Westminster Hall Sitting of 6 November 2002

Preamble
[SIR ALAN HASELHURST in the Chair]

Cancer Networks
Motion made, and Question proposed, That the sitting be now adjourned.—[Joan Ryan.]
9.30 am
Dr. Ian Gibson: This morning's debate on cancer networks is rather appropriate, as the all-party group on cancer is holding a major conference called "Britain against cancer" not far from here in the Queen Elizabeth II Centre. The first day of the conference has been exceptionally successful. The participants have interacted well and have discussed major problems. They believe that progress is being made in the delivery of better services to treat cancer, but the point of today's debate is to discuss what more we can do to assist that progress along the pathways that we all want.
I shall begin with a little history of cancer and its treatment. In 1995, Calman-Hine produced a report with the objective of creating a network of care in England and Wales that would enable patients, wherever they live, to be sure that the treatment and care that they receive is of a uniformly high standard. The report contained several principles around which the delivery of cancer care should be built. It stated that all patients should enjoy access to high-quality care, that care should be provided as close to patients' homes as possible, and that patients, their families and carers should be given clear information about their condition so that they can understand treatment options and outcomes.
The previous Government set the ball rolling. In September 2000, however, this Government signalled a major change by publishing the first comprehensive report for improving cancer care in England, which went much further than the Calman-Hine report. The national health service cancer plan brought together prevention, screening, diagnosis, treatment and research, and set out the Government's plans for future investment in cancer treatment and care. New funding of some £570 million a year extra was provided to support the plan. Clearly, delivering better health services in this country is a major priority. Cancer care is at the forefront, and the Government are demonstrating how to deliver it.
The Government recognised that the quality of cancer care varies throughout England and Wales. In some areas, it rivals the best in the world; in others, it is in urgent need of improvement. Some serious problems need to be addressed—out-of-date equipment, too few cancer specialists, geographical variations in access to treatment, and poor communication with patients. The aim, which we would all endorse, is to save more lives and to ensure that people with cancer receive the right professional support and care as well as the best treatments throughout their cancer journey.
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Tackling inequalities in cancer survival rates needs to be a glorious ambition. Among the problems that the plan addressed was the need to invest in specialist staff, research and preparation for the genetics revolution that is with us now, and to adapt to all the major changes taking place. There were commitments to reduce smoking rates and waiting times, and to improve access to hospitals, hospices and palliative care. Since the publication of that plan, we have seen initiatives such as a ban on tobacco advertising, an extension of breast cancer screening programmes, a national fruit scheme, and investment in primary care with GPs at the forefront with responsibility for cancer services.
We have also seen investment in research. The National Cancer Research Institute has already started to develop strategic plans on how we fund world-class research in this country. Nobel prize winners pour out almost daily as a result of the work that is going on. I predict that there will be more, such as David Lane of the university of Dundee, who, at this very moment, is speaking in the Queen Elizabeth II Centre. His work on a particular oncogene is very important in developing new strategies to tackle the rogue cells of cancer.
Much is happening. There have been improvements in information for patients and in drug assessment and analysis by the Commission for Health Improvement. There have also been visits to different hospitals to look at cancer services and monitor what is happening. Indeed, there is so much activity in this area that it has almost become a paradigm for other services in the health service. Mental health services will build on the back of our experience, and I believe that heart disease services will do the same. We are at the forefront and things are happening, but that activity must be considered in the context of the strategy and the plan for what we are trying to achieve.
One in three people in the United Kingdom will be diagnosed with cancer, and one in four will die of it. At yesterday's conference, Peter Boyle, an epidemiologist of great distinction, presented figures that clearly show that the incidence of, and mortality from, breast cancer and the other major cancers have been gradually decreasing over the past five or six years in Britain. As a result, there is a real feeling that some of the things being done are beginning to pay off in the form of improving rates. It is perhaps not surprising that in other countries, such as Spain, Portugal and Greece, there have been amazing increases in the incidences of cancer. We can all guess the reasons for that; they include smoking, diet and other habits.
We have taken an amazing step forward, but my aim in this debate is to ask, as is my wont, whether we can do more and better. How do we move the situation on? It is no use saying that we have done it all, sitting back and hoping that things will happen. The work force is enthusiastic and determined, although there may not be enough people in certain areas. In a poll at the conference, more than 60 per cent. of the 500 or more people there said that things had got better, which must be music to the ears of some of our friends in Downing street who have to think up these slogans. There is some proof that something is beginning to happen.
However, more could be done in many areas. I do not want to talk about passive smoking, but it is clear that moves are being made on that. There is no definite evidence that passive smoking causes certain types of

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cancer, but there is a suspicion and more work needs to be done. We have started to think about our diets, and more needs to be done on that with the industry. Perhaps companies should be compelled to watch what they put in foods, particularly those given to our young people in school dinners.
Habits and cultures will take time to change, but the process is beginning. I doubt that we will get rid immediately of the culture in Scotland of pizza and chips and everything being fried in batter. That will take a few years, but even the Scots will come round in the end.
I want to concentrate on cancer networks, because they are the organisational model for cancer services to implement the cancer plan, to which I referred. They bring together health service commissioners—health authorities, primary care groups and trusts—and providers, which comprise primary community care groups, hospitals, the voluntary sector and local authorities. Bringing together that group of people, with all the differences in personality and style, is difficult and therefore a real achievement.
I guess that the 34 cancer networks are moving at different speeds, and no doubt some of my colleagues will wish to talk about that. Throughout the country, the networks are working to consider prevention, diagnosis, screening, supportive care, specialist palliative care and so on. I think that they are meant to have reviewed their service provision by now and identified where they need to develop and invest for the future. I challenge my hon. Friend the Minister to say whether all 34 networks have produced their plans, whether they are up and running, and whether there are different tiers or speeds. If there are, what can we do to make them all move at the speed and level of the best?
This is about establishing a patient partnership. Patients have taken centre stage in the NHS. Everyone wants to involve them and their carers in decision making on shaping services, particularly cancer treatment. We shall reform delivery systems by asking people in the networks to collaborate and initiate things in new, fresh and exciting ways. The United States is rather good at that, but we have not been very good at it in many walks of life.
Recently, 17 cancer groups got together. They were from the care and cancer charities, and drug companies such as Aventis and Eli Lilly. One is often cynical about drug companies, thinking that they are interested only in making profits. That is okay but, surprisingly, they have also said in a statement that there should be
"sufficient resources to support the further development of cancer user partnership groups in the 34 Cancer Service Networks in England and similar initiatives across the UK."
In each network, the individual tumour-specific working groups—colo-rectal, breast and so forth—are examining how to develop their programmes. Patients need to be involved fully, not just on an ad hoc basis. To enhance public and patient involvement, patient representatives should sit on the individual working parties as well as the networks.
A Department of Health official, Harry Cayton, well known for his work in the Alzheimer's Society, heartened me yesterday when he stressed the importance of three simple messages about patients. The most
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important was "Trust me, I'm a patient. Listen to me. Please tell me the truth about my condition and don't do anything without involving me." That is the spirit of the age and we have to try to deliver it through the networks. The determination and involvement of patients will enrich the networks' work.
Each network covers about 2 million people. Evidence suggests that they may be moving at different speeds. On 19 December 2001,Hansard recorded that the national health service planning and performance framework required the national health service organisations to work together through the cancer networks to deliver the cancer programme in line with the strategic plans of each of the networks. Everything is in place; the words are written; the people are there. How is it all working out?
We heard evidence yesterday of good work in the Avon, Somerset and Wiltshire cancer network. The secret is that people there are talking together and the important people who deliver the services and carry the cheque books also attend the meetings. They know about the spirit at loose there and that many positive developments are taking place.
I shall refer to some of the issues reported at yesterday's conference. Because the Avon, Somerset and Wiltshire network receives funding from the health authorities, it has five research nurses, five data managers, a research co-ordinator, pharmacy support and additional equipment. It plans to double recruitment by 2004 and to invest more in education and support for all research staff. I suspect that it is the best network in the country: it is working and doing well. It would be good to see it doing even better.
The networks throughout the country also meet and talk to each other through the cancer services collaborative: they audit each other and discuss best practice among themselves. That reveals the positive indicators. We have seen quite a few success stories and I should like to hear colleagues telling me more about success stories in their networks.
Two further initiatives are required. I am sorry to be a bore on cancer again, but I remain committed to a national cancer Act in this country, akin to that in the US, which is currently being revised. It has proved the key to delivering support to all the cancer services in the US: it is the model that we should follow for the next stage of our cancer strategy.I argued in favour of that in a 10-minute Bill in May this year.
It is great to have a national cancer director—the so-called tsar—and Mike Richards has done a sterling job across the country, stimulating and organising the services. But why just one? Why not also have, as the Americans would say, a quarter-back in every network? It would be good to have more tsar-type leaders with the authority to drive and push forward the agenda.
The time has truly come for a national cancer Act, which would ensure that funding is delivered into cancer services year-in, year-out. Services must not be allowed to stutter because of lack of resources.
I chair the Select Committee on Science and Technology. As the Minister knows, we investigated where the extra investment in cancer services has gone. I am unsure how the Minister will react in reply, but we stimulated awareness of the fact that the money does not always get to the coal face, to the people who need it.

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However, that is not quite true. Current evidence shows that at least some of it is getting through to the coal face, and that people are seeing a difference. I do not believe that 60 per cent. of people would say that there was a difference unless they had seen a change, so some of the money is getting there.
However, we need an audit trail of that money so that when we say that it is going to a particular target, it reaches the cancer service that we want it to. Sadly, health authorities can use some of the money to meet wage increases and pay off debts. That is not good enough. If we are to deliver the cancer service that we know is possible, we need to ensure that that money gets through.
Again, at the conference yesterday, when the question was asked and the keypads were pushed, more than 60 per cent. of people agreed that the money was not getting through. I was heartened that 70 per cent. also said that they wanted a national cancer Act, so I have some support for that at present, even if it does not last. I see in the Gallery today that there are people from various networks throughout the country that are doing fine work. It is important that the people from networks, as well as those at the conference and practitioners, agree with me that much of the money that is given to cancer services by the Government is not getting through. Will the Minister assure us that the audit trail is being sharpened up?
We should ask why the radical and bold solution of giving the money straight to the cancer networks should not be adopted. If the people in those networks are doing a good job, and know the priorities in their areas, they will know what is most important and will take decisions on that basis.
The Government are determined to make sure that decisions are taken as close to the point of delivery as possible. This is a real opportunity to do what has been done so brilliantly in schools. Giving head teachers, who may not agree with what I am about to say, a sum of money, say £150,000 or £30,000, sends a strong message to them. It says that they can choose whether to use that money to hire a teacher or a classroom assistant, to put up a partition or to sort out the playground, and they know that they will receive that money every year, so they can plan on that basis. I believe that all cancer networks would engage much more sharply if they had a sum of money about which to decide in their locality so that they could be seen to be delivering for local people. There is no doubt that money brings influence, and I ask the Minister to consider that radical move.
The Government must preside over the resources and monitor the work that takes place. I should like the assurance that all the networks are being examined, and that those that are lagging behind are asked the reasons for thatߞwhether it is leadership or some other factor that means that they are not delivering in the way in which, for example, Avon has.
We must be bold and radical. Our health service is on its way to delivering the best cancer services in the world. The messages that we receive and the lessons that we learn from that area will impinge on our delivery of the mental health Act when it is eventually considered in this place. I am enthused and excited by what we have done. I would not have expected, during my lifetime, to have reached the stage that we have attained during the
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past three or four years. The 500 people at the conference who represent people throughout the country feel the same.
The debate and the issues have changed. We are enthusiastic, perhaps too much so, but if that is the case, the Minister will no doubt slow us down.
Several hon. Members rose—
Mr. Deputy Speaker Mr. Deputy Speaker: Order. Before I call the next hon. Member, I draw hon. Members' attention to the grammatically challenged notice on the Annunciator, and assure them that we are not under orders to evacuate at present. We are cleared to continue.
9.48 am
Mr.David Tredinnick: Indeed, there is quite a to-do outside with the fire brigade all over the place.
May I say what a privilege it is to follow the hon. Member for Norwich, North (Dr. Gibson), who modestly said that he never would have believed that in his lifetime the pace of change would have increased so much in the House? I am glad that he does not represent Leicestershire because I would probably have to campaign against him. He has made a great contribution to cancer care from the Back Benches, and has relentlessly driven that agenda. It is a pleasure for me to follow him. It will be no surprise to hon. Members that I will focus on an area that I have focused on for most of my 15 years in the House and consider some of the complementary aspects of health care for cancer. The Minister's task would be infinitely easier if she were to take more account of the 60,000 complementary practitioners, who generally work in the private sector, and who are always prepared to help cancer patients.
I was struck by what the hon. Gentleman said about the 34 cancer networks. What an opportunity they provide to roll out some of the care listed in the wonderful directory of complementary therapy services in UK cancer care, which is published by Macmillan Cancer Relief. He said that he could not believe how far the cancer treatment movement has come in a few years, and I, too, find it hard to believe how the wind has got behind the complementary movement. The Government themselves are taking some of these issues seriously, perhaps because they have been raised relentlessly and repeatedly in the Chamber. The hon. Member for Oxford, West and Abingdon (Dr. Harris) smiles, as he always does, which is a good thing. Perhaps he is agreeing with me—we shall find out soon.
It is instructive to go to the directory, which lists available treatments on every page. I shall read one or two passages, although I know that we must not read out too much, as I have been called to order in the Chamber in the past and I will not make the same mistake again. The directory quotes a cancer patient who states:
"It's acupuncture that's helped me to cope with the chemo".
That is very true. A patient who took part in a relaxation therapy group said:
"I've learnt to carry on the relaxation at home too. I sleep better and don't get so worked up."
Another patient said:

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"When I first decided to ask for healing"
therapeutic touch, the transmission of energy through a person who is trained to do it, usually because they are able to focus on light—
"I had no idea what to expect. When it started, I began to calm down a little."
The patient now feels much better. A lady who was treated with aromatherapy said:
"I went in as one woman and came out as another".
Roy, a patient describing reflexology, said
"I sleep really well now. I am so relaxed afterwards."
A great friend of mine was diagnosed as suffering from cancer by a reflexologist in the private sector who simply said, "I can sense that you've got a major problem." My friend went in for emergency treatment and has survived.
If the Minister can draw these therapies progressively towards the health services it will make her life in trying to deliver a health service on which there are ever increasing demands that much easier. When respectable organisations are involved in producing this type of DirectoryߞMichelle Kohn has done so much with Macmillan Cancer Reliefߞthe Government must sit up, take notice and think closely and carefully about what the different treatments can do.
I now want to draw hon. Members' attention to Chinese medicine, which is going through a process of regulation, which I welcome. There are many shops throughout the country where people purport to do things that they are not necessarily doing. There have been some scares about Aristolochia, which we all know about, and it is right to move towards regulation. However, there also needs to be a better rollout in the health service, because the pain relief that acupuncture can provide is desperately important for cancer patients.
The use of Chinese herbs is also important in arresting cancer symptoms and keep PSA—prostate-specific antigen—levels down. It may help hon. Members to think of Chinese medical herbs as being like the Whips Office, because they work in the same way: there is a chief herb—
Dr. Gibson: Does the hon. Gentleman mean poison?
Mr. Tredinnick: We hope to avoid the Aristolochia effect. The hon. Gentleman refers to his own Whips, and I will not prejudice his career, as no doubt they are listening.
There is an assistant, or deputy, herb and a messenger, which all work together and help each other. Chinese medicine is fantastically powerful in prevention. The Government should take much more notice of that.
I have referred to acupuncture. There is also homeopathy, a hugely important range of treatments that is available to everyone now. A couple of weekends ago I presented the homeopathic awards at the Society of Homeopaths for those who had trained over four years. Then there is the whole healing movement. The Minister should also be aware of other simple devices that can go a long way towards relieving pain. One
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example is this transcutaneous electrical nerve stimulation machine. It sends an electronic current from one part of a limb to another and is very effective in dealing with acute pain.
Mr. Deputy Speaker: Order. The hon. Gentleman knows that aids of that kind are not normally brought into our proceedings.
Mr. Tredinnick: I have never sought to invoke aids that are forbidden in Parliament. I apologise. What I was hoping to demonstrate, which I now will be unable to do, was a simple TENS machine. Other pieces of equipment are coming on the market now, which look very similar and contain the frequencies of up to 20,000 homeopathic medicines. By connecting them to a wrist strap it is possible for the person to invoke the signature of that remedy and the body automatically interacts with it. It has been developed by a scientist. This is looking at the horizon. This is where I think we will be going in future.
Another area on which the Minister should focus more carefully is the whole healing movement. The group of people who have perhaps done the most with the least recognition for those suffering from cancer, particularly in hospices, are those in the healing movement, the therapeutic touch people. Whether or not one believes in channelled energy or in the results of the extensive trials that have been carried out, anyone who has had it will generally notice an effect of heat going through hands. Such treatment is very effective in reducing symptoms and bringing about well-being. It can give someone who is on their way out an extension of life. I should also like to pay tribute to Lucy Bell and her cancer care team at Charing Cross and Hammersmith hospitals. They well illustrate how complementary therapies can and should be combined in the cancer networks. This successful practice uses massage, aromatherapy, reflexology, relaxation and even an art therapy to treat patients. Its results have been demonstrable and significant.
Let me turn to more general health service issues, but still within the context of cancer care. I have always thought that one of the Government's fundamental problems is that they do not focus enough on preventive medicine. The hon. Member for Norwich, North touched on the issue of diet, which is crucial. We should pay more attention to the problems of obesity and lack of exercise. I welcome the new parliamentary groups that are springing up to address these issues.
The Government should be persuaded to make more of an effort to encourage people to take responsibility for their own health, for example using these little machines. The other machine with the homeopathic remedies that I was going to demonstrate looks very similar to the TENS machine. If people tried homeopathic remedies, which they can now get over the counter at chemists, it would reduce the pressure on doctors' surgeries. If that 5 per cent. of so-called heart-sink patients could be got away from the surgeries, there would be a better turnover of patients who can most likely receive effective treatment. About 5 million people in this country regularly use the treatments that I have described, not just cancer patients.
There is a fundamental problem of staff shortages in the health services. The Government spend £300 million a year on agency staff to fill the gaps. I am not saying

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that complementary therapists can fill all those gaps, but a more effective use of therapists in hospitals would take the pressure off hard-pressed nurses and help improve patients' health.
Regulation has been mentioned. The Government are supporting the efforts of the Foundation for Integrated Health to draw together the various representative bodies of complementary health care. I pay tribute, in particular, to the work of Professor Pittillo, not to be confused with my right hon. Friend who has been in the news recently.
Dr. Gibson: Are you supporting him?
Mr. Tredinnick: I shall not be sidetracked down that path.
The speedy introduction of regulation would be most welcome, and it would be worth while in the long term if the Minister could find a small amount of money with which to speed up the process. We need to complete the regulation of Chinese and herbal medicine, as well as of aromatherapy. Then doctors would find it easier to make referrals, because they would feel less threatened.
That leads me to the training of doctors. There has been a welcome move in medical schools to ensure that newly trained doctors are made more aware of the important issues. Every year, 5 million prescriptions for painkillers are issued at a cost of £265 million. Furthermore, £370 million of health service money is spent on painkillers in supermarket pharmacies. Treatment of the side effects of painkillers costs the NHS between £170 million and £350 million. The Government should focus on those costs and consider the alternatives that are available, such as acupuncture or methods recommended by the healing movement, represented by the Confederation of Healing Organisations. In that way, Mr. Deputy Speaker, the Government would find it easier to meet patients' demands as well as their own targets.
Mr. James Cran (in the Chair): For the avoidance of doubt, I am not Mr. Deputy Speaker, but merely Mr. Cran.
Mr. Tredinnick: On a point of order, Mr. Cran. I was under the impression that, in this Chamber, it was our duty to call you Mr. Deputy Speaker regardless.
Mr. James Cran (in the Chair): No, it should be Mr. Cran.
10.2 am
Dr. Desmond Turner: I thank the hon. Member for Bosworth (Mr. Tredinnick) for providing us with a new insight. I now know that the role of the Government Whips Office is to add a little flavour to our dull lives in this place.
I endorse the comments made by my hon. Friend the Member for Norwich, North (Dr. Gibson) about cancer networks, cancer centres and the cancer Act. Now that we have them, we can say that cancer networks are obviously a good thing—the wisdom of hindsight is marvellous—but we cannot prove it because there have been no double-blind trials to show how much the cancer networks contribute to the improvement of
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cancer survival rates. However, it would defy logic if they did not help because the reasons for their effectiveness are obvious. Nevertheless, they have not always been obvious to the public or to general practitioners, and there is a substantial job to be done educating people.
That is one of the reasons why I support a national cancer Act, which would bring the matter firmly to the public attention and to the attention of all those in the health service who have not yet got the message. The Department of Health is reluctant to select disease areas for special treatment, but there is a case for doing so with cancer, which is uniquely biologically complex. Furthermore, it can be regarded as a paradigm for all health care: if one achieves success with cancer, one can transfer the methods and organisational and scientific approaches that one uses, and massive parts of the knowledge that one gains, to the rest of health care. One can then raise standards throughout.
It is obvious that centres of excellence with full multidisciplinary teams to cover all the areas of specialisation relevant to cancer promote interaction and the more rapid development of clinical procedures. They also promote better results for patients, which is the key to it all—if patients benefit, our approach must be right. That is the way to proceed, and it is increasingly recognised across medicine that people who encounter more cases—whether surgeons, oncologists or whatever—will provide more efficient and quicker treatment, with better results. It is as basic as that.
There must also be a concentration of heavy physical facilities, such as imaging equipment, which is becoming increasingly expensive, and radiotherapy equipment. We cannot spread such equipment around, with isolated machines in different general hospitals; we must concentrate facilities in regional centres for sheer cost effectiveness—we should never forget the importance of cost-effectiveness in delivering a health service. All the logic therefore points to cancer centres, with a collaborative network around them; they are the obvious way to proceed.
I wish that I could say that that view was universally appreciated, but local experience tells me that it is not. It is not appreciated by local elected representatives in Sussex, by all doctors or by all members of the public. I am glad to have in my constituency a general hospital, which is about to become a teaching hospital. It is also a regional cancer centre. It is still developing, and it has quite a long way to go. It ran into a problem, however, because it is on an awful site and it has grown like Topsy in a place where, ideally, it should not be. One day, the trust's chief executive suddenly thought, "Oh dear! Under phase 2 of the development plan the portakabin that houses the breast assessment centre needs to be moved. Where shall we put it? Oh dear, we can't find anywhere. Oh well, we've got a sister hospital in Haywards Heath; let's build a new breast cancer unit there." In other words, the plan was to remove facilities for treating the most common single form of cancer from the cancer centre. All medical practice and logic tells us that that is nonsense, but that was the idea, although it started as a purely administrative device. Fortunately, another site was chosen 20 ft away; it is just over the road from the main cancer centre, so it is perfect. However, there was an incredibly parochial campaign by people from the hinterland of mid-Sussex

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and Haywards Heath who wanted their own centre of excellence. They clearly had not understood the simple message that one should concentrate services for specialist areas such as cancer if one wants results. Had those people succeeded, cancer patients in Sussex would have been the sufferers in the long term because the service would probably—I believe undoubtedly—not have been as good as the service that will now be maintained in Brighton, although that cannot be proved. There would have been a loss for patients: in cancer cases, they would have died—the issue is as basic as that.
The message still needs to be drummed home to the public that that is the way that matters are developing. The message also needs to be drummed into GPs, although that is not a universal criticism. I am a member of the Select Committee on Science and Technology, and when we were doing our cancer report, we were made aware of the variability of knowledge of cancer among GPs. In the first instance, patients go to their GP. If they are lucky and their GP recognises the signs and refers them, that is all right, although that does not necessarily happen. All too many patients go for many months presenting with cancer symptoms and being misdiagnosed. Although cancer is very common—one in three of us will at some time be diagnosed with cancer—the individual GP does not see that many cancer patients in a given year. GPs need a lot of support and education if they are to play their part in the cancer networks, and benefit patients.
The principle of the cancer network is a good paradigm for other specialist areas. The time has long passed when we could expect every district general hospital to do everything. Life has become more complicated and problems more specialised. There are fields for which the equivalent of cancer networks and cancer centres are appropriate. Cardiology is an obvious example—I am happy to say that there is a cardiology centre in my constituency also. Some types of surgery are appropriate for that approach. I would nominate orthopaedics. Orthopaedic surgeons who do a lot of hip replacements on a factory basis produce magnificent results. Those who do one once in a blue moon inevitably do not produce quite the same results. It is best to centre developing technologies so that there is the throughput to make them work effectively. Neurosurgery is another complex surgical field in which the same approach is inevitable.
Cancer networks are a leading example of a principle that we should apply carefully throughout acute health provision. We should not expect every district general hospital to specialise in everything. In a given district, one may nominate one district general hospital to be the leading centre for a given medical condition. In the long term, that will lead to more effective and efficient health care and better outcomes for patients. Cancer networks are leading the way. I ask the Minister not to reject out of hand the notion of a national cancer Act, because it has a lot to offer.
10.13 am
Mrs. Patsy Calton: I congratulate the hon. Member for Norwich, North (Dr. Gibson). As other hon. Members have said, he has made a great contribution to the debate on this subject in the House and elsewhere. On a personal note, I want to thank him for his interest in the development of my thinking on the matter since I came to the House. I am a relatively new Member, and I am grateful to him for the time that he has spent ensuring that I understand what is happening.
The Government published their NHS cancer plan in September 2000. It acknowledged that cancer treatment, although excellent in places, was not of the same high quality or accessibility for all patients. Ten years ago, services were fragmented, as Professor Peter Boyle suggested yesterday in his speech at the "Britain against cancer" conference, hosted by the all-party parliamentary group on cancer. There was no national guidance and there were no multi-disciplinary teams, except in breast cancer.
Cancer networks were expected to take responsibility for implementing the NHS cancer plan. Health authorities, primary care trusts and service providers would have to work together to plan for the investment in cancer services needed to implement the network strategy. The cancer plan set clear targets for cancer networks. By 2001, they were expected to develop strategic service delivery plans to cover all aspects of cancer services. In the document, those aspects were defined as prevention, screening, diagnosis, treatment, supportive care, and specialist palliative care. Again by 2001, the networks were expected to have developed underpinning strategies on work force, education and training, and cancer facilities. Emerging network plans were expected to be reflected in health improvement plans and service and financial frameworks by 2001.
It is now 2002 and 34 cancer networks are in place, but there is a vast difference in the level of implementation achieved. Yesterday, we heard that the Avon, Somerset and Wiltshire network seemed to be working as a joint enterprise, although it was a little unhappy about the word "seemed". Clearly, it has come a long way. It serves a population of 2.1 million people, with seven trusts, two strategic health authorities, 12 PCTs, five hospices and 65 groups from the voluntary sector.
When a network is pulled together, no doubt the commitment of professionals, support staff and those in the voluntary sector—including those involved in complementary medicine and hospices-can be harnessed to produce a sum greater than the parts, and to improve services for patients. However, the Greater Manchester and Cheshire network, which serves more than 3 million people in my area, has only just got going. When preparing for the debate, I thought that there was nowhere better to start than my own area. I was surprised that I knew nothing of the cancer network that served Cheadle; having been a patient, I have a particular interest. I searched the cancer network website, and found only the name and associated trusts, so that network has a long way to catch up.
In "The NHS Cancer Plan: Making Progress", which was published by the Department of Health in 2001, the Government claimed that progress was being made on faster treatment. However, they failed to publish any statistics on efforts to meet the treatment targets. A

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parliamentary answer to my hon. Friend on 11 February 2002 suggested that the Government did not know whether they had met the target set for December 2001 of a maximum one-month wait for breast cancer treatment. It is also clear that the Government drive for patients to be seen within two weeks does not reduce anxiety when treatment takes more than three months to arrange.
The Avon, Somerset and Wiltshire network has put patients at the centre of the service. The intention must be to provide a seamless service for patients, who have enough to cope with being ill and having to face treatments that are at least unpleasant. Although doctors and nurses work hard within the resources available, too often it can appear that hospitals and services are run around the needs of the service providers. Cancelled clinics are the norm. Patients trail all over the hospital site or from clinic to clinic, clutching inadequate information. Tests are delayed.
In a Government survey of cancer patients published in 2002 and based on data collected between 1999 and 2000,16 per cent. of patients could not understand all or most of doctors' answers to questions about cancer, 10 per cent. had to wait seven months between diagnosis and treatment and a further 16 per cent. had to wait between three and six months. Among prostate cancer patients, 22 per cent. had to wait for seven months, while 87 per cent. of all patients had to wait for more than a month between noticing symptoms and being treated, 21 per cent. for seven months. Nursing needs on discharge from hospital were not even discussed with 37 per cent. of patients.
In my experience, patients' suggestions are often treated as complaints. A hospital with which I was involved had a policy of phoning patients to ask whether they were satisfied with their treatment. I said that I was, but that I had some suggestions and that I would write in with them. I did that—they were simple and patient-focused, but I received a reply that said that if I wished to make a formal complaint, the hospital would be happy for me to send it in. I considered throwing it in the bin, but decided to write back to say that I was not complaining but answering the question about whether there could have been improvements in the treatment, and when I did so there was a sudden assumption that I was making a complaint. I was not; I was simply making helpful suggestions and I wanted to hear that the hospital authorities were going to take notice of them. Sadly, that did not happen.
As the hon. Gentleman mentioned, Harry Cayton said yesterday that patients need to be listened to. The vast majority of patients are supportive of their doctors and nurses and of the national health service. They recognise how hard the professionals are working just to stand still. The complaints system treats patients as nuisances to be worn down with lengthy, unnecessary procedures that leave those without stamina exhausted and frustrated and those with stamina angrier than when they started. The Liberal Democrats believe that the NHS can be reformed—our vision is of an NHS that is decentralised, easily able to adapt to the needs of local people and accountable. Cancer networks should provide strategic development plans to ensure that the hard work and commitment of the professionals is supported with up-to-date equipment, trained support staff and a streamlined service to patients.
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For there to be accountability, there must be clarity about where funding goes. The Liberal Democrats are concerned about the health service's culture of secrecy about how funds are allocated and diverted between budget headings. Even health professionals are not convinced about whether cancer moneys have reached the services for which they were intended. As the hon. Gentleman said earlier, at yesterday's all-party cancer conference, 14.1 per cent. thought that the moneys were reaching the services for which they were intended, but 41.6 per cent. said that they were not and a further 44.2 per cent. did not know. That was a poll of people who were mainly health professionals and volunteers supporting those with cancer. Nearly 86 per cent. of the people who should know best what is happening either do not know or think that funds have been diverted. The Government should be very worried by that statistic.
Lack of co-ordination is at its most stark in research into the prevention and cure of cancer. Prevention should be at the forefront of research, yet I hear of the struggle in my area to obtain funding for research into the lifestyle causes of breast cancer—work on exercise and diet that could give much-needed pointers to the one in nine women who need to reduce their risk of getting the disease.
Those at the Europa Donna lecture last week heard from Dr. Martine Piccart, a consultant oncologist, who referred to the lack of co-ordination in chemotherapy research trials. In far too many duplicated studies, the same questions are being asked of far too many people; what is needed is different questions and a pooling of information.
The hon. Gentleman referred to a national cancer Act. The Liberal Democrats would not oppose such an Act, but we would want it to be clear about what was envisaged—and especially whether it would produce more centralisation and prescription rather than enabling local areas to take responsibility for local matters.
We do not believe that tsars are an answer; the very word has almost come to mean that those areas that appoint one will probably not get the attention that they deserve. Resources should support those who deliver the service, and I absolutely agree with the hon. Gentleman that there needs to be a transparent audit trail, showing how the resources get to where they are needed.
The hon. Members for Bosworth (Mr. Tredinnick) and for Brighton, Kemptown (Dr. Turner)—the latter has left the Chamber—spoke of complementary medicine. We very much support complementary medicine, but it should be exactly that—complementary to the support given by recognised, acknowledged and tested treatments. It undoubtedly brings great benefits to patients and should be part of the seamless service on offer to patients.
The Liberal Democrats have supported the vision of cancer networks since the cancer national services framework was published in 2000. The networks have the potential to offer patients modern, streamlined services that reflect local priorities and local needs. Health service professionals provide excellent service when they can, but their work is frustrated by poor resources, and inadequate buildings and equipment. They have to run in order to stand still. Cancer networks could provide them with the opportunity to work

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smarter rather than harder. However, two years on there is still a long way to go before patients will see sustained benefits. I hope that the Minister will tell us how she expects to inject fresh drive into areas such as mine that have only just started.
10.27 am
Tim Loughton: First, I add my congratulations to those already expressed to the hon. Member for Norwich, North (Dr. Gibson). It is with a sense of déjà vu that we debate cancer in this Chamber, because the hon. Gentleman is always here even if he has not instigated the debate. He has a fantastic track record on the subject, and it is a shame that more hon. Members are not here this morning. I presume that they are at the Queen Elizabeth II centre attending the conference that he has organised.
I also congratulate the hon. Member for Cheadle (Mrs. Calton) on her performance on the Liberal Democrat Front Bench. I am sure that we shall cross swords on many occasions on health as well as other subjects.
As usual, the hon. Member for Norwich, North made some interesting points. He is right that much progress on cancer care has been made over the past few years, but there are still many gaps and much progress still needs to be made. The hon. Gentleman is quite rightly always pressing the Minister—as we all do—for more. However, there are still enormous inequalities in cancer survival rates throughout the country, which compares badly with countries on the continent. Indeed, from the examples that he gave, Scotland may be the toughest nut to crack.
The hon. Gentleman's idea for a family of cancer tsars is slightly alarming. The Government already have more tsars than the Romanovs ever had in Russia—and, taking after that country, the Government have already started to give some of them the metaphorical bullet. It is not necessary to add to the fleets of tsars—or tsarettes-in order to put them in charge of cancer networks.
Mr. Tredinnick: Tsarinas.
Tim Loughton: A tsarina is a female tsar. A tsarette is a little tsar of either sex. It would be difficult to see that as a universal panacea for what might be going on in cancer care.
I agree that we need to sharpen up the audit trail—and I might come back to the business of the missing funds. I also have great sympathy with the suggestion that more money should go directly to cancer networks; that is a very attractive proposal, and it is in keeping with the policy to cut out far more of the middle ranges of management, which we are researching and following. We want to see much more money going directly from the Secretary of State to local providers such as cancer networks.
No debate on cancer—or on almost any aspect of health care—would be complete without the contribution on complementary medicines of my hon. Friend the Member for Bosworth (Mr. Tredinnick). It is sad that Mr. Deputy Speaker did not permit him to
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bring out his little devices to give us an audio-visual display, but he can show them after the debate to anyone who is interested in them. My hon. Friend likened the Whips' Office to a herb patch or herb garden; I have never thought of it in that way. It has always been the duty of the Whips to keep rebels at bay, and it is always sensible for one to heed the sage advice of one's Whips, but he has put that in a new perspective. He also raised some serious points about the need to regulate complementary medicines; where they are scientifically proven, they have a great role to play—not least in the areas highlighted in Macmillan Cancer Relief's new book.
The hon. Member for Brighton, Kemptown (Dr. Turner)—who is no longer present—spoke about the cancer network that covers the area that he represents: it also covers my constituency, which is next door to Brighton. He is right that we need to centralise some of the cancer infrastructure and machinery—in this case, it is being centred in Brighton. He also mentioned what he referred to as a parochial campaign by people in my area who did not want their cancer centre to be removed from Haywards Heath to Brighton. However, that had great implications for the longer-term rundown of the Princess Royal hospital at Haywards Heath. There were also many implications for the transport infrastructure in our part of the world; it is difficult for people to travel across what is a rural county into the city of Brighton and Hove. However, I largely agree with his conclusions.
We have heard much about the structure of the cancer networks. There are 34 of them, and they are organised into 11 regions. Within each network, every primary care organisation—the primary care trust, for instance—will have a lead clinician whose job will be to provide strategic leadership in the development of services for cancer patients within the PCT, and to contribute to the development of the network. They will also be responsible for ensuring that services are responsive to patients' needs, which is very important. They will have joint funding from the Department of Health and Macmillan Cancer Relief: that will mean that each PCT will have about £5,000 to fund the lead clinician post. However, Glen Purland, the head of policy development at Macmillan Cancer Relief, said:
"The scope of their job is huge and these people are only funded for two sessions per week at most."
The Runcorn GP Cliff Richards—not to be confused with Cliff Richard—is very involved with his cancer network. He commented:
"While we have a national shortage of GPs, it's difficult to see how they can find the time to sit down in their multidisciplinary meetings. This is something the network can lobby for but it's not something we can demand. We may not need huge new resources but we will need the time because we're talking about changing clinical behaviour and the way we work as teams. Without protected time for education and multidisciplinary training, it will be very difficult."
He makes important points that must be taken on board. However good cancer networks are in principle, only when they are put into practice will we be able to establish whether they will be successful in the delivery of services, which is all-important.
We hear much about performance targets, not least in the area of cancer treatment. Performance targets—including maximum one-month waits, targets on the

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time from urgent GP referral to treatment for children's and testicular cancers and acute leukaemia, targets from diagnosis to treatment for breast cancer, which were supposedly introduced last year, and targets from diagnosis to treatment for all cancers—will be in force by 2005. By this year, there should be a maximum two-month wait from urgent GP referral to treatment for breast cancers, and the Prime Minister, in his speech at the Labour party conference, said that he could tick that box. By 2005 there should be a maximum two-month wait from urgent GP referral to treatment for all cancers.
Reeling off a list of plans, targets and schemes that have been published and "met" should not be the benchmark of the Government's success in tackling the causes and treatment of cancer. What should be measured is the output and outcome, not the amount of paperwork, which the Government are so good at producing. Professor Gordon McVie, the director general of the Cancer Research campaign, said that the targets are reasonable given the state of the NHS, but very soft compared with Holland or France, for example. In France, one can expect a consultant appointment in a couple of days, not a couple of weeks. Let us not delude ourselves about the distance that we still have to travel to catch up in that regard.
Cancer patients and the cancer networks themselves are in no way immune to the problems throughout the NHS. Cancer specialists have asked for 600 oncologists—specialist cancer doctors—during the next three years, but they have been promised 1,000 in six years. The Government need to be going further abroad rather more aggressively to recruit those extra doctors. I shall return to that question at the end of my speech.
There is little point in reducing the waiting time to see a consultant if there is a delay in access to diagnostic equipment or the treatment is simply not available within the NHS. Specialists must now concentrate their valuable time and resources on consultations for diagnosis, which leaves them little time for treatment thereafter.
The great problem, especially in my area, is the shortage of radiographers and radiologists, as the hon. Member for Brighton, Kemptown would agree if he was still here. The Department of Health figures from a few months ago show that 130 consultant radiology posts have been vacant for more than three months. There is a severe shortage of consultants in that speciality, with the breast screening service alone believed to be short of no fewer than 200 consultants. In the hospital in my constituency, only recently were we able to fill a consultant radiologist vacancy after three years. The vacancy rate is stark for radiographers in our part of the world: there is a 5.1 per cent. vacancy rate for diagnostic radiographers in the south-east and a 13.1 per cent. vacancy rate for therapeutic radiographers. That means that we are missing about 30 therapeutic radiographers.
As we heard earlier, there is a problem with cancer funding being siphoned off. The Committee chaired by the hon. Member for Norwich, North did the House a great service in producing a hard-hitting report that brought the issue to everyone's attention. Money promised to improve cancer care appears to have been siphoned off by the NHS to pay for other priorities, not least to cover shortfalls on accumulated debts or carried-over debts. In the Government's cancer plan,
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published in September 2000, the Government promised to increase spending on cancer care by £570 million a year by 2003–04, but the hon. Gentleman's Committee identified £280 million or so in the first round of funding that had been diverted by NHS trusts to pay off debt or to meet administration costs or other targets. The Department of Health itself admitted that it was not entirely sure where the money had gone.
That is evidence of a lack of funding reaching the front line. Professor Jonathan Waxman, professor of oncology at London's Imperial college, said that the money was
"not coming to the coal face. The Plan says the right things, but the money has to come in and, at the moment, there is no funding to put doctors and nurses in posts. As a result, waiting times have gone up because we have more to do, but there are very few of us to do it."
Locally, Stuart Welling, the chief executive of Brighton and Sussex University Hospitals NHS trust, which got very little from the cancer care plan, said:
"Out of £407 million, I would have expected to have seen rather more."
Jo Yardley, the general manager of the Kent oncology centre in Maidstone, said that the centre had asked for in excess of £1 million for this financial year. She said:
"It was reduced to £650.000 and has now been reduced again … The waits cause immense anxiety yet I have never reported on any"
national
"performance programme. It's something that we have been crying out for for years."
Hilary Thomas, a professor of oncology at the Royal Surrey County hospital, said:
"When the money comes in, the chief executives want to put the money into achieving the targets over which they will get sacked."
As The Sunday Times said,
"The public should know that one patient might be getting their varicose veins surgery done to meet some silly target in a manifesto and another",
who does not appear on the waiting list,
"might not get radical treatment for cancer that may make a difference to whether they live to old age or not."
There are many examples from around the country of senior oncologists within cancer networks feeling that they do not see the money at the sharp end where it is really needed. Progress has been made, but the system still militates against much more progress being made in future.
Has the Department of Health yet worked out where the missing money went, and is it prepared to account for it? What progress has the Department made in recruiting new oncologists, and at what level? What success is it having in recruiting from abroad? Press reports say that there has been an increase of only 45 medical staff—doctors—recruited from the continent, and already we are hearing stories about German and French teams leaving after only a few weeks or months in the country.
What progress has been made in recruiting radiologists and radiographers, particularly in the south-east, where shortages are greatest? What progress has the modernisation agency made in extending the cancer services collaborative programme to all cancer networks by 2003, and what practical effect will that

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have on delivery of cancer services? Will the Minister also give an update on the progress made in integrating prevention work into the cancer networks, not least in relation to alcohol—we still eagerly await the Government's alcohol strategy—diet and obesity links to cancer?
What progress has there been on the development of software for a cancer database at primary care level, and which Minister is leading on information technology in the national health service now? What assessment have the Government made of the great diversity in service delivery between the networks, and how will they communicate that information to the House? Those are interesting questions, which will give pointers to how far and how fast the Government are progressing the cancer networks.
The subject is important. Cancer networks are important developments, but the networks are not the be-all and end-all of progress in eliminating cancer in this country. Surely it is what the networks deliver that is all-important to our constituents, and surely it is delivery progress that we need to know more about, rather than progress in setting up yet more structures.
10.42 am
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): 1, too, congratulate my hon. Friend the Member for Norwich, North (Dr. Gibson) on yet again raising the issue of cancer services. He does us all a service by speaking in Westminster Hall and the Chamber on a regular basis and reminding us that we have made progress on cancer but still have a lot more to do. I am genuinely grateful for the constructive pressure that he puts on me in relation to both funding and service delivery.
I welcome the hon. Member for Cheadle (Mrs. Calton) to the Liberal Democrats' Front Bench. I shall come to her comments later, but the picture of misery that she painted is not one that I particularly recognise in cancer networks. I hope that, as time goes on, she will become a little more optimistic about the progress that the Government are making. People from various networks across the country who are daily involved in trying to improve cancer care are present today and I am sure that they too welcome the debate.
My hon. Friend the Member for Norwich, North is chairing the all-party group on cancer's fourth "Britain against cancer" conference. I understand that yesterday, on its first day, the conference was extremely well attended. A number of high-profile speakers, including my right hon. Friend the Secretary of State for Health, made a contribution. Professor Peter Boyle, from the European Institute of Oncology, presented data showing that, among EU member states, the United Kingdom was one of the top performers in reducing cancer mortality since 1960. That confirms the findings of Professors Sir Richard Doll and Sir Richard Peto, who last summer reported that, since the 1970s, Britain's men have had the world's sharpest fall in premature death from lung cancer, and, in the past decade, British women have had the world's biggest decrease in deaths from breast cancer. There is more work to be done, but
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we must acknowledge that Britain is certainly moving in the right direction in beginning to tackle cancer, one of the biggest killers.
Mrs. Calton: There have undoubtedly been improvements, particularly in the prevention of men's cancers. There is, however, a long way to go with regard to women's cancers, particularly that associated with smoking. In fact, the position of women is very different from that of men. Will the Minister comment on the steps that the Government are taking to ensure that women here see the same reductions as have occurred in other parts of Europe?
Ms Blears: I was about to say that the data confirm that we are right to invest in preventive services. Several hon. Members raised the importance of prevention, in addition to treatment and research into a cure. The hon. Lady must acknowledge that this country now has some of the world's leading smoking cessation services. Both Zyban and nicotine replacement therapy are available on prescription and 40 per cent. of such prescriptions are free, so we are clearly getting through to people in poorer communities who smoke more than those in better-off communities. We should also consider the issue of women's smoking and alcohol consumption. The shift to preventive measures is, therefore, a top priority for the Government.
But we are not complacent. I simply want to set the scene and say that we are going in the right direction. I recognise, however, that we have a lot more to do. The Secretary of State reiterated yesterday at the conference that cancer is a top priority for the Government. That has been made evident by the cancer plan and the significant extra investment in cancer resources. I shall come later to the issue of the audit trail and the need to ensure that that money is spent on cancer care.
Just over two years ago we published the NHS cancer plan. That was the first time that any Government had drawn up a major programme of action to link prevention, diagnosis, treatment, care and research to follow the patient pathway through all stages of treatment. It is not an exaggeration to say that that was an almost revolutionary approach to patient care and that it has informed not only cancer care, but a range of other disease pathways. We are undergoing a complete reconfiguration of the organisation of our health services. Patients are being put at the centre of the services and provided with those that they need, rather than having to fit in, regardless of whether the services meet their needs or those of their communities. The cancer plan was a turning point in our reconfiguration of the NHS.
I want to acknowledge the work and commitment of the thousands of staff who are working together across organisations to try to modernise cancer services. It is important for people to be able to take time out from their day-to-day practice to think through new ways of working to try to shorten waiting times and to bring in new and innovative approaches, but that is not always easy when people are working outside their organisations, collaborating with colleagues, working in virtual organisations and attending meetings, and I am conscious of the hard work that is taking place across the service.

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I would also like to thank the 65,000 cancer patients who responded to the first ever cancer survey. Some might say that people do not want to respond to surveys, but we had an incredible response. It is a courageous Government who decide to ask patients what they think about the service, where it is good and bad, where it is working and not working, and to use, for the first time, the results of such surveys to feed into the performance management framework for the service. At long last, we are beginning to measure the success of the NHS by what the patients themselves tell us is going on in their area.
We do not pretend that there are no problems. Of course, there are problems. We do not pretend that the service is not working under incredible pressure, because it is, in every part. We must, however, be clear that patients are benefiting from improvements and cancer is one of our success stories. We are extending the breast screening service to over-65s and piloting new screening technologies. More than 95 per cent. of people with suspected cancer are seen by a specialist within two weeks, more than 31,000 extra people are benefiting from cancer drugs that have been appraised by the National Institute for Clinical Excellence, and more than 500 of the most modern pieces of equipment with which to diagnose and treat cancer have been delivered to hospitals since April 2000. By 2004, a further 385 pieces of equipment will be delivered and used in the NHS. Those are tremendous improvements, but there is a long way to go. We have said that the cancer plan will take five to 10 years to implement and, even though we are in only the first two years, we are beginning to see significant progress.
The current increase in funding for cancer services—an extra £280 million in 2001–02, £407 million in 2002—03, and £570 million by 2003–04—is the largest ever. Concerns have been expressed about how much of that money is getting through to the front line. My hon. Friend the Member for Norwich, North conducted a searching inquiry in the Select Committee, in which I was delighted to take part. It raised interesting questions and, as a result, the national clinical director for cancer, Mike Richards, is now working with the strategic health authorities to bear down on the audit trail to determine where funds have gone. We are also working with voluntary organisations in the hospice movement to see what has happened to the money for palliative care—where investment has been made and whether there are any gaps.
We recently announced that an extra £10 million would come from central funds this year to ensure that there is a swift injection into vital services relating to palliative care and I am determined that the extra investment from the Government will make a difference to cancer patients. I can tell the hon. Member for East Worthing and Shoreham (Tim Loughton) that our targets for treatment times are of key importance because early diagnosis and treatment mean better outcomes and survival rates for patients. Investment has been made in cancer services even in the most pressured authorities, and we are on track to meet important targets to improve services for patients.
Tim Loughton: I take the Minister's point, but will she admit that setting strict targets—especially for initial
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referral—ties up consultant time, which adds to the time delays for people needing treatment. In some cases, it distorts the system because of staff shortages.
Ms Blears: It is important at every stage of the patient pathway to try to ensure that the waiting time is as short as possible. Prioritising one part at the expense of another is not the way to design a proper holistic system that meets the needs of patients. We need to bear down on waiting times in diagnosis, screening, treatment—at all stages in the patient pathway. That is why the Government have developed a coherent programme, rather than caved in to pressures of the moment.
My hon. Friends the Members for Norwich, North and for Brighton, Kemptown (Dr. Turner) have pressed for the introduction of a cancer Bill for some time, and the hon. Member for Cheadle was not sure of the Liberal Democrat position, but the right way forward is through the cancer plan. Cancer treatment is a top priority for the Government, but it is one of a number of clinical priorities. I do not want our system to be fragmented and drawn to specific disease groups. Through the cancer plan, we can allocate funding, gather the work force, shorten waiting times and improve treatment for patients without fragmenting the infrastructure that is crucial to supporting action throughout the NHS, not only in the important area of cancer treatment.
Dr. Gibson: Why then, is there a draft Mental Health Bill?
Ms Blears: My hon. Friend knows very well that the Mental Health Bill will deal not only with treatment, but with several important areas relating to the assessment and identification of individuals needing care and support within the care system. I am sure that he recognises that the area of mental health is significantly different from that of diseases such as cancer. Ring-fencing funds for specific disease groups would cause significant problems for the NHS. As he knows, issues surrounding diagnosis, research, equipment and staff are not always identified only for cancer treatment, but for a range of different diseases—we have had some interesting discussions about the way in which research into disease groups applies not only to cancer. Therefore, it is important to integrate cancer treatment and keep it connected to the rest of the NHS. I have no doubt that we shall continue to debate the cancer plan but, at the moment, we are trying to shift the centre of gravity in the NHS to ensure that money goes to the front line and that, as far as possible, all services are kept together and integrated.
Several hon. Members spoke about patient involvement, and I hope that they know of my absolute commitment to public and patient involvement. Changing the NHS to take account of patients' priorities will allow us to improve services dramatically. I was pleased to appoint Harry Caton as the director of public involvement in patient experience. In highlighting such issues, he is making a tremendous contribution to the NHS. I understand that all the networks now have patient involvement, although some are more developed than others. We want to bring everyone up to the level of the best.

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In December, I shall speak at a conference that has been organised by Macmillan Cancer Relief. The conference will focus on ways in which we can bring together carers, patients and professionals to ensure that we learn from the experience of patients. Some of the best suggestions for change come from people who are going through the service, and we have a great deal to learn from them. I love the phrase "Trust me, I'm a patient." We could all happily support that.
The hon. Member for Bosworth (Mr. Tredinnick) spoke about complementary therapists. He will know that we are preparing NICE guidance on supportive and palliative care. Draft guidance, which will include guidance on complementary therapies, will go out to consultation next summer. Such therapies are becoming more mainstream in the NHS; I know that the hon. Gentleman has been pressing for that for a long time. Such mainstreaming occurs especially in cancer care and palliative care—pain relief. The role that acupuncture can play is fairly well established. We have funded research projects to try to obtain more evidence. Many cancer networks already involve complementary therapists in a range of services. The hon. Gentleman is therefore pushing at an open door, but we must be sure that the therapies work and are based on good evidence, and that investment in them is worth while.
Several Hon. Members spoke about diet and exercise, which are key issues for the Government. They will know about the national school fruit scheme, which will give a free piece of fruit to primary school children every day in an effort to encourage healthy eating habits early in life, and that scheme is expanding throughout the country. I think that 300,000 children are now receiving their free piece of fruit; by 2004, every primary school child will be receiving it.
We are about to launch some exercise pilot schemes to find innovative ways of involving people in exercise-in particular, we will work with people from poorer communities who traditionally have not been able to go to expensive leisure centres. I look forward to the results
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of those schemes. The Department for Culture, Media and Sport has a huge programme of investment in school sports co-ordinators to try to involve young people and children in good exercise early in life.
My hon. Friend the Member for Norwich, North suggested that we might have tsars in every clinical network to ensure progress in cancer care. As he knows, we have clinical leads in every network who have taken on that role and who have done an extremely good job. My hon. Friend said that, in America, they were known as quarter-backs; in my part of the country, they would probably be scrum halves, so some of my clinical leads may see themselves in that role. It is important that clinical ownership is embedded in our networks. We are talking about the people on the front line and they know what needs to be done. Giving them power and influence in the service is key.
The hon. Member for Cheadle read out some fairly depressing statistics on waiting times; however, from April to June of this year, almost 95 per cent. of women with breast cancer received their first treatment within a month of diagnosis. That is not a bad achievement. I therefore urge the hon. Lady to consider the glass half full rather than half empty. In the same period, 93 per cent. of patients with testicular cancer, 100 per cent. of children with cancer and 99 per cent. of patients with acute leukaemia received their treatment within one month. We are making significant progress in tackling cancer and patients are delighted that such improvements are beginning.
The hon. Member for East Worthing and Shoreham mentioned radiology. We are increasing the number of training places, we have more consultants and we are going out to recruit. I remind him that under the Conservative Government, training places in every profession were cut. We cannot create radiologists and radiographers overnight. We are creating extra training places that will come through to the service in due course. At least this Government have a commitment to extra investment—
Mr. James Cran (in the Chair): Order. Time is up.

Nurses' Pay
11 am
Mr. Andrew Lansley: I am grateful for the opportunity to discuss the important issue of nurses' pay. Although I have wanted such a debate for a long time, owing to the happy way in which parliamentary affairs are conducted, I have secured the debate in the week when the Royal College of Nursing published the results of its 2002 membership survey.
My starting point is in my constituency, as hon. Members customarily expect. Addenbrooke's hospital is in my constituency, and last Friday I had the privilege of attending the annual lecture there at which David Lomas, a consultant physician, was explaining the ground-breaking work being done there on emphysema and genetic predisposition. During the lecture, he illustrated how nurse practitioners work with emphysema patients to facilitate a quick return home and reduce demands on the hospital while providing a service that patients find more acceptable and that enables them to live at home independently.
Addenbrooke's is right at the front rank of this country's hospitals. Ground-breaking research that is of the highest quality in the world—the hospital leads an international network of researchers on the subject—is combined with the finest nursing practice. However, the hospital faces severe difficulties. The turnover of trained nurses and midwives is 12 per cent. and the vacancy level for nursing staff is 9.5 per cent. Many vacancies exist for surgery and gynaecology nurses. There is a 22 per cent. vacancy level for midwives, which shows the difficulty of replacing staff who leave.
The consequences of a lack of suitable nursing staff are only too clear. Beds are being closed, and a Select Committee heard a couple of weeks ago that the rate was the equivalent of closing a 30-bed ward in Addenbrooke's every day. Bed use rates in the hospital are driven even higher: they are currently about 98 per cent. The Minister and hon. Members will know that the Department of Health wants rates that are nearer 82 per cent. The Audit Commission report published the other day made recommendations about the rates of bed occupancy in hospitals that would allow accident and emergency facilities to work most effectively and allow onward referrals from them without long waits. High bed occupancy rates cause not only long waits but the cancellation of elective surgery. That is a serious problem at Addenbrooke's from time to time and it is an issue in summer as well as winter.
That all causes nurses' work load to increase. High occupancy levels cause an additional work load, and I suspect that we all know that nurses' work loads are much higher now. In the past, convalescent patients would have been present on wards and patients would spend more time in hospital before being discharged. There is now every pressure to work intensively to discharge patients and release beds as quickly as possible. The vacancy levels that I have discussed are compared with the funded establishment level. They are not necessarily sufficient for today, given the intensity with which beds are being used and the extended role of nurses.
Addenbrooke's is in a high-cost area, one of the highest outside central London. It is an exciting hospital to work in. It aspires to, and reaches, the highest
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standards of clinical care, and has some of the best family-friendly policies in the country. However, the nursing staff are increasingly hard pressed and increasingly hard to recruit and retain.
How can we break that cycle of problems and deliver NHS growth? An issue that is currently being considered at the local level is key worker housing. I acknowledge the benefit that that can provide—we have seen the benefit of housing association provision alongside the Addenbrooke's site—but the numbers are limited. I do not want us to return to the situation in which most NHS staff must live in what is in effect tied housing, because we pay them substantially below the market rates for people working in that location.
The purpose of the debate, from my point of view, is to decide the question of nurses' pay and the contribution that it could and should make to the resolution of these problems. The last debate on nurses' pay in the House was held in January 1999. Much has changed, and it is highly desirable that the Minister and hon. Members have an opportunity to debate the issue. I support the concept of an independent pay review for nurses, so why debate it here? We should debate it for several reasons.
First, the Government's evidence to the pay review body, and the view that they and their Departments take on recruitment, retention and affordability, is a substantial aspect of the process of pay review. Secondly, the agenda for change negotiations, which should now be reaching a conclusion, should represent a substantial long-term development in extending the role of nursing staff in the provision of care, and should be accompanied by a restructuring of pay to reflect the additional responsibilities. That is, of course, a direct Government negotiation. It is not being negotiated through the independent pay review body but will be referred to it after the conclusion of the overall negotiations. I hope that the Minister will tell us something about that.
Thirdly, a great deal of taxpayers' money—one sixth of Addenbrooke's budget—is spent on nurses' salaries. The Government are accountable for their advice on that aspect to the pay review body, and for the value that they attach to the contribution of nurses to the NHS as reflected in pay. It is equally incumbent on us in Parliament to have the opportunity to reflect on that value and on how the Government represent the public sector's and the taxpayers' view.
Mrs. Anne Campbell: I congratulate the hon. Gentleman on securing the debate, which I agree is extremely important for Cambridge and especially Addenbrooke's hospital, but does he agree that the long-term solution to the very high costs in and around Cambridge is to release more land for building? Will he consider the fact that his objections to the county council's structure plan, if I understood them correctly, would be likely to result in the release of less land for building, so continuing the upward spiral of house prices and making the situation much worse?
Mr. Lansley: I am grateful to the hon. Lady for her remarks about the desirability of the debate. She was present at a previous debate in the Chamber on the Cambridge green belt, and will know that on, I believe,

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13 November, at the examination in public on the Cambridge structure plan, I will make my argument about the desirability of limiting building on the green belt around Cambridge because of its incompatibility with the purposes of the green belt. That does not mean that there should be a limitation on the number of houses to be built. There is no argument at the examination in public about the fact that the Cambridge sub-region should build at the rate of 200,800 additional homes a year, only about where those houses should go. I am afraid that her point is irrelevant to the debate, because the houses could as readily be at Waterbeach, for example, with a shuttle-train access from there to the Addenbrooke's site that would take 13 minutes, as in Cherry Hinton or the airfield site, where people would have to use buses, which would take 25 minutes. We may argue about where the housing should be, but I will not take a lecture on the Cambridge green belt.
Nurse recruitment from overseas is a valuable, and possibly essential, part of our response to nurse recruitment difficulties in the short term, but it is a risky long-term strategy. To increase recruitment to nursing to the required extent in a tight labour market will require an increase, not a decline, in pay for nurses relative to the labour market as a whole.
Changes in responsibility and extending the role of nurses are desirable, and will necessitate changes in pay structures and levels, but such changes are complementary to the issue of nurses' general pay level, not a substitute for tackling it. In our previous employment, if we were told that there was to be a restructuring that would lead to new responsibilities, we would all probably have expected additional pay. However, for those who do not expect that, that is no reason for them not to receive pay that reflects the genuine labour market in their professional area.
Comparability is not the primary basis on which to assess pay—although it should not be ignored—since pay is rarely the reason why nurses find their job rewarding, but poor pay in nursing, as in any other walk of life, is a substantial demotivating factor, and will cause lack of retention. A significant part of nurses' perception of whether their pay is good or poor is the comparisons that they make with the rest of the public sector.
The serious recruitment and retention problems in some NHS trusts often reflect the relationship between high labour cost areas and the adherence to national pay scales. If trusts are to be free to pay in excess of national pay scales, as they are in theory, or if foundation hospitals enjoy such a freedom in due course, those foundation hospitals must be assured that they will have the resources to back that up. That is a matter for the contracting bodies—the primary care trusts—whose resources reflect the relative costs of providing a service in that area. Addenbrooke's is, of course, one of the hospitals that is most likely to apply for and receive foundation status, having achieved a three-star rating on two successive occasions.
The determination of nurses' pay must be a matter for independent review and recommendation. No reasonable level of pay increase is likely to be recommended that could not be funded from the prospective 10 per cent. per annum increases in NHS
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funding overall. The consequences of failing to act now on pay may be to place in jeopardy the achievement of reform and service enhancement in the future. If we do not demonstrate that we value the work that nurses do, the loss of trained nursing staff will accelerate, and no amount of target setting by Ministers will stop the beds and theatres lying idle while patients wait.
The evidence this year to the pay review body from the staff side sets out many of those factors. In the past five years, the number of registered nurses in England has increased by 20,000 on a whole-time equivalent basis. In Scotland, Wales and Northern Ireland, the number decreased between 1996 and 2000. However, given that over the same period there have been 35,000 overseas registrations, and even allowing for the limited length of time of some of those registrations, it is reasonable to say that the increase that has occurred in the nursing work force has been through overseas recruitment. That can also be seen at Addenbrooke's, where some very successful recruitment operations have been undertaken, and Filipino nurses, for example, do an excellent job. However, we must work harder to continue to recruit from the pool of talent overseas. We constantly have to replenish our resources from it, and the evidence suggested by the staff side to the pay review body is that international competition for good nurses is increasing.
The work force—the national work force as a whole—is expected to grow over the next 20 years, but at a rate estimated at only 0.5 per cent. per annum. Matching the Government's objectives for the nursing work force, however, would require 1.5 per cent. growth per annum. We thus need not only to sustain the nursing work force in a tight labour market but to increase the share of the work force taken by the nursing profession.
Serious divergences remain between the statistically based view of Departments and the evidence of individual trusts and managers that recruitment and retention problems have worsened and are serious enough to justify action by the pay review body. NHS proposals for the consultants' contract and for GPs have offered substantial—about 20 per cent.—increases in remuneration in return for reform. At the same time, the role for non-medical staff is growing, through more nurse prescribing or, as at Addenbrooke's, through innovative proposals for emergency nurse practitioners in casualty departments.
If nurses embrace reform and responsibility, they should expect significant benefits, but not every nurse will be able to do so and we risk demotivating nurses who continue in their existing role if we do not change basic pay levels as well as providing enhancements for extended roles.
On comparability, according to staff side evidence, nurses' earnings have declined from 89.1 per cent. of non-manual average earnings in 1995 to 87.8 per cent. in 2001. After three years in post, a nurse at the top of grade D will earn £17,760 in comparison with £22,992 for a police constable. I may be reaching back into the dim and distant past, but I recall that nurses and police officers were previously viewed as highly comparable. They used to spend some time together, sitting around waiting for patients, victims or offenders to be discharged from hospital. I know about that because my brother married a nurse who was trained at Addenbrooke's hospital. We have come full circle and

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pay has now diverged. Expenditure on agency staff in the NHS was £570 million last year, nearly four times the amount spent in 1997.
Those examples are taken from the staff side evidence previously submitted. The Royal College of Nursing membership survey was published earlier this week and offers additional significant evidence. Nearly two thirds of NHS nurses felt that their nursing establishment was insufficient to meet patient needs. One third working in hospitals reported that the problem was serious enough to compromise patient care. More and more nurses work in excess of contracted hours, averaging an extra seven hours per week, a quarter of which are unpaid. About 29 per cent. of nurses—the number is increasing—now take additional jobs. Only a quarter of NHS nurses believe that they are well paid for the work that they do. Nine out of 10 regard themselves as not well paid in comparison with other professional groups.
Reductions in grade levels, inappropriate grading and the lack of pay recognition for additional responsibilities are further problems reported in the RCN survey. Such problems undermine the confidence of the nursing profession in the prospect of a pay for responsibilities approach as articulated recently by the Secretary of State in response to the RCN survey. Whereas 72 per cent. of nurses regarded nursing as a rewarding career in the 2001 survey, only 56 per cent. said the same this year.
As the RCN makes clear, the survey results continually come back to two issues: work load and the value that nurses feel that we, by which I mean the public, place on their work. If we do not act, we will end up with a demotivated profession with more and more nurses retiring in future years. A demotivated profession would mean a substantial number of nurses leaving, through both retirement and the attraction of other jobs in a tight labour market. A third of NHS nurses would leave nursing if they could. If that happens, work load pressures will worsen, and the desire to leave will grow, leading to a vicious spiral. Overseas nurse recruitment will not necessarily be sustained, leaving capacity in the NHS unable to grow.
Independent sector health capacity is equally dependent on the supply of trained nurses. The work load pressures in that sector are less great, but I submit that we could not comfortably look to the independent sector to be able to recruit and retain anything like the substantial number of nurses who might leave the NHS.
Agency nursing can help. Agency and bank nursing systems provide a way of filling short-term vacancies, and valuable flexibility in acute care, but they do so at a price. With the hon. Member for Oxford, West and Abingdon (Dr. Harris) present, I confess that I recently saw posts for agency nurses in his constituency advertised at £22.85 per hour. By my reckoning, that is about twice the level of pay per hour that would be available to a nurse on a full-time contract in the same hospital. Demotivation certainly results from such comparisons.
We must consider substantial change to secure an enhanced role for nurses and enhanced pay. In addition, in April 2003, before the agenda for change negotiations can have a substantial effect, we need a general recognition of the need to respond to recruitment and retention pressures for the profession as a whole, to
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demonstrate the value that we place on nurses, who are instrumental to quality care for patients. Expanding the nursing work force would enable progress to be made towards managing better the work load pressures on the service as it attempts to meet the growing demands for ever more intensive and sophisticated health care.
A few months ago, I participated in a conference led by Papworth hospital, which is in my constituency, on extending the role of non-medical staff as a result of the extensive and important role that nurses will increasingly be taking up in delivering care. In some cases, one might almost characterise the consultant physician as overseeing the role not of other doctors but of nurses providing care. Nurses will work substantially within the protocols and parameters set by medical staff, but with a great deal of independence.
Within the leading NHS trusts, those freedoms must be real if we are to provide the quality and volume of care that is increasingly demanded of us. Those hospitals must be resourced to reflect their activity levels and their costs. They must be able to use that freedom to meet the extra pay or accommodation costs involved in recruitment and retention in a high-cost area.
The Government's evidence to the pay review body must not discount the concerns of nurses, talk up the prospects for more recruitment or retention when the front line appears to know better, or trade off service improvements against nurses' pay. That could prejudice the trained staff whose contribution to the NHS is essential. If service improvements and growth in capacity are to be realised, we cannot put nurses in the invidious position of believing that fair pay for nurses is somehow inconsistent with service improvements for patients.
I should like to know that the Minister understands and accepts those propositions. When—the "when" is quite important to Addenbrooke's—and how will foundation trust status be better defined? I would like Addenbrooke's hospital, which for this purpose is my principal concern, and other hospitals throughout the country to have the freedom to reflect not only fair pay in the labour market in their area but any need that they may have in respect of extending nurse responsibilities. Generally, I want hospitals to be resourced to meet those responsibilities and the costs of recruitment and retention in their area.
When I next meet nursing staff representatives at Addenbrooke's hospital, I want to be able to say that when politicians say that we value the work that they do we will actually have done something about it. That is the purpose of this debate.
11.24 am
Dr. Richard Taylor: I should declare an interest, as I am approaching the age when one might need to rely on one's family: one of my daughters is an NHS nurse.
I congratulate the hon. Member for South Cambridgeshire (Mr. Lansley) on the impeccable timing of this debate, which is absolutely staggering. I want to paint a brief picture of the work of an NHS nurse, thinking of a ward sister. She gets into work and finds the chaos of the night. The ward is understaffed, especially in respect of trained staff. She has the stress of achieving acceptable levels of care and of supporting

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other stressed staff. She has to support the nurses who are doing the jobs of junior doctors under the absolutely appropriate extension of nursing duties. She also has to cope with directives from nurse managers who in some cases appear to be more interested in targets than in staff morale. She gets home late.
In my constituency, because of the tremendous overspending, especially on agency nursing, budget holders have had a two-page letter about improving financial control, particularly with regard to agency nursing. First, there is a set of guidelines; secondly, there are four more detailed steps that the nurse, sister or charge nurse in my example has to go through before being able to consider the use of agency nurses. Compare that with the usually protected existence in the private sector where there is adequate staffing, little if any stress from an unexpected emergency load and working hours that staff can keep to. Compare it, too, with the life of agency nurses who can choose exactly when they want to work. They go in and do their nursing duties and they do not have the responsibility of running a ward. Some agency nurses who are very well motivated may help, but it is not part of their job. They have nursing duties only.
I am extremely concerned about the expenditure on agency nurses to which the hon. Gentleman referred. The Department of Health is not yet able to tell us exactly how much was spent on agency nurses last year, but the estimate of the general secretary of the Royal College of Nursing is about £800 million. In Worcestershire, the acute trust spent £3.3 million on agency nurses in 2000–01 and £4.3 million in 2001–02. In the first five months of this year, the figure is already £4.3 million.
There is a better answer than the use of agency nurses, better even than the proposed use of the Government's own agency: to pay NHS nurses realistically to take into account the stress and responsibility of the job as well as their productivity, thus reducing spending on agencies.
The Minister will recall that in a letter to me in July last year, he said:
"The key principle is something for something. Rewarding people for what they do, and the roles and responsibilities taken on.
Our NHS nurses are extremely productive. They have taken on enhanced roles and responsibilities, which must be respected and recognised.
11.29 am
Ann Keen: I, too, congratulate the hon. Member for South Cambridgeshire (Mr. Lansley) on securing the debate, particularly in the week when the Royal College of Nursing is rightly making headlines on this issue. First, I should declare an interest. To my knowledge, I am the only nurse here in the Chamber, and I also still have an association with the Community and District Nursing Association.
I feel very passionately about nursing and nursing care. It is often said that people remember nurses. Well, nurses remember Governments. Nurses have excellent memories. Without wanting to take up hon. Members' time today, I cannot resist the opportunity to point out
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that I took up my first post as a staff nurse on a busy medical ward on a late afternoon shift on the day when the newly elected Conservative Government took office in 1979. I spent much of my clinical nursing practice under that Government's stewardship of the NHS. I know about stress. I know about difficult working conditions. I know about trying to gain credibility and financial recognition for my profession and my skills. I had many skills, and I am pleased that there are now diplomas and degrees in nursing and that nurses' vast knowledge is recognised and accredited in an academic sense.
Nursing is a science and an art. Bringing the two together is very complex at times. As my hon. Friend the Member for Cambridge (Mrs. Campbell) pointed out, nurses have few convalescent patients in hospital or in the community. Nurses have high-dependency patients for whom advanced technical and pharmaceutical knowledge is required to deliver complex health care. How do we ensure that those noble and able people who are the mainstay of the NHS remain? One cannot talk about health without talking about nursing. The recognition that the current Government are giving is very welcome, but much more must take place. I would be the first to recognise and encourage that.
Along with agency nursing and pay comes the issue of flexible working. When I was a ward sister I could not offer flexible working to many of my staff and auxiliary nurses. It was a rigid system. Flexibility and child care were not on the agenda, but they are now on the agenda in many walks of life, and that is to be encouraged. The money that has been invested by the Government in child care facilities for hospital workers allows nurses to he seen as people who belong not just to the NHS but to their family. Nurses need to be able to balance work and family life if they are to stay in a profession that is demanding both mentally and physically. I had to leave clinical nursing to go into teaching because of a serious back injury that I suffered as a district nurse. We must recognise the physical commitment that nursing demands.
Flexibility, time off and rewards are important. I am so pleased that in the Budget earlier this year the Chancellor announced the new tax credits that will come into effect in April next year. For the first time, student nurses will be able to claim tax credits for children. I hope that all hon. Members present today will encourage student nurses to take up their entitlement, which can mean up to £38 a week. Student nurses were not able to claim income support before because they were not classified as workers. They have never been able to claim the working families tax credit for that reason. They fall between the two categories: they are neither proper students nor proper workers. I hope that all hon. Members, but particularly the hon. Member for South Cambridgeshire, will see to it that the issue is taken up. Not only student nurses but all nurses will benefit from the new child tax credit and working tax credit, and I hope that people in all parties will take up the campaign before next April.
It is important that we get modernisation and the agenda for change right. In the past, the pay review bodies have recommended increases for nurses, and I am pleased that they have been paid in full in many instances. That did not always happen under previous Governments, and once, when we did get a pay increase,

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we were asked to donate it to the hospital to fund its desperate bid to buy new equipment. One might expect that to have happened a century ago, but it also happened in the 1990s.
It is encouraging to hear hon. Members talk about the value of nursing. If we are really to value it, however, we must ensure that hospitals implement a family-friendly policy. They must encourage the take-up of the current credits, to which some working people are entitled, and of those to which many more people will be entitled from next April.
We must ensure that we have a team of equals. The medical profession has its problems at the moment, as do consultants, but I ask them to reflect on the way in which members of the nursing profession support the team, and in many instances use their knowledge to lead it. As a former nurse, I am grateful to have had the opportunity to address Parliament on behalf of nurses.
11.36 am
Mrs. Anne Campbell: This is an important debate, and I am pleased to have the opportunity to contribute, although I do so only because I am sorry that there are so few people in the Chamber.
Nurses' pay is a huge issue in Cambridge because of the high cost of living, which affects not only nurses but many other low-paid workers. Indeed, I am sure that the hon. Member for South Cambridgeshire (Mr. Lansley) has come across further education lecturers, university lecturers and others who have had incredible difficulty finding somewhere affordable to live, although one would not imagine that they would.
About a year ago, a staff nurse at Addenbrooke's came to see me. She was not a low-paid worker, but was earning just over £20,000 a year. The problem, however, is that the local authority is unlikely to consider people who earn that amount for social housing, so she was unable to get a council house or to get on a housing association list and she had to rely on the private rented sector in Cambridge, which is very expensive.
That woman had a son of 11 or 12, whose schooling had been disrupted by her housing difficulties. Throughout his primary school career, she had to move from one private rented sector property to another, which inevitably meant that he had to change primary schools several times. The difficulties are not purely financial, and people's lives are disrupted and are sometimes of a low quality. I have not heard from that woman for a good 12 months, and I hope that she is still at Addenbrooke's, but I fear that many people in that situation give up and decide to work somewhere where accommodation is cheaper.
To return to planning issues, Cambridge will not survive in the long term unless it can accommodate low-paid and even medium-paid workers. As the hon. Member for South Cambridgeshire said, house prices have spiralled upwards. Over the past year, they have risen by more than 20 per cent., and people are finding it increasingly difficult to find affordable accommodation. However, I disagree with him about the use of the green belt. The green belt around Cambridge is tightly drawn, which leaves only a small amount of building land in the city centre. That inevitably means that people have either to pay high prices for accommodation in the
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centre of Cambridge or live outside the green belt and travel into the city every day. He said that Waterbeach was a convenient settlement, and I believe that the county council should consider it again, as the rail link to Cambridge makes it an attractive option, not least because the journey takes only 13 minutes. He was quite right to say that an extension of the rail link to Addenbrooke's would make a big difference.
Mr. Lansley: Many of the nurses who have left Addenbrooke's are continuing their nursing work at Papworth hospital, because they can live in cheaper accommodation in Huntingdon or beyond Papworth. We have to solve that problem before we can contemplate moving Papworth hospital to the Addenbrooke's site. That move has many clinical reasons to commend it, but at the moment it would cause all sorts of difficulties with recruiting and retaining the nursing staff.
Mrs. Campbell: There is a great deal of agreement between us on that. However, although the hon. Gentleman is opposing the extension of housing into the green belt, Clay farm in Trumpington would provide an attractive location for staff working at Addenbrooke's. It would provide housing sufficiently near the hospital for people to be able to walk or cycle to work. That seems an extremely attractive option.
It is fair to say that the Government have taken many actions over the past few years to try to ease the situation for nurses and low-paid workers. One of the issues that concerns me is the cost of living supplement paid to nurses in the Cambridge area, which gives them an extra £600 a year. It does not go a long way towards meeting their accommodation costs, but it is better than nothing. However, it applies to nurses and therapists but not to cleaners, porters or catering, engineering or laboratory staff. That is of great concern to those other lower-paid workers, who are essential to the running of a large hospital.
About 18 months ago, I attended a rally at Addenbrooke's, when those staff were starting their campaign for recognition. I understand that the cost of living supplement is paid only to those grades covered by the pay review body, but we need to look even more closely at those who are paid on an even lower scale than nurses, because their work is essential. I hope that the Minister will consider carefully the Unison campaign to allow those workers the cost of living supplement. He and I have communicated about the matter before, but this may be the time to take a fresh look at the situation.
Mr. Simon Burns: Will the hon. Lady also include auxiliary nurses in the list of nursing staff and health service workers who should be included? I have a constituent who has worked as an auxiliary nurse for more than 27 years. Her job has expanded and so have her responsibilities, but she has been excluded from the supplement, as have others at her level. I find that incomprehensible.
Mrs. Campbell: The hon. Gentleman makes a good point. It is easy for us to say that all low-paid workers should get extra money. I have made it clear that in the short term this is a huge issue, but I hope that in the

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longer term it will be resolved by planning and not by the payment of supplements. Although they are badly needed now, they are not the answer.
I should like to mention the starter home initiative. A successful joint application by the health authority, the county council and the police authority in Cambridgeshire realised some £6 million, enabling low-interest loans to be paid to key workers who live within five miles of their workplace. That has made a huge difference to many low-paid workers who are defined as key workers. However, many are excluded in the process of defining. An unfortunate aspect of the scheme is that further education lecturers are excluded—they are low paid, so the distinction is rather absurd. It is up to local authorities to define key workers, and I am sorry that mine did not include further education lecturers.
My hon. Friend the Member for Brentford and Isleworth (Ann Keen) has mentioned the forthcoming children's tax credit. Many low-paid workers in my constituency have already benefited from the working families tax credit and the child care tax credit. They have made an enormous difference: many lone parents, who would not otherwise have been able to afford to do so, have returned to the workplace. Many extra child care places have been provided in the city, but there is still a desperate shortage because there are so many parents in the workplace these days that all the provision has been soaked up. She made an important point about the forthcoming children's tax credit and the working tax credit. They will be available to student nurses and others who now find it difficult to survive.
I hope that, in her capacity as the Chancellor's Parliamentary Private Secretary, my hon. Friend will convey the point that because of high accommodation costs in the city of Cambridge, people have to have very high incomes in order to have the same residual income as those who are paid much less in another part of the country. The problem is that the lower-paid in another area will be entitled to the working families tax credit, whereas many of my constituents who have very low residual incomes because of the high accommodation costs are not eligible. We must address that issue. I shall make the point in my own way to the Chancellor, but I shall be grateful for my hon. Friend's support.

The Government have taken a number of extremely helpful short-term measures. Longer-term measures that are in the pipeline will obviate the need for this kind of supplement and extra pay for specific workers because accommodation costs will stabilise. I congratulate the hon. Member for South Cambridgeshire on having raised the issue at this important and sensitive time.
11.49 am
Dr. Evan Harris: It is a pleasure, as an Oxford Member, to thank a Cambridge Member, the hon. Member for South Cambridgeshire (Mr. Lansley), for giving us the opportunity to discuss the matter. I also thank him for presenting the parameters of the debate so clearly. Oxford shares many of the problems of high living costs mentioned by the hon. Gentleman and by the hon. Member for Cambridge (Mrs. Campbell).
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The Government are in trouble over their policy on the NHS work force. That is a problem for all of us and for our constituents, because of all the areas in which it is important for the Government to have a grip of policy, the emergency services in general and the NHS in particular are the most important. We must be sensitive to the difficulties that the Government are experiencing, some of which are not of their making, but it is also important to challenge them to answer all the criticisms of previous policy in this area.
The Government may say that they are not responsible for nurses' pay and that it is a matter for the pay review body. However, as the hon. Member for South Cambridgeshire clearly explained, the matter should engage us all, because we are responsible for the appropriate spending of Government money, and the Government have clear, although indirect, abilities to influence the matter through the evidence that they give and the climate that they create. I hope that in answering the points that have been raised, the Government will not hide behind the pay review body.
The Minister may say, especially to Conservative Members, that it is no good talking about the need for better pay for nurses without being willing to vote in favour of allocating more money to it. That is a fair point and one that is often made by Ministers in response to such attacks from the Conservative party, but it does not solve the problem of what to do when it is necessary to spend more resources in this area. I supported the announcement of more resources in the last Budget and voted for the tax increase that went along with it. In fact, I stood on a platform of calling for the tax increases that would have made the money available some years ago. More funding is needed to benefit patients, nurses and the economy. The Minister must address that point, rather than simply asking us to will the means as well as the end, because I very much will the means.
In the Government's defence, the Minister can also point to the failure of the Conservative Government to invest in the nursing work force, although that is not especially constructive because it does not help us with the problems that we face today. That defence is much stronger in relation to the problem of the shortage in the medical work force, where the trail time is greater, because it takes so much longer to train medical staff. We are still suffering problems as a result of underinvestment and under-recruitment in the 1990s.
On nursing recruitment, I wish that the Government had acted sooner when they came to power in 1997. There was much talk about hitting the ground running, but there was no real change in the early years of the current Administration and no immediate expansion of training opportunities for nurses to deal with the work force shortage. We are paying the price of the failure by this Government to invest in expanding training opportunities.
I was surprised to hear the hon. Member for Brentford and Isleworth (Ann Keen), for whom I have great respect, and who brings a great deal of experience to the debate, raise the question of the staging of pay awards. It is a matter of record that pay awards were staged by the Conservative Government in the 1990s. I thought that that was bad at the time, and Labour spokesmen agreed, but the Labour Government did the same thing in 1997.

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The Library note on the subject is clear, stating that nurses were awarded 3.3 per cent. in 1997—the last example of Conservative staging—and that all awards were
"to be staged, with a 2 per cent. increase in April 1997 and the balance of the recommended increases in December 1997".
Traditionally, there has been a Government explanation and a highly critical response from the official Opposition, and that was the case in 1997. Lo and behold, nurses were awarded 3.8 per cent. in 1998, and all awards were
"staged with an increase of 2 per cent. in April 1998 and full implementation in December 1998".
Hypocrisy is an unpleasant word, and one that I suspect you would not want us to use, Mr. Hancock, but to criticise something and then to do it is not a practice of which people should be proud. It is best if Labour Members do not have selective amnesia about the staging of pay awards.
Nurses' pay is not the be-all and end-all of ensuring good recruitment and retention, as has been accepted by all hon. Members who have contributed to the debate. We can point to the shambles that was the consultant contract for clear evidence of that. In my correspondence, there was nothing but recognition that pay was not the problem. The pay rise—12 per cent., 19 per cent., or whatever it was—was more than adequate for those people, but the Government were unable to meet their concerns on non-pay issues.
The need for a realistic settlement on pay can be broken down into various matters. Are nurses given fair treatment with their current level of pay? Gender is relevant to that. If men traditionally made up the same proportion of the nursing work force as of the police force, we would not have arrived at such a discrepancy between the pay for this professional group of workers and others that have been more male-dominated.
Have the pay awards been fair in terms of parity with other professionals?
Mr. Lansley: Does the hon. Gentleman agree that part of the problem is that, for gender reasons and so on, nurses were historically often regarded as providing the second income for a household? However, in the RCN survey, two-thirds of respondents said that nurses' earnings accounted for half or more of their household income.
Dr. Harris: I agree. I know that the Minister wants time to respond, so I shall condense my comments and go through them more quickly.
Mr. Mike Hancock (in the Chair): I do not think that that is necessary, Dr. Harris. You can make your own speech in your own time.
Dr. Harris: I am grateful to you for defending my honour, Mr. Hancock, but I know that others want to speak.
Does nurses' pay create distortions? Although many nurses are no doubt inappropriately under-graded, some hospitals inflate grades in order to recruit. That may solve the problem of insufficient grading for staff
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who deserve a certain grade, but there will be distortion. People with identical skills and responsibilities will find themselves on different grades.
There is clearly a problem with insufficient and insufficiently sensitive living allowances for nurses. I agree with what the hon. Member for Cambridge said about £600 not going very far in Cambridge: it does not go far in Oxford, either. There should he much more flexibility. If we want to keep to a national pay scale but deal with problems of regional shortages, there must be higher amounts for living allowances and much more flexibility within them so that they are sensitive to regional and sub-regional living costs.
The main issue is recruitment and retention, however, regardless of whether the Government accept my case that nurses suffer from unfairness and insufficient pay. It is a serious problem, which causes serious staff shortages and impacts on patient care, as we have heard from the survey. It also has an unfair impact on our treatment of economies in the developing world, from which we are sucking some of the best trained professionals. We are not taking advantage of nursing skills in refugee and asylum seeker populations, and we spend over the odds—from £500 million to £800 million—to buy back people who have left. That is bad enough from an economic point of view, but it also has an impact on the quality of care, and it is demotivating, as the hon. Member for South Cambridgeshire said.
We have to recognise that nurses have skills that are transferable in the labour market and that we are simply unable to compete, on current levels, with other potential employers. If for no other reason than that, labour market forces must put pressure on the Government to give evidence to the nursing review body to encourage the body to recognise the real problems. All the advantages of the complex tax credits that the Government have introduced are available to nurses in whatever jobs they do, not only to nurses in the NHS. Some of those jobs have greater flexibility in terms of hours.
We must pay attention to the housing shortage. The Government have recently woken up to that problem, although they are five years too late. I question whether there is a joined-up system in respect of housing, because many brownfield sites lie within NHS trusts, which are not acute trusts but community trusts and want the biggest return on land sales. That return may not come from the provision of affordable housing, which other parts of the health economy would want. The NHS has a real problem in responding to housing need.
I finish with a quote from the Secretary of State, who told the Royal College of Nursing at its congress in April 2000:
"We are putting nurses at the centre of the whole modernisation of the NHS,"
and said that because the health service is
"patient centred, it is nurse-centred too."
Those may be just meaningless words, or they could show a real commitment to doing something about the terrible plight of hospitals that are without sufficient nurses, as in my area, and about the unfairness that nurses have to deal with. I hope that they are more than words and that nurses will receive the rewards that they deserve, with the funding that the Government have finally put into the health service.
12.2 pm
Mr. Simon Burns: 1, too, congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on securing this timely and important debate. I also pay tribute to the nursing staff in the NHS, because as the hon. Member for Brentford and Isleworth (Ann Keen) said, they are the backbone of the health service. Without them, the health service could not function. All too often, their dedication and the commitment that they give to their vocation are overlooked and forgotten, although many hon. Members and our constituents have personal experience of how they look after people at vulnerable times in our lives.
As the Royal College of Nursing survey said, 63 per cent. of nurses are working in excess of their contracted hours by about seven hours a week, and 25 per cent. of that overtime is not repaid, either in time off in lieu or in money. That is a contributory factor to the nurse shortage in England of about 15,000.
The Minister will say that since September 1999 an extra 20,740 nurses have been employed. The fact remains that, regardless of that achievement, about 15,000 further nurses are needed to meet the increasing health care demands. I suspect that there are problems with filling vacancies for nursing staff in the constituencies of many hon. Members in the Chamber and elsewhere.
The Mid Essex Hospital Services NHS trust covers my constituency. The latest parliamentary answer that I received from the junior Health Minister, the hon. Member for Tottenham (Mr. Lammy), was about the number of three-month vacancies there to March 2002, which are the latest figures that the Department of Health has. He said that the shortage in terms of all nurses was 20, and equally, the shortage in terms of all qualified nurses was 20. As many hon. Members have said today, nurse vacancies and nurse retention are at the heart of the problem, especially in areas with high living costs.
I suspect that the problem will be further exacerbated if the survey in The Observer last Sunday proves accurate. It showed that the percentage of nurses under the age of 40 who intended to leave the profession in the next five years had risen from 26 per cent. to 29 per cent. Equally worrying is the fact that the average age of those seeking to take up a career in nursing has risen to between 26 and 28 years old. Twenty or 25 years ago, when nursing was seen as a vocation that people would take up on leaving school, that average age was between 16 and 18. The difference is probably due to changes in society, with people wishing to start a family before embarking on a committed career. That is placing a strain on the system.
Pay has a major role to play in the equation of morale, retention, filling vacancies and recruitment. My hon. Friend the Member for South Cambridgeshire said that the Royal College of Nursing had submitted a paper to the independent pay review body, as other interested parties undoubtedly have, including the Government. As he said, the Government's submission to that body is the most important, because they will set the trend and try to point the body in their preferred direction, so far as they can. In drawing up their submission, the Government should understand exactly what is
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happening in the nursing profession, particularly because of the changes and the broadening of the skills and duties expected of nurses.
The introduction of the cost of living supplement has been a small step forward in helping nurses and other important workers on low pay. London has for many years had a weighting allowance to take into account the accepted fact that the costs of housing and living are higher in the capital city. In the home counties and sometimes further afield, living costs, especially of housing, have risen so dramatically that the difference between London and the rest of the country has been minimised. That was true over the last decade in particular, but the trend has been building up gradually over the past two decades. In areas such as Essex, Cambridgeshire and others from which it is possible to commute, the cost of living is significantly higher than in parts of the country that are far from the large metropolitan cities.
If my memory is correct, the cost of living supplement was introduced two years ago. What I found puzzling at the time—and I suspect that the Government did too, as they have remedied it this year—was that Essex was not included, despite the fact that it adjoins London and our house prices, house price inflation and other living costs are extremely high. Hertfordshire received the supplement and I believe that Cambridgeshire did too. Wiltshire and Dorset received it. Essex did not, which seemed a very odd decision. As I say, that decision has been rectified, which is welcome. However, as I said during my intervention on the hon. Member for Cambridge (Mrs. Campbell), the rules on the boundaries between who qualifies and who does not are too tight and seem unfair. I referred to a constituent who had been an auxiliary nurse for 27 years. Her working life has been dedicated to the national health service but she will not qualify as she does not have the necessary national vocational qualifications.
Mr. Lansley: May I draw my hon. Friend's attention to Addenbrooke's hospital? As the hon. Member for Cambridge said, the fact that the cost of living supplement is not available for grades A and B has resulted in a vacancy level for health care assistants of 18 per cent. That is a substantial figure.
Mr. Burns: My hon. Friend is right. I hope that the Minister will reflect carefully on his points and those of the hon. Member for Cambridge. It is not only nurses who contribute to the quality of care in the NHS. The NHS also needs all the people who do other jobs and those people may be living in areas where the cost of living is high.
The Government have introduced the starter home initiative to support key workers. The Minister will note that the initiative applies not only to nurses but to teachers, police, firefighters and some other groups. Although those who qualify will warmly welcome the initiative, I suspect that it will only scratch the surface of the problem. In areas such as London, Chelmsford and Cambridgeshire—where house prices are high, where those prices continue to increase at a rate that is way above the rate of inflation, and where renting private accommodation is equally expensive—the initiative will not help as much as the Government would wish, because of the low number of those who will benefit.

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For example, in Essex, five areas will come under the initiative—Basildon, Braintree, Chelmsford, Harlow and Maldon—but only 76 nurses in those areas, out of a total of just under 6,000, will be able to take part. The Minister would be right to say that some nurses will not wish or need to qualify because they may be married or may be more mature members of the work force who already have a home or an affordable rented property. However, a significant number of people will desperately wish to be part of the initiative and would benefit from it.
Will the Minister consider one other slightly baffling problem? The Royal College of Nursing, nurses themselves and others will say that they need higher levels of pay in recognition of the work that they do and the extended opportunities that are being offered to them.
Nurses are perplexed about the level of funding for agency nurses. Many agency nurses were originally NHS nurses who saw that if they became agency nurses they could work more flexible hours, or even fewer hours, with consider ably more pay. It seems crazy that if we pay on average just over £500 million a year for agency nurses, we could not invest more of that money in NHS nurses as part of the programme to encourage recruitment and retention.
12.15 pm
The Minister of State, Department of Health (Mr. John Hutton): I warmly congratulate the hon. Member for South Cambridgeshire (Mr. Lansley) on securing the debate. I pay tribute to the balanced way in which he presented his case. He refrained from making any party political points, and I shall try hard to do the same. All hon. Members who spoke in the debate made important, helpful and useful contributions.
I will deal with several points raised by the hon. Gentleman. Any neutral observer listening to him would probably have formed the impression that we were falling down in terms of nurse recruitment at Addenbrooke's—that there were fewer nurses and the vacancy rates were increasing—but the opposite is the case. The figures from 1997 to 2001 show that more than 300 additional nurses were employed by the Addenbrooke's NHS trust and that the vacancy rate fell from just over 16 per cent. to 9 per cent. That rate is far too high and I am certainly not going to say that all the recruitment and retention problems relating to nurses in the NHS have been solved. Quite palpably, those problems have not been solved. I would, however, argue that we are at least heading in the right direction, and it would be wrong to give the opposite impression. He asked in particular about foundation trusts and expressed an interest on behalf of Addenbrooke's in foundation trust status. More details about that status will be available in the near future.
The hon. Member for Wyre Forest (Dr. Taylor) helpfully and kindly, as always, drew attention to some ancient correspondence that I had entered into with him. I have no recollection of that, but the point that he made about the reform of nurses' pay is valid, and I will return to that.
My hon. Friend the Member for Brentford and Isleworth (Ann Keen) made a good contribution, particularly in drawing attention to the further help for
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student nurses that we are providing for child care costs—nearly £38 a week—which will go a long way. She made several good points and, overall, presented a balanced score card of what has been done and what still needs to be done.
My hon. Friend the Member for Cambridge (Mrs. Campbell) drew attention to what she regards as problems that still need to be addressed in her constituency. I will come to that later.
The hon. Member for Oxford, West and Abingdon (Dr. Harris) started well, but I am afraid that he succumbed to his typically curmudgeonly approach. He simply would not recognise any progress in the NHS if it were tattooed on his forehead, but there we are—we live in hope.
Several hon. Members spoke about the high cost of agency nurses and the problems that that poses for the NHS. Those problems are real, and we are spending far too much on commercial nursing agencies, but costs are coming down. We are making good progress, though not everywhere, and in Oxfordshire, for example, the hon. Member for Oxford, West and Abingdon will know that progress has been made recently in developing and implementing NHS professionals and significant savings have been produced. That, too, is progress. I am advised that Addenbrooke's is reducing the amount that it spends on commercial agencies, and I hope that that trend continues.
There are two things that we can do to make a difference, in addition to wider points about improving the terms and conditions of NHS nursing staff, to which I shall return shortly. First, NHS professionals should be developed as an alternative to using commercial nursing agencies. That has enormous potential. Secondly, as a parallel development, we need to extend more actively throughout the NHS in England the benefits that we have already obtained in London from the London agency project. That is a better form of procurement for when we have to use commercial agencies. That certainly has benefits for the NHS. I think that, overall, those two initiatives will help in the long and medium term.
A number of key themes have emerged in the debate. We certainly need to get more nurses working in the NHS—that is common ground among all of us—and we are making progress with that. There have been many references to the figures. Since 1997, an extra 39,500 nurses have been recruited to the NHS. That figure takes into account those who have left, so that is a net increase of 39,500. However, we need to go further still. That is why the Budget settlement—a very good one for the NHS—will allow us to recruit 35,000 more nurses by 2008 than were working in the NHS in 2001.
As well as increasing the number of staff working in the NHS, we are also increasing the number of training places for students. Meeting those targets will be key to delivering longer-term sustained growth in the nursing profession. The NHS plan target is for 5,500 more nurses and midwives to enter training each year by 2004 than there were in 1999. We have already increased numbers by more than 3,000, and we are on course to deliver the target.
It is encouraging to note that applications for nurse diploma courses have nearly doubled in recent years, and nursing degrees are now the second most popular

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university course in the country. Those are both positive developments, which show that we are at least moving in the right direction. Nursing is seen as an increasingly attractive career for young people, and that is important. We need to encourage that development at every turn.
Those increases in training mean that, by 2008, 60 per cent. more nurses will qualify each year than qualified this year, for example. However, we also need to encourage nurses who are already qualified to return to the NHS, because those nurses represent an extremely valuable resource and have experience. Since February 1999, more than 11,900 nurses, midwives and health visitors have returned to the NHS, and we need to continue promoting the ways in which qualified staff can return.
Increasing recruitment is only part of the solution. We also need to take action to retain those experienced nurses who are already working in the NHS. Obviously, pay forms an important part of getting that right, but as the hon. Member for Oxford, West and Abingdon said, other issues matter to nurses too. Such issues include, for example, better resources going into the front line to help them to do the job more effectively. We are trying to do that. Help with child care, more opportunities to develop skills, a better career structure, and measures to tackle violence against staff are important, and I am glad to say that we are taking action on all those subjects.
The Government are also committed to making the NHS a more attractive place in which to work. We can do that by offering better working conditions and improving lifelong learning opportunities—and offering improved child care support in order to help our employees balance work with their family commitments. The hon. Member for South Cambridgeshire is almost certainly aware, because he rightly takes a close interest in the work of the NHS locally, that Addenbrooke's hospital operates one of the largest child care facilities in the NHS, with 240 on-site nursery places.
Our campaign to improve the working lives of NHS staff lies at the heart of the drive to ensure that there are enough well qualified and motivated people in place to deliver the quality of health care envisaged in the NHS plan. Improving working lives places expectations on employers to support staff, promote their welfare and development, and respect their desire to have a healthy balance between work and life outside work.
I want to make it clear that the Government are committed to modernising the NHS pay system. As a number of hon. Members referred to the subject, it would be only right to draw attention to what the minimum starting salary for a grade D nurse was in 1997, and what it is in 2002. On 31 March 1997, a newly qualified grade D nurse starting work in the NHS earned just under £12,000 a year. On 1 April 2002, she would be earning £16,005 a year. That is a cash increase of 35 per cent. and a real terms increase of 16 per cent. I do not want to break my self-imposed discipline of not being party political, but that is nearly three times the rate of growth for the salary of newly qualified nurses that was experienced under the previous Conservative
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Administration. By any reasonable yardstick, our commitment to NHS pay, and especially nurses' pay, stands credible comparison.
As many hon. Members have said, however, we should go further. An independent pay review body has recommended the pay of nurses, midwives and health visitors since 1984. It makes its recommendations after considering evidence submitted from the Government, staff and professional organisations, and NHS employer organisations. For the past four years, the Government have implemented in full the recommendations of the pay review body and avoided the need to stage pay awards, which is an important objective.
Since 1997, real progress has been made in improving nurses' pay. Pay has increased across the board for all nurses and midwives by at least 26 per cent. in cash terms. Some grades of staff have been targeted for larger increases: I have already drawn attention to the starting salary of newly qualified nurses, which has risen by 35 per cent. over the same period. We also introduced the new post of nurse consultant to provide opportunities for staff at the top of the profession to continue to be involved in clinical work rather than moving into management. Nurse consultants can earn more than £46,000: a huge extension to the nursing career structure.
In response to the recommendations of the review body, this year nurses were once again awarded pay increases well ahead of inflation—an increase of 3.6 per cent. was implemented in April when the headline rate of inflation was only 1.5 per cent. We have taken additional action to support clinical leaders who are taking on more responsibilities. The starting pay of nurse consultants was increased by 15 per cent. and staff who took on modern matron roles—who have an important role to play in the NHS—had access to additional pay points worth at least 6.5 per cent.
We also took action to boost the pay of approximately 40,000 unregistered nursing support staff—a theme of the contribution of the hon. Member for West Chelmsford (Mr. Burns)—by guaranteeing a minimum cash increase of £400 a year. The increase can be up to 4.3 per cent. We have taken further action to encourage the culture of learning and development among non-registered staff. For example, we introduced an additional increment at the top of the pay scale for staff who have recently achieved national vocational qualifications. That increased by approximately 7 per cent. this year the pay of some nursing support staff who, as the hon. Gentleman said, do an important job in the NHS.
Those increases are all concrete and positive signs of the Government's commitment to improving nurses' pay. However, the Government recognise the particular problems of recruiting and retaining nurses and other staff in London and high-cost areas in the south of England, where, clearly, accommodation costs are high and where there are conditions of nearly full employment. Both my hon. Friend the Member for Cambridge and the hon. Member for South Cambridgeshire have rightly drawn attention to those issues, which are a problem throughout the public sector in London and the south-east. The Government are carefully considering what further action can be taken. For example, we have introduced new cost of living supplements for qualified nurses. The hon. Member for

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West Chelmsford was highly critical of that initiative for not reaching enough staff. It focused on helping to solve some of the recruitment difficulties that are particularly associated with professionally qualified staff.
Mr. Burns: I am sorry if the Minister thought that I was being highly critical—I was simply trying to add weight to the point made by the hon. Member for Cambridge. The Government should reconsider widening the initiative to include other nursing staff and workers in the NHS on low pay. I was not trying to be highly critical.
Mr. Hutton: I stand corrected. However, in future the issue will be dealt with as part of the agenda for change negotiations.
Clearly, the Government can help with some problems in the NHS and not with others. The high cost of housing is a difficult problem and although we have done good work in the past two years in improving the number of low-cost additional units available for nursing and other NHS staff in London and across the south-east, I would be the first to accept that more needs to be done. We have had some progress, especially in Cambridgeshire, where 17 two-bedroom self-contained flats and six homes have been made available for local staff.
I have not had time to mention everything this morning, but I wish to say something about agenda for change, because many hon. Members have referred to it and it is important for the future. Nurses and other NHS staff clearly deserve to be paid fairly. Investment in pay, like every other area of future NHS spending, must pass a fundamental acid test: it must contribute to expansion in NHS capacity, bring about increases in NHS productivity and deliver improved NHS performance. We are working closely with the trade unions, professional organisations, the other UK Health Departments and NHS employer representatives to agree a new pay system for the NHS based on our agenda for change proposals.
The new pay system that is under discussion will have clear benefits for nurses and other NHS staff. Pay modernisation should ensure that nurses are rewarded fairly for the job that they do and for the skills and knowledge that their work requires. It will lead to an NHS in which staff are paid according to the work that they do, rather than, as at present, the job title that they hold. The nurse who takes on more responsibility or an extended role will get more pay. It will also support a better system of career progression by removing the artificial career ceilings associated with some parts of the current nurse clinical grading system.

Organ Retention
12.30 pm
Keith Vaz: I am pleased but saddened to raise the case of my former constituent, John Hall, who passed away on 3 June 1992. He was a brave man; like millions of his fellow citizens he served his country as a member of the armed services. He was a local councillor in Leicester, and subsequently in Leicestershire. His wife was a justice of the peace and served for a year as the lady mayoress of Leicester. They had three sons—Colin, Ian and Mark.
I have raised the case of John Hall before in the House—on 25 February 1992. I did so because John was a nuclear test veteran. He was born in Burnhope in county Durham, and he moved to Leicester in 1961. He joined the Royal Air Force in 1956, and he was an electrical mechanic who served with 76 squadron of the RAF, which did all the sampling of nuclear tests in the 1950s. The squadron was responsible for flying through the bomb clouds to pick up samples of radiated particles, and he was employed as an aircraft electrician serving the Canberra bombers used for that purpose. He served at RAF Edinburgh Field from 8 October 1957 until 19 August 1958, during which time he was detached with the squadron to Christmas island in the Pacific ocean from 3 March until 19 May 1958 for Operation Grapple Y. The squadron had gone there for the H-bomb test of 28 April 1958.
John Hall was treated for high-grade B-cell non-Hodgkins lymphoma, and subsequently for hairy-cell leukaemia. He received chemotherapy and other treatment at the local hospitals in Leicester.
I raised this case on the previous occasion because of the ongoing campaign for compensation for nuclear-test veterans. I do not wish to dwell on the history of that campaign because it has been aired on several occasions in the House, and it has been the subject of petitions to Ministers. Just before John Hall died, I had a meeting with the former Prime Minister, the then Member of Parliament for Huntingdon, Mr. John Major. Defence Ministers have also been involved in the matter, and the campaign continues. I pay tribute to the nuclear test veterans for the work that they have done, and to the newspapers that have supported them—The People, The Independent and, most recently, The Mirror.
The importance of Mr. Hall's case in the context of the previous campaign lies in what happened to his wife Marilyn a few weeks ago. I attended the funeral of John Hall, which took place in June 1992, as did many thousands of people from Leicester. I thought that the matter had then ended. However, a few weeks ago, I visited Marilyn and Colin Hall at their home. Marilyn burst into tears. She had just received a letter from the Leicester royal infirmary informing her that, when her husband died, his brain was removed, as were the other parts of his body that form tissue blocks, and that they had been retained at the hospital. The letter continued to say that the brain was disposed of seven years later through what the hospital described as the "hospital system". It was clearly shocking for the family to receive such a letter. Mrs. Hall has been so distressed that she could not be present to listen to the debate, but her son is watching our proceedings.

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The tragedy of the case is that, after people bury their loved ones, they feel that that is the end of the matter. They do not believe, even in their wildest imagination, that years later they will discover that they have buried a person without his brain or other parts of his body. Marilyn Hall discovered what had happened only because she had listened to a programme on BBC Radio Leicester that featured another person talking about organ retention. That is why she wrote in.
The hospital did not offer to visit Mrs. Hall. It did not tell her in person about the terrible situation after it discovered that the brain had been removed and disposed of. It just wrote to her, and I have checked the facts because there was dispute about them.
Several questions arise from the case that affect not only my constituent, but people throughout the country. I am worried about the subject because my wife and I had a stillborn child in 1993. I discovered only while researching for this debate that the bodies of stillborn children were retained by several hospitals. I wonder what happened to the body of my child in 1993, and others will be worried about what happened to their loved ones.
I know what the Government have done about organ retention, and I pay enormous tribute to my hon. Friend the Minister, her team, previous Ministers and previous Secretaries of State for the way in which they reacted thoroughly to the Bristol case, its aftermath and the inquiry into it. That case primarily related to children's heart surgery and, at that time, everybody started to talk about organ retention. The case followed the inquiry into practice at Alder Hey children's hospital in Liverpool where it seemed that the retention of organs was especially common. There was a subsequent census by the chief medical officer of all organs and tissues retained.
The census showed that approximately 54,300 organs, body parts, stillbirths or foetuses were held by pathology services at the end of 1999. They had been retained from post mortems that occurred between 1970 and 1999. The holdings of 25 of the 220 national health service trusts and medical schools—12 per cent.— accounted for 88 per cent. of the total retentions. Nearly half the retained organs were brains, and a sixth were hearts. A total of 2,900 stillbirths or pre-viable foetuses were held. Organs were retained from 17,800 adults and 9,800 from children aged one to five, infants, stillborn babies or foetuses.
Several recommendations were proposed, and the Government accepted them all in full. I have enormous respect for my hon. Friend the Minister and I am sure that she will tell us about the good work that has been done on the code of practice and about changes made over the past 10 years. We accept that and welcome it. However, this case raises new questions. I am worried—I am sure that other hon. Members will be worried— about the number of members of the public who will contact hospitals after hearing about the case. We thought that the findings of the census would be the end of the matter.
eWhen I met the health trust a few months ago, it assured me that it had searched through its files, cupboards and laboratories and it said that there was
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nothing left. However, Marilyn Hall was shocked to learn that information about John's brain had been discovered. When she asked why the brain had been taken, the hospital replied that it did not have any notes on the brain. We then asked how, if the hospital did not have any notes, it could know that the brain had been disposed off.
Can my hon. Friend the Minister produce the note that led the hospital to confirm that it had the brain in the first place and that the brain was subsequently disposed of? Secondly, what does disposal in the hospital system mean? We know that the brain was not buried with the body and that the tissue blocks are still with the royal infirmary. Surely the hospital should have come forward at some time during the seven years, told Mrs. Hall that it had discovered the brain and asked her what she wanted to do with it. She would most probably have replied that she wanted a reburial.
We are not talking about a small organ. I checked with the hon. Member for Wyre Forest (Dr. Taylor), who is the only doctor I know in the House. He told me that the brain is almost the same size as our skulls and that our skulls are comparatively thin. The brain is therefore a large organ. It is not easy to take such an organ from the laboratory or wherever the hospital was keeping it, put it somewhere else and then dispose of it. Was the brain buried? Where was it put? Was it incinerated? Are there any incineration records? Mrs. Hall and her family need to know the answer to those questions because that would reassure them about what has happened.
Can we now have an immediate audit of all the laboratories and all the facilities in Leicester so that no one else will get the terrible surprise that Mrs. Hall and her family have had to face? The brain was removed at the time when everyone knew that John Hall was a nuclear test veteran. We also know that a Ministry of Defence official attended the inquest because John served on Christmas island. Did the MOD have anything to do with the retention of his brain? Did it carry out any tests? Did it receive a report? Clearly if we are trying to make out a case that the leukaemia was caused by what happened on Christmas island, the retention of—and tests on—this organ was important. What was the involvement of the MOD? I will not accept the excuse that we sometimes hear that this is a matter involving the security or intelligence services. We want the facts about MOD involvement.
Will my hon. Friend the Minister meet urgently with her counterpart in the Home Office to discuss how coroners are involved in the system? The hospital says, "It is not our fault; the coroner made the order." Mrs. Hall did not consent. The hospital says that the issue is not about consent, but about whether a person objects. Bereaved people do not think about such things at the time. Why did the coroner make that decision? Can we have the coroner's files? Can we know who the coroner was? Can we know why he called the Ministry of Defence? Can we have all that information? I know that my hon. Friend cannot give us that information because it is held by the Home Office, but I do not want to hear her say that it is a matter for another Department. We want the facts of the case. We want to know what is happening.

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As a general point, let us have better liaison between the coroners service and the health service. We know that the responsibilities of one stops and the other starts, but a great mystery surrounds coroners. I know that we watch "Silent Witness" on a Sunday night and see the work that Amanda Burton does. I wish that all the coroners and all the people associated with pathology were like those whom we see on television, but frankly, they are not. We do not know who they are, yet they make crucial decisions that affect the lives of people.
Finally, we need the Minister's assurance that there will be an inquiry. I know that it would be helpful to meet others to discuss the situation on the family's behalf, but they have had enough of meetings. They want to know the facts. They want an inquiry into the whole issue, and they want these matters brought to our attention. We know that the situation has changed and that things have become better, but we want to ensure that the truth comes out, not only for Marilyn Hall, but for people like me and my wife and the thousands of others who will hear about this case and be anxious about what might happen. The bodies of dead people need to be treated with respect, and especially that of John Hall given his record of service to the country. I knew John Hall, so in a sense this case matters more to me than some others. Dead bodies should not be hacked about in such a way, taken to pieces, and left in different parts of the home city, as they were in the case John Hall. I want to know what my hon. Friend the Minister will say about that, but I assure her that the matter will not stop here. We intend to pursue it until we get to the truth.
12.46 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): My hon. Friend the Member for Leicester, East (Keith Vaz) has secured an extremely important debate. I am very aware of the keen interest that he has taken in the case of the late Mr. Hall, and that he has sought further information about the disposal of Mr. Hall's brain and other tissues. My hon. Friend has pursued the matter through a wide range of channels on behalf of Mr. Hall's family, and has raised important and pertinent questions. I will do my best to respond to them. There may well be matters of detail that I will need to follow up after the debate, but I give my hon. Friend my undertaking that I shall pursue the matter and ensure that he receives answers to his questions on behalf of the family.
I take this opportunity to acknowledge the distress that this series of events has caused Mr. Hall's family. The recent discovery that Mr. Hall's organs and tissues had been retained by Leicester royal infirmary is of tremendous and understandable concern, especially as it came to light 10 years after Mr. Hall's death. I have had policy responsibility for this matter for the past 12 months, and I have met several families, especially in the Liverpool area, who have been involved with the issue of retained organs. I have met members of the various campaign groups, and have had first-hand experience of the depth of suffering, anguish and distress that many of those families have experienced as a result of the discovery that they made about the tissues and organs of members of their family. It is hard to overestimate the effect that that has had on families.
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I want to set out the information that I have on why Mr. Hall's brain and other tissues were retained by the Leicester royal infirmary. I am advised that his brain was removed on 5 June 1992, at the request of the local coroner, so as to hold an inquest. The law provides that the coroner can request the retention of any organs or body tissue that may assist with an inquest. I also understand that following the coroner's inquest, the late Mr. Hall's brain was transferred to the Leicester royal infirmary's histopathology department, and booked into the neuropathology department on 12 June 1992. An histology sample was taken at that point, and the remainder of the brain was stored in the tissue store until it was disposed of by, I am told, incineration—which was the normal hospital practice—on 13 December 1993.
There is a lengthy gap between 12 June 1992 and December 1993,and it is right to ask why the brain was kept for such a long period after the inquest. The disposal of Mr. Hall's brain was carried out in accordance with the protocols that pertained in the hospital at that time. My hon. Friend has gone through the history relating to the inquiry by the chief medical officer and the recommendations of the Alder Hey report, but every one of us would acknowledge that past systems were not perfect. They did not function in a way that recognised the dignity and the rights of the individuals and families concerned. That was the widespread practice throughout the country; it does not apply just to Leicester.
The Government take the matter seriously and have taken action to ensure that, in future, the systems work for people in local communities. Too often, consent was not sought. Partly as a result of a paternalistic system that attempted to protect people, such issues were not raised in discussions and in consultation between clinicians and families so routine consent was not sought. I stress that we have acted to ensure that that is no longer the case and, in every case, families must give their informed consent. That is the bottom line.
The law allows the coroner specifically to request the retention of organs or tissue to establish the cause of death. As my hon. Friend says, consent is not a requirement; it is a matter for the coroner to carry out an investigation. Systems need to be improved so that families are part of the process, and do not feel that people are riding roughshod over them.
The law governing organ and tissue retention—in particular, the Human Tissue Act 1961—is unclear, ambiguous and outdated. The law has, in any event, been poorly understood and, as a result, it has not been applied well. Custom and practice developed within the framework of the law and relied too heavily on the traditional attitudes of the people involved in a paternalistic system. The benefits of teaching and research were recognised, but the wishes and feelings of families were not sufficiently balanced with the need for teaching and research. The balance in the previous system was wrong.
The removal and use of tissue samples and organs in medical research and education has significant implications for everyone's health. The development of new drug therapies, the diagnosis of existing conditions and the training of medical professionals rely heavily on the donation of tissue and organs. Many people are happy to donate organs if that has been discussed with

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them and they are able freely and properly to consent to it. However, as this case illustrates, in the past, families were not always asked for their consent. That is why things went wrong.
In March 2000, we began to reform matters dramatically, setting out interim guidance to try to ensure that, from that point onwards, appropriate consent was given for hospital post-mortem examinations and for the retention of organs. That was followed up last year with further advice about the removal, retention and use of human organs and tissue, and 17 recommendations were made to change the practice and culture across the NHS. Major changes are now being proposed in the way that consent is sought. Families have had an input into the codes of practice that have been developed to work practically. There will be new regulatory controls and a wholly new framework of law for the system.
My hon. Friend raised the role of the coroner, which is most important. I am pleased to be able to tell him that part of the programme of work being carried out in response to the chief medical officer's recommendations is a review led by the Home Office in close contact with the Department of Health about the operation of the coroners service. The systems should not operate in isolation. They should be integrated and form part of the same framework and ethos that we are trying to establish in the health service.
Keith Vaz: I do not want to interrupt my hon. Friend, and I am grateful for the information that she has provided. However, I raised several specific points about this case. If she does not have time to reply to all of them, will she agree to meet Mrs. Hall, her family and me in the near future so that the rest of the answers can be given? The problem with ministerial replies is that they raise more questions that require still further debate. It would save time if we could meet in the near future.
On another important point, is my hon. Friend satisfied that today no organs that are unaccounted for are retained at the Leicester royal infirmary?
Ms Blears: On my hon. Friend's last point, understand that 142 organs are retained by the university hospitals of Leicester and the NHS trust. It is the role of the Retained Organs Commission, which was established by the Government, to carry out an audit of where organs are located throughout the country and to assist the trusts and families in organising the sensitive return of organs when the families want that. The system works through families contacting the trusts to make inquiries about whether any organs are held. A search is then carried out of all the relevant databases to establish whether organs are held, and that is followed by a proper discussion with the families to find out what they want done with the tissues, blocks, slides, organs and so forth. Do they want a burial or would they rather that the hospital disposed of the remains? Everything is done very sensitively.
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Let me make it clear to Mr. Hall's family that, if they wish, the Retained Organs Commission can get in touch with them. Part of its role is to act as an advocate for families in these difficult circumstances and to discuss problems with the hospitals.
Keith Vaz: We will discuss this case with the commission, but the family would like to meet my hon. Friend the Minister. I know how busy she is, but these matters must be resolved. They have dragged on for 10 years. If the questions cannot be answered today, it would be helpful to arrange such a meeting.
Ms Blears: My ministerial colleague, the parliamentary Under-Secretary of State for Health, the hon. Member for Tottenham (Mr. Lammy), is in charge of this policy area. If outstanding matters remain, I am sure that a meeting could be arranged, but I can provide my hon. Friend with further information today. I am advised that the normal system used was incineration and that the organ was disposed of in accordance with normal protocols. I shall press the hospital to establish what records are available and when notes were made.
As to the Ministry of Defence, I am advised that it did not contact the trust or the coroner at any time, and I can supply that information to my hon. Friend today. I have already dealt with the Home Office review and I can confirm that close and ongoing work and liaison between the Department of Health and the Home Office is taking place and will continue in respect of this matter.
Over the past few years, the Retained Organs Commission has acquired a wealth of experience in helping families in these circumstances and it would be more than happy to get in touch with the family and liaise with the trust on its behalf to acquire any further helpful information.
Finally, we have issued a consultation document, "Human Bodies, Human Choices", which is all about advancing a fundamental review of the law in this sphere. Several workshops that included family members were conducted, so it is not a matter of only the Government making proposals. We are going out to people and asking what would work for them in the future. The consultation period ended in the middle of October and we are examining what we can do now to proceed as quickly as possible. Families want the recommendations of the chief medical officer enshrined in a whole new legal framework. I am acutely aware of the distress, trauma and pain caused to hundreds of families up and down the country. Clearly, Mr. Hall's family is feeling that pain. We are determined to ensure that this difficult and sensitive matter is handled properly in future, and that Mrs. Hall's legitimate concerns are answered as far as possible by giving the family a clear picture of what happened and information about why and what they can do now to ensure that any remaining tissues are disposed of as sensitively as possible.
Mr. Mike Hancock (in the Chair): I thank the Minister for her reply. If there is further information on the points raised by the hon. Member for Leicester, East (Keith Vaz), it would be helpful if it were placed in the Library. It would be beneficial if as much information as possible were available on this issue.

Local Government Finance (Norfolk)
1 pm
Mr. Keith Simpson: I am greatly obliged for the opportunity to speak on this important subject, not only for my constituents but for those of parliamentary colleagues.
This debate is part of a wider campaign for a fair deal for Norfolk and it has all-party support. I am very grateful for the attendance of my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard) and the hon. Members for North Norfolk (Norman Lamb) and for Great Yarmouth (Mr. Wright). All the Norfolk Members of Parliament support the campaign, and I am sure that at some stage the right hon. Member for Norwich, South (Mr. Clarke), the Secretary of State for Education and Skills, will, perhaps behind the scenes, press Norfolk's case.
I hope that the Under-Secretary of State, Office of the Deputy Prime Minister, the hon. Member for Shipley (Mr. Leslie), will concentrate in his reply on the specifics to do with Norfolk. I think that, within reason, all hon. Members are aware of the general background. I attended the ministerial briefing last month, for which I was grateful. The Minister gave a lot of time to members of all parties on the consultation paper.
I make no bones about the fact that this debate is part of a Norfolk lobby aimed at influencing the Government's provisional announcement at the beginning of December. As politicians, we all learn that it is no good making a noise after a decision has been made; it is best to do so before.
In many ways, understanding local government finance is like Palmerston's famous comment about the Schleswig-Holstein question: only three people knew about it; one was dead, one was mad, and the third had forgotten what the question was. This is a horrendously complex subject. There has been wide agreement that the current system needs changing, but that does not mean that the Government's wide range of options has met with universal approval.
One problem that I want to flag up straight away is that there has been considerable uncertainty because of the range of options. That has made it exceptionally difficult for Norfolk county council and the district councils to plan ahead for the next year; budget decisions have to be made now.
I deal now with the question of fair funding for Norfolk. The Minister will be aware that counties as a group do not do well out of current arrangements, and that historically—not only under this Government, but under previous Governments—Norfolk has received below county average standard spending assessment per head of population. The gap between Norfolk and the county average produces a shortfall in funding of almost £10 million a year, which is equivalent to 5 per cent. in council tax.
We all agree that the old SSA system needed to be changed. Indeed, Norfolk county council and the district councils have warmly welcomed the Government's attempts in that regard and have fully participated in the research. The real question is fairness. When we examine the formula proposals in detail, we feel that they do not impact fairly across the
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regions or the types of authorities. There seems to be a range of potential outcomes. There are some 80 different options in the Government's proposals. Depending on how they are balanced, under the new formula proposals Norfolk could in theory gain £28 million. However, it could lose £33 million. The county council certainly fears that we shall be in the category of net loss rather than net gain, and that is before we consider the major funding pressures that it is already under.
The county council has identified cost pressures for the years 2003–04 at £47.9 million in mid-September. Since September a further £2.8 million of mainly Government-driven changes has been added, making the current total slightly more than £50 million. There are major sources of funding pressure. The impact on council tax of £50 million of additional pressure equates to an increase in that tax of nearly 19 per cent.
We must also bear in mind one of the main thrusts of the Government's policy—resource equalisation. In many respects that is the most contentious element in the proposals. Most of the Members of Parliament in Norfolk, let alone the eastern region, see that as a technical way of transferring more resources to high-spending councils in other parts of the United Kingdom. That alone could lose Norfolk county £10 million, and Norfolk police authority £1.5 million. The consequences for the county are, therefore, enormous.
Mr. Henry Bellingham rose—
Mr. Anthony D. Wright rose—
Mr. Mike Hancock (in the Chair): Order. Before I take interventions, it is the custom of the House, and the Speaker requires it, that Members who wish to make interventions should inform the hon. Member who secured the debate, the Minister and the Chairman. At this stage, only one Member has notified me of his wish to intervene. If Members wish to intervene, they should observe the courtesies of the House.
Mr. Bellingham: I apologise, Mr.Hancock, for not informing you first. I would be grateful if my hon. Friend would elaborate on his point about policing. That point is of great importance to North-West Norfolk, because of the fens project, a tripartite scheme with Cambridgeshire and Lincolnshire. That project shares resources and intelligence, and was set up in the aftermath of the Tony Martin case. If the funds are not forthcoming for that project, it will probably collapse. That would be a disaster for my constituency, and for that of my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard).
Mr. Simpson: I am grateful to my hon. Friend for raising that issue. Norfolk has benefited from the rural policing grant that was introduced in 2000–01, gaining £2 million as a result. The new proposals consolidate the RPG into a general funding formula, but at too low a level-1 per cent. rather than 1.4 per cent. As a result, the grant for rural police authorities will be reduced, which will have a major impact on nearly all our constituencies.
Mr. Anthony D. Wright: I also apologise, Mr. Hancock, for not mentioning to you that I wished to intervene. I did not mean to be discourteous.

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Over the past few years we have seen a growth in resources for the police and education, and we fear that the new formula will turn the clocks back, and perhaps make the situation worse than it was previously. We want to see the current growth as a burden on the government grants system rather than on the individual ratepayers of Norfolk and of my constituency, Great Yarmouth.
Mr. Simpson: The hon. Gentleman makes a fair point. There may be other parts of the country that have requirements, but Norfolk's existing resources are likely to be taken away. The situation could get worse. The figures given earlier assume a 3 per cent. floor, yielding approximately £12 million. The Government have guaranteed that the grant for 2002–03 will be no less, in cash terms.
Norman Lamb: I want to reiterate the concern about matching the grant for last year. That sounds great, but in practice it could be a disaster. Increases in salaries and national insurance, and extra burdens such as recycling, will substantially increase the base cost for local authorities. It is therefore essential that we receive more than last year, rather than simply keeping pace with it.
Mr. Simpson: The hon. Gentleman makes a good point.
Mrs. Gillian Shephard: If Mr. Hancock will allow it, will my hon. Friend give way?
Mr. Mike Hancock (in the Chair): The hon. Gentleman is being extraordinarily patient with everyone.
Mrs. Shephard: This is an all-Norfolk, and indeed an all-party occasion. If the Government kept their promise of guaranteeing no less a grant in cash terms than for 2002, what does my hon. Friend think that would mean in terms of an increase in council tax for the people of Norfolk? It is an empty promise, because the increased pressure to spend would mean an increase in council tax.
Mr. Simpson: Once again, my right hon. Friend presses me on the figures. In the worst-case scenario, Norfolk would be £12 million worse off. That would mean a further 6 per cent. increase in council tax, making a total increase of about 24 per cent. That would be politically unacceptable, if not political suicide. It is a major problem.
Next is the question of predictability. Even the floor of 3 per cent. might be in place for only one year. The Government have not yet confirmed how long it will continue, and it may not be enough to compensate for formula terms.
I turn briefly to the equally important question of fair funding for Norfolk's policy authority. The current funding system once again means that the average funding per head of population in the most rural counties, including Norfolk, is £3.23 a head below the
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national average. If Norfolk police were funded to the average shire level, it would have received £2.6 million a year. The current council tax precepts for policing show that taxpayers in the most rural police authority areas pay £14 a year more than in urban areas. Why?
Mr. Richard Bacon (South Norfolk): My hon. Friend makes a good point about rural police forces. Is he aware that Norfolk constabulary, whose new headquarters is in my constituency, faces additional spending pressures of up to £9.5 million, most of which is statutorily required, and that it estimates it will receive between £300,000 more and £6 million less? How are we supposed to make up the difference?
Mr. Simpson: The options available to the county and the police authority are simple. First, they can try to be more efficient, and it is fair to say that Norfolk county council, the district councils and the police authority are driving as hard as they can to make efficiency savings. Their second choice would be to make cuts, which would be politically unacceptable. Thirdly, the council tax would have to be increased by so much that that, too, would be politically unacceptable.
The notional cost of the loss of £6 million for the police authority mentioned by my hon. Friend the Member for South Norfolk (Mr. Bacon) would equal 200 policemen. However, the county council and the police authority are already under considerable pressure, without looking to the future and considering the impact of the Government's new formula. My hon. Friend touched on the fact that all those authorities already face new statutory burdens, rightly introduced by the Government to raise standards. For example, as employers, the county council and the police authority will suffer the impact of increased national insurance contributions, which will cost them £800,000 next year.
I want to leave the Minister plenty of time to reply, but in closing I want to return to an important point touched upon by several of my hon. Friends. The. Minister for Local Government and the Regions—I see that he is responsible also for fire fighting, which is a happy combination—wrote a letter to the Eastern Daily Press on 2 November. That was just after I heard I had been given this Adjournment debate—another happy connection. In that letter, he wrote:
"It seems that councils in the county"—
Norfolk—
"are unaware of the guarantee I have made to local government that no local authority will get less grant than they got last year on a like-for-like basis".
That sounds like good news, but when we examine those words in detail—the hon. Member for North Norfolk alluded to this—we find that they are slightly misleading, to say the least. First, the guarantee appears to be for only one year, which is pretty limited. Secondly, the Government have budgeted for an increase in money to local government, but they expect councils to spend more than the amount of that grant on public services. Thirdly, as we all know, much of the money that goes to councils is ring-fenced, so they have little flexibility. The situation reminds me of the old Sam Goldwyn comment that a verbal guarantee is not worth the paper it is written on.
The Minister must be aware that Norfolk took a positive attitude when it entered the discussions on reforming local government finance. When it examined

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the options, however, it concluded that, whatever the criteria, it would be at the end of the spectrum where the figures came with minus signs attached. Those Members who are present believe that that is unfair, and I look to the Minister to come up with some hard facts to reassure us. When the proposals are announced at the beginning of December, I hope that we will be able to say that Norfolk has got a fair deal. At the moment, the suspicion is that it has not.
1.16 pm
The Parliamentary Under-Secretary of State, Office of the Deputy Prime Minister (Mr. Christopher Leslie): First, I congratulate the hon. Member for Mid-Norfolk (Mr. Simpson) on securing the debate, not least because the subject has exercised almost every Member of Parliament. Indeed, we have already had a detailed and lengthy debate in the main Chamber about the formula grant review.
Many hon. Members are rightly extremely concerned about funding for their local services, and such issues are raised in many of our surgeries. The hon. Gentleman said that the debate was a shameless lobbying exercise on behalf of Norfolk, and it has been very successful, judging by the turnout of Opposition Members representing Norfolk and the presence of my hon. Friend the Member for Great Yarmouth ( Mr. Wright).
I shall deal with the specifics of Norfolk in a moment. The hon. Gentleman suggested that everyone was familiar with the broader issue, but it is worth touching on some general aspects of local government funding and on our intentions for change. I shall not repeat much of what I said in the main Chamber, but I should emphasise that we shall see the demise of the old standard spending assessment—the SSA system. We want to move away from the practice of central Government telling local authorities that their spending should or should not be at a particular level. We want to find ways of giving them greater freedoms and greater flexibility so that they can be more directly accountable to local people. That means that we must get away from the SSA system and focus on how we divide up grant—the money that actually goes to local authorities. The SSA system will be no more.
Even if more money is available to authorities—and it will be, given the announcements made in the spending review—they will not all be able to have a bigger slice of the cake, because that is statistically impossible. It is therefore unsurprising that the Government have received strong representations from many authorities. We want to consider the relative circumstances of different authorities, and to try as best we can to base decisions on need. We will consider several different factors to determine grant.
The right hon. Member for South-West Norfolk (Mrs. Shephard) queried the guarantee that we have been able to give so far that there will be no cash loss, on a like-for-like basis, for particular authorities. That does not mean that it is the optimum guarantee; it is the
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minimum guarantee that we can give while we are still gathering statistical evidence to produce the formula. We hope to do much better.
Mrs. Shephard: That was not the point. I was asking what the impact would he on the Norfolk council tax payer if the Government managed to keep the guarantee.
Mr. Leslie: As I say, I hope that we can do better than the no cash loss guarantee. I shall mention later the extra education money that we have allocated. That has enabled us to guarantee a real terms increase in education services. That is the largest component of the formula grant review.
I must record my appreciation for Norfolk county council's work with the county council network in devising some of the formula options that we have discussed. It helped to commission research on formula change to distribute mental health service moneys, and on how to take account of additional costs associated with providing home care services in rural areas. The research and its implications have been considered carefully and are reflected in the options that are in the consultation package with which hon. Members are familiar.
Norman Lamb: The Minister mentioned the cost of services in rural areas. The rural services partnership, which represents the 50 most rural councils in the country, is concerned that inadequate attention is being given to rural deprivation. It is often hidden, but it does exist in Norfolk. It is essential for any new formula to take account of such concerns.
Mr. Leslie: That is a fair point, particularly as far as education funding is concerned. A number of authorities serve sparsely populated areas, so the Government think that the formula should reflect sparsity, as it affects the cost of home to school transport in rural areas and the help required for rural primary schools. In the course of research, we found that sparsity may make a difference in respect of primary schools but the case is less clear in respect of secondary schools. There is likely to be as many small secondary schools in densely populated metropolitan areas as there are in shire counties such as Norfolk. Nevertheless, we recognise that secondary school pupils often have to travel further to get to school in sparsely populated areas, which is why we have examined our transport expenditure options. We hope that the new formula will cover 60 per cent. of the transport element of the LEA block through the sparsity index and 40 per cent. through the number of pupils covered by the authority. That will reflect the high levels of transport expenditure in sparsely populated LEA areas such as Norfolk.
The Government want a fairer, clearer system justified by the educational needs of children and based on the evidence of cost and need. I can give a commitment that no local authority schools will lose out in real terms. In addition, all local education authorities will benefit from increased funding over the next three years, following the Chancellor's spending review announcements.
Mr. Simpson: Does the Minister know whether the Government will compensate the county council for the

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increase in teachers' pension contributions? Giving welcome money with one hand and taking it away with the other will have a major impact on the education budget.
Mr. Leslie: I often find Conservative Members arguing for higher and higher public expenditure. That is understandable in many respects. We intend to ensure that, where appropriate, we reflect additional pay costs. The additional costs adjustment is controversial among many MPs, but we will take pay costs into account. Deprivation is also extremely important, and we would not want our debate to go by without considering additional educational needs and the education spend. The options that we set out in the consultation paper reflect several variants on how deprivation can be taken into account, and we intend to introduce a phasing-in period for some of the proposed changes.
I appreciate that expenditure on policing is an issue close to the hearts of all our constituents. The aim of the police formula review is to develop a robust mechanism for distributing Government grant fairly and simply. There are many different pressures in rural and metropolitan areas, and we are anxious to do our best to allocate resources as fairly as we can. Any extremes at either end of the options illustrated in the consultation package will be tempered by the floors-and-ceilings mechanism with which hon. Members are familiar. Of course, those floors and ceilings are applied after the calculation of the grant, and announcements on that will be made shortly. However, it is important to remember that we are taking decisions against a background of substantial increases in expenditure on the police. By 2005–06, the total provision for policing will be about £1.5 billion more than it was in this financial year.
The hon. Member for North Norfolk (Norman Lamb) asked us to concentrate on issues affecting Norfolk. To set those issues in context, I point out that, in the past five years, there has been a 20 per cent. increase in real-terms expenditure for local government, compared with a 7 per cent. reduction in the last four years of the Conservative Administration. We have continued to prioritise education and social services, on which there will be a 6 per cent. increase in expenditure over the next three years.
Mr. Bacon rose—
Mr. Simpson rose—
Mr. Leslie: I know that Conservative Members are champing at the bit to ask about the Norfolk settlement. I understand that Norfolk county council has benefited significantly from our extra investment in local
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government. Under this Government, there has been an average increase in the grant of about 4.9 per cent. compared with an increase of 2.1 per cent. in the last four years of the Conservative Administration. We have managed to sustain an average increase of more than twice the rate set by the Conservatives.
Mr. Simpson: The Minister has misjudged the mood of the debate. This is not a party-political issue. We understand that the Government have increased the money available in certain areas but have imposed new requirements on Norfolk county council, and I have quoted the figures. With the best will in the world, people in Norfolk and hon. Members who represent Norfolk constituencies believe that we currently have a net loss and that, under the Government's proposed formula, we are likely to be worse off. Can the Minister guarantee that, when he makes his announcement at the beginning of December, we will be able to say that the Government have given Norfolk a fair deal and that Norfolk will not be worse off?
Mr. Leslie: I can most certainly guarantee that Norfolk will receive a fair deal, and I can guarantee right now that there will be no cash loss for councils. I can put people's minds at rest about the more extreme options in the consultation document.
I want to touch on the important issue of social services, about which I know that hon. Members are concerned. This year, there has been a 5.8 per cent. increase in expenditure on social services; a 15.9 per cent. increase in the children's grant and a 21.9 per cent. increase in carers grant. Similarly, in education, the standard spending assessment for Norfolk has increased by 36 per cent. in five years. Those are significant sums of money. On police funding, there are extra officers—more than ever before.
A formula grant review consultation is now underway. We are involving as many people as possible and have heard representations. Floors and ceilings will be introduced to give the measure of protection that hon. Members are concerned about. We try to take a balanced view at all times. It is difficult to make everyone a winner, but the Government are putting in much extra investment. That investment will be the message that will come out of the announcements that we make in December. We want a more transparent system, but we also want to make sure that we have decent investment and public services.
Mr. Mike Hancock (in the Chair): We are about to move on to the next debate but, before we do, I remind hon. Members that in Westminster Hall there is a convention that if hon. Members are to make an intervention, they must inform the Member who initiated the debate, the Minister and the Chairman. To my knowledge, no one has done that. On this occasion, am prepared to give way on the issue, but hon. Members should be mindful of that duty.

Portland Search and Rescue Helicopter
1.30 pm
Jim Knight: I am grateful to be granted this debate on the future of the Portland search and rescue helicopter. The threatened transfer of that service to Lee-on-the-Solent represents a threat to the Dorset economy and marine safety in south-west England and, most importantly, would lead to a needless loss of life.
I am grateful to the Minister and officials of the Maritime and Coastguard Agency for meeting me on many occasions in the past six months to discuss my concerns about the proposals. Equally, I am grateful to my fellow hon. Members, some of whom are present, for their support in the campaign. I know that the right hon. Member for West Dorset (Mr. Letwin) and the hon. Member for East Devon (Mr. Swire) would have liked to be here, but were unable to. Thanks must principally go to the many members of the public—including the 25,000 who have petitioned me on the subject—who have given so much momentum to the campaign.
Last night, I visited the website of the Maritime and Coastguard Agency. The first thing to greet me was the inevitable vision statement. It reads:
"Our vision is to be a world class organisation that is committed to preventing loss of life, continuously improving safety and protecting the marine environment."
None of us could argue with that, but moving the service from Portland to Lee-on-the-Solent is totally contrary to that vision.
The current uncertainty has come about because of the need to replace the existing hangar at Portland. The hangar is located at Osprey quay, which is being redeveloped by the South West of England regional development agency following its sale by the Ministry of Defence. Although the coastguard hangar needs replacement, the requirement has been brought forward because of the RDA's need to redevelop the site. When that first emerged a few years ago, there was agreement in principle between the RDA and the MCA, but negotiations subsequently broke down over the flood risk to the site.
At that time, the MCA looked for alternative sites from which to operate the service, and judged that it would be viable and cheaper to operate from the existing hangar at Lee-on-the-Solent, which, incidentally, is old and in need of replacement. Retaining the service at Portland is now regarded as an extra cost. The issue is less about running costs than about the cost of building the hangar. That, as I understand it, remains the key outstanding issue.
The search and rescue helicopter Whisky Bravo covers the coast from Poole harbour to Start Point. West of Start Point, cover from Culdrose and Chivenor is provided by the Ministry of Defence. Whisky Bravo operates 12 hours a day, and is the biggest civilianised search and rescue helicopter in Britain. At the beginning of this week, it had responded to 177 incidents this year, as opposed to 165 at Lee-on-the-Solent, 112 at Stornoway and 75 at Sumburgh. All are operating at half the hours of Portland, and yet none are busier. That makes the idea of removing the service from that section of the coast somewhat bizarre. Would not the logical development be to increase the service at Portland to 24 hours and make savings elsewhere?
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The idea of 24-hour working has been proposed to the MCA and has been shown to be possible. I know that the MCA response would be that it is not considering removing the service, but simply relocating it to Lee-on-the-Solent, 51 nautical miles away, and that it is possible to operate the service from there and still meet the national guidelines for response times. However, I question that, and I shall explain why.
Let me first deal with the substantive point. The MCA would be moving an emergency service away from its busiest area. The estimated flying time between Lee-onthe-Solent and Portland is 28 minutes. At a time when ambulances are trying to reduce their response times, the MCA is considering increasing its response time by 28 minutes. That would be a cut in the quality of the service and would go against the MCA's vision of preventing loss of life.
I shall read from a letter from Dr Karim, who is the senior house surgeon in the accident and emergency department of Dorset county hospital. He comments on a patient who, in May this year, was in the water at Durdle Door for approximately 15 minutes before being rescued. The response time of the Portland search and rescue helicopter was just three minutes, and the rescue and the delivery to Dorchester took just another five minutes. Dr Karim says:
"It is my professional opinion that"
my patient
"was very lucky to have survived this incident and had the Air Sea Rescue helicopter been delayed by only a further 5 minutes he would most certainly have died."
That patient was very lucky—only a further five minutes, not a further 28 minutes, and he would have died. If Portland had been closed, that patient would have died, and he would not have been the only one this year. Whisky Bravo's crews have rescued several people this summer who would have died had the response time been significantly longer.
Mr. Adrian Sanders: I congratulate the hon. Gentleman on securing this important Adjournment debate. He will know that Torbay is one of the country's main maritime playgrounds. Moving the helicopter will increase rescue times in the summer when—as we joke— the Birmingham navy comes to play. That is a joke, but there is a serious point. Inexperienced people can get into difficulties at sea and minutes can save lives. We are right behind the hon. Gentleman.
Jim Knight: I thank the hon. Gentleman for his support. He makes a good point, and I shall mention Torbay a little later on.
The crews of Whisky Bravo are to receive a bravery award at 10 Downing street later this month. I cannot understand how the MCA can even consider relocating this service in the knowledge that doing so will cost lives. I have said that the relocation fulfils national guidelines, which require a helicopter to reach an incident in a high-risk area within one hour; but I shall explain what would happen if there were an incident immediately off Portland. The contractor would have to be airborne within 15 minutes and flying time to the incident would be about 28 minutes, depending on wind speed and direction. On a good day, the response time would therefore be 43 minutes. That is fine, and within the

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guidelines. If, however, the incident were off Torbay, another 25 minutes would be added and the test would be failed. A helicopter would have to be sent from Culdrose. That helicopter could get to the incident in 15 minutes, but it would leave the busy Cornish coast with no cover.
Ms Candy Atherton: I, too, would like to congratulate my hon. Friend on securing this important debate. Will he join me in congratulating the personnel at Culdrose on their incredible work? Does he agree that, if the relocation goes ahead, it could have a serious impact on the lives of the mariners on the west coast of Cornwall whom I represent?
Jim Knight: I agree. The reduction in service would have knock-on effects around the coast. That reduction would have to be compensated for, which would mean an increased work load for Culdrose. Anyone who represents a constituency in the south-west peninsula ought to be concerned about those effects.
Between Torbay and Portland is Lyme Bay, which is in a grey area. It would be a struggle to get there in time, especially when the weather was bad—-which, of course, is just when rescue services are likely to be needed. A further problem would be the need to refuel between incidents, which entails returning to base or, if pushed, to an airport such as Bournemouth or Exeter. Hon. Members will understand that, on a busy day, Whisky Bravo would really struggle to fulfil its minimum requirements.
I imagine that the MCA has carried out a risk assessment for such eventualities, and I should be grateful if the Minister would arrange for a copy to be placed in the House of Commons Library. I believe that the existing guidelines are flawed and I would respectfully suggest to the Select Committee on Transport that it consider them the next time it discusses the operation of the MCA. The guidelines should differentiate between different types of incident.
I also understand that a review of national search and rescue cover is due in the next few years through the Ministry of Defence. The MCA has explored the possibilities of sites for basing the helicopter other than the site at Portland in Dorset, but to no avail. If the agency abandons Portland now, it cannot go back, and it will have prejudged the outcome of that national review for the south coast. That cannot be right. Incidentally, the savings made by civilianising the service nationally would pay for a new hangar at Portland every year.
Any review must look for differential guidelines for different types of incident. Divers, for example, need to be taken to a decompression unit quickly—normally within 30 minutes—to prevent permanent or fatal damage. This year, there have so far been 50 incidents of divers being taken to the pool decompression unit by Whisky Bravo. Of those incidents, 17 were assessed as requiring rapid decompression to save life. Those divers could not have waited for the aircraft to come from Lee-on-Solent; they would have died or suffered serious permanent disability.
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The guidelines make no allowance for such incidents, and they should do so. If an area attracts a high number of incidents that require a faster medical response than the national guideline of one hour, the guidelines should be changed to reflect that fact.
There are other reasons why we need the service to remain at Portland. One reason is our economy. Tourism is the most important local industry to us on the south Dorset coast. Last December, the Dorset and east Devon coast received world heritage status from the United Nations Educational, Scientific and Cultural Organisation. Our coast uniquely exposes a perfect geological time line of the Jurassic age. The result, we hope, will be an increase in visitors coming to see the varied beauty of the area, from walkers on the coastal path to dinghies and small boats on the sea. We are already experiencing that increase. Each year, Whisky Bravo responds to 30 or 40 incidents from cliff top walkers and climbers. With world heritage status and the encouragement that we are giving to visitors, that number can only rise.
The Portland sailing academy sits alongside the Whisky Bravo hangar. The academy is the home of our national youth sailing teams, and if any hon. Members come to Portland harbour in the summer they will see those teams in training, including many of our Olympic medallists. The academy is the subject of a large lottery bid, which will develop the National Sailing Academy for the Royal Yachting Association. Sailing and water sports are the leading economic development driver for the area according to Weymouth and Portland borough council, and they are assessed as the leading economic driver for the area by the regional development agency, yet we are set to abandon them. Each year, Whisky Bravo responds to 40 or 50 incidents involving small boats and windsurfers. With the development of the sailing academy, the numbers will rise, as will the risk to the lives of people participating in those sports.
Removing Whisky Bravo puts at risk the economic development of our area, which will lose its reputation as a safe place to visit.
Mrs. Annette L. Brooke: I, too, congratulate the hon. Member for South Dorset (Jim Knight) on securing the debate and thank him for allowing me to intervene. As he knows, I represent an area to the east of his constituency, and our economies are inextricably linked. Does he agree that the views of those in the east and the hinterland of Poole harbour are just as strong as those in his own area and in the west? The hon. Member for Poole (Mr. Syms) and I have received thousands of representations. The move will have an impact on the local economy and activity, because people value the service greatly and we have many visitors to the harbour.
Jim Knight: I am grateful for the intervention. I agree that there is a strong link between the economies of my constituency and the Poole area. In fact, I represent 80 per cent. of the Poole harbour area, so I would certainly agree on that score.
There is nationwide interest in the issue. The 25,000 signatures do not come from constituents alone, but from divers, windsurfers, sailors and walkers from all over the British Isles who come to the Dorset coast and

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expect to have a safe experience. I plead with the Minister to make the right decision, and to tell us when it will be announced. We have made good progress. The cost of building the hangar has fallen since a solution to the flood risk was found, which was funded by the regional development agency. We simply must find the money now to build the replacement hangar at Portland.
I ask the Minister to listen to hon. Members, to the regional media and to the 25,000 petitioners and save our life-savers. What is a couple of million quid against the many lives that have been saved this year by the busiest search and rescue helicopter in the country?
1.45 pm
The Parliamentary Under-Secretary of State for Transport (Mr. David Jamieson): I congratulate my hon. Friend the Member for South Dorset (Jim Knight) on securing the debate, on the way in which he has conducted it and on his campaign during the past six months. He is certainly a tireless campaigner for his constituents. I have to say that I have felt, on occasions, almost as if I was being harassed by my hon. Friend, because every time I appeared somewhere he would dive on me and question me. I say, good for him, because Members of Parliament are here to give us a hard time about such things. He has missed no opportunity to make his point. I understand the powerful points that he has made today about safety, and I am also mindful of the other issues that he mentioned, such as the importance of inward investment to the Dorset coast and other parts of the region.
My hon. Friend has detailed much of the background, but it is appropriate to place the Portland helicopter issue in a national context. Before doing that, just as my hon. Friend the Member for Falmouth and Camborne (Ms Atherton) praised those who operate out of Culdrose, I would like to put on record my tribute to the courage and utter dedication, sometimes in the most extreme circumstances, of those who crew the nation's search and rescue helicopters. This is a very worthy subject and we should place on record our thanks to those people as a tribute to the work that they do on behalf of the people of this country.
The House will be aware that the helicopter that covers the Portland area is part of a national helicopter search and rescue coverage organisation. There are 12 search and rescue bases throughout the United Kingdom: eight are military bases and four are civil. Portland is one of the civil bases. With the exception of Portland, the bases operate 24 hours a day, 365 days a year. The Portland aircraft operates for 12 hours a day, from 9 am to 9 pm each day all year round. That aircraft replaced the helicopter that was previously operated by the Royal Navy from the base hitherto known as HMS Osprey. The Portland helicopter is operated by Bristow Helicopters Ltd. under a contract to the MCA. According to the operational criteria for search and rescue helicopters that work 24 hours a day, civil aircraft should be available at 15 minutes' notice from 7.30 am to 9 pm daily and military search and rescue helicopters should be available from 8 am to 10 pm daily. Outside these times the aircraft should be on 45 minutes' notice. In practice, the aircraft are usually airborne within a few minutes of being notified during the day and within about 30 minutes at night. Each aircraft has a minimum
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operational radius of 180 miles, which takes into account the 30 minutes that it could take to winch up the 20 or so people that might be on the scene, and the need to retain 30 minutes worth of fuel for landing. The helicopters travel at about 120 knots.
The criteria for search and rescue helicopters were reviewed this year by the UK search and rescue strategic committee working under the aegis of my Department and were implemented on 1 April. That review followed a National Audit Office report in 1998 on civil maritime search and rescue, which recommended that consideration should be given to rationalising helicopter coverage on the south coast before renewing the Solent and Portland contracts in 2003.
The United Kingdom search and rescue strategic committee recommended the criteria that I mentioned and that the helicopter organisation on the south coast should remain as it is for the time being. Ministers accepted those recommendations in the knowledge that a further review of helicopter coverage by the MCA and the Ministry of Defence is under way to harmonise arrangements between military and civil facilities. The project is at the pre-business plan stage, and it is expected that initial reports will be made to Ministers in spring next year.
Outside the 9 am to 9 pm time, the Portland area is primarily covered by the coastguard civil contract helicopter at Lee-on-the-Solent in Gosport near Portsmouth—you might know that place, Mr. Hancock. The area can also be covered by military helicopters from the Royal Naval air station at Culdrose or the Royal Air Force base at Chivenor. Operational analysis has shown that the daytime national criteria can still be met for the Portland area by the helicopter at Lee-on-the-Solent.
As my hon. Friend the Member for South Dorset said, the current Portland base is in the hands of the South West of England regional development agency. It is rightly the job of the agency to develop the Osprey site commercially and for the benefit of the local community.
Jim Knight: Before my hon. Friend gets going on that section of his speech, does he acknowledge that there might be merit in looking again at the national guidelines to differentiate between different types of incidents, as I described in my speech?
Mr. Jamieson: That matter will certainly be considered . At present, the coverage that would be available if the change went ahead would be within existing national criteria and would amount to the same coverage as many other parts of the coast have. If I may declare an interest, I think that that includes my own area of Plymouth.
While the site is being commercially developed, it is necessary for the South West of England RDA to move the helicopter hangar and realign the runway, which is required for the helicopter under Civil Aviation Authority rules. The realigned runway has been bunded by a wall more than three metres high to protect the commercial sites either side from flooding. In short, the runway has become a sacrificial flood plain. The proposed new location for the hangar is outside the runway area. The RDA has agreed to pay for the

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preparation of the new location and to put a steel access door in the flood bunding to allow the helicopter access to and from the runway. I am grateful to my hon. Friend for the enormous amount of work that he has put in, for resolving much of the detail with the RDA and for working with officials from the MCA. He has spent much of the past six months in discussion with them, and he has tirelessly pursued his case in meetings with me.
As my hon. Friend pointed out, the fundamental issue is funding for the new hangar. The estimated cost is between £2.5 million and £3.5 million. If the hangar had been rebuilt on its existing site, the cost, at today's prices, would have been about £1.5 million. That money was lost from the MCA's budget with the passing of time, and it does not have the required new funding in its budget plan. My hon. Friend has, therefore, made representations to me about central Government funding for the project, and I have listened long and hard to what he has said—not only today, but on other occasions.
It is a fact that the helicopter runway site is a sacrificial flood plain to allow commercial development of the site, and that the Portland operational area can be covered adequately from Lee-on-the-Solent within the national guidelines. We must not forget the view that was expressed by the National Audit Office in 1998.
Those points raise serious issues about the expenditure of taxpayers' money. There are already considerable pressures on the MCA's budget. It has continued to make efficiency savings and it has been bringing more ships on to the flag. It has also improved ways of working with the shipping industry. It has provided a much better service for about the same budgetary provision. The Department is also under pressure to provide funds, as is apparent from debates in the House and comments in the press and other places. Alas, those funds are not unlimited.
I understand the regional issues and the importance that is placed on the helicopter locally. I also understand the issues that were raised by the hon. Member for Torbay (Mr. Sanders) about the Birmingham navy, because this issue does not affect only people on the coast. I accept his point about inward investment from the many waterborne activities that are pursued in the area—and from some of the further activities that have been proposed. I realise the importance of that, and how
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it might change the way in which this matter is considered. I shall need to balance the different arguments.
Jim Knight: It would be helpful if the Minister could clarify whether the MCA could sustain the ongoing revenue costs of maintaining a service at Portland. If it could do that, we are talking only about the capital cost. I know that that is a significant cost, but people in government often baulk at revenue costs and allow capital costs to be incurred.
Mr. Jamieson: My hon. Friend refers to two relevant issues: the extra capital cost of providing the new hangar on the site because of the type of development that has taken place under the South West of England regional development agency; and the ongoing extra revenue expenditure of maintaining it on that site, as well as of keeping the site going at Lee-on-the-Solent. We must consider the ongoing revenue costs, but the more important consideration for us at present is the extra capital cost that would be imposed on the MCA if the decision were taken to build the new hangar.
We will carefully consider the arguments that my hon. Friend has consistently made for quite some time—and those that have been made by other people in this House and outside—when we make recommendations to the Treasury about the funding for the new hangar. I am sure that my hon. Friend is aware of the current position, and I undertake to inform him of any decision at the earliest opportunity. His assiduous pursuit of this matter has led us to rethink. The decision would have been taken a long time ago had it not been for his efforts in constantly raising new issues—and some of them have been very good issues—and for the way that he has conducted the argument.
I congratulate my hon. Friend on securing the debate, and I assure him that the points that he has raised on behalf of his constituents will be given serious and careful consideration before the final decision is taken.
Mr. Sanders: Will the Minister comment on the risk assessment?
Mr. Jamieson: The risk assessment is currently commercially in confidence, but we will find out what information can be provided, and if any of it is useful, I will pass it on to the hon. Gentleman.
Question put and agreed to.
Adjourned accordingly at one minute to Two o'clock.