the way in which young people become involved in minor criminality, which, if left unchecked, leads inevitably to the more serious consequences that he has identified.
We intend that the initiative announced this morning will at first apply to the 10 police areas with the greatest robbery problem. That includes the West Midlands police because, as I have said, the increase in robbery and the problem of car-jacking is sadly not just a London issue, but exists far outside the capital. Then we intend to try to spread the good practice that is learned in the initiatives to other forces beyond the 10 that are initially targeted. Furthermore, we shall bring together the other agencies across government who can work together to support the police in tackling the problem and its causes. We must not forget that the whole community has a responsibility to work with the police and help them in their task.
West Midlands police are well aware of the public's concerns about car-jacking. In common with other forces, they are dealing with it as part of their wider anti-robbery strategy, to which the robbery reduction initiative provides added stimulus. The problem is being given the high priority that it deserves. I am told that West Midlands police intend to enhance their strategy by adopting intelligence-led policing, which targets the offenders in all robberies. I hope that that means that the national intelligence model will be introduced throughout the West Midlands police service. West midlands Members will want to make sure that it is introduced, because there is much to be gained from encouraging all our police services to adopt the national intelligence model, although I know that many police forces have not been able to do so to date.
My hon. Friend talked about how technology can assist us in that regard. I know that, as a result of his association with motoring organisations, he is aware of
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the pilot scheme in Northampton on automatic number plate recognition. We need to look into the benefits of such a scheme. Criminals of all kinds need to use the roads and their vehicles to go about their criminal activities, so there are great benefits to be gained from automatic number plate recognition in dealing with car-jacking as well as other crime. That information needs to be fed into the robbery initiative, and I shall ensure that that happens.
We must do better at learning from international lessons. Some of the ideas that we try to put to good effect in this country have been learnt from other jurisdictions. We must do better in learning from the problems of other countries.
Crucially, we must not forget, especially if we want the community to support the police, that there is a victim in every car-jacking. We are fully committed to providing a better deal for victims of crime and ensuring that they receive the support that they deserve. A major plank of our programme to support victims is provided by the voluntary organisation Victim Support. Since May 1997, we have doubled our grant to Victim Support, and I am pleased to say that, as part of the robbery reduction initiative, we will see whether we can do even more to support victims and witnesses in those terrible crimes. It is not only important to support victims because their circumstances mean that they need support; victims are often the best people to help us to bring criminals to justice by acting as witnesses. The British public will help the police to do their job and help the criminal justice system to bring people to book only if their confidence in the police enables them to come forward to act as witnesses without fear of further victimisation. Therefore, there is a double benefit to any assistance that we can give victims, because not only do we help vulnerable people who have been victimised by crime—an end in itself—but we build the confidence of the community so that people will work with the police to reduce crime levels.
I welcome the opportunity that this debate has given us to talk about car-jacking. It is a problem that is closely associated with the recent increase in robbery and street crime. I hope that hon. Members will accept that the Government are taking the issue seriously. We are doing everything that we can to support the police and the courts in bringing the situation under control and to ensure that people are again confident to walk the streets in safety.

Solihull Hospital
1 pm
Mr. John Taylor: I am grateful to the Under-Secretary of State for Health for taking this debate. I respect her and her office. I come with an all-party mandate from Solihull and, whereas there may be the odd political remark in what I am going to say, I have no party political axe to grind either now or in any subsequent developments. If she can help my constituents we will all be grateful to her. That is the spirit in which I approach this debate. At a recent meeting in Solihull involving all political parties we agreed that we are all in this together. In the same spirit, I acknowledge the presence of my hon. Friend the Member for Meriden (Mrs. Spelman) and the hon. Member for Birmingham, Hall Green (Mr. McCabe), who has wished me well in this debate.
The great, and so far unhappy, saga of Solihull hospital began for me in my earliest years in the House when, with many others, I pressed the case for what we then hoped would be a new district general hospital for Solihull. The regional health authority, as it then was, proved receptive and a splendid new hospital building costing £38 million was ultimately erected and opened in June 1994. We rejoiced—but later in 1994 the hospital applied unsuccessfully for trust status. That was not in itself a decisive alarm, but by the end of 1994 I was privately alerted to the fact that all was not well.
The origin of whatever miscalculations had been made may well lie in the NHS planning of the 1980s, which had anticipated that one of the five principal hospitals in Birmingham would close and a district general hospital in Solihull, to the east of the city, could well be justified, not least in the light of Solihull's expanding population and expanding economy. In the event, there was no such hospital closure in Birmingham.
I have documented the litany of events between 1995 and March 1997, but I will not recite it here in the limited time available to me in an Adjournment debate. March 1997 is, however, a significant date in that it was marked by a statement by the then Minister for Health pledging the future security of services at Solihull hospital, in particular accident and emergency services. I have given the current Minister a copy of that pledge.
Two months later I was to become, involuntarily, a member of the Opposition, following an election in which the Minister's party promised that it would do much better in health matters than my party had managed to do. It may surprise the House to know that I was prepared to believe that it might indeed do so. The economy was strong and it was in a position to make a fresh start with an overwhelming majority and an unchallengeable mandate. There was also a feeling, or mood, that health services might become more consumer led and less consultant or administrator led, and—a welcome thought—that decision making would be more local.
However, the uncertainties at Solihull hospital would not go away, although for a time they were counterbalanced by optimism, and there was a period of abeyance that seemed to me to persist, though uneasily, until last year. There were recurrent assertions in accident and emergency that throughput figures in
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Solihull did not justify a comprehensive 24-hour service. However, many of us found those contentions bogus and unconvincing, as ambulance crews were instructed to exercise a preference to take accident and emergency patients to Birmingham Heartlands hospital. In that case, the statistics would be inevitable and self-fulfilling.
I could waste the whole half hour if I repeated all the questions that I raised during the period—1995 to the present—that I am reviewing. However, neither the Library nor I can find the date of one question that I raised. It may not have passed muster with the Table Office. The question was about accident and emergency provision and is still pertinent. Should difficulties in staff recruitment be a valid determinant in establishing levels of service?
Whether or not that question was included on the Order Paper, it addressed another seemingly bogus argument with which we had to deal—that one could not provide the service because one could not get the staff. That too was self-fulfilling in its own way. We argued that it was surely the job of those in charge to address that argument the other way round. It should be their responsibility to ensure that the staff provide the service.
The next vexingly unconvincing argument was similar. Some greatly respected consultant would take a critical view of facilities or the level of staffing and pronounce that the situation was clinically unsafe. No one would quarrel with that, for understandable reasons. That judgment is potentially final. Our frustrated response to that would be, "Make it safe."
That is the background. I have endeavoured in this small compass to try at least to depict, if not re-create, the mood of uncertainty that attended the discussion of the security, or insecurity, of services at Solihull hospital, and the sort of arguments with which we had to contend, with mixed feelings of hope and exasperation.
Some things are clear. The population of Solihull is 205,000, but the daytime population is much greater. Solihull ceased to be a commuter town long ago. Approximately 9,000 people work at Land Rover. Solihull is a huge retail attraction, not least following its new Touchwood shopping centre with its many employees and its many shoppers from outside Solihull. It is estimated that on average, 60,000 shoppers visit it each day, and that 8 million have visited it since last September. Such is the prestige of Touchwood that Her Majesty the Queen will formally open it later this year.
Solihull's population growth is generated by new housing development mainly in the south of the borough, the area that is most naturally served by the hospital. There is an enormous amount of traffic on the M42 within a mile of the hospital. The M42 in Solihull is, in effect, a confluence of the M6, M40, M5, M45 and M69 motorways and the Birmingham northern relief road. Although I do not want to depict it as a hazard, I must add that Solihull also has a rapidly expanding airport—Birmingham International airport. It employs 6,500 people on site and had a throughput of 7.6 million passengers last calendar year, despite the events of 11 September. The National Exhibition Centre is also in Solihull and attracts further large numbers to the borough—to visit Cruft's dog show, for example, or the motor show. All that is visible, patent and obvious.

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Furthermore, Solihull expects 30,000 new jobs to be created in the south of the borough in the next eight years.
I hinted that I did not wish to tempt providence by anticipating a disaster in Solihull, but it could happen. Could Solihull cope? It is obvious to me, as their parliamentary representative, that my constituents should demand an appropriate hospital that includes a comprehensive accident and emergency service. They feel that they have earned and paid for one.
A new strategic health authority will be in place from 1 April, although it may not be fully fledged until October. That much we know, but real and poignant uncertainties surround the future. We are told that there will be a consultation on the range of services to be provided at Solihull hospital, with an emphasis on examining A and E provision. We are told that there would have been little point in the outgoing health authority setting that consultation in train, and that the new strategic health authority will start the consultation process when it is in place—but will it also assess the results?
Who makes decisions about the consultation process—the Minister, or someone, some body or some institution that has the Minister's authority? What is the role of the primary care trust in that context? We need clarity. What will be the terms of the consultation? By what criteria will its findings be measured and judged? Who will decide? Is it ultimately a matter for the Secretary of State? Above all, what is the future of accident and emergency provision in Solihull?
At the moment, we have patients waiting in ambulances and plenty of first-hand accounts of utterly unacceptable waiting times. The overwhelming majority of people in Solihull are law-abiding taxpayers who have normal fears and apprehensions about illness and injury. They want certainty that a good efficient hospital will be there for them in Solihull should they need it. I hope that the Minister will reassure us about that, and I will give her the credit if she does.
My hon. Friend the Member for Meriden will now share the debate with me.
1.13 pm
Mrs. Caroline Spelman: I am grateful to my hon. Friend the Member for Solihull (Mr. Taylor) for giving me a small share of his time, and I will confine myself to asking specific questions. Does the Minister accept that any downgrading of accident and emergency provision at Solihull hospital will be seen by the people of Solihull as a broken promise? If the previous hospital management secured an agreement with the royal colleges that doctors could safely be rotated between Birmingham Heartlands and Solihull hospitals, what has changed?
I endorse my hon. Friend's view that an inability to staff the A and E department is a poor reason to close it. That is a supply-driven argument that does not reflect the true demand or wishes of the people. The Minister may say that the matter is local and should be decided locally, but does she accept that a perfectly reasonable local solution is under threat? It takes 38 minutes to get from the border of my constituency to Heartlands A and E at off-peak times. Does the Minister regard that as an acceptable journey time in the event of an emergency?
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What is the Government's overall strategy for national accident and emergency services? Solihull hospital, together with five other hospitals throughout the country, faces the closure of its accident and emergency department.
Is the Minister aware of the editorial in the British Medical Journal of 4 August last year? It said that the Royal College of Physicians and the NHS Confederation had together announced a working group to rethink accident and emergency provisions. The editor wrote that the preferred model would place accident and emergency departments within 10 minutes reach of those who need them.
1.15 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I congratulate the hon. Member for Solihull (Mr. Taylor) on securing this important debate. Primarily, it raises issues about Solihull, but it also touches on broader issues about accident and emergency departments. I thank him personally for giving me notice of the issues that he intended to raise. If Ministers can respond to specific points rather than talking generally, it makes for a more focused debate.
The hon. Gentleman has a keen interest in the services that Solihull hospital provides. He has tabled parliamentary questions about it on several occasions, and he is keen to ensure that the highest possible standard of health service is available to his constituents. I assure him that the Government, too, are committed to ensuring that local people get services of the highest possible quality, and we want to provide services that are as close to people's homes as possible. Obviously, that is consequent on safety and viability, but striking the right balance between local access and high-quality services has always been a tension in the national health service, and we all continue to grapple with it.
At the outset, I acknowledge that local people want accident and emergency services to be as close to their homes as possible. The hon. Member for Meriden (Mrs. Spelman) quoted a journey time of 38 minutes, and the working group is examining a period of 10 minutes. People want access, but we must acknowledge that they also want extremely high quality. It is not easy to achieve consensus; that requires much local consultation and discussion on the detail of local services.
Mr. Stephen McCabe: I am extremely grateful to my hon. Friend for permitting me to intervene. She knows that my constituents use some of the facilities at Solihull hospital, and they want two assurances from her. First, will she give a categorical assurance that there is no threat to Solihull hospital? Secondly, will she assure me that any changes that the trust contemplates will be subject to a full, transparent and above-board consultation process?
Ms Blears: I am delighted to give my hon. Friend those assurances. The Government, the health authority and the community see a vibrant future for Solihull hospital. Any changes to the services will be subject to the same rigour that has always been required. If there is a requirement for public consultation, it will be open, transparent and inclusive.

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We want to make the consultation process more real to local people. Instead of presenting local people with a fait accompli, we want to get them involved in drawing up options at the outset. That will allow them to be part of the decision-making process. In the past, local people felt that they entered the process right at the end, and if they had not had the chance to influence policy making at the outset, they were often forced into a position of opposition and defending a situation. We want that change to be introduced.
The hon. Member for Solihull set out the background of the hospital and trust. He was right that the merger with Birmingham Heartlands hospital in April 1996 brought financial and managerial stability to Solihull hospital. Savings were made at that time, such as efficiency savings that managed to turn the financial situation around, and the merger was beneficial. Since then, there have been several dramatic new service developments in areas such as renal dialysis, ophthalmology, oncology and dermatology. Activity levels at the hospital have increased year on year. The trust is performing very well with regard to waiting times. It has been successful with the fourth wave booked admissions bid, which means that patients will be able to book their admissions at a time that is convenient to them. I hope that that will lead to a significant reduction in appointments that are not kept, which means that we will save money, which can be invested in services.
There have been several improvements to the physical environment, including better facilities for obstetrics, gynaecology, day surgery and endoscopy, as well as MRI and CT scanning, dermatology, the out-patients department, pre-operative assessment, and the mortuary facility. That goes to show that there has been significant investment in the hospital, so that it can provide a wide range of services for local people.
Some of the investments resulted from Government expenditure, some from efficiencies as a consequence of the merger, and some from publicly raised funds. It is also the case that much of the progress has been made because of the hard work of the trust's staff, and we should acknowledge their contribution.
Since the merger, there has been no major change to the A and E service but the trust has long expressed concerns about the clinical safety of maintaining a 24-hour A&E department at the hospital. The removal of training accreditation from certain posts has contributed to recruitment difficulties, and concern has also been expressed about the case mix of patients who are presenting at the hospital, which is of relevance to the training of doctors. The relevant factors include the supply of doctors, their training needs and their working practices. I am sure that hon. Members will agree that all of those are essential to the delivery of high-quality health care.
Clinical quality requires a minimum work load, so that doctors can build up experience. In an acute hospital without a minimum work load, doctors cannot be properly trained and senior doctors cannot maintain the expertise that they need to ensure the best treatment and care for patients. That situation has been developing for a long time, and it involves two issues:
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accessibility, which local people greatly value, and the pressure towards greater specialisation, which is advocated in particular by some of the royal colleges.
Therefore, there is tension in that situation, and I am delighted that extra attention is now being paid to looking at the future of A and E services, by examining, for instance, whether we can use new technology such as tele-medicine. It is important to take a fresh look at how we provide A and E services, to see whether we can provide as much as possible in local communities, while maintaining a balance by continuing to provide excellence. Most people accept that it is not possible to have top-quality specialist care on everybody's doorstep; that is common sense. Therefore, getting that balance right is a key issue. We must look afresh at emergency care.
As hon. Members may be aware, in November 2001, we published a document called "Reforming Emergency Care: First Steps to a New Approach". It was worked on by all of the royal colleges, nurses, consultants, paramedics, the ambulance service—by everyone who is employed in emergency care. The document sets out a new strategy for joining up all of the elements of emergency care, because the issue is not only about A and E departments; it is about primary care. It is about whether people who currently come to A and E departments could be dealt with more appropriately, and faster and better, by primary care, community mental health units and a range of other partners. It is also about whether we can use the ambulance service more effectively. One ambulance service is sending consultants out in their vehicles, which enables them to make rapid decisions about diagnosis and admissions in patients' homes. As a result, emergency admissions to A and E departments are falling dramatically.
The issue is also about joining up walk-in centres, and joining up NHS Direct so that it can take some of the telephone calls that are currently made to A and E departments. We are planning for every health community to appoint an emergency care leader, who can try to join together all of the parts of the network. A great deal of innovation is going on in terms of looking at the future of A and E departments, and I urge hon. Members to get involved in that endeavour.
The issue is also about reform and changing the way that we do things. The Government intend to put in extra investment to change the way that services are delivered so that patients receive a better standard of care.
Mrs. Spelman: The Minister encourages us to look at innovation. Does she accept that it was an innovative solution to rotate doctors through the two hospital sites, to satisfy the criteria of the colleges for their training? Is she also aware that, although A and E services might not have significantly altered since the merger, the loss of an emergency surgeon at Solihull was crucial with regard to what could be done in the A and E department?
Ms Blears: I am delighted that people have come up with different ways of providing services and training doctors. There is no single solution to all such matters, which is why I have advised the hon. Lady to get involved in all that is contained in "Reforming Emergency Care". I urge her to read the document and

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take an active, participative role in ensuring that its proposals happen in her local community. I am sure that she will.
The hon. Member for Solihull asked important questions about whose responsibility it is to make decisions and what the process is for that. I shall not say simply that that is a matter for local consideration, but, primarily, it is. We should aim to achieve consensus in a local community if we can. The primary care trusts, which will have a major role in examining reconfigurations in their communities, will be key to the process. They are the bodies with which local people will be involved and they will be able to look at the local community's needs. The primary care trusts will be able to decide what services are appropriate for the people that they represent. That is what I mean by getting people involved right at the start of the process. The primary care trust, which will have the majority of the budget and be commissioning services for local people, will be the driving force behind changing services locally.
Of course, if a major change is not agreed, it can be referred to Ministers, as at present. That power currently lies with community health councils. If the NHS Reform and Health Care Professions Bill, currently in the other place, is enacted, that power will be transferred to the local authority overview and scrutiny committee. I have given an undertaking that the power to refer configurations to Ministers will be no less rigorous under the new system than it is under the existing one. There will be that right to refer. It is very important that local government, with democratically elected members, can take a view on such issues right across the community and that there can be the links between local government and the health service that have, perhaps, been lacking in the past.
The Government are in the process of setting up the independent reconfigurations panel, an independent body to offer advice to Ministers on contested and controversial reconfigurations. The panel is likely to be operating by the autumn, but if the matters under discussion were referred to it in advance of that, it might be in a position to offer some advice to Ministers. It is a very good development, which will be able to work up some consistency around configurations. It will examine not hard and fast rules or a rigid framework, but the way in which reconfigurations should go through. At the end of the day, decisions will remain the legal responsibility of Ministers. That situation will not change. I urge all hon. Members to get involved in that process, and I
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know that they will. The hon. Member for Solihull has been very active on that, representing the views of his constituents and ensuring that Ministers are fully aware of the concerns surrounding a matter.
Staffing and training issues are important, but they are not the only issues. Access is incredibly important to local people, and such matters will be weighed in the balance when decisions are being made.
Mr. John Taylor: Will the Minister kindly take into account and acknowledge now the point, which I have made, that the daytime population of Solihull is much more than its residential population, for the reasons that I have given?
Ms Blears: I am delighted to deal with that point. The hon. Gentleman mentioned new homes, the new Touchwood site retail development, the airport and 30,000 new jobs to come. Those are important developments, which are happening as a result of the strong and thriving economy under this Government. I am delighted that his area is doing extremely well and that local people are thriving to such an extent. Clearly, his point is important, as it is in seaside areas that have a great influx of tourists. We must be conscious of such variations in communities.
It would be wrong to speculate on the future because, by the process that I have just explained, decisions might end up being made by Ministers. I am aware of the previous pledge given, as a result of the merger, on maintaining a 24-hour service. I am not in a position to say that the position will never change, because Ministers have a legal duty to take into account any changes in the population, the area and the services provided. However, we are determined to ensure that people have access to high-quality health services in their local communities.
Whatever is decided, the overriding aim should be the delivery of high-quality treatment in a modern, up-to-date setting, in an NHS fit for the 21st century. The hon. Gentleman's constituents are entitled to that, as are people throughout the country. The primary care trusts have a new role, a new responsibility and new powers to drive that system, and I urge them to make sure that they consult local people as widely as they possibly can in drawing up options for the future. It is crucial that local people are able to participate in formulating options as well as deciding on them at the end of the day; if we can get some kind of consensus on that, so much the better.

Mr.Gordon Downie
1.30 pm
David Cairns: Before moving into the substance of my contribution, I hope that you will indulge me, Mr. Taylor, if I make two preliminary and vital comments.
Today, British soldiers once again stand on the brink of active military service. The task that we have asked them to perform is crucial, and we know that it is highly dangerous. From the Balkans to Sierra Leone, from the remote mountains of Afghanistan to Northern Ireland, the men and women of our armed forces have shown without doubt that they are the finest in the world. Nothing that I say today can or will diminish the absolute respect that my constituent, Mr. Gordon Downie, and I feel for our armed forces.
My second preliminary remark is of equal weight. I am fully aware that today's debate comes with a price tag attached, and I am well aware of the pressure on the Ministry of Defence in its tough budgetary negotiations. It is time for the Government—I am happy to make this point in any forum—to increase the defence budget and defence spending if we are to rise to the challenge that the Prime Minister has set for us of fulfilling Britain's historic role as a leading world power.
Justice sometimes has a price tag attached to it, which is the case with my constituent Mr. Gordon Downie. The case is one of justice long denied that must be corrected, and a fair degree of recognition and compensation must be awarded. The case is complex; it went on for a number of years and involved several locations throughout the world. I hope that it will make it easier for you, Mr. Taylor, and the Chamber if I strip the case down to its bare essentials and give a brief chronology.
Mr. Gordon Downie is one of my Greenock constituents. His ambition as a boy was to join the Army, and he fulfilled it at the age of 16 when he joined up. He was given a medical, as is customary, and was passed fit to join the Army. In 1979, three years after he joined the Army, a medical examination revealed that he had a rare congenital deformation of his spine, which was diagnosed by the Army as a very gross congenital deformity of the upper-thoracic and cervical spine. At that time, the Army doctors who had discovered Mr. Downie's condition did not inform him about it. He received further postings and undertook a tour of duty in Northern Ireland.
In 1981, two years after the discovery of his condition had been withheld from him, Mr. Downie was on a tour of duty in Belize, and was injured during physical training exercises. A local doctor examined him and diagnosed a pulled muscle. At no stage were his medical records from the UK sought. Those records would have informed the local doctor that Mr. Downie had a congenital back condition that may have been damaged by the accident. Mr. Downie was told to return to his duty until his tour ended four months later.
Upon returning to Scotland, Mr. Downie collapsed due to the severe pain in his back. A doctor, who knew that Mr. Downie had that congenital condition, examined him and, realising that it had been exacerbated by the accident in Belize, recommended
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that he be discharged from the Army because he was unfit to continue in service. The Army did not comply with that recommendation and for a second time Mr. Downie's congenital deformity was not disclosed to him. The following year, 1982, Mr. Downie was promoted to the rank of corporal and posted to Cyprus where the pain in his spine caused him to collapse again. The local medical officer yet again recommended that Mr. Downie be discharged, but yet again that did not happen and, for the third time, a medical officer did not tell Mr. Downie that he was suffering from a severe congenital ailment that was being exacerbated while he remained in active service. Mr. Downie returned to Scotland and served as a section commander, but his condition deteriorated further and he was eventually discharged in 1983 at the third time of asking. Mr. Downie now has constant pain in his back, neck, left arm, the left side of his chest and his left leg and several doctors have told him that his condition is inoperable.
In summary, the condition was discovered in 1979 but not disclosed to my constituent. In 1982, it was recommended that he be discharged, but that did not happen and the condition was again not disclosed to him. The same thing happened in the following year. Three recommendations for discharge from the Army were required before it happened and during that time, Mr. Downie's condition deteriorated. Mr. Taylor, consultant neurosurgeon at the Southern general hospital, Glasgow, issued a report stating that
"50% of his symptoms could be attributable to his spinal congenital abnormality and 50% could be attributable to the injury"
suffered in Belize.
"It is unlikely that he would have developed symptoms to the current level of severity if he had not sustained such an injury."
As the House knows—and I am sure the Minister will remind us when he replies—because the events occurred before the Armed Forces Act 1986, Mr. Downie, as a serving member of the Army was not legally able to sue the armed forces. He acknowledges and accepts that and there has been helpful correspondence from the Minister. However in recent months, the Human Rights Act 1998 was introduced in United Kingdom law and has opened a window of opportunity for people such as Mr. Downie who suffered accidents before they were able to pursue claims against the Crown and the Army as their employer.
Mr. Justice Keith ruled in the High Court that the law barring legal claims by veterans injured through negligence—I contend that that applies in Mr. Downie's case—before service men won the right to sue clashed with the Human Rights Act 1998, which guarantees the right to a fair hearing. It is worth noting that civilian employees of the Ministry of Defence have always had that right and I have personal knowledge of civilian employees being given compensation for asbestosis when such compensation was denied to the men and women of our armed forces.
A declaration of incompatibility has been issued and we await further cases. We must wait for a test case to pursue the matter to its conclusion because my constituent is not a wealthy man. He is not part of a large group such as a veterans association, which might support his case. He simply does not have the financial

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means to pursue a test case through the courts and must rely entirely on those who may be able to pursue such a case and on the outcome of that case.
This is a matter of fundamental justice. This gentleman is suffering because of negligent diagnosis, failure to inform him of his condition, and failure to act on the clear recommendations and medical advice from the Army's own medical officers, which resulted in his condition deteriorating and being exacerbated. In a letter to me about a month ago, Mr. Downie wrote:
"I only wish disabilities could change the way that this Act does, as my disability is as real now as it was in 1983."
That is the point. It does not matter whether someone suffered an injury before or after 1987. The pain and suffering are as real now as they would be if the person had suffered the injury after the Act was amended and they had been allowed to sue for compensation.
Mr. Downie's ability to work and move is limited, and his future earnings are certainly limited. He is entitled, as I believe my hon. Friend the Minister will point out, to an Army pension, but because 50 per cent. of his condition was diagnosed as existing before he joined the Army, the amount of pension to which he is entitled is also limited. That is unfair, as Mr. Downie clearly would not have joined the Army if his condition had been diagnosed or disclosed to him at the time.
We are talking about a man who has served his country well in difficult circumstances, not about one of the usual suspects, a troublemaker or someone who wishes the Army ill. We should listen to the words of Mr. Downie's commanding officer on his certificate of service:
"Cpl Downie has unfortunately had to end a very promising career with the Army as a result of being medically downgraded. During his service he has proved himself to be a loyal, conscientious, trustworthy, cheerful and reliable NCO. He has shown great enthusiasm for his work and has adapted well to the variety of jobs he has been faced with. A likeable young man who has got on well with his contemporaries and who has been an asset to the Regiment."
This man gave the best years of his life to the Army and is suffering as a result. He was a loyal, decent, conscientious and brave soldier and is not asking for the earth or for untold riches; he simply wants a degree of compensation to make up for the gross negligence of which he has been, and continues to be, a victim, and because of the suffering that he endures today.
The Minister may say that he has to discharge the law and that his hands are tied. I understand that, as does Mr. Downie. However, we need a resolution of the matter, not just for Mr. Downie but for those who are in a similar situation. I would be surprised if there were many other cases in which the negligence was so culpable and clear and had resulted so directly in continued suffering for an individual. I hope that this good and loyal soldier will receive the justice that he has long been denied and that, in due course, he will receive the pension to which I believe he is entitled as well as some degree of ex gratia compensation as recognition of his current pain and suffering.
1.42 pm
The Parliamentary Under-Secretary of State for Defence (Dr. Lewis Moonie): I am grateful to my hon. Friend the Member for Greenock and Inverclyde
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(David Cairns) for securing this debate on the case of his constituent, Mr. Gordon Downie, and the important issues surrounding his claim for compensation against my Department. My hon. Friend will recall that we corresponded on this matter last year. However, other than repeating the advice that I provided in that letter, there is little that I can add at present.
I understand that, in 1981, while serving in Belize with the 1st Battalion, Gordon Highlanders, Mr. Downie injured his back during physical training. He was subsequently, after the events outlined by my hon. Friend, medically discharged from the Army in January 1983. Our records show that he submitted a claim in May 1997, alleging that his medical discharge from the Army was a direct result of his accident in Belize and not a consequence of a congenital abnormality to his spine.
Notwithstanding the Limitation Act 1980, which provides that personal injury claims be made within three years of the date on which the cause of action accrued—the date of the accident—or three years from when the claimant knew, or might reasonably be expected to have known, certain specified facts, Mr. Downie is barred by law from suing the Ministry of Defence by section 10 of the Crown Proceedings Act 1947.
Before 1948, no individual could sue the Crown, because of the long-held principle that the Crown could do no wrong. We might discuss that at some stage in another forum, but that was the principle at the time. In 1947, legislation in the guise of the Crown Proceedings Act 1947 was passed enabling the Crown to be sued for acts of negligence. Section 10 of that legislation prevented service personnel from suing for compensation. Section 10 in turn was subsequently repealed by the Crown Proceedings (Armed Forces) Act 1987. Since then, service personnel have been entitled to sue the Ministry of Defence for compensation as a result of the Department's negligence and have had the same legal rights as any other employee against their employer or organisation.
When the Ministry of Defence receives compensation claims, they are considered on the basis of whether the Department has a legal liability to pay compensation. Where there is a proven legal liability to pay compensation, we do so. The amount varies according to individual circumstances, determined by common law principles. However, in the case of my hon. Friend's constituent, as the injury he sustained while serving in the Army preceded the repeal of section 10 of the Crown Proceedings Act, I am prevented by law from paying him compensation.
During the passage of the 1987 Act, the question of retrospection was debated and motions to allow present and past members of the armed forces to pursue claims against my Department for injury or death suffered in incidents since 1947 were moved, but they were defeated or withdrawn. The view that prevailed at the time was that there would have been no logical time to draw a line, short of trying to cover all incidents and all types of injury going back to 1947. To make the Act retrospective would create many new examples of unfairness and injustice.

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My hon. Friend said that he is aware that a former member of the armed forces suffering from an asbestos-related disease recently mounted a legal challenge the case of Matthews v. the Ministry of Defence. However, section 10 of the 1947 Act is incompatible with the European convention on human rights. The claimant alleged a breach of article 2, the right to life, and article 6, the due process right, of the convention. The case under article 2 was that, by exposing him to asbestos dust, the Crown was in breach of its obligation to take positive steps to safeguard his health. The case under article 6 was that, as section 10 of the Crown Proceedings Act is a blanket immunity, it deprives the claimant of his right of access to the court. The matter was heard in the High Court on 10 and 11 December 2001. Mr Justice Keith handed down judgment on 22 January 2002 in favour of the claimant.
The Department has secured leave to take this matter expeditiously to the Court of Appeal, where it will be argued strongly that there is a general presumption that legislation does not and should not have a retrospective effect, in the interests of legal certainty and the rule of law. It is also highly arguable that article 6 of the convention does not give new civil rights to claimants. In the case of service personnel who suffered injury or illness prior to the repeal of section 10, they had no rights until 1987, and therefore in relation to the Crown Proceedings (Armed Forces) Act 1987, claimants would have to argue that the 1987 Act, in giving them a right, was nevertheless deficient. Therefore, until such time as the higher authority has ruled on the case, my Department's position concerning the payment of claims preceding the repeal of section 10 of the Crown Proceedings Act 1947 remains unchanged.
My hon. Friend may recall that the question of retrospective legislation was referred to in the Official Report. The Solicitor General said:
"The Government's policy before introducing a legislative provision having retrospective effect is to balance the conflicting public interests and to consider whether the general public interest in the law not being changed retrospectively may be outweighed by any competing public interest. In making this assessment the Government will have regard to relevant international standards including those of the European Convention for the Protection of Human Rights and Fundamental Freedoms which was incorporated into United Kingdom law by the Human Rights Act 1998."—[Official Report, 6 March 2002; Vol. 381, c. 410W.]
My Department has no way of accurately predicting the number of claims, previously barred by law, that would likely be made if the Court of Appeal and ultimately the House of Lords were to uphold the judgment in Matthews v. the Ministry of Defence. As my hon. Friend will be aware from my correspondence
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of last year on Mr. Downie's case, the War Pensions Agency, which is now part of my rapidly increasing area of responsibility, makes provision for ex-service personnel suffering from injury or illness attributable to their service in the form of a war pension and associated benefits. War pensions are non-discretionary. They are not means-tested and are made on a no-fault, tax-free and retrospective basis. They are also uprated annually. In addition, most pension and related benefit rates vary depending on the degree of physical disability. They do not, however, reflect actual financial losses or hardships.
According to the War Pensions Agency, Mr. Downie has been in receipt of such a pension since the early 1990s and, following a recent successful disability assessment appeal hearing, his level of pension has increased. However, although not relevant in this particular case, my hon. Friend should note that in cases where a recipient of a war pension is subsequently awarded common law compensation, the level of war pension is abated by the War Pensions Agency in line with the principle of a claimant not being compensated twice for the same loss.
My hon. Friend will recall that in our correspondence last year he inquired about the possibility of Mr. Downie being awarded an ex gratia payment by my Department in recognition of his injury. As I explained in my reply then, except for two special categories of claim relating to injuries sustained by criminal activities overseas and accidental injuries sustained by service personnel voluntarily involved in research trials, it is my Department's policy to consider claims for compensation on the basis of legal liability. With the exception of those two categories, I have no discretionary powers to award ex gratia payments. As Mr. Downie's case falls into neither of the above categories, he is prevented also from receiving an ex gratia payment. I have looked at this very carefully and I can see no room for manoeuvre on my part.
I can assure my hon. Friend that his constituent, Mr. Downie, is not being denied any form of compensation to which he is legally entitled. As I have advised today, as well as in correspondence, my Department considers claims for compensation on the basis of legal liability. Mr. Downie is legally prevented from pursuing a common law claim for compensation. I am really sorry that I cannot be more helpful, but compensation legislation is unambiguous and its constraints cannot be set aside, no matter how deserving the case. I am afraid that there is nothing more that I can do at present.
Question put and agreed to.
Adjourned accordingly at seven minutes to Two o 'clock.