Westminster Hall Sitting of 22 January 2003

Preamble
[MR. JOHN MCWILLIAM in the Chair]

King Edward VII Hospital, Midhurst
Motion made, and Question proposed, That the sitting be now adjourned.—[Mr. Jim Murphy.]
9.30 am
Mr. Andrew Tyrie: The first point that I want to make to the Under-Secretary of State for Health, the hon. Member for Salford (Ms Hazel Blears), about the impending closure of the King Edward VII hospital is that the campaign to try to save the hospital enjoys cross-party support, as can be seen by the fact that Liberal Democrat and Conservative Members are present for the debate. I have also received many messages from Labour Members and a huge amount of support from people throughout the country. The issue is neither purely local nor party political, but it is extremely grave.
I shall read out one of the several hundred letters that I have received from consultants and general practitioners who practise in the area. It states:
"I am a Chichester GP. Closing King Edward VII will cost lives. Here's why."
The doctor points out that the Portsmouth machines for radiotherapy are not all in good shape:
"One will be closed from April … Without the one at KE7, they will have 50‥ reduction in capacity. Waiting times for radiotherapy for breast and other cancers are currently 12 weeks at Portsmouth. They will double or more in April if KE7 closes."
He notes that the standard waiting time for radiotherapy is four weeks. The letter continues:
"So West Sussex and Hampshire patients will be terribly at risk, waiting perhaps 6 months to start treatment instead of 4 weeks. Survival at 5 years is related to time of starting treatment.
Apparently the bosses at the Strategic Health Authority are saying that the closure will not affect waiting times. They say that existing facilities can absorb the load without increasing delays. They must be wrong.
The public will not hear about this"—
well, they are hearing about it now—
"Why? Because the consultants that work in the Portsmouth department have been told they cannot speak to the press. That is terrible.
I work in the Orthopaedic department at St Richards, assessing patients before they have their long-awaited hip or knee replacements. I know that the department cannot do more operations per week. There are too many blocks—time available in theatre being the biggest … without the previous use of KE7 for elective orthopaedic surgery, waits are bound to go up—they are already currently around 1 year."
I have received hundreds of similar letters.
The King Edward VII will close in three days. Only the national health service can save it. The immediate cause of the hospital's difficulties is the sharp decline in the work given to it by the NHS. It is extraordinary that a hospital of such quality, with spare capacity to provide crucial cardiac, cancer and orthopaedic procedures can be faced with closure at a time when the NHS is
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desperate to find places to treat patients. The hospital needs to address some issues for the future, but one point is clear, if the hospital closes in the next few weeks, it will be because the NHS turned off the blood supply.
In the House last week, the Minister said that the NHS was in the business of increasing capacity, not reducing it. The opposite seems about to happen. That will be incomprehensible to my constituents and to those in neighbouring constituencies, many of whose MPs are in the Chamber today to add their support to the campaign to save the hospital.
Mr. David Tredinnick: I have a long association with the county of Sussex. My mother worked in the King Edward VII hospital for many years. My father died there. I know the premises well and I urge the Minister to visit the hospital before the proposed closure and save it. It is set in the rolling Sussex countryside and has wonderful rehabilitation facilities.
Furthermore, is my hon. Friend the Member for Chichester (Mr. Tyrie) aware that, last summer, a friend and I had to queue for five hours for treatment in the accident and emergency department at St. Richard's? It is well known in West Sussex that that hospital is overloaded.
Mr. Tyrie: I strongly agree with my hon. Friend's comments. His points are well taken. St. Richard's does a very good job, but it is under enormous strain.
If the NHS closes the King Edward VII, it will be seen to have made a colossal blunder. A sign of the concern about the closure is the fact that 75,000 people signed a petition that was put together in less than a fortnight. Could many issues in British politics at present generate such a response?
In the past few weeks, there has been a miasma of claim and counter-claim in the local, regional and, to some degree, national press about the reason for the closure, so I want to get some basic facts straight. First, is the King Edward VII a private or an NHS hospital? The answer is neither. It is a unique, independent, non-profit-making charitable foundation.
The hospital has a 125-bed capacity and can treat 400 cardiac, 2,000 radiotherapy and 3,000 hip and knee patients per year. It has been treating large numbers of NHS patients since the NHS was created. Since 1948, well over a third of its income and nearly half its patients have been from the NHS. That has been broadly true for the past 10 years, too. No distinction is made between public and private patients in respect of their medical care. The gap between the amount of NHS funding coming to the hospital and the number of patients makes it clear that the charity subsidises NHS work. The Minister frowns, but if she has concerns about that point I shall be happy to give way.
Furthermore, the NHS has benefited from the huge groundswell of local good will for the hospital, which has enabled it to mobilise enormous funds in charitable giving for the benefit of both the public and private sectors. During the past eight years, £10 million has been raised, providing a magnetic resonance imaging scanner, a linear accelerator for radiotherapy and other facilities.

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In that respect, King Edward VII is a prototype for what I thought the Government meant by foundation hospitals: hospitals that work closely with, and in, their local communities. Last year, the Secretary of State said that foundation hospitals would be
"modelled on co-operative societies and mutual organisations."
That is what King Edward VII is.
Mr. Francis Maude: Can my hon. Friend confirm that some of the excellent new state-of-the-art facilities at the hospital, especially the radiotherapy units for cancer care, were paid for by the hospital itself, from its own cash flow and voluntary donations? At present, people with cancer have to wait for up to 14 weeks after their diagnosis to start radiotherapy. If the hospital closes, those waiting lists will go up and people will die needlessly.
Mr. Tyrie: I agree with my right hon. Friend. Indeed, several of the hundreds of letters that I have received from clinicians and doctors far and wide made the same point. People will die if the hospital closes.
A second area of dispute in the press about the hospital relates to the reasons for its financial difficulties. At present, the hospital has expenditure of about £20 million per annum and income of £17 million. Most of that deficit has opened up in the past couple of years and the lion's share of the accumulated deficit of £8 million is attributable to the gap between those figures. The number of private patients and the income for private work increased slightly in the same period.
Why has the gap between income and expenditure opened up? The answer is unambiguous: the sharp reduction in NHS business. The number of patients being treated has gone down drastically and the amount of cash coming in has also decreased. Since I became MP for the area a little more than five years ago, I have been worried about the hospital's vulnerability to NHS strategic planning. In 1999, I warned that the hospital's long-term future could be jeopardised if the NHS turned off the tap. That is exactly what has happened: contracts have been withdrawn almost without warning.
The NHS line on the hospital's financial problems is that the hospital has been mismanaged. An official spokesman for the NHS described King Edward VII as "a failed hospital". That claim does not bear serious scrutiny. In an immediate sense, the hospital is failing largely because the NHS has ensured that it does so. That is why the official spokesman's description of the hospital as a failure sticks in the gullet of every member of its staff, from receptionists to surgeons.
For a failed hospital, the King Edward VII has done pretty well. In the past five years, it has treated 30,000 in patients and 90,000 out-patients. Its output measures and survival rates for cardiac care are well above those of nearby NHS hospitals, even after adjusting for differences in case mix. In all major areas of care, it is at least as good as the NHS. Readmission rates for unsuccessful procedures are lower than those in the NHS and, above all, staff retention rates are high, which shows that it is a happy place in which to work, with very high morale. That is also reflected in the quality of care.
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The King Edward VII is a wonderful place. As a charitable institution, the hospital is a not-for-profit organisation, so one would not expect it to have a large surplus. In any case, if running a deficit is a definition of failure, many NHS hospitals are failures, too.
It is true that the hospital, like many—public and private—must deal with some longer-term issues. It was doing that and, as the liquidator pointed out, it had a good chance of success. It would probably have succeeded if the NHS had not pulled the plug. Some NHS managers have suggested that poor management and nothing else is to blame. Whether or not that is true of the King Edward VII, it is certainly true of much health care in the NHS, which has one or two severe management problems of its own to sort out, as the Secretary of State and others have frequently pointed out.
The Surrey and Sussex strategic health authority has an accumulated deficit of £60 million. Which part of the NHS planning process allowed that to happen, with all the related managerial stresses and the shocking implications for waiting times for my constituents? It is deeply regrettable that the NHS primary care trusts, especially the Western Sussex PCT, and the Sussex and Surrey strategic health authority have reacted to the closure by suggesting that their role in it was peripheral—that it was nothing to do with them. A more thorough and frank explanation of the financial constraints that led them to those contracting decisions would have been much better.
Any reasonable assessment of the accounts—I have taken a look at them—will show that the lion's share of the shortfall that triggered the financial crisis and led to the appointment of a provisional liquidator was a consequence of the loss of NHS business. The hospital made repeated attempts to engage the strategic health authorities, PCTs and trust hospitals in discussions but it was largely ignored.
Peter Bottomley: Some of the hospital staff live in Worthing and we also have a number of NHS patients who have benefited from the hospital. The Government cannot walk away from the issue; they set up the constraints and created chaos in the NHS due to the continual reorganisation of the past five years—tomorrow, they will be advertising for a chairman of the strategic health authority. It is not capacity, cash or the commissioning system that is at fault, but the Government. The problem is in the hands of the Government; it requires action and they should treat it as important.
Mr. Tyrie: I agree with my hon. Friend. There is a drive towards decentralization at least that is the current rhetoric—but in fact much of the responsibility for such issues and the authority to deal with them still lies with the Department of Health.
Another allegation is that the hospital lost business because its charges were too high. However, a detailed examination of prices shows that that is not true. If the Minister has been given figures, I warn her that many of them do not bear careful scrutiny. The Western Sussex trust has put out some highly contentious figures—on the cost of cardiac treatment, for example. Some of the more bizarre claims that the trust has put into the press

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about the relationship between the PCT and the hospital are not true either. I do not want to delay the debate by going into detail, but I shall refer to one claim about cardiac care. On 14 January, the PCT issued a press release which stated:
"The PCT had recently negotiated a three year agreement with KEVII for cardiac surgery."
A reasonable man might have concluded that a three-year deal had been struck—very good news. However, when I examined the matter in detail I found that no such deal had been struck. Some discussions had taken place, but there was no financial support for a three-year deal for cardiac surgery.
I have also been told privately by PCT management on two occasions that the quality of care in cardiac surgery is lower at King Edward VII than at Southampton. I was surprised to hear that, so I took the trouble to obtain the British Cardiac Society's peer review of the hospital, conducted about a year ago. Unless the Minister challenges me, I shall not go into the detail of the review, but it concludes that the overall level of cardiac care in the hospital is excellent and is higher than in the NHS alternatives available, including Southampton.
The Minister should be wary of taking at face value some of the highly controversial public and private briefing that she has probably been receiving. If she takes a careful look at it and asks some penetrating questions, she will find that things are not quite as they appear.
Of course, no one suggests that life is easy for the PCTs or the STHAs affected. They have been constrained in the amount of business that they can send to the hospital, as my hon. Friend the Member for Worthing, West (Peter Bottomley) pointed out. They have not been given sufficient funds to enable them to take people off waiting lists. Locally, the waiting time for cardiology and cardiac surgery is 12 weeks; for radiotherapy, it is up to 12 weeks and rising; and for orthopaedics, it is 15 months. That compares with national targets published by the Government that the maximum waiting time for elective surgery should fall from 18 to six months by 2005.
Mr. James Arbuthnot: I am listening carefully to my hon. Friend who is making an excellent speech in defence of a superb local hospital. Is not one of the problems that the local area receives only 83 or 84 per cent. of the average health spending per person nationally? It is not an area in which it is cheap to live or to employ people, so we need significantly more funding. That might help to save the hospital.
Mr. Tyrie: My right hon. Friend describes a double whammy. First, money has been moved away from the south to other parts of the country. Part of the reason that more hospitals in the north of England have higher star ratings is that they are not under such intense strain as hospitals in the south, as several of the Government's advisers on that issue have recently pointed out. Secondly, costs in the south are much higher than they are in the north. The hospitals are squeezed from both sides.
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The targets set for NHS hospitals locally would have been difficult to achieve in any case, but they will be impossible if the King Edward VII is closed. Waiting times will rise further. The claim that things could be otherwise, as the STHA suggests, is ludicrous.
That brings me back to one of my earlier points: at the very time when massive capacity constraints throughout the NHS are leaving patients untreated, the King Edward VII hospital is to be closed. Has the NHS done all that it should have done to keep the hospital's capacity on stream? Regrettably, I think not, although it seems that at one minute to midnight something may be stirring.
What can the Minister do to help? First, as my hon. Friend the Member for Bosworth (Mr. Tredinnick) suggested, she could visit the hospital—before Friday—and see for herself. It is only an hour from her Department by train and it would take her less than three hours to do the journey and see everything that she needs to see. She could then make up her own mind.
Secondly, the Minister could take a look at the huge raft of schemes, some of which are run centrally, that enable the distribution of discretionary finance to help PCTs. For example, can something be done through the access initiative scheme for orthopaedics? Can end-year flexibility be used to bring money forward from the next financial year?
Thirdly, will the Minister bring an end to the absurdity that forces my constituents to be taken abroad for treatment at huge cost when they could be treated up the road at the King Edward VII at less expense to the taxpayer? I have heard grotesque stories about people being lined up to get on coaches to be treated in France after expensive pre-operative investigations at the Nuffield hospital—at £1,000 a throw—for treatment that will cost even more than at the King Edward VII once the travel costs are included. That is absurd and will require considerable justification. The budget is ring-fenced. Will the Minister consider what could be done about the ring-fencing?
Mr. Andrew Turner: Does my hon. Friend agree with Dr. Mark Connaughton, the heart specialist at St. Mary's hospital, Newport, who points out that when a patient is treated outside this country, responsibility for their long-term care falls back on the NHS, whereas it would remain the responsibility of the King Edward VII if they were treated there?
Mr. Tyrie: My hon. Friend makes an extremely good point. It leads me to reflect more generally that NHS planners have not taken into account the fact that if the hospital closes, the NHS will have responsibility not only for its current NHS patients but for a fair number of its private patients because they may not immediately be able to find alternative care elsewhere, or may decide not to do so.
I was setting out a list of things that the Minister could do. Fourthly, she could bring forward an announcement that the Department will have to make about the need for more cash for Hampshire because the county will face a crisis when it is stripped of the doctors and support staff who will go to the Gulf as part of the contingency planning for a possible Gulf war. There will be an acute shortage in some Hampshire hospitals; Portsmouth will be hit especially hard.

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I hope that the Minister will announce that she will release some funds. After all, we are not talking about new money—it will have to be released in any case, as everyone knows—and it will help enormously. The extra capacity in the King Edward VII is already needed, but it will be vital in the event of action, or even preparation for action, in the Gulf.
Fifthly, will the Minister examine carefully the waiting time targets that have been set and consider whether they could be delivered even before the closure of the King Edward VII? Is there a cat in hell's chance of delivering them after it closes? Any reasonable appraisal would conclude that keeping the hospital going for the next year would be extremely important to the NHS in delivering those waiting-time targets and, as I have just suggested, it would cost the NHS little or no extra money. The money would have to be found in any case.
As the Minister knows, the hospital has just offered to carry out 300 cardiac procedures, 2,500 elective surgery procedures, 420 radiotherapy procedures and 1,000 investigative cardiology procedures. All are being offered at the NHS's own reference prices for the coming year—the marker prices that it considers right for work put out to the private sector. Throughout the south, people are waiting desperately for treatment for those conditions. The deal that is being offered could save the hospital and do something to plug that gap.
Ministers have repeatedly said that capacity not cash is the real constraint. They now have an opportunity to demonstrate that. I urge the Minister to encourage acceptance of the deal. I do not urge her to interfere but merely to pick up the phone and say to her senior management team, "Use some common sense."
Several hon. Members rose
Mr. John McWilliam (in the Chair): Order. A large number of hon. Members want to speak, so may I ask them to be as brief as possible?
9.53 am
Mr. James Arbuthnot: I shall be extremely brief, Mr. McWilliam.
The long-term problem in our health system is not the quality of its staff, who are superb, nor is it the quality of our hospitals, which are often superb—in the case of the King Edward VII, my constituents have been writing to me in their hundreds to tell me how superb it is. The long-term problem in the national health service is capacity. I am not alone in saying that, the Minister has said it, too.
Closing such an excellent hospital will astonish and anger my constituents, and it ought to astonish and anger the Minister. I ask her to listen very carefully indeed to what is being said in the letters that she has been receiving from my constituents and those of my hon. Friend the Member for Chichester (Mr. Tyrie). I endorse everything that he said.
If the hon. Lady does not take the action to which my hon. Friend referred, she risks being part of the problem, even though she is an extremely hard-working and effective Minister. The NHS runs the risk of being
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seen as remote from the people of this country. The Minister should make it plain that we need to deliver on the health system and that means providing this local hospital—King Edward VII—for our constituents. I hope that she will listen to what my hon. Friend said.
9.55 am
Sue Doughty: I shall concentrate on how the closure will affect the Royal Surrey county hospital in Guildford. I shall not repeat what has already been said. Instead, I shall set out some of the good things that the management and clinical staff at Guildford have told me about the high quality of care, especially in orthopaedics, at the King Edward VII hospital. When a health care professional says, "If I had to have my hip done, that is where I would want to go", things do not get much better than that.
Some staff work at both Guildford and the King Edward VII, so there is continuity of patient care and a close working relationship. I understand that about 400 orthopaedic cases were expected to be undertaken at the King Edward VII next year. A certain amount of general surgery takes place. Less cardiac surgery is undertaken because there are facilities for that elsewhere. The closure of the King Edward VII will have a bearing on the Royal Surrey county hospital, especially in terms of radiotheraphy.
If the King Edward VII closes, Guildford will take more cases. Is that feasible? Royal Surrey county hospital is a good hospital. It has excellent staff who work desperately hard to try to meet targets. A huge effort is involved. Like everyone else in the south-east, we have massive problems involving national pay scales and a hugely expensive cost of living. These factors work against staff retention. As a result, we are continually investing in recruiting. However, we get there.
The closure of the King Edward VII will have an impact. Local private hospitals are already running near to capacity. In Guildford, fortunately, some people are better off than others and will not wait, or they club together to buy treatment for family members. As a result, we do not have a large amount of spare capacity, even though several private hospitals are immediately local to us.
I was pleased to hear that the strategic health authority is talking to the liquidators to ascertain what can be done. We would want any action taken that would delay or avoid closure to be explored in every way possible. As I have said, closure will have a huge impact.
On cancer care, the closure of the King Edward VII will have an impact on Guildford's performance and its ability to treat many people in Guildford and the surrounding area. I am speaking not only of my constituents but of all people who use the hospital. First, Guildford is unhappy that it takes seven weeks to get somebody into radiotherapy. That period is substantially longer in Portsmouth, and I know that my hon. Friend the Member for Portsmouth, South (Mr. Hancock) will have something to say about the problems in Portsmouth, where the waiting time is about 17 weeks. It should be understood that those patients will be coming to Guildford. That will extend waiting times.
When I spoke to specialists, I was told that the strategic health authority is considering commissioning more linear accelerators. I asked the hospital whether, if

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that happened, and the hospital was closed tomorrow, patients would receive treatment. Two linear accelerators are already in commission to deal with the existing work-load, but not the work-load that would accrue as a result of closure of the King Edward VII. Even if orders are in place, that does not solve the problem. If the hospital is closed tomorrow and orders are placed, how long will it take to bring a system on stream? The reality is that it takes about a year. It takes about six months to build a room and to put things in place. The technical commissioning takes a further six months. Technicians undertake detailed and wonderful work to make the equipment work as well as possible.
Ownership has its own costs. The Minister will be aware that it costs about £30,000 a year to keep software up to date and to ensure that the various pieces of technology continue talking to one another if we are to make use of all the brilliant things that the machines can do. Cost of ownership is a factor.
The Minister might suggest that we could run longer hours at the Royal Surrey county hospital. That is something that I have explored. The cost of running longer hours is greater than that of buying more linear accelerators because of the additional costs involved. As the Government and the Minister for Health have regularly reminded the House, linear accelerators need radiographers. There must be that match. Radiographers are like hens' teeth.
It has been argued that if we closed the King Edward VII, a number of staff would be available elsewhere. The reality is that if we ran more linear accelerators to fill the gap, that would take a year, and the available staff would no longer be available. Secondly, available staff who are now at the King Edward VII would not come to Guildford. They live on the south coast and they cannot afford to live in Guildford. We would not get the radiographers or other technical teams.
Our concerns are not only the concerns that have been strongly expressed already. I urge the Government not to let the hospital close on Friday. It should be bought outright, but the Government should consider all the models and all the what-ifs. What will happen to health service provision as a whole in the south-east if the hospital is allowed to close? What will happen to patient care and the high quality of orthopaedic treatment? We are aware of the misery of people waiting for replacement hips, for example. What will happen to those waiting lists? Where will patients go? Where will they get the same high level of aftercare that patients get at the Royal Surrey county hospital when they are sent to Midhurst? When farming out surgery to other hospitals, physical proximity is so important, especially when there are complications.
I add my plea to the Minister to consider a buy-out. An interim rescue package should certainly he considered, until all the questions that we ask today can be answered satisfactorily within the localities that we represent.
10.2 am
Mr. Michael Mates: I, too, shall be brief. There has not been such an outcry in Hampshire about health since the Government closed Lord Mayor Treloar's hospital in Alton. That hospital was doing excellent work, but in their centralising zeal the
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Government decided that it was no longer needed. The hospital concentrated exclusively on elective orthopaedic surgery. That is one of the areas where waiting lists in my part of the world are longer than those for anything else.
As we heard from my hon. Friend the Member for Chichester (Mr. Tyrie), the King Edward VII hospital is doing a marvellous job. This is at a time when the Queen Alexandra hospital in Portsmouth—one of the hospitals graded as failing—was almost coming to a halt on orthopaedic surgery. Disaster was nearly upon us when the situation was saved, to an extent, by the fact that the hospital at Haslar became available. That is where all the orthopaedic surgery is being undertaken now. That has taken place at great expense. As I have said, Lord Mayor Treloar's hospital was closed. It was then found that there was an orthopaedic disaster. That was solved in some nick-of-time way by transferring orthopaedic work to Haslar, at great cost. It seems that the national health service will go through exactly the same process again.
I do not want to talk about all the other excellent specialties because most of our constituents find that the shoe is pinching most when it comes to orthopaedics. They are waiting 15, 18 and 21 months for orthopaedic surgery. Now, we are to reduce capacity. The question is whether we give up capacity now to introduce the reorganisation that the Government say that they want. My argument—it is a simple one—is that we should get capacity right first, reduce waiting lists and ensure that people can get their orthopaedic surgery and cardiac surgery right. If the Minister wants then to reorganise the health service to make it more efficient, that is fine. However, at present it is stretched at every point. To reduce capacity now is nothing short of criminal.
10.4 am
Mr. Peter Viggers: We used to hear about joined-up government bringing Departments together. We do not hear so much about it now because I think that we are not getting it. We are debating matters where it is necessary to have joined-up government. The Minister cannot sit back and say that the issue is not directly her responsibility—that the hospital is not directly within the national health service because it is not controlled by the NHS. We need to take an overall approach.
In central southern England, we have serious health sector problems. For example, there are money problems. The Portsmouth hospital trust is running at a deficit, and the plan by which the chief executive has awarded a franchise to the hospital does not tackle where the money will come from to rectify the situation. We face a capacity problem. It is not possible to lose any facilities within the NHS or within allied health services without that leading to serious damage to local residents.
My hon. Friend the Member for Chichester (Mr. Tyrie) did not refer to the fact that he is supported this morning by 14 Members from the area that is concerned. Nearly all of those representing central southern England are present to express their profound concern that the Government have not so far taken action in joined-up government to rectify the possible loss of the superb facilities at the King Edward VII hospital.

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I shall quote from a constituent who wrote to me a couple of days ago. He has had surgery at the King Edward VII hospital on five occasions. He writes:
"It is beyond belief that this excellent hospital, which has served both NHS and private patients for many years, should be allowed to close. Meanwhile the Portsmouth area is saddled with a zero-rated establishment where ambulances have to wait for hours outside the hospital entrance because beds cannot be found for emergency cases."
The loss of any hospital facilities in our area will worsen a situation that I have already described as dire. I plead with the Minister to listen to my hon. Friend the Member for Chichester and respond to his requests.
10.6 am
Mr. Mike Hancock: I congratulate the hon. Member for Chichester (Mr. Tyrie) on initiating the debate. I support much of what he said and in particular, his five questions to the Minister. It is vital that those questions are answered. He invited the Minister to visit the King Edward VII hospital. If she sees the facilities that are there, there is a real possibility that even at this late stage she will be minded to do all that is in her power to keep the hospital open.
Hon. Members have talked about the King Edward VII as a local hospital. In fact, it goes way beyond that, as is made clear by the presence of so many hon. Members this morning. I believe that we are all speaking up for the people who would like to be present this morning. I refer to those who have been fortunate enough to be treated at the hospital and to consultants who have been prevented from taking part in the debate. One or two of them have been courageous enough to take on their bosses and to speak out on behalf of their patients, and how right they were to do so. I am sure that many other people have spoken to those present about their fears of what will happen.
The record speaks for itself. The hon. Member for Chichester spoke of being cautious about costings. Indeed, those bear close examination. They are far from the costings that have been reflected by some who have tried to do down the King Edward VII hospital on that basis. Costings must be balanced against the care that is provided, along with skill and treatment.
I have received about 20 or 30 letters in the past week or so from constituents who have been treated at the King Edward VII hospital. I shall mention two. Mr Damen lives in the heart of Portsmouth. He writes:
"I believe I have to complain to you about the proposed closure of the K. E. VII hospital. What on earth are they trying to do—bring the whole national health service to a standstill? I was treated there … a short time ago and found it to be a superb hospital with staff and nursing to match."
He writes that he went there
"because the Q.A. couldn't cope with the work load. Yesterday I had to take my wife—
this was to another hospital that was out of area—
"because Q.A." —
that is in Portsmouth—
"was full up".
Apparently it was unable to deal with her problems.
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I have a letter from another constituent, Mrs. Edwards, who knows the hospital well. She talks about the shameful way in which the issue has degenerated into the threat of imminent closure of a facility that so many have used.
The figures speak for themselves. Nearly 30,000 patients in the NHS have been treated at the hospital in the past 10 years. It has planned for what it can do in future. In the current year alone, more than 1,000 seriously ill patients have been offered care. I come from Portsmouth and I know the position only too well. We are facing a crisis because we failed as a hospital, despite the best efforts of the staff and management. Despite having had three chief executives in two years. we have a failing hospital. It is being held together now by the support of the Ministry of Defence staff who are working there. Many of them will leave, if they have not already done so, during the next few weeks. That is a serious problem and I have written to the Secretary of State about it. I have yet to receive assurances from the Secretaries of State for Health and for Defence about their proposals for filling the gaps.
It is unacceptable to wait 16 weeks for radiotherapy in any circumstances. To remove the facility will mean that my constituents and other people living in the Greater Portsmouth area will wait even longer. It is unacceptable that more has not been done. We should not be having the debate three days before closure. The hospital is far too important to the health service generally in the area. When the Minister replies, I hope that she will set out a well thought-out solution that will be a guarantee for my constituents and for many thousands of others who will not benefit if the hospital closes. If she is not to save the hospital, they will need to know where they will be treated. They will need to know also how long it will be before they are treated.
10.10 am
Mr. Howard Flight: I, too, congratulate my hon. friend the Member for Chichester (Mr. Tyrie) on securing the debate, albeit at the last hour. The representation in Westminster Hall makes it clear that the issue is important for the hundred of thousands of citizens that hon. Members present represent. It is also, I suggest, an important test for the Government. Candidly, are they in earnest and are they to be trusted in organising and working with the voluntary sector to make available the capacity that is necessary to reduce waiting lists and to deliver national health service care?
I greatly respect the Minister's competence and integrity. However, I urge her independently to examine the data. It is apparent to several of us that behind the scenes many in the NHS have seen the failure of the HCA International deal as being quite convenient in leading to the closure of the King Edward VII hospital, and in terms of longer-term plans and views about it. For example, we were told that it cost 38 per cent. more to have cardiac care at that hospital than at Southampton. The figures are matters of fact—£8,153 and £9,485. That is 16 per cent. more for the operation. The Minister will find how the spin was placed. The King Edward VII kept people in slightly longer, with the health authority's approval. That resulted in increased costs, which were presented as the cost of the treatment.

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I urge the Minister to look for herself and to test the data. This is something more than just a terrible thing that has suddenly happened. My hon. Friend told the story in pretty full detail but some points should be stressed. There is a capacity issue. There is major scope for primary care trusts to use the King Edward VII facilities to reduce waiting lists. The Minister knows—we have been in correspondence for the past year—that the waiting list for radiotherapy is serious. It is approaching 14 weeks. Southampton has a one-year wait for diagnostic cardiac catheter investigation. The waiting list for coronary artery bypass grafts is causing significant and unnecessary mortality. Brighton is at capacity. As the Minister will know, it has been sending patients to the King Edward VII because of that. There is generally about a three-week wait at Portsmouth. With the possibility of war in Iraq, the immediate situation will become serious in Hampshire.
The King Edward VII hospital could perform 400 to 500 open heart operations a year. It could undertake 600 to 700 anaplastics and 1,000 diagnostic cardiac catheters. It is not often pointed out that it is the centre of the crucial Macmillan unit, which looks after many older people and others who are suffering from cancer.
It is crucial to buy time to investigate how the hospital's future could be resolved. The Minister will be aware that various proposals have been presented in the past few days. It is clear that they cannot be assessed by the liquidator within three days. Local MPs, doctors, councillors and, indeed, the entire community, have pointed out to the powers in the NHS in the area that time can be bought. The work can be done. Waiting lists are long and, candidly, if those involved stood back, the stories told would be believed. We hear about intentions behind the scenes. The local community would not forgive the NHS for many years.
There is the power at least to buy time to ascertain whether arrangements can be made to save the hospital in the long term. Those arrangements may be radical. They may involve turning the existing building into a nursing home. We are drastically short of beds in that sector. A smaller purpose-built hospital could be constructed. It is clear that there is a need for the capacity that has been provided.
Again, I ask the Minister carefully to check the claims that have been made by the NHS in the area about the ability to make up capacity. The advice of those in the other hospitals is that the claims do not stand up to examination. As I outlined, waiting lists are already higher by far than in other parts of the country. The hospital treats 30,000 patients a year, 12,500 of whom are NHS patients. It is not only an NHS issue—if the facility is lost, many private patients are likely to put on the NHS. That will increase costs and usage, as many doctors in my part of the world have said.
The King Edward VII hospital has been a voluntary sector partnership, it has been almost a prototype for much of what the Government are thinking about. It worked extremely well until two years ago. There have been management problems and we are all aware of many issues, but the crucial issue to affect finances has been reduced NHS usage. I think that some of that was deliberate. There should have been negotiations on price and other matters.
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We are interested not in debating the past, but in getting the data right. We desperately urge the Minister to give the hospital sufficient time to work out a solution. If the hospital goes in three days' time, the Minister will not be forgiven.
10.17 am
Mr. Nick Gibb: I start by congratulating my hon. Friend the Member for Chichester (Mr. Tyrie) on securing the debate. This is likely to be the most important day in the 54-year history of King Edward VII hospital.
The hospital is in my hon. Friend's constituency, but its importance spreads way beyond the bounds of Midhurst and Chichester to all parts of West Sussex and parts of Hampshire and Surrey. It is a vital hospital for many of my constituents. Over the years, it has treated many thousands of people from the Bognor Regis area for cancer, heart problems, back complaints and orthopaedic surgery.
As my hon. Friend the Member for Arundel and South Downs (Mr. Flight) said, about 12,500 national health service patients a year are treated at the hospital. It has always been an NHS provider. About half its patients come from the NHS. Hundred of my constituents who have written to me on the issue are astonished that at a time when the NHS is short of capacity, a hospital that has capacity in cardiac, cancer, orthopaedic and ophthalmic procedures could be closed.
National health service spokesmen say that the costs of the KE VII are too high. However, the hospital says that it will charge the prevailing NHS rates for any secure bulk contracts. NHS spokesmen hint at quality issues, but they provide no evidence other than citing the current NHS orthodoxy that only very large-scale hospitals provide the throughput of patients that is sufficient to provide quality. That is not the experience of my constituents who have been patients at Midhurst.
The very reason for the volume of anger at the proposed closure—it is an anger that has surprised many—is that the hospital provides a higher quality of medical care than that people have experienced at other NHS hospitals. It is not only the fact that it is tiny and intimate that elicits that response; it is the medical care itself that is the key factor behind many people's support for Midhurst.
On Friday, a friend of mine in Bognor Regis told me of her experience of the hospital. Ten years ago she found a lump, she went to her GP who said that because it was causing pain it could not possibly be malignant. She insisted on being referred to a consultant and because she had BUPA cover, she went to the King Edward VII. Tests there proved that the lump was malignant and she was treated straight away. Ten years later, another lump was discovered. She went back to her consultant at Midhurst, who took five biopsy samples—four from the lump itself and one from the area adjacent to it. Normal NHS procedure, I understand, is to take biopsies just from the lump. None of the four samples taken from the lump proved malignant, but the sample taken next to the lump was malignant and she was then treated. Had my friend not gone to the King Edward VII 10 years ago and again more recently, she would not be alive now.

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I have received a huge number of letters from constituents with similar stories to tell, pointing out that the quality of clinical care is higher at the King Edward VII than at other hospitals. When I hear intimations from NHS civil servants that there are quality issues at the King Edward VII, I do not believe them. When that is coupled with their claims about costs, with which my hon. Friend the Member for Chichester successfully dealt, I come to the conclusion that I cannot trust anything that is said by the NHS on the issue. I urge the Minister to take the same approach.
Officials are far from being infallible. As a Minister, it is always tempting to take the advice of officials, particularly in such a technically difficult area as health care, but officials do get things wrong, especially with regard to the NHS. For example, the Tomlinson report published in 1992 called for a reduction in hospital capacity in London. The report concluded:
"There is likely to be a significant fall in the requirement for inpatient beds in the inner London hospitals … Closures and mergers will be necessary."
Last Monday, I went round the newly acquired London Heart hospital. I also toured the 20-storey new-build hospital in the Euston road, and a new hospital is being built at Barts. So NHS advice now is to increase capacity in London.
Advice has changed. When I put that to the director of policy and planning at the Department of Health, he said that the advice 10 years ago was probably wrong, but that civil servants have moved on. The NHS has its fads, which are in vogue and then go out of vogue again. The current fad in the NHS is "large is beautiful"—the belief that a certain minimum but large number of patients being treated at a particular hospital is needed for it to be regarded as being of a sufficient standard. There is obviously some truth in that. The experience gained by performing 1,000 bypass operations a year must be better than the experience from just five. But is the experience from 400 operations a year so much worse than the experience from 800? Surely there are diminishing returns to clinical excellence as the numbers increase to very high figures. Clearly, there is a balance to be struck.
The public believe that in addition to the large general hospitals, there should also be some smaller, friendlier hospitals that can give more tailored care and attention to patients. In a debate such as this, where the public view is clear, but contradicts the view of the health professionals, whose views should prevail in a democracy? I believe that in this case, the public view should prevail, particularly where the costs and comparisons are far from clear and there is no evidence of a diminution in quality as a result of the smaller scale.
I shall quote from a couple of letters from constituents, as other hon. Members have done. One constituent from Aldwick in Bognor Regis wrote:
"I did the Ambulance Car Service for approximately five years when I retired in the 80s and know only too well how the NHS patients travelling to King Edward VII for treatment felt about this particular hospital. Every one of them expressed views that they were in safe hands compared with other hospitals, and were consequently uplifted by this knowledge."
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Another constituent from Bognor wrote:
"Many, many people have had the facilities of this hospital made available to them … The Macmillan Unit has cared for many cancer patients, giving peace and constant 1st class service to the terminally ill patients".
Finally, a letter from a constituent in Shripney, Bognor Regis stated:
"Unfortunately, in June 1999, I was diagnosed as having acute prostate cancer. This entailed daily radiotherapy treatment for a period of seven weeks and it was carried out at the King Edward VII hospital. During this very traumatic time I received wonderful care and attention from the staff of a dedicated unit where emphasis was upon accuracy and careful attention to detail. Without any shadow of doubt I would not have been here to write to you today had it not been for the excellence and efficiency of the specialist doctors and radiography staff at the King Edward VII hospital."
I urge the Minister to read the letters that she is receiving on the matter, to take her own counsel, talk to the hospital administration, and not, like so many of her predecessors, to fall into the trap of following officials' advice at great political cost, only to find five years down the line that that advice has proved to be wrong.
10.25 am
Mr. Andrew Turner: I shall not detain the Chamber for long. Hon. Members can read for themselves comments I made in my Adjournment debate last week. I am sure that the Minister has done so. I welcome her to her place. I know that she is an honest and decent Minister, and she has helped me with constituency matters in the past. It was noticeable that the Under-Secretary of State for Health, the hon. Member for Tottenham (Mr. Lammy), was unable to complete his speech last week in the Adjournment debate. When I asked what he had intended to say, I was told by the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), in a written answer that she would reply to me as soon as possible.
The most dangerous aspect of the entire debate is the reasons given for the withdrawal of contracts from the King Edward VII hospital. Some have been withdrawn on costs grounds, and they have been dealt with by my hon. Friend the Member for Arundel and South Downs (Mr. Flight). Some have been withdrawn on throughput grounds, which have been described by my hon. Friend the Member for Bognor Regis and Littlehampton (Mr. Gibb). Some have been withdrawn on the basis of slithy imputations about quality issues, which hospital administrators are not willing to put on the record. If officials have something to say, let them say it in public, rather than make such imputations, which support the decisions that they have taken, but which they are not prepared to put on the record.
There has been a somersault in the Government's approach to the private sector over the past six years. I understand that. When the right hon. Member for Holborn and St. Pancras (Mr. Dobson) was Secretary of State for Health he had a different approach to the private sector from that which the Government now take, and I welcome their change on that. However, I must point out that the heart doctor in my constituency, who is an NHS professional, is clear that no problem would stop a doctor referring patients to the King Edward VII.
I have spoken to my strategic health authority chairman on the matter. He warned me that Ministers were taking a hard line: it is not up to the NHS to bail

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out a failing private hospital. That is the line that he has been given by the Department of Health. I do not know what idiot behind the scenes dreamed up that line, but it is a singularly inappropriate response to a hospital that has given 54 years of wonderful service to the national health service.
There are three areas with which the hospital deals: cardiac care, for which, I am pleased to say, some new arrangements are in place, but people have to wait more than six months to go to Brighton, which is causing bed blocking in my hospital, St. Mary's; radiography, for which there is no plan in place to deal with the relevant patients if the King Edward VII closes—one of my constituents had to wait 16 weeks for radiography at Southampton; and finally, orthopaedics, for which the local hospital thinks it can find the extra capacity, but it will be hit when 20 per cent. of the staff at Portsmouth go to war. The case is clear—the Minister must act, and act swiftly.
10.28 am
Virginia Bottomley: My constituents are devastated by the possible threat of the closure of the the King Edward VII. For almost 19 years, the most dedicated and committed staff at King Edward VII have provided a quality of care second to none. It is not just a matter of clinical issues; it is a matter of the values and ethos associated with the hospital, which are hard to replicate elsewhere. In an area where there is a shortage of staff, miraculously and wonderfully the King Edward VII recruits, retains and provides a resource for the national health service locally.
Local general practitioners are already under enormous pressure because the waiting times are some of the worst in the country. For far too long, we have had a huge proportion waiting more than a year. As the Minister knows well, we are caught in a pincer. The cost of living is so high, but because local people are healthy they are deemed not to be worthy of financial support for health care delivery. It is unacceptable that there should be so much public squalor amid private affluence. However, that is a separate debate, which the Minister and I have had on many occasions.
The King Edward VII has sought to follow the Government's agenda. It has tried to achieve a creative partnership. A much-loved, long-standing voluntary hospital has developed a partnership with HCA International in the commercial sector. It is not only local people who are devastated and deeply distressed and who are sending letters in a volume that I have not known for many years—the wider health community is watching. The Government said that they believed in partnerships, and that they had no hostility towards the independent and the commercial sector. If it emerges that it is impossible for an independent provider to form such a partnership—an innovative solution—many will take to heart that example and think that the additional effort and cost of arranging contracts with the NHS is too difficult. When push comes to shove, the whole relationship will implode.
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The last time the Minister came to my constituency, she did so to turn the sod for the much sought-after Farnham community hospital. I have every confidence that somehow the Minister will be the bearer of good news to us today. I very much hope so.
Mr. McWilliam (in the Chair): Order. Before I call the winding-up speeches, I congratulate all the. Members who have taken part in the debate this morning. I think it is some kind of record.
10.31 am
Dr. Evan Harris: All of us owe a debt of gratitude to the hon. Member for Chichester (Mr. Tyrie) for securing the debate and for the open, cross-party, cross-constituency and cross-county way in which he has pursued the issue. As has been said, he and the cause have been rewarded by the turnout today—14 right hon. and hon. Members from the area who are concerned about their hospital. That shows Adjournment debates and Westminster Hall at their best.
The Government have claimed that it is not part of the job of the NHS or the taxpayer through the NHS to subsidise, as they put it, a private or charitable or voluntary hospital by paying above the rate that can be obtained in the NHS, elsewhere in the private or voluntary sectors or abroad. In that narrow sense, on principle, the Government are correct, but I very much doubt that that is what pertains in the present case. If it does pertain, the Government must present evidence that it would effectively be a subsidy if non-value-for-money services for NHS contracts continued to be placed at the hospital.
It is very much the job of the NHS to safeguard capacity where it is needed. It is clear from what has been said and from all the evidence we see around us that capacity is needed in the NHS, and that such capacity is needed locally. If the hospital closes, the doctors and nurses will not necessarily transfer into NHS employment in the area, so it is unlikely that any capacity could be saved, despite the fact that there may be staff shortages that limit capacity in the area. There must be a fit. As my hon. Friend the Member for Guildford (Sue Doughty) said, if there is no fit, people will simply leave the NHS or leave the area. That would be a disaster, especially given the threat of the loss of staff to troop deployment or war in the Iraq theatre.
It would be sensible for the NHS to find the means to acquire the hospital as an NHS hospital, with a view to using its entire capacity for NHS patients. Arguably, some private work could remain, equivalent to NHS pay beds, although there is a separate debate to be had about that. Given that capacity is so short in the NHS, that would seem a sensible investment to preserve capacity, even before one considers the need to preserve existing services. As the Minister knows, the NHS acquired the London Heart hospital in that way. Indeed, that was one of the early announcements that she made in her post. That was about 12 months ago, and the National Audit Office published a positive report on the finances, so the model exists.
The key question is whether the strategic health authority has the ability and the means to acquire the hospital, or whether it requires central Government

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approval. One hon. Member suggested that the Government could not interfere in the matter. It would be an historic moment for this Government if they did not seek to interfere in local issues, especially strategic issues.
I should like to see the hospital used to increase NHS capacity, which is a top priority. I have heard that the hospital may need extensive structural repair, mainly to its roof, but that would surely be cheaper than the cost of a new-build diagnostic and treatment centre. Such a "cold" hospital is exactly the sort of facility whose growth the Government want to promote. It is curious that the NHS has allegedly chosen not to make a long-term commitment to send work to the hospital. Such a commitment was said to be required by HCA International in seeking to buy it. The NHS decision may be due to a shortage of revenue, such that the commissioners cannot commit to buying capacity outside the NHS in the medium to long term. Unfortunately, in the pursuit of short-term targets, health economies in the NHS tend to look no further ahead than the next quarter. That is a problem when we are trying to create partnerships with the private sector.
If there is a quality problem—that seems unlikely, given the testimony that we have heard—the NHS should be open about those concerns, rather than allowing them to be raised by rumours, which are impossible to check out. If the problem is one of throughput, we need to think more widely than length of bed stay. It is known that the shorter the bed stay, the greater the possibility of readmission acutely, which would create pressures elsewhere. If local purchasers are buying capacity outside the area or even abroad, they might argue that the prices offered by the King Edward VII are not competitive. The Government have always claimed that treatment abroad compares favourably with private sector contract prices, although that says more about private sector prices for spot contacts than about the cost of overseas treatments.
If local purchasers are buying capacity elsewhere, the Government may be right to say that there should not be long-term subsidy for non-value-for-money prices, but I do not think that that is the case in this instance. I fear that, because of their fragmentation, the small purchasers involved in the modern NHS—primary care trusts—fail to see the strategic effect of withdrawing contracts. The strategic health authority and central Government have a role to play. The Government should start publishing the prices that are obtained by the NHS abroad and in the private sector, rather than hiding behind the cloak of commercial confidentiality; otherwise people will not understand why contracts are being placed where they are being placed.
Peter Bottomley: Hon. Members on all sides will welcome the hon. Gentleman's comments. Will he add that West Sussex and West Surrey—two of the three health authorities with the longest waiting times in the country—are not the place to start running an experiment?
Dr. Harris: Quite so. I entirely agree.
It has been alleged that the NHS has deliberately manoeuvred the hospital into non-viability by withholding a commitment to long-term contracts, even
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where they would be value for money, in order to place the NHS in a position to buy the hospital cheaply. That would be unfair practice, and if there is any evidence of that it needs to be provided and the Minister needs to give assurances. There is a case for the Audit Commission to investigate how the present situation has come about, as it may well happen elsewhere. We need action from the Government, but in the short term, and certainly before Friday, we need answers.
10.38 am
Tim Loughton: I shall be brief, in order to give the Minister time to respond to many of the points that have been made. First, we should put on record our congratulations and thanks to my hon. Friend the Member for Chichester (Mr. Tyrie), not just for bringing the issue to the Chamber today and raising it in the House but for the active part that he has played in the campaign with the local community and the health professionals to make sure that the issue is decided at the highest level. I speak today wearing two hats—as a shadow Health Minister and as a West Sussex MP whose constituents will be greatly affected by the decision if the worst comes to the worst for the King Edward VII.
Many of my colleagues have made pertinent points, which I shall not repeat in detail. My hon. Friend the Member for Chichester dispelled some of the myths about costing and quality issues at the King Edward VII. I hope that the Minister has taken them on board. The situation is dire, and the debate could not have been more timely. This time next week, the hospital may no longer be looking after patients—one of the largest independent charity hospitals in the country may have been closed.
We should think not only about the 70,000 in-patients the hospital has looked after in the past 10 years, and the 180,000 out-patients it has treated, half of whom were NHS patients, but about the 90,000 in-patients it could look after in the next 10 years, the 180,000 out-patients and the 2,000 radiotherapy patients per year it is capable, willing and eager to handle in the crucial years ahead. We should consider the 422 happy, dedicated and professional staff who work in the hospital, as I saw for myself when I visited the week before last.
More than 50 per cent. of the hospital's patients in most years have been NHS patients, whom it has treated in real partnership with no barriers. It is a model of the way in which private, not-for-profit and NHS providers can work together in harmony for the good of patients, which is the ultimate aim. All that will be lost in that hospital's centenary year, after the 100 years during which it provided an excellent service to the people of Sussex, Hampshire, Surrey and beyond.
I shall make four quick points. First, if it ain't bust, don't fix it. The hospital is not bust. We heard today that the quality of the care offered there is second to none. It is doing a good job. It is not a failing hospital. It is not an NHS hospital that has just been awarded zero-star status, which would be cause for concern. If it has not been doing a good job, why has the NHS awarded it so many contracts in the past and, by all accounts, received 100 per cent. satisfaction?
The King Edward VII is a not-for-profit hospital. It has not produced surpluses because it has reinvested all its money in state-of-the-art equipment so that it can

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continue to offer its patients the best treatment and service, which are not available in other parts of the country or the county. That equipment has been made available to NHS patients without any of the investment or depreciation costs that the NHS would have had to take into account if it were NHS equipment. That contrasts with other local hospitals, which have benefited from large increases in investment in the NHS, which we all know about. They have also benefited from a share of the £93 million from the new opportunities fund, which has paid for much of the cancer equipment in NHS hospitals. Obviously, that has not happened at the King Edward VII. The ParseNet scores for quality of care at the King Edward VII show that it is second to none.
Secondly, it would be against Government policy if the hospital went down the tubes. We need a multiplicity -of providers. The Government acknowledge that in their policy. We have serious problems with capacity. The Government have negotiated a concordat with the private sector. We wish that well; it is the way things will be in the future. There is a good example in Scotland, where the Scottish Assembly recently negotiated a £4 million initiative to clear the backlog of people waiting for hip and knee operations. All the spare orthopaedic capacity in the private sector has been booked over the next six months at discounted rates, and 500 patients who have been waiting up to a year will benefit from that arrangement. Why can we not make a similar arrangement with the King Edward VII and other hospitals?
My third point relates to patients being sent overseas. It is absurd and obscene that my constituents and those of many of my hon. Friends present today are sent off to Germany and France—and if anything goes wrong, the residual liability will come back to the UK, as my hon. Friend the Member for Isle of Wight (Mr. Turner) pointed out—at a cost that we do not know, because our repeated requests have failed to produce the costings. The same patients could have been sent up the road to the King Edward VII and treated quickly.
The fourth point concerns the waiting list impact. Most people seem to think that there will not be an impact on other hospitals. Of course there will. There is no more depressing sight than cardiac equipment, angioplasty machines and linear machines lying idle for more than half the week, when our constituents queue for weeks, months and years to gain access to that treatment. King Edward VII radiotherapy referrals are usually seen within two weeks. That contrasts with the Queen Alexandra hospital in Portsmouth, where the wait is currently 10 to 12 weeks, and we have heard from other sources about waits of 14 weeks. We know that there are problems with the machines at that hospital and waiting times will get worse in future. That is a zero-star hospital which was rated as under-achieving for two-week cancer waits, under-achieving on cancelled operations and under-achieving on financial management.
The Brighton hospital, at the other end of Sussex, has long waits for the radiotherapy department and 20 per cent. vacancies for radiographers. As my colleagues have argued, people will die if those desperately needed facilities are not available in a few weeks or months. In orthopaedics, which as we all know is especially crucial in Sussex because of the elderly population, at the
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Southampton, Portsmouth and Royal Surrey hospitals, there are typically 372-day waits—more then 12 months—for a hip replacement, and 443-day waits for knee replacements. Those patients could be seen within weeks at the King Edward VII.
Those hospitals are improving and they are doing a good job in difficult circumstances, but they need help, and they need it now. That help will not be there next week unless the Minister does something today. The impact on capacity elsewhere in the area will be immense. We are told that capacity will improve by 2005 with the extra investment in Southampton, but we need that capacity now. Is it not absurd to build new capacity at large cost, some years hence, which could be much more expensive than supporting the existing capacity? This really is an urgent case.
We are not looking for a handout. This is not about a handout or bailing out a private hospital. We are not even looking for investment. All that we want is for contracts to continue as they have done. All that the King Edward VII hospital wants to do is to continue to offer operations and conduct the business that it is there to do, for private and NHS patients. That is all it is asking for. If the recent offer that has just been placed on the table, which does not involve comparative costs with the NHS—in fact, those comparative costs are very similar in normal circumstances—involves doing the work at the NHS reference cost, there can be no question about cost, just as there is no question about the quality of the service offered.
In these final minutes of the eleventh hour, the Minister has the power to intervene. It is in her interests to do so, and it is also in the interests of the NHS, the King Edward VII hospital, all its staff and the patients it serves. As my hon. Friend the Member for Chichester said, this will be a win-win situation if she will just take the simple step of giving the hospital a breathing space so that it can continue for the benefit of its patients. This is basic common sense, and I hope that the Minister will continue to show today the characteristic common sense that she has shown in the past.
10.46 am
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): The strength of feeling on this matter is illustrated by the number of hon. Members in the Chamber today, and they have made some interesting and passionate contributions to the debate. Clearly the hospital is held in great regard in the community, and I would like to thank the hon. Member for Chichester (Mr. Tyrie) for securing the debate because it gives me a chance to put my response on the record and to answer most of the questions put by hon. Members. I shall certainly do my best to do so.
There has been a lot of misinformation and speculation in the media and the community over the last few weeks as a result of the events that have occurred at the hospital, and I want to try to give the community some reassurance about the future of its health services, because that, for me, is the important matter in this debate. Clearly, we need to ensure that high-quality services are available for NHS patients, wherever they live, and I am concerned that there is a great deal of wild speculation in the press at the moment. We must try to get this issue into perspective.

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The hon. Member for Chichester set out the history of the hospital. It is a charitable hospital—neither an NHS facility nor a private facility. It is in that third sector that the hon. Gentleman rightly suggests the Government want to promote and to work with to develop more interesting and innovative partnerships. It employs 420 staff and currently has 41 patients, although it has the capacity to treat 150. It is not owned by the NHS, but we should recognise that it has a long history of good partnership working with the NHS. NHS patients have traditionally made up about 30 per cent. of the hospital's income, not 50 per cent., as has been suggested. A substantial proportion of its patients are NHS patients, none the less.
Until fairly recently, the hospital has provided routine surgery, cardiology treatment, cardiothoracic surgery and radiotherapy and oncology care to a mix of private and NHS patients. The Macmillan centre at the hospital has been mentioned, and it has clearly been of great value in providing terminal and palliative care to patients. There are 10 primary care trusts in West Sussex, Hampshire, the Isle of Wight and Surrey that regularly send patients to the hospital, spending a total of between £4.5million and just over £6 million at the hospital each year over the last five years.
I have had a look at the figures: in 2000–2001, those trusts spent £4.85 million: the year before that, they spent £5 million. This year, up to December, the hospital has received £3.35 million from the NHS, which—if the expenditure had carried on, and if we had not got into the difficulties that we have—would have been the equivalent to an annual figure of £4.5 million. That is comparable to the expenditure in 1999–2000 and in 2000–2001. There has not, therefore, been a huge slashing of NHS funding. I want to put it on the record that the NHS is perfectly prepared to continue with that level of funding to the hospital. Last year, there was a different order of funding—I think it was £6.3 million. One of the main reasons for that was that last year there was a much higher level of waiting list initiative projects right across the NHS—not just in that region—but, in terms of the underlying funding, there has been no huge slashing of NHS contracts. The hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) said that the NHS was closing this facility. The NHS is not closing this facility; it is not an NHS facility. We are perfectly prepared to carry on with the current level of funding and we are actively engaged in discussions with the hospital almost as I speak.
Mr. Tyrie: I suggested to the Minister that it might be advisable for her not to quote figures that she had been given by her officials without having checked them extremely carefully. It is not correct to say that NHS contract levels are broadly similar, in cash terms, to the levels of previous years. I have the figures in front of me. As early as 1998–99, the hospital had contracts to the value of almost £6.3 million. If we look at the run of the last five years, health cost inflation must of course be taken into account. Any reasonable assessment of the contracts over the last five years before the current year would show a fall of about one third in the level of
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contracts going to this hospital, resulting directly in the shortfall of cash that it has at its disposal. That is also the conclusion of the provisional liquidator.
Ms Blears: The hon. Gentleman and I can trade figures—he has the figures for the last five years, as do I—but the point I want to make is that there has been a variation in funding for this hospital over the last five years. In the year following the year that he has just cited, the funding was down to £4.85 million. So, we can trade those figures, but it is important to recognise that in April last year the management team at the hospital advised the Isle of Wight PCT that costs were to rise by about 20 per cent. That was a significant event, and, on that basis, the Isle of Wight PCT reviewed its cardiac requirements and decided to cancel its contract with the hospital because the costs were going up by that amount. It decided to commission those services from an alternative service provider.
All Members will recognise that it is the responsibility of the NHS, through the primary care trusts and the strategic health authority, to ensure that we get best value from the investment of public money. In April last year, the King Edward VII hospital told one of its main purchasers that it was going to put up its costs by 20 per cent. A decision was therefore made by that purchaser. We are trying to devolve power to the local communities that have the information on the ground, and this one decided that it could purchase care for its NHS patients from an alternative service provider. That is how we have arrived at the situation we are in today.
For the last three years, the hospital's expenditure has exceeded its income, and that remains the position, so this is not simply a matter of what has happened in relation to the NHS contracts. This has been a long-standing issue. All hon. Members will know that the hospital recently held discussions with HCA International, a large American health care provider, but they did not produce a positive outcome. Nevertheless, NHS officials at strategic health authority level and the director of health and social care of the southern region are now engaged in discussions with the liquidator, to see what steps can be taken to secure provision for NHS patients. Clearly, those negotiations are commercially sensitive. I understand that, as late as last night, the hospital put forward new proposals, and they will be considered extremely seriously by the NHS because we are determined to ensure that we can provide good continuity of care and increased capacity.
I am on record as saying many times that the NHS is facing not a financial difficulty but a capacity difficulty, and that is quite true. We are increasing capacity, as the hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) acknowledged when he went on a visit with the Public Accounts Committee to look at the heart hospital and the other new hospitals being built in London. We are undertaking the biggest hospital building programme ever seen in this country and making the biggest investment in the NHS since 1950. Most primary care trusts are getting a real-terms increase of 30 per cent. over the next three years, so capacity is increasing and we are determined to have those negotiations and to ensure that we do not lose out on capacity. That must be balanced, however, with getting a good financial deal for the public investment that we are making.

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I referred a moment ago to the heart hospital. The hon. Member for Oxford, West and Abingdon (Dr. Harris) said that the National Audit Office had said that project represented a good deal in terms of spending public money. We are getting a good facility and increasing capacity. At every stage, I am committed to our spending public money in a way that will get a good return for the patients whom we all represent.
Mr. Oaten: The Minister has confirmed that negotiations were taking place up until last night. Given the short time scales involved, will she give a commitment today that the NHS will put in place a package of temporary funding, so that the King Edward VII hospital does not have to close next week and there can be more time for those discussions to continue, rather than working to the time scale that means that the hospital will close next week?
Ms Blears: Officials and the Department are actively engaged in those discussions, but we are not able to give the simple guarantee that was requested of us at the meeting just before Christmas, which was that we should pick up the bill, whatever the cost. We are not in a position to do that, and I do not think that any responsible Members would expect us to do it. I can, however, give the hon. Gentleman the reassurance that we are actively engaged in those discussions.
I want briefly to respond to the points made by the hon. Member for Arundel and South Downs (Mr. Flight). I was a little surprised by his contribution. He raised concerns about the figures. He knows how important it is to get value for money, but he is on record as saying that he thinks we could cut NHS expenditure by 20 per cent. That is an important point to make, and I am very surprised that the hon. Gentleman made the comments that he did. I think that he would acknowledge that it is important to get the very best value out of public expenditure.
Tim Loughton: I want to put the record straight. At no point has my hon. Friend the Member for Arundel and South Downs commented to any extent on any cuts in NHS spending, so let us get that clear. If the Minister is so concerned about value for money—a subject on which we all agree—and if there are no quality issues involved, what possible justification can there be, when the hospital has yesterday made this winter sale offer of a large quantity of much-needed contracts at the NHS reference price, for the Minister's turning it down? For whose benefit would she do that?
Ms Blears: As I have just said, I think that the offer was put on the table last night. The Department of Health and the strategic health authority have been in discussions with the hospital since before Christmas.
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The offer will obviously need to be examined properly. Hon. Members have urged me not to take figures at face value, and to drill down and find out exactly what they will mean for the NHS. That is exactly what we will do, to ensure that we get best value.
The right hon. Member for South-West Surrey (Virginia Bottomley) talked about the dreadful waiting times in her constituency, and I acknowledge that they are still far too long. I have to say, however, that they were much longer under her stewardship, when, in many cases, people were waiting up to 30 months for heart care.
Virginia Bottomley: Will the Minister give way?
Ms Blears: No, I have only two minutes left.
The right hon. Lady also made the point about funding this area on the basis of need. We have had discussions about trying to tackle health inequality and ensuring that the formulae are accurate. I understand the stresses and strains that exist in the south of the country, in terms of high living costs, wages and the need to recruit and retain staff. That is a significant issue for us, but we must balance it with targeting our funds towards the areas of greatest need, where health inequalities still scar the country and are of great concern to the Government. The right hon. Lady made a better point about partnership, and, as I have said, the Government are anxious to pursue that issue, both with the independent sector and the not-for-profit sector, which the King Edward VII hospital is in.
Mr. Tyrie: The Minister has descended into making spurious and, in some respects, cheap party political points. Will she, in the final few seconds available to her, address the question whether, if the hospital is able to offer a deal at the marker prices—the reference prices—that the NHS itself thinks are correct and good value for money, and if there are no quality issues at stake, there should, in principle, be a deal to be struck?
Ms Blears: I have tried to emphasise that the Government are committed to increasing capacity and to providing good services for NHS patients. We will examine with rigour whatever proposals are put forward to us, to ensure that we get the best deal for the people who fund the NHS—the taxpayers—and the people who use it. It is this Government who will provide good stewardship of the NHS and who have decided to put in massive investment to ensure that the services can grow and that we get capacity into the system. We are absolutely determined not to let down the people of these communities who rely on these important services, but it is also right that we should take a rigorous approach to ensuring that we get the very best value from the investment that we make.

Del Monte Factory, Methwold
11 am
Mrs. Gillian Shephard: I am extremely grateful to have the chance to raise in the Chamber the matter of 316 job losses at the Del Monte factory in Methwold, a village in my constituency of some 800 people. I am also very grateful to the Minister for the trouble he has already taken to understand the issues, and their impact on a highly rural area. The facts are as follows: last June to July, following the receivership of Albert Fisher Foods at King's Lynn, the food processing plant at Methwold was acquired, along with its fellow plants in Wisbech and York, by Del Monte. These plants had formerly been part of the Albert Fisher chilled food division. The Methwold plant produces prepared salads for supermarkets.
As hon. Members can imagine, there had been enormous anxiety about the future of the plant during the uncertainty surrounding the Albert Fisher receivership. It is a huge employer in an area of very small businesses with very small employment patterns. With 555 people employed there, the plant was clearly of great importance to employees and suppliers alike. The whole community breathed a collective sigh of relief when Del Monte—on taking over the three plants, including the one at Methwold—made optimistic statements about the plant's future, the excellence of the work force, and the prospects for the plant.
I should make it clear that I and everyone else in a community whose prosperity depends on the fortunes of the agriculture sector understand that it is impossible for any company to give cast-iron guarantees about its future. Competition is intense in this sector, and retailers are ruthless in their demands, in the interests of their customers. This is the world in which we now live. Despite those harsh realities, which everyone concerned understands, it was a shattering blow to the local community when, on 16 December—one week before Christmas—the work force at Methwold were told by the management that there were likely to be some 300 redundancies. According to a letter sent to each employee, dated 16 December, the situation had arisen because
"the company has lost the Sainsbury's business and this has depleted demand on the plant by 60%. As a result, the company is operating at a significant loss, which is jeopardising the entire operation. Action is therefore being taken to address this matter and rebalance the number of employees to meet current demand".
I ask hon. Members to imagine for a moment the effect of that news on the 555 people concerned, just one week before Christmas. It is true that some of the employees are agency workers, but many are local, and some come from families in which two, three or even more members work at the plant. Many of the employees are women, a lot of the work involves shift work, and there are a number of part-timers. I know that the Minister will be aware of the employment patterns that are usual in the food processing sector.
The impact of the announcement on people who, by any definition, are neither powerful nor prosperous was immense, and the timing, just before Christmas, was incredible. Indeed, it was all the more incredible because, the next day, 17 December, I contacted the chief executive of Sainsbury, Sir Peter Davis, who told
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me that in June and July 2002, when Del Monte purchased the plant, it had been made aware that doubts already hung over the contract, and that Sainsbury had finally told Del Monte that it had lost the contract on 2 October 2002. When the Del Monte management became aware that I had contacted Sainsbury directly, they sent me a fax—I have to say that their communication with me has been, shall we say, economical—which stated:
"I would like you to be fully aware that the decision to reduce our workforce in Methwold is not one for which J Sainsbury can be held accountable."
That is by interesting contrast with the letter to the work force just two days previously. There is also the question concerning the delay in informing the work force, which I shall come to later in my speech.
I immediately contacted the Thetford citizens advice bureau, warning it to expect a large number of queries about redundancy rights, job prospects and so on. On the same day, I also rang the East of England Development Agency to ask for immediate help with job search and other appropriate action. The Minister may wish to describe to hon. Members what the development agency was able to do at that stage, and what it might be able to continue to do.
During the Christmas period, I was contacted by a large number of constituents, including some who worked at the plant, some who were members of the local community who were very concerned about the situation, and others who expressed their amazement at the timing and general handling of the redundancies. Sadly, but very significantly, several people pointed out that they had been forbidden to speak to the media, and asked that, if I intended to pursue the matter, as I am doing today, I respect their anonymity. I intend to quote people without giving their identities, but will hand in the original letters with my notes. Hon. Members might like to reflect on the fact that we are in the 21st, not the 19th, century.
One correspondent, a former human resources manager at the plant, wrote on 20 December:
"On acquisition, the workforce were told by the receivers that Del Monte were not in the habit of buying out businesses followed by redundancies and they were not to worry."
He added:
"At no time since the acquisition have Del Monte assembled the workforce to advise them of the new company strategy, structure, future plans or indeed anything at all."
Another wrote on 21 December:
"I am one of the many employees at Del Monte … who this week has found himself getting well and truly shafted."
That may be unparliamentary language, Mr. McWilliam, but never mind—it is a quote. That person went on to say that he had kept a diary of events following the hammer blow of the announcement of the redundancies on 16 December. He had been in the plant and had decided to document what was going on. He said that some employees had been aware that job losses might occur, and went on:
"What many of us find curious is the timing. You did not need to be too bright to figure out that something was amiss when I saw a member of personnel removing the company rules on redundancy from the main notice board several weeks in advance … We all thought that when Del Monte bought the site that at last there would be sweeping changes and improvements to the place … We waited and waited but the situation grew worse by

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the month … With all that has happened this week there is a growing feeling that nothing changed because they knew something we did not. Why change the system if nobody is going to be here to implement the system?"
The entry in that constituent's diary for 18 December reads:
"A number of people here are in tears. This is not good. Why string us along like this? Everyone seems to have a story to tell about the lack of communication. I myself am being told conflicting answers to the same question. You just don't know what to believe. For example, there are now rumours that the transport drivers will be starting their redundancy packages on the day that they leave whilst we are not. We just don't know. Our manager cannot help because he is being given the runaround whenever he does try."
The rest of his letter catalogues a series of broken promises, lost opportunities for dialogue, and what he considers to be unfairnesses. He concludes:
"Even if I could meet their terms I would not want to work for a company that has shown such disrespect for the welfare of their staff. I would have no loyalty, drive, or commitment for a company that treats dedicated staff in this manner."
I also received an e-mail from a woman who stated that no fewer than five members of her family worked at the plant. She wrote:
"We were informed of this news on 16/12, we were then told to expect to hear of some news about who would lose their jobs by 19/12, and when they could expect to receive their pay. It is now 30/12, and we are still none the wiser. We were told we would hear by 23/12, and then it grew to 4/01, and now it is 6/01 … We had a black cloud hanging over Christmas and now it appears it is never going to end."
I repeat: we are now in the 21st century.
The Chamber would be entitled to ask what contacts I have had with the company itself. I have had two communications from it. One, dated 18 December, from the managing director, Mr. Peter Miller, was brief in the extreme, and gave no indication of the HR work planned to help so many people facing redundancies. The other, giving me the background to two specific cases that I had raised, arrived on 20 January.
It is only fair to say that the company disputes some of the evidence that I have just given to the Chamber. It maintains that when it learned that it had lost the Sainsbury contract on 2 October, staff were made aware of that fact. All I can say is that that is not the impression I have been given by people who worked at the plant. It is possible, of course, that staff were given some indication, but in such guarded terms that they had no idea of the implications for them and for their jobs.
What is not in doubt is the impact on staff, which I have already described, when they received a full account on 16 December. The company maintains that efforts were made to help redundant staff, and it is true that on 8 January jobcentre staff and representatives of local employers were present in the plant to give advice and counselling.
Mr. Henry Bellingham: I am sorry that I could not be here for the start of my right hon. Friend's speech. Is she aware that many of the staff affected live in King's Lynn, in my constituency? Obviously they are dismayed by what has happened, but they are also very grateful for the effort and the work that my right hon. Friend is putting in on their behalf.
Mrs. Shephard: I thank my hon. Friend for that contribution. We discussed this matter when there
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redundancies were announced, because, as in the case of Albert Fisher Foods, the rural nature of the constituencies that we represent means that our constituents have to travel a long way to work, and transport arrangements have to be in place especially for work such as food processing. Perforce, a blow such as this affects people over a wide area. As my hon. Friend says, redundancies on that scale are a hammer blow to the whole of west Norfolk.
The managers of Del Monte pointed out that many of those made redundant had already found new jobs. We are fortunate in Norfolk in that, as the Minister will be aware, we have very low unemployment at the moment. It is also true that jobs of that sort can be filled by people working for agencies—the agencies that, as my hon. Friend will be aware, used to be called gangs. Some of the people who work for the agencies these days come from overseas, and companies that impose many redundancies still have the flexibility that the agency network affords them to cope with the highs and lows of demand.
At my meeting with him, the managing director of Del Monte said that he wished to correct the bad press that the company had had over the issue. I believe that he intends to put some of that right today, which is a good month indeed, five weeks—since the trouble arose. He admitted that mistakes had been made, that he might not have been aware of all the problems perceived by employees during the redundancy period, as he is not on site, and that improvements had to be made.
As the Minister knows, I fully recognise that the Government's role in such matters is limited. We all live in the real world, which is one of difficult decisions and harsh competition. When such decisions have to be made, there is not always time to do everything perfectly. However, in the case of the Del Monte employees, it seems to me that the procedures were rushed, unclear to the people most affected, and uncaring. The work force did not deserve such treatment. The effect of 316 redundancies out of a total work force of 555, in an area of very small communities, where families often contain two or three members of the same work force, can be imagined by those in the Chamber—and the timing of the announcement defies description.
As I have already said, I am grateful to the Minister for the great interest that he has shown in this case. I hope that he will now give the Chamber the benefit of his views on what I have said, and that he will also tell us what the Government, through their agencies, have been and will be able to do to help my constituents.
11.16 am
The Parliamentary Under-Secretary of State for Trade and Industry (Nigel Griffiths): This debate is on one of the gravest subjects that we ever consider—the loss of jobs and livelihoods on a large scale, affecting whole families, and generations within those families, in a rural area where incomes are not high and opportunities for other employment are hard to find. The right hon. Member for South-West Norfolk (Mrs. Shephard) has set out the issues in the case with great clarity, and I know from my discussions this morning with both the chief executive of the East of England Development Agency and the manager of the local jobcentre the veracity of her words.

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Redundancies are, of course, sad, but they are an inevitable part of commercial life. Some companies handle them well, treating their work force with dignity and compassion, working with employees and their trade unions to save jobs wherever possible, and where jobs cannot be saved, working with local agencies to help secure employment or training with others. Sadly, in this case Del Monte has not been one of those companies. That illustrates the need for an information and consultation directive to provide a real opportunity for better employee involvement in larger companies, and to help to steer employers round the potholes, rather than leaving them to be lifted out.
I recognise that Del Monte employs a large number of people, and I have no wish to damage its reputation further, but rather to give it some words of counsel. However, I must say that I am taken aback, if not astonished, by Del Monte's attitude to one of our most distinguished and experienced Members, who has Cabinet experience and is highly regarded on both sides of the House. Its failure to listen to the right hon. Lady and treat her with the respect that the House expects from companies dealing with Members, especially senior Members, is a grave disappointment, to say the least. I know that the company will feel that its apparent disregard for the feelings of its employees and their relatives is a matter of shame, and that it will want to go a long way to restore its reputation. In a moment I shall ask the right hon. Lady to help them to do that.
As the right hon. Lady said, although Del Monte was aware that it had lost a major contract on 2 October, it apparently made no contact with either the East of England Development Agency or the jobcentre—or, as far as I can see, with any agency that could have helped the company and its workers. It formally notified the Department of Trade and Industry redundancy payments office in Birmingham on 13 December that there would be large-scale redundancies—news that it communicated to its work force on 16 December.
It is not true to say that the company did nothing; that would have been illegal. It fulfilled its absolute minimum legal duties by informing the Secretary of State through the redundancy payments office. It also held some consultation with the representatives of its employees, as it had to do at least 90 days in advance of the first dismissals taking effect if, as was the case, there would be more than 100 redundancies. That was the company's legal obligation under section 181 of the Trade Union and Labour Relations (Consolidation) Act 1992. It appears to have done nothing else.
Fortunately, the right hon. Lady, with her finger on every pulse in her constituency, and her formidable experience and drive, had already contacted the East of England Development Agency and the rapid response service. The chief executive of the development agency, Bill Samuel, told me this morning how grateful he was for that, and also highlighted a data protection anomaly that may interest the Chamber. EEDA and all the other development agencies are not automatically informed when form HR1 is received by the RPO, until the employer gives permission under the Data Protection Act 1998. The data protection registrar might look into that as a process that hinders rather than helps possible victims of redundancy.
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The jobcentre, the learning and skills council and the Government office for the east of England were all made aware of the situation. The right hon. Lady has asked me for an account of the action that they took, and I know that the Chamber will want to have those details. I have to confirm the impression, and the facts, that she gave us earlier, which show very poor co-operation by the employer in this case. Phone calls from both the jobcentre and the development agency were unreturned, and constant pestering—perhaps "pestering" is the wrong word, but certainly constant chasing up—by those agencies, offering the sort of help that I shall describe in a moment, was rejected.
I do not know whether companies in that situation get caught in the headlights and are paralysed with fear about how to deal with redundancies and about whether the bad publicity might have an impact on their share price, or some such factors, but I can tell companies that it is much better to be frank with their work forces and explain that there are no certainties and there might be further redundancies, than to leave them living in a climate of fear, without information.
This is not an American phenomenon. My hon. Friend the Member for Alyn and Deeside (Mark Tami) came to see me with trade union representatives from Corning in his constituency. Because they were coming to the Department of Trade and Industry, officers from the company flew from America to meet me and talk frankly through with the work force why the redundancies and closures were necessary. They said that similar redundancies were taking place both in their home town in America and in Germany. That information was not fresh to the unions, but it was shared with the work force, and it was very useful. Why Del Monte has taken a different approach I do not know.
The manager of the jobcentre eventually managed to set up a meeting with the company's work force on 6 January, but that meeting was a shambles. It was held in a different building so people had to leave the factory and go up the road, very few employees attended, and the human resources people from the company were 20 minutes late. There was a general impression of a lack of co-ordination, for reasons that Del Monte management must explain and justify, both to themselves and to their work force.
The jobcentre manager contacted the company yesterday to say that she would organise a jobs fair for the employees, as she had managed to extract from the company the information that some of the employees had finished before Christmas—some were due to be released on 20 December and some about 27 December—but that the bulk would go on 15 March. She was told that there were only another 30 people who were to go still left in the company. Almost all had gone already, so she has not been able to organise the jobs fair, the offer of which could have been available from day one of this sorry episode. She has not been able to do what, if the employers had co-operated, she would normally have done—
Mrs. Shephard: Is the Minister saying that, if the company had bothered to return the phone calls from the jobcentre and the East of England Development Agency before Christmas, a huge percentage of the 30

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people now left would have benefited from the advice that was available then—and that sadly, those 30 people cannot now benefit from that advice?
Nigel Griffiths: I am saying precisely that. The jobcentre manager was in contact with other employees, with the Inland Revenue, with the Department for Work and Pensions and the social security offices, and with the training agencies. Indeed, she had even contacted the town hall to book it tentatively for a jobs fair. More than that—it is important that the right hon. Lady and her constituents know this—on day 1 she immediately applied for day 1 eligibility for those who wanted to apply for workplace learning. That scheme is normally for people who have been out of work for six months or more, but when there are large-scale redundancies an application can be made for day 1 eligibility. That means that training can be provided in the workplace of the new employer while the person is working, without taking them into a training room—almost on the production line.
The jobcentre manager gave me an example of how one employee, who had applied under their own steam, had been helped—and that help is still in place now. The manager has a full programme, with a host of ways of helping individual employees who come to the jobcentre, but she has to operate it without the tremendous help that the company could have given by notifying all its employees about that programme. They are helped with interview skills and with how to find agencies and update their CVs, and can use free postal and telephone services, and many other facilities that can be so helpful.
Indeed, the jobcentre could have helped the company to cut down the bureaucracy and red tape—that red tape that I am always banging on about, which is a common cause of complaint on both sides of the House. There is a facility by which the company, by liaising with the
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redundancy payments office, can have all the employees notified. The RPO is duty-bound to write to all 300-plus employees individually via the company. I understand that the office asked the company—if the request did not get through, that was the company's fault—to supply it with a list of all the employees, which would have absolved people of the need to open more than 300 envelopes and process the contents. That is the sort of co-operation we expect; it is common among employers, but sadly it did not happen here.
I have described the help that could have been available. Indeed, that very same jobcentre in the hon. Lady's constituency is already giving such help to others. It helped Fenmarc last year when it closed its unit in Southery. The Jobcentre Plus staff went to the factory, interviewed all the staff and gave them information about payments, working families tax credit and current vacancies. They also gave other help such as I have already described. The King's Lynn jobcentre is working with staff at Snap-on Tools, where there are now approximately 125 redundancies, and that company is co-operating. The regional development agency worked hard on the Luton Vauxhall partnership. I shall be happy to send Del Monte the examples.
I have asked the right hon. Lady, and she has kindly agreed, to chair a meeting with the regional development agency, the jobcentre, the training agency—the learning and skills council—the rapid response team, and, I hope, Mr. Miller, the plant manager and representatives of the work force. I think that we could learn some lessons that would be beneficial both to the company, in restoring its reputation, which I am keen to do, and also to the workforce and to others who find themselves in the same position.
Sitting suspended until Two o'clock.

National Service Framework for Long-Term Conditions
2 pm
Mr. Mark Todd: First, I shall set out the reasons why I asked for this debate. The proposal is to adopt a national service framework for long-term conditions. That will add to a series of NSFs, the purpose of which is to remove the lottery of care that currently applies to many conditions and circumstances in medical and care planning. I strongly approve of the principle behind the establishment of the NSFs. I am delighted that the Government have chosen this approach, and I am pleased with the initial steps that have been taken. For example, the implementation of the NSF for diabetes has recently begun, and this approach has been taken to the care of older people.
The NSFs are a key part of ensuring that our national health service addresses the needs of all its potential users. They permit a localised response, but clear national standards are established, and any citizen facing a particular circumstance or condition can expect them to be met. The principle behind the NSFs is absolutely right. They are also a mechanism for establishing whether best practice is shared, and for setting out ways in which it can be more widely adopted.
The methodology of NSFs commands partnership. Many of the aspects of care that they address rely not only on the NHS but on the activities of social services, the voluntary sector, carers and the patients themselves. What we are looking for from any NSF is the bringing together of the various parties involved in an individual's care to achieve the best possible outcome.
I particularly welcome this proposal. By their very nature, long-term conditions require complex co-working between different agencies, carers and the patient. That often continues over a long period, as one would expect from the definition of a national service framework. During that time, the care of the patient will need to be changed. The protocols for defining how that change is most efficiently brought about are crucial, and involve the wishes of the patient and the carer. I understand why this NSF has been proposed, and I welcome it.
It is worth recalling the principles behind the establishment of NSFs. In politics—and in health politics—a lot of worthy and substantial documents are produced that add greatly to our knowledge but do not necessarily prompt action. That is not the purpose of NSFs. They are supposed to provide a framework for progress towards set goals within an agreed time scale.
The expectation is that this NSF will be activated in 2005, and that there will be a time scale of 10 years. A key part of the process is that goals are set and achieved within a time scale and with a particular methodology proposed in the NSF. The goals are not wish lists: such an approach should not be part of this NSF.
When the Secretary of State announced the scope of the NSF for long-term conditions, he said:
"The NSF will have a particular focus on the needs of people with epilepsy, Multiple Sclerosis, Parkinson's Disease, motor neurone disease and other similar conditions."
I commend that approach. There is much common ground between many of those conditions, and I shall dwell on the common aspects that should concern us all when we respond to the needs of people with these conditions.
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Since the announcement, the approach to be taken has been refined. The focus is on people of working age, on facilitating their continued working, if that is possible, and on implications for people who suffer from several of the conditions listed in the Secretary of State's initial speech. I do not want to cover that now.
One could describe the approach that has been taken as measured. We have not raced away with the establishment of a body of people who will prepare the NSF. That is not a criticism, because it is important to assemble the right people to do the task. An expert external reference group has been put together, and I know of several people on the group. They seem to be well chosen, and it is a good model because it contains clinical specialists, managers from the NHS and other agencies, participants in the voluntary sector and representatives of service users. The group does not contain anyone with an individual disease-specific perspective. That is understandable, because it would be difficult to accommodate all such people who could contribute to the exercise. I assume that part of the group's work will be to ensure that people with a perspective on each disease have input on the preparation of the NSF through the external reference group.
Several generic points about the identified conditions should worry us. Most are neurological conditions. There is a massive resource gap. I would be amazed if most Members of Parliament did not have a constituent who had encountered difficulties getting referred to a neurologist in their local NHS trust. There is an acute difficulty, and there is certainly a painful shortage of people in South Derbyshire with the appropriate skills to diagnose people who suffer from many of the conditions.
The United Kingdom has six neurologists per million head of population. Germany has 12 per million, the Netherlands has 33 per million, Italy has 71 per million and Denmark has 100 per million. One could argue that those statistics are not necessarily precise reflections of skill levels, but they give a clear indication of the shortfall. All our observations as constituency MPs would confirm the shortfall in the first level of skill, which is correctly to diagnose the condition that a person is suffering from.
The second generic point is the identification of a person's need for therapy and the delivery of that care. It is also clear that there is a desperate shortage of physiotherapists in this country, and the welcome attempts by the Government to recruit and train additional physiotherapists have, to date, drawn relatively small yields. I emphasise the need for the Government to deal urgently with that requirement.
A third problem, and one that I would be surprised if hon. Members had not encountered, is the difficulty in finding an occupational therapist to advise on adaptations of living circumstances for many people with such conditions.
Miss Anne Begg: With many conditions, the problem is not only finding someone to assess the need for adaptations and aids but the speed at which such demands can be delivered. By the time some of my constituents have received the aids for which they

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have been assessed, their condition has already progressed. Six months' delay is no use if a person has a neurological condition and has only one year's life left.
Mr. Todd: My hon. Friend has made an important point. I was about to deal with that matter, but I am glad that she has raised it. I have referred to the assessment of appropriate adaptations. I imagine that, at present, there are significant waiting lists in many areas for people to be assessed for adaptation of their living circumstances to a level that they can live with in the future. As my hon. Friend rightly said, there is massive difficulty in the delivery of solutions to such problems. That brings to mind the co-ordination of various elements of care support for people with such conditions. There are often huge delays in obtaining adaptations that are necessary for a person's home. As she said, speed is of the essence in some cases. If a response is not rapid, it will be irrelevant. It will be too late to improve the quality of the individual's life. That is clearly a problem that most of us encounter with our constituents, and I am glad to receive my hon. Friend's support.
I am chair of the all-party parliamentary motor neurone disease group. The disease affects about 5,000 people at any one time. It is a progressive, and sometimes rapidly progressive, disease. There is no cure for it. It is fatal. The mechanisms that we put in place to respond to people with neurological conditions face their sharpest test when responding to motor neurone disease. If we can devise approaches that respond effectively to the needs of someone with MND, it is likely that we will achieve a quality of service that is more than acceptable for people with a less progressive condition.
The unique features of motor neurone disease are its rapid progression, which, incidentally, highlights the desperate need for early diagnosis. The early symptoms of the disease are easily confused with several other conditions, but if it is not spotted early, some of the steps that can be taken to improve the quality of the person's life and slow down the progression of the disease cannot be taken. At present, diagnosis can take 17 months, and some people with motor neurone disease could be dead within 12 months of diagnosis. That is a huge part of that person's potential life span in which no effective response can be made by either the national health service or caring agencies.
I have already touched on generic issues. I suggest that the focus should be on early diagnosis and the co-ordination of services to enable a flexible response to progression. My hon. Friend the Member for Aberdeen, South (Miss Begg) rightly said that we must be able to respond to a moving process. We cannot simply say, "We have seen this person and will devise something that will be delivered in three months", because it may not work any longer. We must have a protocol that drives a more urgent response than is currently available.
We must identify particular clinical interventions that work best and promote their wider adoption within the NHS. If there is doubt about whether the approach is the right one, referral should be made to the National Institute for Clinical Excellence to establish whether the best technology is being used to respond to the condition.
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Carers should have support frameworks. In my view, the voluntary sector is well established, partly through the crisis of need faced by an individual with a particular condition. I am a strong believer in the voluntary sector co-working with state agencies whenever possible. In any protocol, we should devise a way of making best use of the unique skills, commitment and knowledge of particular diseases gained by people working in the voluntary sector.
We must also recognise that with some diseases the role of the expert patient is critical. I would be surprised if hon. Members had not encountered people in their constituencies who fit this bill. Expert patients gather information from the internet and develop a genuine knowledge of their diseases. Such patients want to contribute to the quality of their care, suggest outcomes and be listened to. We must devise systems in which that can happen. Such systems are less relevant in cases involving rapidly progressing diseases such as MND, but arguably more important for sufferers of Parkinson's disease, which has a longer life cycle.
I understand the relatively recent aversion to targets in the NHS. I have long argued—privately and publicly—for fewer targets that are more focused on critical outcomes in the NHS. I am glad that the Government have adopted that approach. However, I would not want the NSF to become a NICE shelf document in which people share valuable good practice but do not necessarily make solid commitments about how it can be shared and adopted throughout the country. Targets for early diagnosis and mechanisms for establishing quality social services—with a clear model of what is meant by such services locally—should be defined in the document for particular diseases.
It is right that each of the diseases originally listed by the Secretary of State when the NSF was announced should have clear reference in the framework. I would be disappointed if it became a generic document and people said that, somehow or other, all the responses were relevant to all the conditions, because they vary substantially. The document should attempt to highlight the particular needs created by individual conditions, and should seek a clear goal for each of them. I need not dwell on that at considerable length, but there should be clear reference points back to the fact that these diseases were identified at the start.
Some of the more recent statements require a little more reflection. The Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith), made a speech that emphasised the importance of people of working age who suffer from long-term conditions. No one would wish to minimise the importance of that issue. Again. most constituency Members will encounter people who long to have more time to work, even though they suffer from a long-term condition. However, we must accept that the onset of some of these diseases tends to be towards the end, or at the end, of someone's working life. It would therefore be wrong if we set aside the importance of the quality of life of people aged, say, 55 and over, on the basis that they had ceased to be part of the active work force.
I ask the Government to consider that statement further, and to reassure us that it does not suggest that people who are beyond working age should not regard the document as particularly relevant to their concerns. There has been concern that that is suggested.

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Most people who suffer from a long-term condition are dependent on benefits. Indeed, I became involved with the Motor Neurone Disease Association as a result of a visit from a person who told me about the extraordinary processes that someone who suffered from MND had to go through to get the disability living allowance. We need clear co-working with the Benefits Agency to meet the expectations about its response to the changing circumstances of people with long-term conditions.
It would be wrong if the document focused purely on the care aspect. The anxiety and stress that is produced by relationships with the Benefits Agency for some of the people who live with these diseases is substantial, so it is important that we get that protocol straight. I recognise that that is a demanding task for the authors of the document. No one in the reference group has that particular brief, but I urge my hon. Friend the Minister to consider carefully how we can bring that element into the NSF.
This is a great opportunity to spread good practice, and there is good practice.
Miss Begg: I am sorry that I cannot stay much longer, for this is a very important debate, but I have to attend a Select Committee. My hon. Friend is talking about good practice. He may be interested to know what Sue Ryder Care is doing in my constituency for people with Huntington's disease. It involves a new model of care for people who are end stage. Currently, most young chronically sick people end their lives on geriatric wards in hospitals or in nursing homes, but Sue Ryder Care is developing a new model whereby they can live with all the necessary care, but in a home environment—in small houses within a bigger complex.
I hope that other people and charities working with those suffering from diseases such as motor neurone disease and Parkinson's disease will consider the model that Sue Ryder Care has developed in Aberdeen and Kincorth, which may be a model for the future. It is expensive, so my hon. Friend's comments on the benefits system have an important part to play in that regard.
Mr. Todd: I thank my hon. Friend for her comments. I agree that that is certainly one model of care. The key concept that I always emphasise is choice. That is a working framework for many people; others choose different models. We should try to ensure that there is a flexible response.
As I said, this is a great opportunity to improve the quality of care for people who are suffering from some of the most terrible and, sadly, intractable diseases. We should not miss that opportunity. The purpose of calling the debate was to prompt the Government to think all the harder, having taken the welcome step of setting up the NSF, about the quality outcome that we seek from it.
2.24 pm
Mr. Paul Burstow: I congratulate the hon. Member for South Derbyshire (Mr. Todd) on securing the debate, not least because when it is read
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alongside the debate on head injuries that took place in this Chamber yesterday, which was secured by my hon. Friend the Member for Colchester (Bob Russell), we may begin to get a picture of the progress that the Government are or are not making in developing neurological services.
I come to the debate wearing several hats, or with several interests. I am a vice-chair of the all-party disability group and a vice-chair of the all-party multiple sclerosis group. Recently, I was invited to act as a patron of CMT UK, which is a small charity that deals with a neurological condition known as Charcot-Marie-Tooth. CMT is an inherited neuromuscular condition with a range of symptoms that include pain and gastrointestinal, hearing and eyesight problems. In most cases, it has a genetic basis. The charity has raised several issues, some of which pick up on themes in the opening remarks made by the hon. Member for South Derbyshire.
I want to address three issues. The first concerns the capacity of the work force, because I believe that that is fundamental to delivering a national service framework of a standard that we all want, in a time frame that will make a difference to the lives of people today. Secondly, I shall briefly return to the focus of the national service framework and discuss whether the statements that have been made so far address all the issues on which we need to concentrate. Finally, I shall deal with implementation of the national service framework, which is absolutely crucial.
Neurological conditions account for 17 per cent. of visits to general practitioners and almost one in five acute hospital admissions. Studies suggest that 3 million people have a neurological condition of one kind or another. What is interesting about the figures is that the studies on which they are based are often ancient, because we do not have a robust mechanism for gathering data about prevalence. I raised that issue yesterday but did not receive a reply.
In 2001, the British Medical Association proposed to the Government that a health and injury surveillance system should be set up to capture such information so that the Government would be able to plan and commission services on the basis of need. It would be helpful if the Minister would say whether the Government are minded to do that.
One in four of the people who have neurological conditions need daily help with living tasks to remain in their own homes. Among the range of conditions with which the national health service grapples, only heart disease and cancer affect more people.
On work force planning, I understand that the average length of training for a neurologist is six years. On the basis of the numbers in training, there will be fewer than 90 extra trained neurologists by 2006. At present, there are 358 neurology consultants, which is one to 177,000 people. As we have just heard, that is the lowest number of neurologists per head of population anywhere in the western world and way below what the Association of British Neurologists says we need to provide a good-quality neurology service. Indeed, the ABN puts the required figure nearer 950. With just 30 new neurologists coming on stream each year, and given retirements, there will on current trends be 550 more neurologists by 2010. With no retirements, it would take

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until at least 2020 to hit the ABN's target, which is outside the planning horizons of the national service framework. The figures raise some questions that I hope the Minister will be able to address.
Similar concerns apply for therapy staff and specialist nurses. There has been an increase in the numbers entering training in allied professions, and that is welcome. However, the initial increase in places has been disappointing. For example, the figures show a 1 per cent. increase in the intake of physiotherapist trainees between 2000 and 2001. How is the target of a 59 per cent. increase in NHS physiotherapists to be achieved within the planning period encompassed in the national service framework?
The hon. Member for South Derbyshire referred to the patchiness of provision. I was struck by some recent work undertaken by the Parkinson's Disease Society to garner information about understanding, awareness and expertise of that disease among geriatricians and neurologists. In London, there is apparently one gerontologist, or neurologist with any expertise in Parkinson's disease for every 465,000 people. I suspect that for some of the more rare neurological conditions, that figure would be even worse. That raises concern about how we can ensure that the pathways not just to care but to initial diagnosis can be established robustly and clearly.
I hope that the Government will tell us that they are aware of the problem. Although they are doing much that is to be applauded in recruiting extra staff, it is clear from the figures that I have given that we are well adrift of what is needed to deliver a meaningful national service framework. That takes me on to the questions about the focus of the framework.
Many patients' organisations and neurological research charities share a concern about the statements made so far concerning the intention to focus the national service framework on people of working age and on getting people back to work. Given that neurological conditions tend to be more prevalent among the older population, we need to ensure that the framework addresses their needs, not least because the national service framework for older people addresses only dementia and fails to address any other neurological conditions that impact on older people.
Given that the forthcoming national service framework on children's services also does not address neurological conditions, will the Minister assure us that the framework under discussion will address the needs of children with neurological conditions?
Mrs. Patsy Calton: Should ME, which particularly affects young people, and autism be considered as two of the long-term conditions?
Mr. Burstow: I am of the view that the key to success with the national service framework is to build its foundations on generic issues. Having said that, and as the hon. Member for South Derbyshire rightly said, one can from that point identify and deal with the unique aspects of a particular condition. Many ME sufferers feel in limbo when it comes to how the NHS deals with their needs. Many are affronted at being sent down the mental health route rather than the neurological route. There is a case to be made for their needs to be addressed in that way, but others may have a different opinion.
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The focus of the national service framework should be on promoting independence and quality of life and on supporting carers. Will the Minister clarify whether the framework will cover all ages? If not, will those who have needs but are outside the working population be picked up? How will joined-up services be achieved if the transition points between paediatric and adult services, and adult and geriatric services, are not addressed in the national service framework?
My third and final area of concern is implementation, which has been touched on, but which is important to the success of the national service framework and all such frameworks to come. How will the Department ensure that implementation is achieved in the context of the new devolution? What role will strategic health authorities have in monitoring implementation? Will there be clear targets and milestones, and what feedback mechanisms will be in place between the Department and the strategic health authorities? We need a picture of how the process will work. The early national service frameworks had very clear, robust milestones and targets, and were monitored by the Department. It appears now that some monitoring mechanisms have gone and data are not being collected. Will data be collected under the new system, or are we now talking about guidance?
On a number of occasions I have raised with Ministers—not the Under-Secretary, but others in previous debates—concerns about the national service framework process blighting existing planning and work in the Department and the NHS. I would like to touch on two examples. In 1999, during a debate that I secured on MS, the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), told me that the Department was working on a compendium of good practice for general practitioners and primary care groups in commissioning neurological services. Furthermore, that was regularly trotted out in written answers as evidence that the Government were acting to improve the situation. That was back in 1999. I suspect that the work had been commissioned even before then.
Will the Minister explain why that compendium has never been published? Why does it appear to have been dropped altogether? Surely it would have been a valuable tool for primary care trusts, which as we heard just yesterday will pick up the specialist commissioning role from April 2004. Was any work done on that compendium? Why was it not put into the public domain? Why do we have to wait for the national service framework process to result in that work coming into the public domain and benefiting people with neurological conditions?
The second example concerns assessment of neurology specialist nurses, which is being reviewed by the Department. Numerous written answers have referred to the work that the Department has been doing. Again, it dates back three or four years but has never seen the light of day. Why not? Again, the patchiness of specialist nurse provision is a real issue.
I shall conclude on a number of core issues. My hon. Friend the Member for Torbay (Mr. Sanders), who chairs the all-party group on diabetes, is concerned that there is no ring-fencing for funding to deliver national service frameworks. I hope that the Minister will take that point on board. The first core issue is speed of

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diagnosis. People must be diagnosed quickly and their health and care needs must be assessed too. Rehabilitation services need to be strengthened. Symptom management is crucial and pain management should be part of it. Patients need to be seen as co-producers of their care. We need to ensure that carers are part of the national service framework. All that rests on a foundation of multi-agency working. Unless the agencies share information, and plan and deliver services together, the experience of the patient will be poorer.
Only if these services are founded on strong common ground will we deliver services that are tailored to the individual's unique circumstances and condition. Neurology has been a Cinderella service for far too long—undervalued, under-resourced and unrecognised. As a result many thousands of people do not get the support they need to enjoy a quality of life that the rest of us expect and have. I hope that the Minister can give some positive responses.
2.36 pm
Phil Hope: I congratulate my hon. Friend the Member for South Derbyshire (Mr. Todd) on securing this important debate and on his excellent analysis of the issues of concern. My focus will be on primary headache disorders as another aspect of neurological conditions that could be covered by a national service framework. Primary headache disorders have been misunderstood and under-recognised for far too long. They are often incorrectly diagnosed and inappropriately treated. To put it bluntly, it is time that headache sufferers got taken seriously in this country.
I have to declare an interest. I am a migraine sufferer. I do not have them too frequently, but in creating the all-party group for primary headache disorders I discovered that a great many Members of both Houses are migraine sufferers. Some of them suffer from cluster headaches, which is a particularly severe condition. This newly created group will press hard to move the issue much higher up the health agenda. I am delighted to say that the Migraine Action Association has its headquarters in my constituency. Its chief executive, Ann Turner, has been helpful, along with the Migraine Trust and others, in supporting the all-party group. It has a good website—Migraine.org.uk—and it runs a helpline for those who need support.
Some 60,000 people are members of the Migraine Action Association and the Migraine Trust. They have joined a voluntary organisation because they suffer severe headaches and migraines. That is the extent of the condition. We have heard of the prevalence of other conditions, but that is a huge proportion of the population. Headache UK is an alliance of people who work on headache and who have come together to promote this agenda. I thank them for their support. I welcome the new national service framework for long-term conditions, most of which, as my hon. Friend said, are neurological. The scope of the external reference group's activities has not been finally determined, and there is anxiety about the fact that migraines and severe headaches have not yet been included in the national service framework. I ask the Minister and his colleagues
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in the Department seriously to consider whether such headaches should be included in the national service framework.
I share hon. Members' concerns that the frameworks should be not just about guidelines and suggestions but about targets and goals, which should be monitored so that we can find out what is being developed. I understand from a meeting held earlier today that it might take five years to create the national service framework, and that it might not be published until 2007. I hope that I am wrong about that. However difficult the task may be, I hope that we can get on with it a lot quicker than that.
I shall explain why I am pressing my case so hard. The facts about headache astonish me, as does the fact that the issue has not been at the top of the agenda. The World Health Organisation has already classified headache as a major health disorder, and 75 per cent. of the UK population suffer from headaches each year. I do not think that there is any other condition that is experienced by 75 per cent. of the population. Migraine, the most common cause of severe headache, has a prevalence of 15 per cent. Roughly one in six people in this country suffer from migraines.
The difference between a headache and a migraine headache is profound. Someone who has never had a migraine headache will not know what migraine sufferers are talking about. Migraine completely wipes people out. They suffer from appalling pain, have trouble with vision, and can do nothing—they cannot go to work or look after their children. They just have to lie down in a darkened room, take whatever works for them, and live with the migraine until it goes away. That is happening to one in six or one in seven people in this country, which means that some 187,000 people on any given day are going through the appalling experience that I have described. About 10 per cent. of schoolchildren get migraines. It does not take much to work out how that affects their studies and their performance at school. Some 60,000 people suffer from cluster headaches. That is a much rarer, but very severe disorder.
Those suffering from migraines cannot go to work or look after their family, or may be absent from school. Up to 3.8 million people feel that they are not in control of their condition. They have migraine, but do not know what to do about it. They have tried treatments, but none of them have worked. Many feel that the treatment on offer is unsatisfactory.
There is also the economic cost of not dealing with headache. It is under the surface, but affects so many people daily. It is estimated that some 270 work days a year per thousand people are lost due to migraines, and an estimated 820 work days a year per thousand people are lost due to tension headaches. That is the huge economic impact of our failure to get to grips with the condition. If we take into account the regular medication needed, the cost of child care, loss of earnings, and the fact that people cannot function properly, the cost to the economy is some £1.5 billion. That is a big sum. It amazes me that people with migraines wake up and get on with their lives. They just cope, yet our country is failing to recognise their plight and the consequences for the economy.

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The difficulty within the NHS is that headache remains a low priority. There is limited understanding of headache diagnosis or effective management by health care professionals. There are guidelines and protocols, but they are not very well applied. Up to 30 per cent. of neurology referrals are for headaches. In a Migraine Action Association survey conducted by the organisation in my constituency, 70 per cent. of migraine patients said that they wanted better treatment. Some 31 per cent. of general practitioners—one third—felt that they did not understand their patients' migraine illness, and 45 per cent. of migraine patients needed up to five visits to the doctor before their condition was understood. Some 20 per cent. needed 10 visits to the doctor, until the doctor suddenly understood what the problem was. Those figures are staggering. Clearly, there is an urgent need for better guidelines for treatment and referral.
The NHS Modernisation Board has accepted that neurological conditions are neglected and poorly understood. The National Headache Alliance feels that headache is the most neglected of all the neurological conditions, despite being the one that people get the most. It seems to us that the physical, emotional, social and economic burden of headache is poorly acknowledged compared with other less prevalent neurological conditions. Some 75 per cent. of GPs in this country—three quarters—say that they do not know how to treat migraine, or find treating sufferers difficult. Incorrect treatment and interventions lead to 60 per cent. of referrals going to secondary care headache clinics for chronic headache. That represents 20 per cent. of all referrals to consultant neurologists—so those 20 per cent. of referrals are because the doctor did not know what to do and said, "Oh well, we'd better send you off to the consultant." That is a crazy use of resources, and it should not happen in today's NHS.
People can be knocked out by migraines and left not knowing what they will be like the following day. However, they get other symptoms too, especially depression. If a person gets migraines regularly, it is so appalling that there is nothing more likely to make them feel like giving up.
We do not know the quality of headache services because no one has measured them. The response to demand is pretty ad hoc. We know that services are inadequate and are not cost effective. There are no national or local targets for dealing with migraine, and very little research or auditing has been undertaken. We cannot seem to generate much interest among GPs or neurologists in focusing on and dealing with headache.
Current spending on headache is inadequate, unevenly distributed and poorly managed. That is a damning indictment, and it is time that we did something about it. There is a way forward. Professionals in the field have considered this issue and produced some detailed proposals. The first is inclusion in the national service framework. That would certainly ensure more equality in the delivery of care and in access to the best treatments that are currently available for headache sufferers. I am pleased to be able to draw to the Minister's attention the new guidelines for the management of migraine in primary care that have just been published by a group of professionals—the migraine in primary care advisers group. Those guidelines are going out to everyone in primary care.
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Those professionals have also produced a shorter guide for the use of clinicians. Hon. Members may be interested in seeing it. A patient guide will also be produced. Those guides are comprehensive and thorough, and show how migraine might be better managed in primary care. I hope that the Minister will give the guides his endorsement. A larger group, the National Headache Alliance, has also produced a summary of how it would like headache services to develop and improve.
I will briefly summarise the key points that have to be addressed. First, we must have better patient education and information, along with support for groups such as the Migraine Trust, the Migraine Action Association and others. As hon. Members have suggested, patients with information can control their care much better. If they do not know what it means to have their condition, how can they control their care?
Secondly, we have to take a multi-disciplinary approach, as hon. Members have said. We need to use the skills of a range of people—GPs, therapists, nurses and pharmacists. Thirdly, it has been suggested that, working to accepted guidelines, each GP should have available a first-line headache service, based on best practice—we need to spread best practice round the country—and evidence-based medicine, so that they can enable individual patients to manage their needs.
To achieve Government targets, we will need to develop specialist headache centres within primary care—either in GP clinics or in primary care trusts. Primary care trusts may have a specialist headache clinic or centre staffed by GPs with a thorough knowledge of particular headache problems. Some might ask, "A clinic just for headaches?" However, when 75 per cent. of the population experience headaches and 60,000 people experience migraines that are so debilitating that they become members of a migraine association trust, having specialist headache centres in every primary healthcare trust is not unrealistic.
In secondary care, there could be headache centres in every region, so that consultants with a specialist interest in headaches in every regional neurology centre could support the primary care centres. People could visit a GP, a specialist headache clinic and a consultant at the end, so their needs could be met where those services are required. At the moment, if a person has migraines they go to the doctor and the result is either a painkiller or a brain tumour—there is nothing in between. That is something of a caricature, but we must provide a range of services for people who experience headaches.
I hope that the debate will mark the start of a step change, whereby the policy makers and the professionals in the NHS—the health care providers, managers and the Department—give significant and proper recognition to the problems presented by migraines and other, sometimes severe, headaches. That issue must go higher up the agenda. Will the Minister ask his colleague the Minister of State, Department of Health, the hon. Member for Redditch (Jacqui Smith), who is responsible for such matters, to receive a delegation from the all-party group on primary headache disorders? We could put our proposals to the Government, we could go through all the issues and concerns and get headaches firmly on the agenda, then

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the three quarters of the population who have a problem would be convinced that the Government are taking their needs seriously.
2.51 pm
Mr. Alan Campbell: It is a pleasure to follow my hon. Friend the Member for Corby (Phil Hope). As a former headache sufferer, I recognise the frustrating picture that he so clearly painted for us. I congratulate my hon. Friend the Member for South Derbyshire (Mr. Todd) on securing the debate and on his introduction to it.
I want to raise some issues regarding neurological conditions that are pertinent to the NSF, and some of the concerns of consultant neurosurgeons at the Newcastle upon Tyne neurosurgical unit, which is the regional centre. I have already drawn some of those concerns to the attention of the Minister of State, Department of Health, the hon. Member for Redditch (Jacqui Smith), to which she has already kindly responded. I would like to take this opportunity to place those concerns on record. Before I do that, I declare a personal interest, having undergone surgery at the Newcastle unit some two and a half years ago. I want to place on record my thanks for the vital work that it did for me and for my family, and to thank it on behalf of the thousands of people across the region whom it helps every year.
The consultant neurosurgeons in Newcastle welcome the principle of the NFS, but they have some concerns and they want to ensure, as we all do, that it achieves what it is intended to achieve. Those consultants are concerned that the framework, as it stands, focuses rather narrowly on services for people with the chronic neurological diseases and long-term impairments that follow a brain or spinal injury. They would also like to draw attention to the importance of the acute services. The initial treatment may involve an operation, and there may be long-term consequences. They cite head injuries, vascular disease, brain tumours, or, as in my case, a tumour on the spinal cord. In such situations, timely and effective neurosurgical services are crucial in preventing long-term neurological disabilities. They are concerned that, if there is no proper provision of acute neurological services, that will frustrate the aims of the NHS framework in seeking to reduce the long-term burden of neurological disease. I am sure that the bureaucrats in the Department and the Treasury will be keen to note the fact that, if we provide first-class acute neurological services, we could reduce the need for support and help later on. That would represent good value for money.
The consultants asked for the framework to incorporate the requirements of neurosurgery as a whole, including acute neurosurgery. Will the Minister tell us when we should expect the appointment of the external reference group? Will he ensure that the Society of British Neurological Surgeons is involved at every stage of the development of the framework? Will he also ensure that the needs of people with neurological conditions are met at all stages of their illness, including the acute stage?
I want the NSFs to succeed. National standards and investment are the two most important aspects of NHS modernisation. Long-term conditions such as
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neurological illness often show the NHS at its best, not least in its aspirations for people in its care. Such conditions also underline the importance of ensuring continuing investment through collective funding via the public purse. If that investment is reduced by some arbitrary figure, such as 20 per cent., some of the most vulnerable people will be put at further risk.
I recognise that long-term conditions, such as those we have discussed today, make a nonsense of the idea of a health care system that is largely or wholly based on private insurance. If insured people develop neurological conditions, they struggle to have their insurance policies renewed. If people have such a condition and seek insurance, they can forget it, because they will not be able to get insurance. We need proper investment and national standards, and I believe that we are now getting them. However, we must get our actions right.
2.56 pm
Dr. Evan Harris: We should express our gratitude to the hon. Member for South Derbyshire (Mr. Todd) for introducing this debate. He has been very active in the past week with the food supplement directive and the traditional herbal medicines directive. He has followed his interest in other matters in the House as well as preparing for today's debate. He is certainly earning his wage this week. I am sure that his staff are also working frenetically.
I shall raise some general concerns about the national service framework in order to paint a picture, and I shall question the Minister about his approach to NSFs and that already taken by the Government. I shall highlight concerns about the process, and shall ask the Minister for solutions. I shall also respond to issues raised in the debate so far.
The Liberal Democrats believe that national service frameworks are doubly worthwhile. They are worthwhile in their own right, because they identify good practice, standards, treatment mechanisms and approaches, but also because the standards in the NSFs, in so far as they are targets, are so much more evidence-based, rational and clinically-focused than some of the other targets in the NHS.
Indeed, some of the targets that the Government have imposed on the NHS give the setting of minimum standards and progress benchmarks a bad name. In many cases—almost invariably outside the NSF—there is no evidence that achieving targets actually improves patient outcomes in the long term. They are not necessarily rational, nor do they solve the problem of the distortion of resource allocation without good purpose and clinical priority, when the target is treated rather than the patient.
It is much harder to make those complaints about the standards set in NSFs. Some of the standards in the coronary heart disease programme have proved to be useful in levering up performance, because they involve prevention and primary care. However, they also involve the levering-up of expenditure on drug budgets.
The NSF approach is welcome, but the Government must recognise that hon. Members from all parties are aware of problems that have arisen as a consequence of the NSF programme. The Government owe it to the House to ensure that they recognise the problems and

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ameliorate the situation. The first problem is the blight that is almost inevitable when waiting for the publication of a national service framework. It is well known that primary care trusts and health authority commissioners were loth to commission and develop new services when an NSF was in the offing, because they thought that they may be taking the wrong action. Competing priorities gave them an excuse to wait. We experience such blight with the appraisal of drugs by the National Institute for Clinical Excellence and in the development of NSFs.
The timetable and the speed at which NICE makes its determinations is somewhat swifter—probably because of necessity—than that for the NSFs, which are a bigger piece of work. Nevertheless, the Government must recognise that the speed at which NSFs are established has big implications for the services that are blighted because people are waiting for the outcome of the NSF. An NSF was announced in February 2001, but the chair of the external reference group—which, to the outside world, is a sign of work being done—ppointed only in October 2002. As the hon. Member for Corby (Phil Hope) said, the time scale is already long, and people worry that it may be even longer. The treatment of conditions such as motor neurone disease, which were first thought to be included in the NSF or in its recommendations, is likely to suffer as a result of this blight. It will be doubly disappointing if it is not included in the NSF.
The second problem is the tyranny of the appraised. That is inevitable to a certain extent, but it is a real problem. A national service framework has standards against which commissioners and providers are measured, and resources are applied to the area. When resources are limited or the increase in expenditure to meet standards is greater than the share of the growth money that that area of expenditure would receive, resources are pulled from elsewhere, such as areas that do not yet have an NSF—often it is not even in sight. That has been a worry. The priority given to mental health, coronary heart disease, services for older people and diabetes is at the expense of clinical investment in long-term medical conditions, for which resources are limited. The Government must recognise that. Support is needed for those people working in increasingly tight financial circumstances, even though there have now been reasonably generous increases in overall health expenditure.
The third problem is that target setting, even within NSFs, is an inexact science. There is a risk that unrealistic targets are set, which creates doom and gloom, and heavy pressure is put on expenditure to try to meet them. Some obvious targets merely go with the flow and follow long-term trends. They do not represent a challenge to people, so services are not improved. In a given area, targets will be met without the service necessarily being improved when it needs to be.
The fourth problem that surrounds NSFs is the need to ensure that there is adequate user input. The NSF provides an opportunity for user input. Obviously, that is easier for some conditions than for others, but for long-term medical conditions the opportunity to use the expertise of a patient group that has experience of the illness and knows how it affects people is significant. Expectations of user input into the NSF are raised, but are sometimes not met. Many of our constituents come to us with such concerns.
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I shall now deal with the question whether there is a rational programme of NSFs or whether goal posts are shifted at inappropriate times. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) said that the working age focus of a particular NSF was announced some time after the publication of the NSF for older people, so there was no opportunity to pick up the slack in fields that might not get as much attention as it was once thought they would. Such problems are significant for NSFs generally, and I would be grateful if the Minister accepted that they exist. I realise that some of those problems are an inevitable part of the process, but I hope that we can agree that the situation needs to be ameliorated.
My hon. Friend mentioned important work force issues. If, as we expect, this NSF raises standards, as other NSFs have, additional staff will be needed. Staff take a long time to train. Responsibility for the shortage of consultants in this field clearly cannot be laid at the door of the current Government, because of the length of time it takes to train consultants. I have always made it clear that there was a failure many years before the 1997 general election to put in the pipeline the number of home-grown staff who would be needed. None the less, career decisions are still being made based on that pipeline, and unless consultant expansion in certain fields continues apace, people will not choose to train in those fields.
People following medical careers are not concerned only with where the glory is. The Government must consider forming a policy on consultant expansion, and not merely leave it be. There are targets, thresholds and limits at every stage of a medical career, from students and house officers to senior house officers and specialist registrars. Only at the end stage do the Government say that that is not their business but a matter for local providers. Without planning, we get inadequate consultant expansion. That can cause oversupply, so that people have nowhere to go at the end of their training, or undersupply.
My hon. Friend the Member for Sutton and Cheam and the hon. Member for South Derbyshire referred to the problems of physiotherapy. The hon. Gentleman made various points that are worth stressing, including the importance of early diagnosis. As many long-term conditions are often, although not invariably, insidious, there can be a period of morbidity before presentation, let alone before diagnosis. It is therefore very important that a swift diagnosis is made.
The hon. Member for Corby gave the excellent example of headaches. People think that they just have a headache, without realising that something more serious might be going on. Neurology is considered by the medical profession to be a hard subject—take it from me that it is. General practitioners are less likely to have a specialist interest in neurology than in other fields, and GP specialist clinics are an excellent idea. That is a major problem.
The same applies to acute medicine in hospital. The neurological side is not the highest priority for the on-take medical team. That works both ways. Someone very close to me had headaches and failed to be diagnosed with a tumour. That person was over-diagnosed with migraine in primary care, and the tumour was not even picked up in hospital. There is a real gap in knowledge, and I plead guilty to such gaps in

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my own medical career. The hon. Member for South Derbyshire mentioned the importance of the voluntary sector. That is not unique to this clinical field, but it is significant, and ensuring that we preserve the value of the voluntary sector is important.
We have had a useful debate, and valuable contributions have been made. I hope that the Minister, in praising the Government's NSF programme and their investments, will recognise that there is still a long way to go.
3.9 pm
Mr. John Baron: I, too, congratulate the hon. Member for South Derbyshire (Mr. Todd) on securing this important debate and on his thoughtful speech. Contributions to the debate generally have been of very high quality. As chairman of the all-party group on motor neurone disease, the hon. Gentleman has a substantial interest in such illnesses, and during his opening speech, he showed a substantial knowledge of motor neurone disease, which is one of the many illnesses that are collectively termed long-term medical conditions. As we know, that term covers a vast array of illnesses that can be defined as:
"a condition of prolonged duration that may affect any aspect of the person's life".
Symptoms may come and go, and usually there is no cure for the condition, although things can be done to maintain and improve quality of life.
It is estimated that one in three people generally and two in three people aged 75 or over are currently living with a long-term medical condition, so I welcome the Government's February 2001 announcement about establishing a national service framework for such conditions. Few would disagree with the aspirations cited by the Secretary of Sate, who said that the framework should overcome the lottery in care and ensure that health and social services work together in all parts of the country. The Government now have a duty to ensure that those aspirations are delivered. The debate is an opportunity for the Minister to provide us with more details of how that will happen.
I am concerned about the adverse impact that Government targets can have, particularly on illnesses such as long-term medical conditions, which are not targeted. I suggest that the Government are so fixated by the 300 or so NHS plan targets that services that are not on their hit list are suffering. Recent figures for neurology, pain management and ophthalmology, for example, all show that an increasing proportion of patients are forced to wait longer for out-patient appointments following a GP referral. The worry is that long-term medical conditions are not headline-grabbing conditions. As one doctor from John Radcliffe hospital recently put it:
"if you don't have a vote winning illness, then sod you."
Medical professionals must determine clinical priorities and politicians must stop interfering. Recent figures show that although spending on the NHS has risen by more than 21 per cent. during the past two years, hospital treatments have increased by only 1.6 per cent., hospital admissions have fallen by 0.5 per cent. and the
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number of bureaucrats and administrators has increased by 13 per cent. That is partly due to the meddling of politicians.
Too often the needs of those with long-term medical conditions have been overlooked in favour of more headline-grabbing conditions, such as coronary heart disease and cancer. The Long-Term Medical Conditions Alliance has pointed out that the NHS focuses on acute and emergency care, rather than on the needs of those living with long-term health conditions. We fail as a nation if we provide for one and not the other. I therefore ask the Minister to assure us that that will not be the case.
As for the timetable and content of the framework, we know that it will be published in 2004 for implementation in 2005, with a timetable of something like 10 years. Certain bodies, including the Neurological Alliance, believe that to be a very challenging timetable, as other hon. Members have mentioned. Bearing in mind the fact that the external reference group did not hold its introductory meeting until the end of last year and has not met again since, the timetable does indeed appear to be very tight. That is particularly true given that many experts in the field who need to be consulted work within the charity and voluntary sector and will need more time.
Can the Minister assure us that when the framework is published, it will be published in full? That is preferable to publishing only the principles, with the implementation plan following up to a year later, as was the case with the framework on diabetes. Can the Minister confirm that it is the Government's intention to ensure that the national service framework will be as inclusive as possible and will cover the full range of medical conditions?
A press release issued on 12 June last year explained that the framework will focus in particular on services and support for people of working age. Several hon. Members have picked up that point. That focus would exclude so many in our society, yet surely the mark of a civilised society is the extent to which it cares for the vulnerable and less able. Can the Minister explain why the framework discriminates as it appears to? Certainly the Neurological Alliance questions the focus on work and how that sits with previous statements from the Minister that the framework should be about the needs of users.
The Department of Health has confirmed the need for the national service framework to have a joined-up approach to people's social, educational and employment needs. Can the Minister confirm what role the Department for Transport, the Department for Education and Skills and the Department for Work and Pensions have had in helping to formulate the framework?
Looking forward, a precondition for any national service framework to work is that a sufficient number of medical professionals are in place, but we are all aware of the problems of staff shortages in general

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practice. The British Medical Association recently highlighted that GP vacancy rates have increased dramatically, and an article in The Independent last year stated:
"the shortage of consultant Neurologists is so acute that most patients admitted to hospital with brain disorders including stroke, epilepsy and meningitis, never see one—they have to be treated by specialists in other disciplines".
That point was made by the hon. Member for South Derbyshire. The Neurological Alliance believes that because of a problem with recruitment and retention, we will still be 400 specialists short by 2010. It should also be noted that there is currently a shortage of specialist nurses. What progress is being made to correct those acute staff shortages, with emphasis on the training programmes required to do so?
I have asked a series of questions because the success of national service frameworks cannot be guaranteed by good intention alone. The Government's track record on national service frameworks has been patchy at best—an example is the national service framework on coronary heart disease. The Minister will know that the target was that by April 2002 three quarters of all suitable patients should have received clot-busting drugs within 30 minutes of arriving at a hospital. However, research by the Royal College of Physicians found that fewer than one in three hospitals met that door-to-needle target, and more than 50 per cent. of hospitals were 25 per cent. outside the target.
Conservative Members will keep a close eye on development of the framework. Stating intentions is a worthy start, but the Government must be judged by the improvements felt by those who use and deliver the services. I pay tribute, as other hon. Members have done, to those who work with people suffering long-term medical conditions, not only the medical professionals but the army of carers who support people who are less able than themselves, and those in the voluntary and charitable sectors who dedicate so much of their time promoting the needs of those with long-term medical conditions. Many are unsung heroes in our communities and I am sure that we all want to congratulate them on their work and ensure that they are properly supported.
Outside this place, many people with long-term medical conditions are anxiously waiting for a real improvement in the way in which they are treated. It has been two years since the Secretary of State's announcement on the framework. I hope that the Minister will now provide us with more details by answering my questions fully.
3.18 pm
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): I join other hon. Members in congratulating my hon. Friend the Member for South Derbyshire (Mr. Todd) on securing this debate on the national service framework for long-term conditions and on raising the issue in the measured and assured way that we have come to expect. I am afraid that it is extremely unlikely in the 12 minutes left to me that I shall be able to answer all the questions asked in the debate, but I shall endeavour to write to my hon. Friend if I do not reach some of his points.
This has been an excellent debate with some excellent contributions from my hon. Friend the Member for Aberdeen, South (Miss Begg), the hon. Member for
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Sutton and Cheam (Mr. Burstow), my hon. Friends the Members for Corby (Phil Hope) and for Tynemouth (Mr. Campbell), and the hon. Members for Oxford, West and Abingdon (Dr. Harris) and for Cheadle (Mrs. Calton).
Many people in the country, from all backgrounds, have a wide range of neurological and long-term conditions. More than 300.000 people have epilepsy, 120,000 have Parkinson's disease, and 100,000 have brain injury. Fewer people have other, rarer, conditions, such as the 4,000 with motor neurone disease. In a primary care trust covering 250,000 people, about 1,500 adults will have a physical disability that affects their quality of life and means that they require help with their daily activities.
Co-ordination between hospital and community services and health and social care services could be better. Professionals are sometimes not aware of the wider impact of long-term conditions on people's lives, and service users could be more involved in the management of their conditions. We want to improve services and the experience of people with long-term conditions by addressing some of the issues, such as ensuring that people receive the right kind of integrated health and social care assessment and support, including access to community commitment, providing good-quality information and support for carers and families when they need it, and developing the concept of the expert patient so that people can take an active role in managing their condition if they want to.
Previous national service frameworks, such as the national cancer care plan and the coronary heart disease framework, have made real improvements in their services, and I am sorry that the hon. Member for Billericay (Mr. Baron) felt that he had to make political points in that respect. There is no doubt that there has been tremendous improvement across the board in those fields, and I am particularly proud to have announced the NSF for diabetes a few weeks ago. The long-term conditions NSF will build on the successes and will be developed and implemented in a world in which there are fewer national targets but more scope for flexibility in local implementation.
Mr. Baron: Will the Minister give way?
Mr. Lammy: No. I want to make progress.
My hon. Friend the Member for South Derbyshire shares the concern felt by some that the NSF will have fewer teeth than its predecessors. However, it is a fine balancing act. We cannot talk about targets in the wider NHS while wanting targets for every condition or NSF that we choose to introduce. As I have seen in examining the NSF for diabetes during the past months, we are working in a context in which primary care trusts have funds over three years to examine closely what is happening locally. We put that in place. Alongside PCTs, there are national bodies such as the Commission for Health Improvement—we will introduce legislation soon to firm up the inspectorate for that—patient advisory and liaison services in hospitals and the Commission for Patient and Public Involvement in Health. All those bodies ensure that NSFs and the standards, rather than the targets, that lie within them are delivered. They report back to both the PCT and the

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centre, so in the next two years, hon. Members will be able to hear what the inspectorate or patient forums in local communities say about whether the local communities are delivering the standards. That is the context in which we now operate, together with the National Institute for Clinical Excellence.
The NSF for long-term conditions is a good opportunity to put right some of the problems that my hon. Friends have identified. We want a wide range of people to benefit, but we need to be realistic about the service improvements that we can deliver. The long-term conditions NSF will focus on neurological conditions and brain and spinal injuries. It will cover the whole patient pathway, examine the common issues that affect this group of people, and set standards that can be more widely applied. The NSF will acknowledge that people often have neurological conditions that will deteriorate and lead to long-term disabilities. It will focus on working-age adults, but it will also address important transitional issues between children's and older people's services. I want to emphasise that in the light of hon. Members' comments.
My hon. Friend the Member for Corby made an impassioned speech about headaches and migraine. The Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith), who has responsibility in this area, will closely look at Hansard to see what he said, and will consider his invitation to meet her.
Some people will be disappointed that more conditions are not included in the NSF, but we have a wide range of other mechanisms—
Mr. Burstow: Will the Minister give way?
Mr. Lammy: I will not give way because we have had a rich debate and I want to make progress.
Some people will be disappointed that more conditions are not included in the NSF, but we have a range of other mechanisms such as the NICE programme, existing NSFs, Action On programmes and modernisation service-redesign programmes to tackle all of those other areas.
Although people with neurological conditions share many common issues and problems, there are specific issues that are relevant to particular conditions, so, where necessary, the NSF will address those issues that
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are relevant specifically to people with, for example, epilepsy, motor neurone disease, multiple sclerosis, Parkinson's disease, or brain injury and spinal injury. It will also consider conditions such as headache.
Motor neurone disease is a rapidly progressive condition, and my hon. Friend the Member for South Derbyshire is right to bring to our attention the importance of people getting an early diagnosis. That takes an average of 14 months, as there is no quick and easy way to diagnose the disease—to some degree, it is a process of elimination. Following diagnosis, people immediately need a wide range of support from health and social care professionals to help them to live independently at home for as long as possible. That support includes fast-track access to welfare benefits. That rapid response can be a great challenge for local services, but it can be made to work. In Warrington in April 1998, a motor neurone disease service was set up, funded jointly by health and social services. It aims to co-ordinate care for people with motor neurone disease and to avoid delays and interruption to services for people who cannot wait for boundary disputes or arguments about who pays the bill to be settled.
People with motor neurone disease need access to clinical interventions, such as tubes being fed into the stomach and special equipment to help them breathe through the night. Those services must be available throughout the country, and professionals need to be aware of them. NICE has already issued guidance on the use of relevant drugs to help to control the progression of the disease. The Government support research into motor neurone disease through the Medical Research Council and the Department of Health. In 1999 to 2000, we spent approximately £1.6 million on research.
We are aware of many of the problems that were mentioned and we are addressing them by taking forward the NSF. We have set up the external reference group to advise us on what a modern neurological service should look like and how we can put things into practice: its members are drawn from a wide range of fields. I say to the hon. Member for Billericay that Ministers do not in isolation in Whitehall set the targets that improve the quality of people's lives; we set them in conjunction with the royal colleges, the professionals and others. We work together to improve services across the board.
We plan to publish the NSF in 2004, and to start the 10-year implementation programme in 2005. We know how important it is to listen to representatives from across the board of stakeholders, and we hope to do that in the months, weeks and years ahead.

Obesity in Children
3.30 pm
Dr. Howard Stoate: I am delighted to have secured the debate on obesity in children, the importance of which we are only beginning to understand. Had we had this debate a few years ago, we might have categorised childhood obesity as a cosmetic problem and talked about image, self-esteem, peer pressure and bullying. However, as I hope to show, the problem of obesity is far more serious than that. If not tackled effectively, it could become as serious a public health issue as smoking. Obese youngsters have already brought lawsuits against McDonald's in the US.
The impetus for this debate comes from my research assistant, Brian Jones; he and I wrote a report on public health in children that was published by the Fabian Society under the title "All's Well that Starts Well". The facts are stark. According to Andrew Prentice, professor of international hygiene at the London School of Hygiene and Tropical Medicine, seriously obese children are losing up to nine years on average to diseases that were not as common in their parents. The number of obese children in the UK has doubled in the past 10 years: about 10 per cent. of children are now officially obese and are therefore at serious risk of developing any number of potentially life-threatening conditions such as diabetes, heart disease and cancer.
The Harvard growth study assessed mortality and morbidity in 508 lean or overweight adolescents after 55 years of follow-up. The relative risk of death almost doubled for obese adolescent boys. Obese teenagers are now being diagnosed with type 2 diabetes, a condition that is closely linked to obesity and usually found only in those over 40. Those who develop type 2 diabetes in their teens run a high risk of visual impairment, leg amputations, renal failure requiring dialysis or transplantation, or premature death from heart disease. Obese people are 27 times more likely to develop diabetes than people of normal weight. It is estimated that at least 5 per cent. of all cancers can be attributed to obesity. There is also a class dimension to obesity: the UK 1958 birth cohort shows that only 18 per cent. of obese seven-year-old boys from non-manual backgrounds remained obese at 23, compared with 31 per cent. of boys from manual backgrounds.
Exercise is vital. Compared with 20 years ago, our diet now contains much more fat and high-energy foods, whereas we burn about 700 calories a day less. According to the British Heart Foundation, one in three children between the ages of two and seven do not do even the minimum recommended amount of exercise a week, and by the age of 15, two thirds of girls fall into the physically inactive category. In the past five years, the time spent by primary school children in physical education has more or less halved. Only about a third of secondary school children receive two or more hours of physical education a week, compared to half in the mid-90s. That is particularly alarming given that, as the report by Fairclough and Stratton shows, school sport provides the only form of regular exercise for 30 per cent. of secondary school pupils. The National Playing Fields Association also points to a huge drop in the number of school playing fields in the past few decades.
Fear, too, has become a factor. According to the Children's Society, 15 per cent. of parents refuse to let their children play outdoors because they are worried
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that their children might be approached by strangers. Less than 5 per cent. of children now walk or cycle to school, compared with more than 80 per cent. 20 years ago. Nurseries rarely let their young children play outdoors for fear of accidents and due to lack of supervision. Children become accustomed to staying indoors and become unused to exercise. Faced with such disincentives, children are simply abandoning exercise in favour of other pursuits. Who needs a playground when you have a PlayStation? Studies in the USA suggested that television viewing may be one of the most important determinants of childhood and adolescent obesity. One study showed a 2 per cent. increase in the prevalence of obesity for each additional weekly hour of television viewing.
There is considerable epidemiological and metabolic evidence that dietary fat plays an important role in the aetiology of obesity. The proportion of fat in the UK diet has increased dramatically since the second world war, from about 20 per cent. to nearly 40 per cent. of total energy consumed. There is evidence that obese people tend to have diets that are far higher in fat than the average. National surveys show that the typical diet in the UK contains 11 per cent. of its energy as protein, 37 per cent. as fat and 48 per cent. as carbohydrate. The report of the Committee on Medical Aspects of Food and Nutrition Policy—COMA—indicates that we should keep our dietary proportion of calories from fat to less than 30 per cent.
High sugar intake is also an issue. Twenty-one per cent. of seven to 10-year-olds in the UK drink almost 10 cans of fizzy drink per week. The US Department of Agriculture, however, recommends consuming no more than 40 g of refined sugar per day—the equivalent of one can of fizzy drink, which can contain up to 11 teaspoons of sugar. Only 12 per cent. of UK children choose to drink water. In addition, a Government study of the diets of more than 2,000 children aged four to 18 over a week in 1997 suggested that, on average, British young people were eating fewer than half the recommended five portions of fruit and vegetables per day, and one in five children ate no fruit that week. Seventy per cent. of parents with young children who were interviewed in a recent survey admitted that they do not know enough about food and nutrition to feed their children healthily. Many parents use sweets, biscuits and fizzy drinks to buy good behaviour from their children.
What can we do to prevent that? First, it is vital to instil the habit of exercising in children when they are young if they are to carry on taking exercise when they are adults. Traffic, fear of crime and intimidation, dirty and poorly maintained facilities, and a lack of time have, as we have seen, led to a decline in children using public parks and playgrounds. To make those amenities more appealing to parents and children, we must invest in equipment and facilities to ensure they are safe to use, and as attractive and child-friendly as possible. We must make it easier for children and parents to walk or cycle from home to community facilities. That means creating safer road crossings, dedicated cycle lanes and, where necessary, better lighting. Wherever possible, road planners should give priority to pedestrians and cyclists, especially in heavily built-up areas. We need more home zones and quiet lanes.
We must deal with the fear of crime. The public want
to see a greater uniformed presence—be—it police officers, park wardens or street wardens—on our streets

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and in public places. Visible patrols may not add much to the crime-fighting capability of the police and other law enforcement agencies, but they have the effect of reassuring anxious parents.
We must ensure that young people are consulted when new play spaces and amenities are being designed. There is no point in investing money in facilities that will not be used. Better use must be made of the 100,000 voluntary sport and leisure clubs across the country. By creating links with local clubs and municipal leisure centres, and by encouraging them to provide coaching sessions for schoolchildren, schools could make extra-curricular sport much more accessible. That would also ensure that children are introduced to a much wider range of sports and leisure activities than the schools themselves can provide. If they are to let children use their facilities without charge, most clubs will require extra funds from somewhere to meet their additional running costs. The Government would have to consider making grants available to any club that participates in such a scheme.
The Government White Paper "Schools achieving success" gave a commitment that all children will be entitled to two hours of physical exercise and sport every week, within and outside the curriculum. However, much work must be done before that pledge can be realised. The new opportunities fund, the Department for Culture, Media and Sport, and the Department for Education and Skills are making substantial funds available to enhance and refurbish existing physical education and sports facilities, especially in deprived areas, but that is only the start.
We need better teaching. Primary teacher training puts little emphasis on sport and PE, and the Qualifications and Curriculum Authority does not offer primary teachers who teach PE much guidance. Much PE teaching is stereotyped, with most children being exposed to the major sports only. Schools need to broaden the range of sports that they offer. Given the choice, many teenagers would prefer to use a treadmill or weights than play hockey or football. If young people would prefer disco-dancing or roller-blading, why not let them do that? If every secondary school could buy fitness machines or at least come to an arrangement with a local fitness centre, it could significantly boost physical activity rates among teenagers. We must also improve access to school facilities. The key to sustaining children's interest in sport is to ensure that they have access to school facilities and equipment after school, at weekends and during school holidays. Schools should keep their sports halls and fields open all year round, although pupils would have to be properly supervised. We need to look into how that could be funded.
The responsibility for school and community sport should be transferred from DCMS to the Department of Health. To give that Department the responsibility for promoting sport would highlight—in the most public way possible—the link between sport and exercise, and good health. It would show that we consider sport to be more than simply entertainment.
How can we set about modifying young people's diets? We must broaden their food horizons. If they get into the habit of eating fruit and vegetables from an early enough age, they will continue to do so throughout
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life. An obvious place to start to teach good nutritional habits is at school, but an outright ban in schools on sweets, chocolate, burgers, crisps and the like is not the answer; children will simply react against any such coercion. It is perfectly reasonable to serve burgers in school canteens once or twice a week, as long as plenty of healthy alternatives are on offer. The challenge is to ensure that healthy alternatives are appetising and affordable. We need high-quality produce and imaginative catering staff. We must also ensure that schools have the required resources at their disposal. Earmarked funds may be necessary to ensure an annual healthy meals grant that would go directly to the head teacher.
We need to make fresh water freely available to all children; for example, there should be a water cooler in classrooms. Children are often forced to drink fizzy drinks simply because there is no alternative. In 50 per cent. of schools, drinking water fountains in the toilets are the only source of fresh water, and in 10 per cent. of schools, there are no facilities at all. Children should not be prevented from buying fizzy drinks, but they should be encouraged towards better alternatives, providing fresh water is available.
We should make nutrition and food education a compulsory part of the primary and secondary curricula. Food education has become increasingly marginalised in recent years because of pressure from core curriculum subjects, a lack of specialist equipment and kitchen space in schools, and a shortage of properly qualified staff. There is a statutory obligation on primary but not secondary schools to offer food technology lessons. The Government strongly recommend that schools offer students the opportunity to study food technology, but 10 per cent. of schools offer nothing at all, and many others offer only a limited introduction to the subject. Unless children are given a grounding in cooking and have some understanding of what they are eating and the effect that it will have on them, they will not learn the skills that they will need to eat properly when they leave school. We need a food education syllabus that is focused specifically on cooking and nutrition. At present, there is not enough emphasis on food in food technology lessons. Pupils are more likely to spend time designing biscuit packaging than baking biscuits. Schools would have to be given extra capital grants to invest in facilities, but I believe that it would be money well spent.
I will now tackle the controversial area of food advertising. Sustain recently carried out a survey of television food advertising to children. It found that between 95 and 99 per cent. of the advertisements are for products that are high in sugar, salt or fat. Sustain points out that there are twice as many advertisements for such products during Saturday morning children's television than after the 9 o'clock watershed. That shows that food companies are deliberately targeting children. Food companies are also allowed to sponsor children's programmes. Although broadcasting rules prevent them from displaying their products on screen, they remain entitled to put their logo on the screen whenever there is an advertising break. For example, McDonald's sponsored GMT V's early morning show "Diggit".
Persuading children of the dangers of over-consumption of food that is high in sugar, salt or fat and of the need for a balanced diet is difficult when they are

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confronted every day by a barrage of food industry advertising that promotes processed foods. The adverts are designed to show that the regular consumption of sweets, crisps, chocolate and so on is perfectly natural and consistent with a healthy lifestyle. Backed up by celebrity endorsements, special offers and plenty of glitz and glamour, it is not surprising that young children, who are the most credulous and impressionable section of the viewing public, find the products attractive.
Obesity is a killer. Its consequences can be just as devastating as smoking or alcoholism, yet as a society we are prepared to allow the processed food industry to target its products at children. The Government should consider a comprehensive ban on food advertising to children. Doing so would not be without precedent in Europe. The Swedes, who have some of the best health outcomes in Europe, have had a blanket ban in place on all advertising to under-12s for some years. Not only has it stood up to legal scrutiny but it is highly popular with the Swedish public.
Far from restricting consumer freedoms, a total ban would enable young people when they reach adulthood to make a more informed choice as consumers about the food that they eat, having had the opportunity as children to learn about food in an environment free from undue external influences. The purpose of a ban would not be to prevent children from eating chocolate, crisps and so on but to help them be more discriminating as to when and in what quantities they eat such foods. A ban would help children to see such products more as the occasional luxuries that they once were than the staple foods that they threaten to become.
What about food labelling? According to the Food and Drink Federation, more than 80 per cent. of manufactured products in the UK carry nutrition labelling. However, there is considerable doubt as to whether consumers understand or even read the labels: for example, a recent survey carried out by Safeway revealed that only one in five people know what RDA stands for. Consumers have complained about the sheer number of different messages that appear on labels and have said that they find it difficult to gauge the value or relative importance of each of them. Messages such as low fat, percentage fat free, low in saturated fat, and others in the same vein leave consumers confused and no better informed.
Shona McIsaac: On the point about fat content in food and so-called lower fat products, is it not the case that some of the advertising is completely false? Manufacturers bulk out the product with water and then sell it at a premium as lower fat food. In fact, the way in which they work out the figures is wrong and misleading and can lead to people eating higher quantities of so-called lower fat foods, which cause obesity.
Dr. Stoate: I thank my hon. Friend, who has considerable expertise in this field. I have discussed this issue with her on a number of occasions and I share her concern that food labelling is very misleading, often deliberately so. Consumers want manufacturers to employ simpler, standardised and above all spin-free language on their packaging. Instead of labels that say that a produce is low fat or that it is a certain percentage fat free, they want to be told how much fat is in the
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product that they are buying. The Food Standards Agency should draw up a universal nutritional code that incorporates a handful of readily recognisable symbols and a set vocabulary that is as transparent as possible. Nutritional labels should also follow a set form.
Not since the British standard diet in world war two have the public had access to a definitive, or supposedly definitive, guide to precisely what, when and how much they should eat each day. It should be possible for the Department of Health to produce a set of broad nutritional guidelines that incorporate advice on recommended daily allowances for the average man, woman and child, what foods contain and even some suggested daily menus. If the Government decided to send an officially sanctioned national nutritional guide to every home in Britain, it would transform the profile of public health in the United Kingdom and allow us to hammer home the importance of healthy eating.
We must focus on public health. In our society, as in every other advanced market economy, we perceive health as something that inevitably worsens with age, but it can be restored quickly and efficiently through the intervention of trained professionals. Many seem to believe that the test of a good health service lies in its ability to manage disease, not prevent it. Perhaps that is because effective disease management is much easier to measure than effective disease prevention. Statistics relating to bed numbers, MRI scans, waiting times and successful operations can be easily compared, whereas successful disease prevention is less easily quantified. It is hardly surprising that the media and Parliament focus to such an extent on acute services, but that debate inhibits our ability to create a healthier society. After all, it is by influencing lifestyle choices, not by pouring billions into high-tech medicine, that we will make the biggest difference to the nation's health.
The Wanless report states that effective public health measures could save the national health service about £30 billion—20 per cent. of its budget—by 2022. By investing in prevention now, we could in the long term save the NHS billions in terms of expensive interventions of possibly limited effectiveness and treatment for long-term, chronic conditions. The human and financial costs of obesity are astronomical. In 1998, the cost to the NHS of treating obesity-related conditions was already close to £500 million, while the loss to the economy through 18 million sick days and 40 million days lost through premature death was nearly £2 billion. Obesity places an enormous financial burden on the individual through lost earnings and increased insurance premiums. According to figures given to me by Diabetes UK, the annual cost of treating diabetes is nearly £5.2 billion, or 9 per cent. of the NHS budget in 2000. By the time that this short debate is over, the NHS will have spent nearly £250,000 on treating diabetes. Given that there are at least 1 million undiagnosed diabetics in the UK, that figure will surely rise considerably.
There is no magic pill for obesity. Its effects—heart disease and diabetes—are almost irreversible. The wrong lifestyle choices during childhood and adolescence can prove devastating in later life. Until that is widely understood by parents and families, we will not be able to tackle obesity effectively. Refocusing the health debate on disease prevention is therefore

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essential. Unless we do that, we will not be able to persuade people of the importance of taking responsibility for their own health and living healthily.
The Government must take the lead. They must spell out the dangers of obesity to the public and make it clear that, although they can make it possible for families to live healthily by investing in schools and local amenities, the primary responsibility for preventing obesity in children lies with families.
3.48 pm
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): I am grateful to my hon. Friend the Member for Dartford (Dr. Stoate) for raising the very important and serious issue of obesity in children. He is extremely active in the House on health issues.
UK researchers have predicted that the increase in obesity threatens to reverse gains in longevity made during the past 100 years and could in some cases result in parents outliving their children. A National Audit Office report highlighted the fact that obesity is responsible for more than 9,000 premature deaths each year in England, and that it reduces life expectancy on average by nine years. My hon. Friend will agree that we need to work hard to combat this disease. I was particularly alarmed when recently I visited an accident and emergency department in one of the most deprived communities in London, and a consultant told me that just a few months previously a four-year-old had died from obesity in the department.
Obesity is not simply a health matter. It requires cross-Government action, which is why the issue is at the heart of many of the Government's priorities. My hon. Friend is right to say that the percentage of obese adults in England has trebled since 1980. Figures from the latest health survey for England, which was published this week, show that 21 per cent. of all adult males and 23.5 per cent. of all adult females—more than a fifth of all adults—are now obese. Although the majority of obese and overweight adults were not obese children, we know that children's weight tends to track from childhood to adulthood. Obesity in childhood is an important risk factor for adult obesity.
The increase in the number of people who are overweight or obese is too rapid to be explained by genetic factors alone. It is most likely to have been caused by changes in lifestyle—diet and physical activity habits. The majority of children and adults in the UK do not meet recommendations on diet and physical activity. Increased snacking, increased consumption of carbonated drinks, and diets that are high in saturated fat may all contribute to increasing obesity rates. Few children eat the recommended five a day portions of fruit and vegetables. Four in 10 boys and six in 10 girls do not take the recommended hour of physical activity a day.
The World Health Organisation recently highlighted prevention as the key to lowering the global burden of heart disease and strokes. More than half of all deaths and disabilities caused by heart disease could be prevented by national and individual action to reduce major risk factors, which include obesity. The
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prevention and management of obesity are highlighted in the NHS plan and national service frameworks. Promoting health will be a key component of the children's national service framework, and the prevention of obesity in children will form an important element in that.
As my hon. Friend mentioned, obesity is linked to diseases such as diabetes. I am proud to have recently published the diabetes national service framework. The key elements of the delivery strategy include systematic plans to achieve NSF standards by 2013. They include plans for every primary care trust to provide eye-screening services, regular check-ups and appropriate medical treatment for every person who either has diabetes or is at risk of developing the disease. Further plans include setting up local diabetes networks and giving appropriate advice on diet, physical activity and smoking.
We are working with a range of national, regional and local partners on programmes to tackle obesity, improve diet and increase levels of physical activity. Government action on obesity takes a life-course approach. The prevention of obesity starts at birth. Breast-fed babies are less likely to become obese later in life than formula-fed babies. Breast-feeding may also help mums to return to their pre-pregnancy weight. The infant feeding initiative, which was launched in 1999, aims to increase the incidence and duration of breast-feeding. We are moving ahead with the NHS plan commitment to reform the welfare food scheme. Our healthy start proposals will ensure that pregnant women, mothers and young children in low income groups have more access to a healthy diet, in addition to increased support for breast-feeding and parenting.
The fruit and vegetable intake of both children and adults remains low. We know that increased consumption of fruit and vegetables can reduce the risk of coronary heart disease and cancer, but increased consumption might help the maintenance of a healthy weight and the achievement of other dietary goals, such as a reduced fat intake. We are bringing fruit into nurseries and infant classes throughout the country through the national school fruit scheme, which is backed by £42 million from the new opportunities fund. The scheme will provide every four to six-year-old in school or nursery education with a piece of fruit a day. Much more needs to be done to ensure that both children and adults have all the information that they need to choose a healthy lifestyle. We have developed a simple "5 A DAY" brand to help people to recognise the five-a-day message and to give the message consistency in all settings. Children and young adults were involved in the development of the brand logo, and they decreed it to be trendy, cool and so on. The message is reinforced by the food in schools programme, which aims to improve children's health by encouraging a healthy diet at school and promoting clear and consistent messages on diet and nutrition within the school environment. Initiatives being set up as part of that scheme, such as the assessment of water provision in schools and the inclusion of healthier options in vending machines in schools, are part of the ongoing programme of promoting healthy diets in school. which includes nutritional school lunches.

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My hon. Friends the Members for Dartford and for Cleethorpes (Shona McIsaac) both raised the issue of labelling. We are keen to engage with the food industry to ensure that the levels of fat and sugar in their products contribute to a healthy diet. Clear and explicit food labelling is vital if people are to make healthy life choices. My hon. Friend the Member for Dartford, in his recent paper for the Fabian Society, drew attention to the fact that fat-free claims are often confusing. The Food Standards Agency is working to improve food labelling as well to provide clear, practical advice for consumers on what constitutes a healthy diet.
Shona Mclsaac: Is my hon. Friend aware that although we can purchase sandwiches from the Members' Tea Room that are advertised as being healthier, the percentage of calories that come from fat in those products is higher than in normal sandwiches? It is happening even in the House. It is essential that we tackle the problem of calories from fat, and food labelling should show the information clearly. A measure that gives the real content of fat in food should be used, instead of the figures constructed by the industry.
Mr. Lammy: My hon. Friend will recall that I was with her a few days ago when she made that point in the Tea Room. I do not wish to cast aspersions, but it is a serious issue and I would encourage my hon. Friend to talk further about the subject with the Refreshment Department.
Poor diet is only one side of the problem. A low level of physical activity among children also contributes to a rising level of obesity. We are putting in place a major programme of work to provide opportunities for children to be more physically active. My Department is working with the Departments for Transport and for Education and Skills to help children to develop travel plans and to put in place measures to make it safer and easier for children to walk and cycle rather than be driven to school. More than 1,000 schools have a travel plan in place, and a further 2,100 schools plan to have
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one during the next two years. Success stories include a school in Suffolk where 60 per cent. of pupils now go to school by bicycle. That is a result of a series of changes, including the introduction of traffic-free cycle routes that link nearby housing estates and neighbourhoods—[Interruption.]
Mr. John McWilliam (in the Chair): Order. Will hon. Members wishing to take part in the next debate please not interrupt this one?
Mr. Lammy: Thank you, Mr. McWilliam. Those routes, which link nearby housing estates, enable pupils to cycle to school from up to five miles away without having to go along main roads.
The Departments for Education and Skills and for Culture, Media and Sport are developing schemes aimed at increasing the take-up of sporting opportunities among five to 16- year-olds. They aim to increase the percentage of children who spend at least two hours each week on high-quality PE and school sport. Significant investment is also being put into transforming physical education, school sport and club links over the next three years. For example, we are spending £224 million to expand the school sports co-ordinated programme; £60 million on club capital to help sports clubs to develop good-quality junior programmes and to make links with schools; and £10 million on supporting playgrounds. Those programmes are not only about sport in the traditional sense; they include other forms of physical activity such as dance, and walking and cycling to school.
The early identification of overweight and obese children is vital so that they can be given appropriate guidance and support. The Department supports the development of recently published guidance from professionals in primary care on the weight management of children. I hope that my hon. Friend the Member for Dartford will recognise that we are doing much in this area, and will be encouraged to work with us to take the agenda forward.

Dolphins
4 pm
Matthew Taylor: I appreciate the opportunity to raise the extremely important issue of dolphin deaths, especially in and around Cornwall.
Last month, 31 dolphins and other cetaceans were washed up on the beaches of Devon and Cornwall. I understand that this month the figure is 70 in Cornwall and 24 in Devon. Between January and March last year, 120 dolphins and porpoises were found washed up and the scale of the problem is substantially greater even than these horrific figures suggest. Some 800 dead dolphins and porpoises were washed up on French beaches over the same period—30 times more than would normally be expected at that time of year.
The cetaceans that wash up represent a small fraction of those that are killed, as most carcases sink at sea. Although this year's winter storms have probably washed up more than usual, we know that the problem has been going on for some years and has rapidly escalated. I shall speak in a moment about a new form of fishing, pair trawling for bass, which has only been established in the last six or seven years, with which it has been linked.
There has been huge and widely expressed public concern. The Western Morning News has run an extraordinarily effective series of articles outlining the scale of the problem. As a result, large numbers of members of the public from around the country as well as from my constituency have contacted my office. That concern will increase as the number of deaths increases It reflects not just a sympathy for the dolphins, which sustain horrific injuries as a result of being caught up in fishing gear, but also the more fundamental concern that we risk wiping out our local dolphin and porpoise populations.
The best research information available from the Institute of Zoology is that the common dolphin could be extinct in the area within a decade. The small, but well-established, bottle-nosed dolphin population, closer inshore, is at risk of extinction within the next two years. That is at threat from a different type of fishery—gill netting—for which a solution is at hand. However, the Government have failed to implement any action, despite an EU agreement.
The estimated impact of pair netting is substantial. Post mortems conducted by the Institute of Zoology at London zoo established that many of the deaths have been the result of by-catch. From 1995 to 1999, more than half the dolphins for which a cause of death has been established by post mortem were killed as a result of by-catch. It is estimated that approximately one dolphin is caught in every two hauls. The International Council for the Exploration of the Seas has repeatedly identified by-catch as the biggest single threat to cetacean populations in the seas.
To gauge the scale of what is happening, an Irish study of the trial pair trawl fishery for tuna observed 30 dolphins being caught in a single haul, with 145 caught by just four pairs of trawlers in one season. During 2001 observers on UK pair trawlers, targeting the winter sea bass fishery, recorded a catch of 53 dolphins in 116 hauls. It is important to emphasise that the fishery
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involved in this is not a traditional fishery. It has been established only in recent years. I have written to Ministers on several occasions to express my concern that it entails severe overfishing of the bass stocks in any case, and poses a threat to the traditional local fishery, with long-lining, and the sports fishery. Increasingly the problem for cetaceans presents an even more immediate risk.
The fleet is, incidentally—although this need not be the prime motivation for the Minister in tackling the problem—almost entirely composed of French and Dutch vessels. Perhaps eight Scottish vessels take part for part of the year, fishing out of Plymouth, but they are a very small proportion of the vessels in the fishery.
Tackling the problem is ultimately a matter for European Union action. There must be European Union agreement if the problem is to be tackled overall. The good news is that the fact that there is a problem has been clearly acknowledged. Parties to the agreement on the conservation of small cetaceans of the Baltic and North seas have acknowledged the threat posed by by-catch and are committed to taking steps to reduce unacceptable by-catch.
The EU Commissioner has said that action must be taken without further delay, but there are caveats. In his letter of 28 October to the Minister, Commissioner Fischler said:
"If we want to succeed better than in the case of driftnets … we need to build a strong case on the basis of the best scientific and technical information … we need more specific details both on the areas in which and times for which closures of certain fisheries would be desirable and on other technical specifications for the remedial measures proposed. As soon as the scientific information becomes more complete, we intend to take swift action"—
the problem being, of course, that there is some contradiction. Swift action does not happen, because the information is not complete. Commissioner Fischler is also pressing for
"a co-ordinated observer programme in all fisheries where by-catch is suspected a problem."
The Commissioner has thus given a pledge to take action, but only where evidence has been assembled, whether that relates to closures or fishing techniques.
Andrew George: My hon. Friend raises some important issues and I know that even this past weekend Looe and Polperro fishermen went out and witnessed considerable numbers of dolphins and pilot whales floating dead on the surface. Their injuries were clearly consistent with pair trawling. We know that there is a small, insignificant catch in the gill net fishery, but does my hon. Friend agree that it is not good enough to play for more time for research, when it is clear where the problem is, and that action is needed, particularly in France where most of the pair trawlers are based?
Matthew Taylor: I strongly agree with my hon. Friend, which is why I sought the debate. I hope that the Minister will acknowledge what we say, because he has several times expressed concern about the issue. He is aware of it, and has pressed the Commissioner on it. All of that is welcome, but the simple fact is that both at European Union and United Kingdom level there is pressure for delay. Not enough speedy work is being done.

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In addition, in some cases a concerted effort is being made to refuse to act, on grounds of lack of evidence, when people actually engaged in the business—certainly the Cornish fishermen who get blame from some people who have not looked into the matter, but who are innocent in this case—want action in a hurry. They do not believe that there is any question about what is happening. Some countries are blocking the observer programme. Only Denmark, the United Kingdom and Spain have any monitoring programmes at all. In particular, as my hon. Friend said, France has no monitoring programme at all, despite its having the largest number of such trawlers. Some member states have simply refused to accept that there is a problem.
Mr. Adrian Sanders: I would not like my hon. Friend to give the impression that the fault is all that of the European Commission. In direct discussion, Commissioner Fischler quite openly said to me that there is a desire to do something, but the Council of Fisheries Ministers has not given the permission to do so. The delay is in getting the issue on the Council of Fisheries Ministers, not so much the lack of scientific evidence to support the case that my hon. Friend makes.
Matthew Taylor: I share that concern and would go a little further. There is more that the Government could do to provide the evidence. The UK has a unique ability to answer those who would resist action on the grounds of lack of evidence. There are things that the Minister could do. He needs to act more quickly and firmly, and I have no doubt about his desire to do so.
The Department promised conservationists a by-catch response strategy as far back as June 1999. It has been four years and we still do not have that strategy. The Minister needs to explain what is happening on that and why it has been so long delayed. However, a debate about history is not terribly relevant to saving dolphins, and we cannot put off action on a wider strategy, particularly in relation to the pair trawlers.
I would like to see observers on the Scottish boats. The UK has the role of ensuring that that takes place now. There are no plans for observers until February. I would like some reassurance that the observers will be placed at the earliest date, and an explanation of why they are not there now. Without those formal data, it will more difficult to persuade other EU countries of the need for immediate action, however much we believe we know the answer.
The Department is in the middle of trials of adapted nets. Those trials have been dogged with problems. Last March, the camera fell off the adapted nets and no dolphins were recorded escaping. The trials planned for December were put back again after the adapted vessel that was hired for the trials was rammed, and it is now, I understand, in dry dock. Could the Minister explain why it is not possible to find another vessel for that work? Trials have been put back to at least March and might in practice be put back to next year, given that the fishery ended at that stage last year.
In any case, the Minister should not pin all his hopes on trials that are, frankly, highly unlikely to deliver. That fact is unfortunate, and I wish it were not so. Similar trials in New Zealand left sea lions with lethal injuries sustained while escaping the nets. They are
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smaller and less liable to damage than the dolphins, and I am therefore not over-optimistic. Pair trawling is a threat not only to dolphins but to bass stocks, and is not a sustainable technique compared to traditional fishing, which sustains a viable economy for the local communities that have traditionally used techniques such as long-lining, not to mention the high value of the sports fishery. Given that the Government have invested huge amounts of time, effort and money in preserving the spawning stock and the estuarial stock, it seems extraordinary to then allow such stock to be scooped up mid-water on its way to and from the spawning grounds, effectively wiping all the effort out.
I therefore put it to the Minister that he should seriously discuss with colleagues—perhaps he could tell us whether he has already done so—whether it would be more appropriate to close the fishery, at least pending the development of techniques that will avoid the problem of the dolphin by-catch and deal more clearly with the issue of bass stocks. The Cornish Fish Producers Organisation supports that option. Indeed, it makes the point that driftnets were banned for similar reasons, arguably on the basis of less evidence of their impact on dolphins than is available in relation to pair trawlers.
I want to mention a couple of other techniques about which I am concerned. First, I hope that the Minister will agree that research should be carried out by observers on industrial trawlers, which also fish midwater areas, albeit that horse mackerel do not attract dolphin to the same extent. However, dolphins are present in those waters and no research has been done into whether the trawlers pose a threat. Secondly, the European Union agreed last year that pingers should be fitted to gillnets because there is evidence to suggest that that is effective. There is a highly vulnerable bottlenose dolphin population around Cornwall, but there is not time to wait for the introduction of that change, to which the United Kingdom is committed.
Mrs. Annette L. Brooke: I should like to point out that although we are largely talking about Cornwall, the problem also affects the Dorset coast. All the conservation bodies are 'working well together. There is enormous public awareness of the issue, especially among young children. Only last week, I delivered dozens of postcards, showing pictures of dolphins caught in nets, to Tony Blair, so it is the Government's duty to respond in the way suggested by my hon. Friend.
Mr. John McWilliam (in the Chair): Order. The correct mode of address is the right hon. Member for Sedgefield (Mr. Blair) or the Prime Minister.
Matthew Taylor: There is no doubt about the degree of public concern, which is shared by local fishing communities, and it is the duty of the Government to act. Even more attractive to the Minister might be the fact that he would receive enormous public support for action. We cannot rely on technology to solve the problem and we cannot wait for technology. We need to take action now. Research may continue, but we need the Minister to save the dolphins before there are none left to save.

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The Minister's Department is in some financial difficulty and is having to make cuts as a result of differences of opinion between the Treasury and the Department for Environment, Food and Rural Affairs over staffing levels. We have heard that large numbers of staff are likely to be departing from the Department. I trust that this issue will not be caught up in that. In particular, I hope that the dedicated team at Bristol, whose members have expertise in the area, will be retained, so that work to protect dolphins can continue.
4.18 pm
The Parliamentary Under-Secretary of State for Environment, Food and Rural Affairs (Mr. Elliot Morley): I congratulate the hon. Member for Truro and St. Austell (Matthew Taylor) on obtaining the debate and addressing this serious issue. As the hon. Gentleman said, I have been aware of the problem for some time and have not been idle in terms of addressing it.
Three years ago, no one in any sector of the fishing industry, including our own, would admit that there was a problem. The observer programme implemented and paid for by DEFRA identified the problem in the winter bass fishery. I understand the concerns of non-governmental organisations and acknowledge and pay tribute to campaigns, such as the one run by the Western Morning News. That effective campaign has been helpful to me because I have shown it to Commissioners and representatives from member states to demonstrate the level of public concern, as well as the alarming number of dolphins that have been found washed up on not only our coastline but the French coastline. That is the crux of the issue. The Department for Environment, Food and Rural Affairs has committed funding to the sea mammal research unit, which is doing most of the study's work on identifying where the problem is and how we can best tackle it.
On the observer programme, there have been observers of every type of fishery, including pelagic, mackerel and sprats fisheries, on UK vessels. The only fishery involved in a by-catch problem was the winter bass fishery, although that is not to say that other fisheries are not causing problems, too. UK vessels have very little involvement with the winter bass fishery; it is other—and, in particular, French—vessels that are active in that fishery.
The hon. Gentleman should be aware that there is not much activity in the winter bass fishery at the moment; it tends to build up to a peak at the end of February and beginning of March. Yet large numbers of dolphins have been washing up. Many of the French pair trawlers are away in the south, in the bay of Biscay, at the moment. They tend to work their way north at this time of year. UK pair trawlers are operating offshore in the pelagic fishery. It is quite possible that other fisheries are causing the mortality rates, and it would be wrong to think that this is simply a pair trawling issue. It is about the kind of gear used, where and how it is used, how and in what fishery it is fixed, and in what conditions.
It is a mistake to think that if pair trawling were banned, the problem would be solved. It is clear that pair trawling in the bass fishery is implicated; we know
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that because we have some information. However, it is quite likely that the issue goes further than that. Often, comments about pair trawling are made by people who do not like pair trawling, do not do it themselves and would like the practice to end. We need a better and sounder scientific argument than that, and that means collecting information and looking for solutions.
Ms Candy Atherton: There is genuine concern in Cornwall and the wider west country on this issue. I understand that there is a marine mammal project that a London zoo vet, Paul Jepson, has co-ordinated. He said recently that two dolphins have had post-mortems, but we have not had the results. Could the Minister enlighten us as to the findings, in light of his request for more science?
Mr. Morley: I do not know of that particular case, but I know that there have been a great number of post-mortems. They suggest that the animals have died as a result of fishing activities, and were part of the fisheries' by-catch. I know my hon. Friend's concerns about the matter, as she has raised the issue with me a number of times.
I have raised the issue with the Commission, and with the Council of Minisers. It is not quite accurate to say that the Commissioner has to wait for the Council of Ministers to act. The Commissioner can take action under both the habitats directive and the cetacean by-catch strategy, which we have agreed in Council as part of a common fisheries policy review, and which calls for observer programmes of all member states. That strategy is agreed, so it is now a matter of the Commission pressing member states to ensure that that information is collected. To be fair to Franz Fischler, the Commissioner, he has been quite strong on the subject. He has been very supportive in response to the letters that I have sent to him. However, support is one thing; action is another, and I agree that it is needed.
In relation to the action plan and strategy on by-catch, I assure the hon. Member for Truro and St. Austell that we will put that in place in the near future. Much work has been done on that strategy, both in relation to the agreement on the conservation of small cetaceans in the Baltic and North seas, and by other Departments and the devolved Administrations. The strategy is in its final stages, and we will be launching and implementing that soon. We will of course be pressing ahead on our work on acoustic devices.
Matthew Taylor: Obviously, the strategy is welcome, if indeed it is to be imminent. Can the Minister give me any idea of what "imminent" might be interpreted to mean?
Mr. Morley: I cannot at this stage, but I assure the hon. Gentleman that we are talking weeks.
Acoustic devices on gill nets is a United Kingdom issue.
Andrew George: I should be grateful if the Minister would clarify a matter. He said that French pair trawlers had not been fishing in the western approaches, yet the Cornwall sea fisheries committee has confirmed to me that pair trawlers have been operating offshore from the

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ornish coast where a large number of dolphins and pilot whales have been found floating dead on the surface and a few might have floated to the coast. Can he confirm that now or could he write to me and my colleagues and confirm that no French pair trawlers have been operating in that area recently?
Mr. Morley: I can certainly give the hon. Gentleman more information. Pair trawlers may be operating, but not in the bass fishery. They may be operating, in other fisheries and some may be French. Those that are generally involved in the winter bass fishery are not in the area. It is wrong to think only of pair trawling. There are, for example, Dutch horse mackerel fisheries and industrial fisheries. We need observers on all those vessels and fisheries to see exactly what the implications are.
We have pioneered acoustic devices and we should not be slow to acknowledge that, on many of those issues, the United Kingdom leads the rest of Europe. We were the first to treat the issue of dolphin by-catch seriously and the first to identify where the problem fisheries are. We were the first to trial solutions in relation to the separator trawl and we were the first to begin to develop acoustic devices. The earlier ones had reliability problems, but the later ones are much better and will feature in our action plan.
We have had some setbacks in the trials of separator gear and no one is more frustrated with that than I am. We cannot simply use another vessel because the vessel we engaged for the experiment has had some rather expensive gear fitted, including winches and equipment for cameras and nets. It is expensive to remove those and refit them and by the time that it has been done, the vessel will be ready again. However, I have some positive news. The vessel has been repaired and is operating again, but we have chartered it for the period of the bass fishery and it has now gone to the pelagic fishery on the west of Ireland. It will be back in Cornish waters at the end of February and we hope to have the net up and running at the end of February or beginning of March, which is the peak of the winter bass fishery. That will be helpful in ascertaining whether the net works.
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I know that reservations have been expressed, but some of them seem to have been motivated by people who just do not like pair trawling and believe that it is the reason for everything. I do not believe that. Pair trawling may be a problem, but we must research it carefully. The comments on the website of the hon. Member for Truro and St. Austell suggest that the net does not work. The hon. Gentleman is an able Member of Parliament, but he is not psychic and we should give the net a chance to see whether it works. I know that it caused some injuries to sea lions in the New Zealand fishery, but I have spoken to the New Zealand Minister for the Environment and she told me that although there were some problems in the early stages, adjustments and changes to the net had eliminated injuries to sea lions. Sea lions are very different from dolphins.
I am not saying that the net may be the magic solution, but I certainly believe that we should try it out and see whether it works. We shall not know until it has been used in a fishery where dolphins are going into nets. We know that when it was used last year, a tope, which is a species of shark, went into the net and was ejected successfully from the escape hatch. We also know that the net catches fish, which is important if we are to persuade fishermen to use it. Some people were saying not only that the net would damage dolphins but that it would not catch a single fish. We know that that is not true, so let us see how effective it is for dolphins.
If it is not effective, I do not rule out further action and arguing for closures and restrictions. That may be necessary, but it is important first to obtain the evidence, ensure that other member states are doing their bit in collecting evidence—we need more help from other member states—and to see how we can tackle it and where it is. I assure hon. Members that I am fully committed to that. I share their frustration about what is sometimes seen as slow progress, but we are committed to dealing with the problem, to making progress and to ensuring that there is progress throughout the EU as well as the UK.
Question put and agreed to.
Adjourned accordingly at twenty-nine minutes past Four o'clock.