Westminster Hall Sitting of 25 June 2003

Preamble
[MR. JOHN MCWILLIAM in the Chair]

Dietary Salt
Motion made, and Question proposed, That the sitting be now adjourned.—[Charlotte Atkins.]
9.30 am
Mr. David Tredinnick: On a point of order, Mr. Deputy Speaker. Has the difficulty of accessing Westminster Hall come to your attention? Some Members experienced particular difficulties in reaching the Chamber this morning, not least because the gates in New Palace Yard are closed and the directions are not clear. Furthermore, access through the centre of the hall, towards the Members' Cloakroom, is also barred. Are you satisfied that Members have been given sufficient notice that they might encounter difficulties as, perhaps, my hon. Friend the Member for Totnes (Mr. Steen) has done in finding his way through the maze, and would you raise the matter with Mr. Speaker?
Mr. Deputy Speaker: Order. The Serjeant at Arms has sent instructions on how to get here to all Members. If some Members have not caught up with them, that is up to them. I apologise for the difficulty. I understand that it is caused by the need to check the roof beams, and that that is being done for the sake of Members' safety. I notice that there is a good attendance this morning, and I am sorry that I have run out of orienteering badges.
9.31 am
Mr. Anthony Steen: As we have started one minute late, Mr. Deputy Speaker, I hope that you may allow us to carry on until 11.1 am. I am delighted that Mr. Speaker felt that salt was sufficiently important to be given the prominence that he has conferred on it by granting a one and a half hour debate.
Salt is vital for our health. It is an essential source of sodium, and it keeps our nervous systems working. However, it is also a killer. We eat too much of it, and the health of the nation is paying a terrible toll. Last year, nearly 250,000 people died in the United Kingdom as a result of high blood pressure. Strokes accounted for 50,000 of those deaths as well as for substantial illness and disabilities. High salt intake is overwhelmingly linked to high blood pressure; the evidence is now as stark and dramatic as the evidence that smoking kills. There are warnings on cigarette packets; there should be warnings on food products that contain high levels of salt. The Government should insist that they carry a statement such as, "The food in this packet contains a high concentration of salt, which can damage your health."
The food industry, the Government and the national media all have a responsibility to warn people of the risks posed by a high cumulative intake of salt. The message should be, "This is your wake-up call: cut your daily intake of salt or you will damage your health."
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The simple five-a-day fruit and vegetable message has been undermined by a plethora of off-the-peg, well-presented packets of pre-packed processed foods. Most of them contain more salt than one person requires in a single day. The food industry is our second largest industry after defence. It contains very powerful groups and many multinational companies. There are big advantages for them if salt is added to food; it makes people thirsty and more likely to buy a can of soft drink. In fact, PepsiCo produces both soft drinks and Walkers crisps. It is predicted that if the salt in snack foods were reduced, UK soft drink sales would slump by 8 billion cans a year.
How many people are aware that a slice of bread contains almost a gram of salt? Just six slices contain most of the recommended daily intake. If one ate a whole loaf, one would consume two or three times the amount of salt one needs in a day. People should eat bread that contains less salt, but it is very difficult to find. Breakfast cereals also contain high levels of salt—except for Weetabix and Shredded Wheat. If one pours cornflakes into a bowl of water, then takes out the cornflakes, the water tastes like sea water.
Tinned soups are extremely high in salt; even so-called fresh soups in cartons can contain over half the daily salt requirement. However, baked beans take the biscuit. On 27 May, the Daily Mail highlighted the fact that one tin of baked beans contains an entire daily allowance of salt.
A couple of sandwiches—four slices of bread—contain two thirds of the salt requirement for an adult; not to mention the filling, such as beef, cheese or ham, which will probably take the salt consumed above the recommended level. Mr. Deputy Speaker, how many receptions have you attended in the last few weeks where those delicious House of Commons sandwiches are served? We all tuck into them, but they contain a lot of salt. After eating four of them, one has consumed more than half one's daily salt requirement.
Ready meals are increasingly popular, and are fast and easy. However, this year's "Salt and Health" report from the Scientific Advisory Committee on Nutrition shows that many people have very high levels of salt in their body, leaving little room for the salt that we take in from other foods, such as bread and cereals. Convenience should not mean an increased health risk. When products aimed particularly at children contain lots of salt, the damage starts.
The survey of ready meals by the Food Standards Agency published last month shows that 83 per cent. of ready meals contained more than 40 per cent. of the target salt intake for one day. Although "healthy eating" ready meals often contained a little less salt than the standard versions, the differences were small. One meal, Asda's "Good For You" lasagne, contained 60 per cent. of an adult's target daily intake of 6 g a day. However, Asda is committed to reducing salt in its products and will shortly achieve a reduction of up to 18 per cent. in the salt in its products since 1998. Safeway had some of the lowest-salt products; lasagne and chicken korma and rice from its "Eat Smart" range. Heinz "Weightwatchers" and Birds Eye "Less Than 3% Fat" chicken korma were also relatively low in salt.

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Salt quite simply makes totally inedible food palatable at little cost. Take cheap sausages as an example. They contain 85 per cent. fat and 5 per cent. meat bound together with a cereal whose concentration of salt is 50 per cent. higher than that of sea water. Those products are cheap to produce and are most profitable. They also tend to be purchased by those on tight budgets who often need to watch their diets closely.
What about children's snacks such as Cheese Strings and Dairylea Lunchables? The amount of salt contained in those products is as high as salt levels in the Atlantic ocean. Once manufactures have managed to titillate children's salt receptors, those receptors become less capable of detecting salt concentration. As a result, children feel the need to consume more and more salt each day than they require. Any food that does not have a high enough salt content tastes bland to them. Nor is it just children who become addicted to salt; adults get hooked on it too. Even those who are aware of the dangers of too much salt in their diet consume large quantities unwittingly because 98 per cent. of the nation's shopping is done at supermarkets, where it is often more convenient for people to buy pre-packed rather than fresh foods.
Why exactly is it so important that salt is a component part of our daily diets? Salt not only confers its own flavour on products, but is used as an enhancer to modify the flavour of other ingredients and reduces the bitterness in some products. Salt is also a preservative mechanism, working via a reduction in water activity. Micro-organisms require water to survive and grow, but salt absorbs water, leaving a reduced amount for them. The Egyptians discovered that 5,000 years ago, when they used salt to keep food from decaying.
The Scientific Advisory Committee on Nutrition makes it clear that people are consuming too much salt and that that has a direct effect on their blood pressure—the more salt eaten, the higher the blood pressure. High salt intake also causes other damage, such as high water retention, and it can contribute to the thinning of the bones, known as osteoporosis, and is closely related to gastric cancer. Salt intake is an important consideration for people with diabetes, especially those who suffer from type 2 diabetes. High blood pressure, or hypertension, is a major risk factor for strokes, heart attacks and kidney failure. In western countries, average blood pressure increases with age. Although often considered normal, such an increase does not occur in traditional, hunter-gather societies, such as the Yanomamo people in Brazil. However, when hunter-gather peoples migrate to urban environments, their blood pressure levels come into line with those of people in industrialised societies.
According to a report in the British Medical Journal in 1996, people who consume large amounts of salt are at greater risk of suffering from strokes and cardiovascular disease. The recent Intersalt study measured the salt intake of more than 10,000 people in 32 countries and found that a difference of only 6 g of salt a day can result in a dramatic difference of systolic and diastolic blood pressure. Researchers at Leuven university in Holland reviewed the dietary habits of
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people in 24 countries and discovered that high salt intake can significantly increase the risk of stomach cancer. There is no laboratory evidence that that is the case, and it is more likely that diets consisting of highly salted, spicy foods are often associated with low intake of fresh fruit and vegetables, which might contribute to the development of cancer.
In 1995, the effects of sodium intake on the bone density of 124 women who had been post-menopausal for more than 10 years were studied. A 50 per cent. reduction in the intake of dietary sodium was as effective in reducing bone loss in the hip and the ankle as supplementing the diet with calcium. Professor Graham MacGregor from the pressure group Consensus Action on Salt and Health has done much pioneering work in the field. Recently, he linked salt with calcium when he brought together several research papers on decreased bone density and reduction of calcium retention. He concluded that reductions in salt intake would reduce mobilisation of calcium from bone in post-menopausal women.
New salt targets for children highlight the fact that children's salt intake is higher than that of adults in relation to their body weight, and that approximately 75 per cent. of their salt intake is from processed foods, usually bought from supermarkets. A snapshot of the salt content of children's ready meals shows that some ready meals aimed at children have levels of salt as high as in standard adult meals, while some supposedly healthy option meals contain more than half a whole day's target intake. Marks & Spencer and Asda are pioneering a salt reduction programme for that group.
In 1994, the Government recommended that people reduce their daily salt intake. However, scientific evidence for the conclusion that daily over-consumption of salt is linked to serious health problems has come to the fore only recently. The Department of Health and the Food Standards Agency recommended that everybody should cut the amount of salt that they eat from the current average of 10 to 12 g of salt a day, which is equal to two teaspoonfuls, to 5 to 6 g a day, which is equal to one teaspoonful or less. In 1994, the Department of Health published a report entitled "Nutritional Aspects of Cardiovascular Disease", which recommended that the figure should be lower still-4.1 g. Other European countries are trying to achieve similar ends. It is not a British problem, but a western problem.
The salt that one adds in cooking or at the table is only about one quarter of the salt intake over which we have any control. As hidden salt lurks in processed foods, people are completely unaware of how much salt they consume. It is that hidden salt that is the killer. Everyone is consuming salt that they do not know they are consuming and which they would not necessarily consume if they had the choice.
Nutritional information on food packaging labels is confusing. Only a scientist—there are some here today—would understand it. Why does the law insist on having sodium levels on the packet, but not salt levels? Six out of 10 people say that it is important to look for salt when trying to eat healthily, but only two in 10 say the same about sodium. Only one in three think that salt and sodium are the same, and four in 10 have no idea

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whatever about the relationship. CASH feels that information about salt, not sodium, should be on the label, because 99 percent. of sodium consumed in this country is from salt. The term "sodium" means little to the consumer. Of course, there are salt alternatives, but I shall not discuss those this morning.
Information on food labels must be rethought to make them clearer and more consumer-friendly. Marks & Spencer has devised a simple but effective panel that explains the ingredients of a product extremely well, and I commend that idea to the Minister and will send her an example. As I said, the panel is extremely effective, but Marks & Spencer tells me that it is illegal for it to display the panel, because it is supposed to include merely sodium levels, not salt levels. It is a wonderfully simple table that explains a product's contents in a moment. Furthermore, the information on the labels for Marks & Spencer's "Count on us" range makes admirable sense. It contains the information that one needs in order to lose weight, the amount of salt in the product and, most importantly, the amount recommended for consumption each day by adults. The fact that Marks & Spencer sells £100 million worth of that range each year demonstrates only too well that the public are acutely aware of their health and the way in which it is affected by what they eat.
Will the Minister say whether the Government are prepared to legislate so that, alongside each nutrition label, there is a list outlining the exact amount of each nutrient in a way that people can understand? Consumers could check that at a glance and make an informed but simplified choice without having to spend hours doing sums. Whatever the Minister says, my constituents and I do not understand the current labelling, and I doubt whether her constituents do. In fact, the information is printed so small that one cannot read it anyway.
Professor Alan Jackson, the chairman of the Scientific Advisory Committee on Nutrition, states in his "Salt and Health" report, which was published in April:
"It is for the Government to consider the action required to achieve the recommended reductions in the salt intake of the population. Achieving these targets will not be easy. Key to achieving a sustained salt reduction for public health benefit is the engagement of the food industry (manufacturers, retailers and caterers)."
Renowned chefs such as Nick Coiley of the highly acclaimed Agaric restaurant in Ashburton, Devon—formerly of the Carved Angel in Dartmouth, which happens to be in my constituency—recognise that the public expect modern chefs to respond not only to fashion, but to health requirements. Fine food, he says, can be produced using a range of fresh herbs as salt alternatives that can bring out flavours in keeping with the demand for healthier food. However, House of Commons catering still relies far too much on salt. In one outlet last week, I commented on how delicious the roast lamb was and was told that salt is rubbed into it, which brings out the flavour. Yesterday, the baked potatoes were beautifully crisp. I discovered why: the skins had been rubbed with salt.
There is reluctance among the 40 or so chefs in this great Palace to reduce the amount of salt to what is considered good practice in a healthy diet. Who will change that? Some 3,000 people work in the Palace. I wonder how many people have higher blood pressure as
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a result of the food that they eat here. I am convinced that the Government should issue guidance to restaurants, cafés, and other food outlets to indicate beside each item on the menu whether it is high or low in salt, or how much salt a portion might contain. There is no reason why that should not happen. It could be done as a voluntary code. It would focus the minds of the caterers and chefs as well as making the public aware of the issue.
Food is usually prepared and cooked behind closed doors in restaurants, and since more and more people eat out, especially city dwellers and younger people, it should be incumbent on restaurants to help raise the level of health consciousness. It is essential that the salt content per serving be stipulated. The Government could take a lead, which would fit in nicely with their long-term health plans to stimulate a pattern of healthy eating and diet awareness.
Why is the Government's NHS label so complicated? Supermarkets must pay£100 a licence for each product, and the logo looks like an MOT testing station logo. Hon. Members may have seen it. It is supposed to support healthy living but can be used only on fruit and vegetable products. I gather that Marks & Spencer believe it to be a complete waste of time. I should mention that I am a shareholder of Marks & Spencer, in which I declare an interest. I spent a morning going round one of its stores with its nutritional team, and was slightly infected, and affected, by its approach, which I found encouraging. It says that the NHS logo is a red herring—expensive, irrelevant and without credibility or recognition. Will the Minister explain why the labels have not been brought up to date or abandoned?
Salt in our diet is a matter of life and death. The Bible exhorts us to "seek life", and as a nation we are more aware than ever before of our health and vulnerability, and of the need to be kind to our bodies and to respect our diet if we are to enjoy quality of life in the years that we have left. Our new lifestyles, including the liberation of women, have resulted in a change in our cooking and eating patterns. The nuclear family has been replaced by a number of independent units in the same household. Processed foods have become part of the armoury of any home, and children eat separately from adults, mostly on the hoof, between computer games. Traditional sit-down, freshly cooked and prepared meals have all but disappeared.
Salt has become man's enemy because of the quantity consumed. What is good in small quantities can become bad in large quantities. It is not only food that is over-salted; I wonder how many people have considered the amount of sodium in bottled mineral water, which as mineral water, not spring water, goes through rocks. I will not mention brands that contain high levels of sodium. Far from being superior to tap water, mineral water contributes to the daily intake of too much salt.
The Government have a huge task to educate, legislate, advise, cajole, and lead by example. The debate is meant to send a signal to the country's caterers, retailers and food manufacturers of the national concern about the amount of salt in our diet and its impact on our health. This is, of course, an individual matter that everyone in the country must address. It is for everyone to decide what they eat, how much they eat

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and where they buy their food. We enjoy immense choice, and our farmers produce some of the best food in the world. However, we no longer eat food fresh. If we did, salt intake could be halved, which would save thousands of lives in this country alone. I hope that the debate will light a beacon of awareness that will continue beyond 11 am today.
Mr. Deputy Speaker: Order. I see five Members standing. If they do the mathematics as quickly as I can, they will see that if they restrict their time voluntarily, they may all get in. I have no powers to restrict their time.
9.54 am
Mr. Kerry Pollard: I congratulate the hon. Member for Totnes (Mr. Steen) on securing the debate. I am pleased that he invited me to take part in it to discuss this vitally important issue. I also welcome the Under-Secretary of State for Health, my hon. Friend the Member for Welwyn Hatfield (Miss Johnson), to her new post. She is an old friend of mine and represents a neighbouring constituency. I know that she takes the issue seriously.
Salt is vital for life, and I shall give an example of that from my own family. My second son, Adam, is diabetic and has epilepsy, and therefore his salt balance is critical. If he loses salt, he goes into a coma and has to go into hospital to have his salt level rebalanced. Within minutes, he is bright and breezy again and back home with his family.
I agree with what the hon. Member for Totnes said. I have had to change my speech, because much of what he said, I had intended to say, and I am sure that that will be the case for other hon. Members. That will certainly help, Mr. Deputy Speaker, in cutting down on the length of our contributions.
It is not universally accepted that we consume too much salt in our diet, and one of our big challenges is to get that message across. We are going on a journey similar to that taken on tobacco a number of years ago. Some 40 years ago, when I was 15 or 16, starting to smoke was a rite of passage. We all did it and accepted it—that was the way things were.
I am pleased to say that I did not take to smoking, and do not smoke now—I have not smoked for donkey's years. I did not like it, and it did not like me, and that has saved me thousands of pounds. I am also pleased to say that my wife does not smoke, and nor do any of my seven children. I hope that none of my seven grandchildren will either. However, the journey that we are taking now is similar.
Chris Grayling: I am concerned by the hon. Gentleman's comments, because he draws a parallel between tobacco which, in any shape or form, is directly linked to disease, and salt which, as my hon. Friend the Member for Totnes (Mr. Steen) pointed out, is of concern only in excessive intakes rather than in a
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balanced diet. Surely the hon. Gentleman does not want to see us go down the same route of significant regulation that has been necessary for tobacco?
Mr. Pollard: The hon. Gentleman makes a good point, but the only parallel that I could think of with reducing salt consumption was the journey that we went on in raising awareness of the dangers of tobacco.
As the hon. Member for Totnes said, Professor MacGregor has been a pioneer in making everyone aware of the dangers of salt. A few years ago, when he started his campaign, he was castigated by many of his colleagues, and looked on as a little cranky. I am pleased that he remained cranky, and that he has carried the campaign forward. I have been a member of Consensus Action on Salt and Health for five years and have worked closely with Professor MacGregor. He now has a national reputation in the field, and people accept that what he says is true. The CASH awareness campaign has had some success, in that many of our supermarkets and others who add salt to food are gradually reducing it. However, that success has been insufficient.
In March 2000, I tabled early-day motion 558, which stated that high salt intake leads to high blood pressure, causing more strokes and heart attacks—the two commonest causes of death in the United Kingdom. It also stated that
"three-quarters of people's salt intake … comes from … processed food."
I received 28 signatures in support of that motion. The hon. Member for Bosworth (Mr. Tredinnick) tabled a similar early-day motion this year, which attracted 53 signatures. That might indicate greater awareness among Members of Parliament that salt can be dangerous, although it is vital to life.
Professor MacGregor and the CASH team have organised three annual events on salt awareness day. I sponsored one, which was attended by Raymond Blanc, the internationally known chef. He regaled us with tales of the amount of salt that he puts in his restaurant food. In his restaurant, he said, people had become used to a lower level of added salt and their taste buds had adjusted accordingly. I said that I would pop into his restaurant and have a meal with him one day, not realising that there is almost a year's waiting list and that dining there is more or less by invitation only—it is like going to Buckingham Palace. I have not yet been to see Raymond Blanc, but he uses less salt in cooking and evangelises about it around the country.
Anton Edelman, another renowned chef, came along to a salt awareness day. He, too, is well aware that adding too much salt is dangerous. As the hon. Member for Totnes and others have said, salt added to processed food and bread is the real killer. I have twice met representatives of the Federation of Bakers, who are trying their best to cut the amount of salt they put in their products; they have made some progress but nowhere near enough. It is a matter of taste; we need to persuade, bully or, if necessary, force a reduction in salt intake. The story could then have a happy ending for tens of thousands of babies, who will not die prematurely, suffer crippling strokes or have a poor quality of life. We must not fail children, who are vulnerable and innocent victims being force-fed too much salt. Action now will save lives.
10 am
Dr. Richard Taylor: The hon. Member for Totnes (Mr. Steen) has outlined the problem before us very clearly. Those of us from the northern half of the country know that there is a dialect word for food that is short of salt: it is "wallow", which has nothing to do with a hippopotamus in mud. The Oxford English Dictionary, which has about 10 volumes, includes the word and gives the meaning as "tasteless, insipid and sickly". That is why we will have such a battle to reduce salt consumption—it is what makes some food worth while.
I shall quickly whiz over some of the things that the medical profession have been told in the last few years. I am not a nutritionist; I am a retired physician who is probably out of date and therefore I shall speak with caution.
In 1995, a document entitled "Health of the Nation" was sent to all hospital doctors. It stated that the average intake of salt per day was 9 g, which should be cut to 6 g, which alone would reduce average blood pressure by 2 to 3 mm of mercury. At that time, the aim was to reduce blood pressure by 5 mm of mercury, because that would reduce strokes by 34 per cent. and heart attacks by 21 per cent.
In 2000, the national service framework for coronary heart disease was issued. It described the reduction of risk factors and encouraged healthy eating. There was not much specific mention of salt and sodium, but the healthy eating advice recommended a balanced diet—increasing fruit, vegetables and oily fish, and decreasing fat, saturated fat and salt. I should be interested to know from the Minister how milestone 3 in the NSF is being achieved. It states that
"by April 2002 every local health community will have quantitative data no more than 12 months old on the implementation of the policies"
on promoting healthy eating, among other things.
Healthy eating advice is to eat more of the good things and less fat, saturated fat and salt. The hon. Member for Totnes made the good point that we must convince the food industry, because food marketing affects what people eat. The hon. Gentleman said that if companies sell both crisps and drink, they are doing themselves a lot of good. However, Walkers are producing crisps in the old-fashioned way, which most of us will remember, with a separate little packet of salt that one can choose to tip on to the crisps or not. Perhaps the message is getting through.
Mr. Steen: I thank the hon. Gentleman for his comments, and it was a chat on the steps outside that resulted in his being here. When he was in general practice—it was not that long ago, although he may think so—did he raise the issue with patients, or is it only just coming on the radar screen now?
Dr. Taylor: I must correct the hon. Gentleman—I was a hospital physician not a general practitioner. However, the issue was certainly covered in the list of advice that we gave patients with blood pressure problems. We were well aware of the issue in 1995.
I was about to tell hon. Members about the tremendous battle that has gone on with the food industry and the salt manufacturers. As recently as
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2001, the Salt Manufacturers Association appealed to the Government
"to open up the debate on dietary sodium consumption and promote a policy on salt consumption based on sound scientific evidence."
It added:
"We do not believe this has happened to date."
It also produced a very persuasive, lengthy paper, which it sent to the Food Standards Agency's Scientific Advisory Committee on Nutrition. The paper states:
"Specifically, since 1994 new evidence has emerged that … defines far more precisely any blood pressure relationship with salt restriction in normal and hypertensive persons… provides critical new data on the blood pressure benefits of improving the overall quality of the diet as opposed to simply restricting salt … shows that salt sensitivity is not the primary contributor to premature cardiovascular events, but simply a surrogate marker for a poor quality diet … argues that the 1994 … recommendation on dietary sodium intake should be reconsidered."
Sadly, I have not had that long to prepare for the debate, and I have been unable to find out whether the Food Standards Agency replied, although I hope that the Minister has the facts.
On 8 March, the British Medical Journal reported that the World Heath Organisation had concluded
"that a diet low in saturated fats, sugar, and salt and high in fruit and vegetables, together with an hour a day of exercise, can counter cardiovascular diseases, cancer, diabetes, and obesity."
That is certainly the gold standard recommendation at the moment. However, to convince the food industry, and the salt manufacturers, in particular, we must find out whether the association's paper was considered.
How do we tackle the issue? To be honest, the NSF on coronary heart disease contains only platitudes. It says that we should improve access to healthy foods, make them affordable and ensure that public agencies make
"a variety of healthy foods readily available to staff".
Contrary to my usual experience of House of Commons potatoes, those in the Terrace Cafe never have enough salt on them, so perhaps some of the chefs have got the message.
Mr. Steen: Portcullis House would be worth a trip.
Dr. Taylor: I thank the hon. Gentleman very much.
It is essential to raise awareness about the importance not only of the issues around salt, but of food labelling. Like other hon. Members, I have taken the trouble to look at a few food labels. The sandwich that I ate yesterday—in Portcullis House—contained 1.9 g of sodium. while the dietary information on another sandwich was in very small letters. I am lucky in that I can take my glasses off and see things close to, but I could not have read the information on that sandwich otherwise.
I emphasise that there must be balance in everything. One must balance one's diet, but one must also strike a balance between dietary considerations on the one hand, and exercise and weight loss on the other. I am very lucky in having an office in Portcullis House. I have discovered that it is exactly a quarter of a mile between my office and the voting Lobbies. Yesterday I made

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eight journeys two ways, which means that my exercise quota is being reached quite easily. I am pleased about that.
I shall certainly try to avoid convenience foods. There are terrible stories of other contaminants of salted peanuts in pubs, which I am sure all members have heard—I shall never eat any of those. I shall concentrate on crisps with separate salt. I shall finish with the hope that the Minister will give us some definitive answers, particularly on how we should persuade the food industry—the salt producers—that it must market products containing less salt, that will yet be attractive and encourage people, particularly the young, to buy them.
Mr. Deputy Speaker: Order. If everyone else takes 10 minutes, not everyone will get in.
10.10 am
Dr. Howard Stoate: I congratulate the hon. Member for Totnes (Mr. Steen) on securing this important debate, and on his huge background research, which has informed the House and shows how much interest he takes in this important subject. Members should be able to reduce the lengths of our contributions; most of the points that I was going to raise have been well covered by the hon. Gentleman.
As we have heard, salt is necessary for life. It is in virtually all living organisms and it is therefore contained in everything we eat. As with many foodstuffs, too little is dangerous and too much is dangerous. It is similar in many respects to the other major food groups such as fat, protein and sugar, all of which have consequences if we eat too much or too little of them.
So what is the problem? As we have heard from hon. Members on all sides, we all eat too much salt on average. That is undoubtedly having a significant effect on our overall health. The reason why it is such a difficult problem comes down to the difference between epidemiology, which is the study of disease in populations, and individual health care, which is the study of disease in individual people. The public fully understand the effect of eating too many calories, too much fat—particularly saturated fat—and too much sugar. It goes without saying that most people will be able to tell us that if we eat too much, we get fat, and that if we eat too much fat, we are likely to get heart disease and will certainly put on weight.
What is more significant is that most people understand that if one reduces one's calorie or fat intake, one can reverse the health effects rapidly. The diet industry, which is now worth£2 billion a year, is testimony to the fact that most people realise that limiting food has a direct personal effect on their health. The difficulty is that that does not apply to sodium and salt. As the hon. Member for Wyre Forest (Dr. Taylor) said, if everyone reduced their sodium intake to the recommended level, we could probably see a 2 or 3 mm reduction in blood pressure across the population. On an individual basis, that would have a vanishingly small effect, but the effect on the whole population would be enormous. As the hon. Gentleman pointed out, it would save tens of thousands of lives a year.
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The problem remains that individuals have little control, because modifying one's sodium intake does not make a great difference: people do not look or feel different if they change the amount of salt they take in. We have to look more at what Government, manufacturers and the industry can do to limit the sodium people take in their diet, which is clearly far too much at the moment. That will be difficult.
It would be easier to say, for example, to manufacturers, "There's too much salt in the food. Reduce it". That would be nice, but there are good reasons why they will not do that. The main reason is that salt is incredibly cheap. It is also a good preservative and flavour enhancer. It alters the texture of food, and it is therefore a valuable commodity. It is a cheap way of producing flavoursome, well preserved, safe food.
Unfortunately that has consequences, particularly for children. I recently went to a healthy eating talk at Sainsbury's, organised by the National Obesity Forum, BUPA and Sainsbury's. A tour is offered, and one can go around the larger Sainsbury's stores with a nutritional adviser who will point out which foods are good for one and which are not. A good range of foods is available in Sainsbury's. I would not deny what it is trying to do; it is very positive, but I looked at the con tent of food in a so-called healthy eating range, and it still contained far too much salt. Admittedly, there was less than there was in the standard range, but only a bit less. The manufacturers concentrated far more on calories, saturated fat and sugar, all of which are important, and were taking insufficient interest in salt. The reason is simple. If salt is reduced, people do not like the food and do not eat it; anyone who has eaten salt-free baked beans knows that they are disgusting. There is pressure on manufacturers to use salt to make their food more palatable.
There is a particular problem in respect of children. If we do not do something radical about their salt intake, we will face a major problem. I recently wrote a pamphlet for the Fabian Society on obesity in children. In the course of the research, it became obvious that salt was a major problem. Because of children's smaller body mass, the amount of salt that they take proportionately is worryingly high. The other difficulty is that most of the foods that children like, particularly crisps, nuts and pizzas, contain far too much salt. It is not an exaggeration to say, as I concluded in my Fabian pamphlet, that if we do not do something radical about children's nutrition, we shall raise a generation of children who predecease their parents. In that case, I was talking more about obesity and its effect on type 2 diabetes and heart disease, but the same could easily apply to salt. Much more research is needed.
I call for radical measures. Telling people, "eat less salt" will not work. It is not an easy message to get across, and the average member of the public will not understand it. If it does not have a direct effect on their appearance or their well-being, people will not do it. With other Members, I am calling for far more controls on advertising to children, on snack machines in schools, and on sponsorship, particularly by fast food manufacturers. That is where the problems lie. On children's television, 97 per cent. of food advertisements are for foods that are high in fat, sugar, salt or other things that children should not eat to excess. Kids are

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bombarded with advertisements for the most damaging foods, so we should take stringent measures. I do not believe that a voluntary code, or advising people to take in less salt, will work.
I appreciate the difficulty that the Minister and the Government will be in if she starts talking about punitive measures against manufacturers and advertisers. However, if we do not do something drastic, we will face a major health problem. It must not be underestimated. Today's debate shows that people are aware that if we do not do something radical, soon and far reaching, the consequences will be huge.
I am pleased to have had an opportunity to take part in the debate and I congratulate the hon. Member for Totnes on securing it.
10.17 am
Mr. David Tredinnick: It is always a great privilege to follow my hon. Friend the Member for Totnes (Mr. Steen), who has campaigned for many years on the issue. When I say many years, I mean it—
Mr. Steen: Not as long as my hon. Friend.
Mr. Tredinnick: My hon. Friend is very generous, but he is wrong: he has represented his current constituency for 20 years and, before that, Liverpool, Wavertree for 10 years, so he has unbroken service of 30 years in the House.
I welcome to her post the Under-Secretary of State for Health. She succeeds the hon. Ladies who are now, respectively, the Minister for Crime Reduction, Policing, and Community Safety, and the Under-Secretary of State, Office of the Deputy Prime Minister. I wish her well. I see that she was instrumental in the banning of carcinogenic asbestos products and took a lead in issues relating to lead in paint, so she is well placed to consider this subject. I notice also that she has opposed ageism in employment, so those of us who are over 50 are glad to know that she will not object to our extended tenure in the House.
Like everyone else, I find that most of my arguments have already been made. However, I should like to say a little more about children, and to make some international comparisons. The worst example of salt poisoning that I have ever come across was in the Gaza strip in Palestine. Due to the extraction of water under Israeli Government policies, the salination of drinking water means that the Gaza strip has the highest level of renal failure in the world. That illustrates how serious the issue can be.
The hon. Member for St. Albans (Mr. Pollard) mentioned the early-day motion that I tabled in February, and mentioned other motions on sugar intake and omega oil supplements. The Government must look at diet much more seriously. Much could be done to improve the health of the nation by gently warning people of the effects of food consumption. The hon. Member for Dartford (Dr. Stoate) mentioned taste; he said that bland beans were not much fun. I see the tin of beans belonging to my hon. Friend the Member for Totnes. It is not bland; it has lots of salt in it.
If one examines Elizabethan cookery books to see what was in people's diets, one can see that tastes were quite different. People did not have the taste for sugar
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that we have today. We must try to reduce progressively consumption of salt by persuading the food industry to take action. The arguments made by the hon. Member for Wyre Forest (Dr. Taylor) were absolutely spot on. The industry has tried to mount a defence with quite spurious arguments in many cases. We need to secure a gentle reduction that will coincide with a change in taste, as the hon. Member for Dartford said.
My hon. Friend the Member for Totnes mentioned children, and the marketing of foods that are aimed at them. Children have been subjected to phenomenal marketing campaigns, which have coincided with the food industry's expansion of salty foods. Consumption of all the new crisps, the little circles, ringlets and so on that our children try to persuade us to buy for them at motorway service stations—"Daddy, may I try Doritos?"—peaked in the 1980s. Those consumption levels are starting to decline, but far too little has been done in that respect. The Minister must pay attention to that.
Another important issue that was raised by my hon. Friend the Member for Totnes is labelling. Labelling is confusing; I would like to know what percentage of the population know what sodium is. I imagine that a large proportion think that it is quite different from salt. The Minister must take that point on board. How small is the small print? What percentage of the population can read a label without glasses? That would be an interesting statistic. We need clearer labelling. There have been motions in the House over the years—certainly over the bur Parliaments in which I have served—that have addressed the labelling issue.
A related issue, which the Minister must address, is that of food supplements. The Minister will be aware that the Food Supplements (England) Regulations 2003 have been laid before the House. It has become apparent from discussions with food industry representatives at the Food Standards Agency that the setting of maximum permitted levels of nutrients in food supplements by the European authorities is likely to lead to very low permissible levels, reflecting outdated concepts of nutritional need rather than safety. That is a battle that the Minister must fight and win. The risks of excess sodium consumption are well documented and well known, but the documentation and information available on that subject far exceeds the information available on the known risks from excessive consumption of vitamins. However, the Government are proposing to accept European legislation that will remove a whole raft of very valuable nutrients and minerals from our diets. The point was made about the use of herbs rather than salt. If we are going to use the natural products of this country, we do not wish to see effective species elimination by the European Union.
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)indicated dissent.
Mr. Tredinnick: The Minister shakes her head, but that motion has been prayed against and may be the subject of a Supply day debate. The Minister should be aware that one of the well-known experts in the industry, Patrick Holford, is making a presentation to the House on 7 July. He is the founder of the Institute for Optimum Nutrition. Before the Minister says that that is bound to be an industry organisation, it is a not-

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for-profit educational trust that accepts no funding from vested interests, including vitamin, food or drug companies. Patrick Holford and that organisation are clearly at odds with the Food Standards Agency and its interpretation. The FSA says that limiting B6 is wrong and that the EU directive on vitamins and minerals will be had for one's health.
The Minister should be aware that there is massive opposition in the industry. She should also get a grip on the problems with the food supplements directive and the traditional herbal medicines directive, and on what we are trying to achieve in this country through preventive medicine, an improved diet, more and better labelling, and reduced sugar and salt intake—the whole package. The hon. Lady's predecessor accepted a delegation of industry manufacturers who said afterwards that they believed that they had been misled. They had been promised that the criteria used would be different, but they believed that the Government had caved in. I urge the Minister to reconsider the issue.
I am mindful of your warning about time, Mr. Deputy Speaker, and of my desire to help other colleagues. I want to talk briefly about the situation overseas. In the United States, about 50 million adults have high blood pressure or hypertension, about 700,000 die from heart disease each year, and 166,000 die from strokes. It is estimated that the average American blood pressure would drop by 5 mm Hg if US food manufacturers were to reduce by half the levels of sodium in their products over a 10-year period. As a result, the country would experience a 20 per cent. reduction in high blood pressure, a 14 per cent. reduction in death from strokes and a drop in overall deaths of 7 per cent. Such a change in sodium content would save 150,000 lives a year.
The World Health Organisation has been mentioned. Its teams evaluated the cost-effectiveness of 17 measures aimed at preventing cardiovascular disease worldwide, including what it calls non-personal measures such as media messages about the importance of blood pressure, body weight, cardiovascular disease and cholesterol counts, and personal measures such as being screened and, if necessary, being treated for high blood pressure and elevated cholesterol. The WHO found that the measures, which include moves to cut salt from the food supply, could be very cost-effective. The Minister should take note of its conclusion that Government action to reduce salt appears to be more effective than voluntary efforts. The WHO is behind us on the issue.
The Food Standards Agency wrote a letter to me that was addressed, "Dear Colleague." I thought for a moment that the chairman had been elected to the House of Commons, because we use that form of address in the House. The letter said that the agency was taking action. I would not say that my early-day motion in February had influenced that decision, but as my hon. Friend the Member for Totnes knows, early-day motions are tabled and press releases can be issued. Nevertheless, the Food Standards Agency has committed itself to achieving a 10 per cent. reduction in average salt intake. That is welcome, although 6 g a day is still too high. Some progress has been made, but not a lot.
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I am a great fan of Westminster Hall. The debates are often very good and we have a range of expertise here this morning. What we have heard so far must give us all hope. We know that we are dealing with a serious issue that must be addressed. I look forward to hearing further contributions.
Mr. Deputy Speaker: Order. I will call the hon. Member for Angus (Mr. Weir) if he promises to take no more than three or four minutes.
10.29 am
Mr. Michael Weir: Much of what I would have said has already been said, so I shall be brief.
It has long been recognised that Scotland has a health problem because of poor diet, and salt is a contributing factor in the high incidence of heart disease and cancer. A Scottish health survey of 1998 reported that 33 per cent. of men and 28 per cent. of women suffered from high blood pressure. However, there are huge variations in that overall statistic. The figure for men in the younger age group of between 17 and 24 years of age is much lower: it is only 10 per cent. The figure for those in the older age group of 16 to 74 rises to about 76 per cent. Women showed the same general trend.
Those of us who have passed the mid-point of our 40s will be all too familiar with general practitioners regularly taking our blood pressure and advising us to reduce our salt intake. Most of us have probably taken that advice and at least moved to low-sodium alternatives. However, that will do us no good if a lot of the food that we eat is heavy in salt or sodium. We could, of course, stop eating pre-prepared food, bake our own bread and so on, but for practical purposes that is impossible in the lives that we lead.
A serious problem that concerns me as a father and which has been mentioned by other hon. Members is the effect on children. It is not easy to cut down on children's salt intake. Most children, and not a few adults, are over-fond of potato crisps, some of which are very salty indeed. For example, I stopped buying a certain brand of crisps advertised by the former captain of the England football team—I hasten to add that that had nothing to do with my decision—because they tasted very salty indeed. I instead bought the brand with the separate little blue bag of salt that the hon. Member for Wyre Forest (Dr. Taylor) mentioned. Those crisps have been about for many years under a different name, but, ironically, are made by the same firm, Walkers crisps. Interestingly, when my daughter was given those crisps, she ate them but did not put the little blue bag of salt on them and was quite happy to eat them without the salt, which gives rise to the question whether the salt is required in the first place. That is a small victory, but shows that perhaps the cause is not lost and that reduced salt can work if we push at it.
I am one of those perhaps deeply sad persons who goes round supermarkets looking closely at the labels on the products that they buy. As has been mentioned, one needs a degree in food science to understand much of what is on the labels. It is also worth recalling that it is not always clear from the labels what the salt or sodium content of a product is. Someone with high blood

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pressure might want to know the salt content, but it may be listed as sodium. The salt level in any food might be around two and a half times the listed sodium level, and even then not all sodium may be apparent, because it can come from ingredients other than salt. That is highly important, because, as has been mentioned, 75 per cent. of our daily salt intake is hidden in the food that we eat, which contributes to a large number of strokes. If we reduce that proportion, 50 per cent. of those may be avoided.
Conscious of your constraints, Mr. Deputy Speaker, I shall finish on that point.
10.31 am
Mrs. Patsy Calton: Most of the points that I wanted to make have already been made, but I hope to add a small amount of extra value.
Most people consume more salt than is absolutely necessary; the average is 12 g as compared with the average daily requirement of 6 g. Some 75 per cent, of our salt comes from processed foods, which makes it more difficult for people to understand exactly what they are taking in. Salt comes from ready meals, and canteen, restaurant and fast foods. I would particularly single out restaurant and fast foods rather than ready meals, because at least when one buys something from a supermarket there is a label on the packet if one cares to look for it. However, all of us over 50 suffer from a problem with labels in that we have considerable difficulty in reading the text if it is in 6 or 5 point type, and usually have to take our glasses off to do so.
There are large quantities of salt in foods; for example, the hon. Member for Wyre Forest (Dr. Taylor) said, I think, that there was 1.9 g of sodium in the sandwiches that he had for lunch yesterday, which represents 76 per cent. of his recommended daily intake. It is worrying if we can buy or are enticed into buying such food in this place. The figures in the hon. Gentleman's example probably included the filling, because I checked the bread that I used to make toast this morning and it had less than 0.1 g of sodium, so I thought, "Well, that's okay then." I can usually control my salt intake until lunchtime, but once lunchtime comes in this place it goes haywire. When I was preparing for the debate I first thought that I would check how much salt I eat in a day. I was doing well until lunchtime, but my husband got to the Red Lion pub ahead of me and ordered me a cheese and bacon sandwich, which threw the whole thing out for that day. I was also very much aware of the extra water that I needed to drink for the rest of the day.
The Food Standards Agency and the Department of Health have proposed a reduction of 25 per cent. in salt levels in processed foods as a first step. We should strongly support that recommendation. We need a staged process that deals not only with salt, but with a healthy, balanced diet and exercise as part of our lifestyle. It is not sufficient to talk simply about salt and sodium. However, we must be careful not to overstate the case. It has been recognised in the past few years that one problem with diet is that once officialdom recognises one issue—body mass, for example—some people go to the opposite extreme and we see all the difficulties of eating disorders, such as anorexia and bulimia. We do not want people to try to cut salt out of their diet completely. That would be a great shame.
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The Scientific Advisory Committee on Nutrition has concluded that the evidence for a direct link between salt intake and high blood pressure is now much stronger. The hon. Member for St. Albans (Mr. Pollard) said that the way in which we grew in knowledge of this issue was similar to what happened with tobacco. There is a link in terms of public perception. We now believe that there is a direct link between salt and blood pressure, but we have not quite got the final piece of information. What we do know is that people who suffer from hypertension will reduce their blood pressure by reducing their salt intake. That is important research, important information for us to have and a good pointer in the right direction. Although there is evidence that does not show a direct link between salt intake and blood pressure, the information that we have indicates that reducing our salt intake would do most of us no harm and some of us a great deal of good. It would be sensible to ensure that we move forward on that basis.
There are three areas in which we can do something about this issue. However, it is complex, and several steps must be taken into account. We need to worry about what is happening with children. Baby foods and the amount of salt in them are already strictly controlled. The problem arises when children move to the next stage of nutrition and start to eat normal adult foods. That is when they are likely to be overloaded with salt.
I shall conclude shortly, because I am aware that other hon. Members want to speak. As I suggested, there are three areas in which we must work much harder. First, we need a standard food labelling system to make it clear to consumers exactly how much salt is in a product. I accept that we are talking about whole populations, but when populations are examined, we see that it is the activities of individuals that make a difference. Individuals must therefore be able to work out exactly what they are taking into their body and take informed decisions about that.
Secondly, manufacturers should gradually reduce the salt content of foods. That should be encouraged by whatever means the Government have at their disposal. Thirdly, steps must be taken to increase public awareness of the potential risks of an excessive salt intake, with an emphasis on the importance of a healthy, balanced diet combined with physical activity.
Together, those three steps would enable the public to make an educated choice and perhaps assist them in preventing the ill health resulting from strokes and so on that is likely to come later, and the premature deaths that could well occur as a result of raised blood pressure, which an increased salt intake is thought to produce. We need to be slightly careful about assuming that there is a direct link, because we do not know that yet.
With hon. Members' indulgence, I should like to conclude by thanking my temporary researcher, Helen Kearney. She is a student on work experience and she is here today. I thank her for the work that she has done on this issue and I hope that she found it interesting. I praise her school for producing such an interested and interesting student.
10.39 am
Chris Grayling: I congratulate my hon. Friend the Member for Totnes (Mr. Steen) on securing the debate and on making a powerful speech. Judging by the speeches from both sides of the Chamber, there is general concern about the issue, as well as a general awareness that we must deal with it if we are to improve the food environment.
My hon. Friend made some important points. He said that salt had taken a terrible toll on the health of the nation, and he set out some reasons for that. His remarks encapsulated very well the public health problems that we face, and he gave practical examples. He talked about salt in cornflakes, lasagne and even mineral water, although, judging from the contents label on the bottles in the Chamber, we would have to drink 20 to 25 cases to reach our daily allowance. I do not think, therefore, that mineral water poses an imminent health threat.
My hon. Friend hoped that the debate would act as a beacon of awareness to the nation. I would like to think that many people outside are listening with rapt attention, but I suspect that we shall all have to do much more work to build awareness of the problems.
My hon. Friend referred to developing ideas that could help to tackle those problems. He talked about labelling, and his comments were echoed by the hon. Member for Cheadle (Mrs. Calton). There is general agreement that labelling must be smarter and more effective, and that the message must be clearer for consumers who do not fully understand the health issues around salt. In that respect, I sense consensus in the Chamber that improved food labelling is a non-controversial way of educating shoppers who buy products that contain excess salt. It is also a way of encouraging the industry to look for ways to reduce salt.
My hon. Friend talked about the possibility of low-salt items being highlighted on menus in restaurants. Clearly, there is increasing labelling on menus nowadays. It started with vegetarian food, and vegan foods are now sometimes labelled, too. It is even becoming commonplace to see gluten-free items. I see no reason why restaurants should not be free to put low-salt items on their menus as well. However, I suspect that that is not really the answer and that we need lower salt levels across the board rather than in just some dishes.
The hon. Member for St. Albans (Mr. Pollard) made a thoughtful contribution, which was clearly based on his experience. I was glad that he clarified his position on the comparison with tobacco, a point also raised by the hon. Member for Cheadle. There is a danger in pursuing such an analogy too far. The important difference is that tobacco is a direct contributor to ill health, whereas salt is an essential part of our daily diet. Too much may be bad for us, but too little is equally bad. If we create the sense that salt is a demon like tobacco, we shall do people a disservice.
Mr. Pollard: I was trying to make the point that we and our children are being force-fed salt and have no control over that. A distinction can be made as regards tobacco, because people can choose whether to light a
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cigarette and put it in their mouths. That was the point made by my hon. friend the Member for Dartford (Dr. Stoate).
Chris Grayling: I accept that point and the desirability of reducing salt in food. However, salt is part of a balanced diet, and we do not want the consumer to believe that it must be avoided at all costs. As with fatty foods and other foods about which there is a health issue, we need balance not prohibition. That is why I raised concerns about some comments that have been made.
Mr. Steen: Does my hon. Friend agree that what is required is a little health warning—perhaps something along the lines of "Too much salt could damage your health"?
Chris Grayling: That is a fair point. Public education should get that message across, just as it has done with fatty foods. I shall return to education in a moment.
The hon. Member for Wyre Forest (Dr. Taylor) made the extremely important point that in an age of industrial production, food is often tasteless and needs additives to pep it up and make it attractive to the consumer. I want greater expansion of organic farming, and more use of traditional methods, although I recognise that in a modern, industrial society we cannot wholly leave behind industrial farming methods and it would be wrong to do so. However, the agricultural sector has a duty to explore ways of ensuring that the products of industrialised forms of farming have the taste that makes it less necessary to put salt in food.
The hon. Member for Dartford gave his views on banning advertising to children. He and I have debated the issue before; I have great anxiety about taking the route of regulation rather than education. The hon. Member for St. Albans mentioned using force, and I have genuine concerns about that, although I shall not rehearse the arguments at length. I understand the motivation for wanting to pursue the issue, but in an era of 24-hour news channels, multichannel satellite television and a variety of marketing ways to reach consumers, enforcing a ban and defining the territory in which it would apply would be difficult.
Dr. Stoate: The hon. Gentleman and I do not see eye to eye on the matter because manufacturers of processed foods that are high in salt have huge advertising exposure and make large profits, but there is no profit in healthy and natural foods. Therefore, the advertising that kids are exposed to is completely unbalanced. I am merely calling for balance.
Chris Grayling: My view is that we should try to educate consumers. The trend in recent years has been for manufacturers to start producing healthier options. They have taken a step along the way, although there may be further to go. The more they can see the benefit of responding to genuine market need, the more likely it is that there will be a change in consumers' behaviour. I am not persuaded that telling people what to do or cutting them off from a section of marketing will deliver that objective; only education can do so. The difficulty is in deciding where to draw the dividing line if bans or restrictions are to be imposed in marketing foods—for

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example, when is a food healthy? Who decides whether it is appropriate to market a food? Legislating in that respect would be extremely difficult.
Mr. Pollard: The hon. Gentleman is talking about choice, but as I said, people do not have a choice: they are being force-fed the stuff. That is why legislation may be necessary.
Chris Grayling: It is my hope and belief that the retailers and manufacturers are taking steps in the right direction, as the hon. Member for Dartford and my hon. Friends the Members for Totnes and for Bosworth (Mr. Tredinnick) said. There may be a long way to go, but the retailers and manufacturers deserve credit for the improvements that have been made. We need to go further; society is afflicted by obesity and is becoming aware of the problems caused by excessive salt intake. These are not the only issues relating to food and nutrition. The food industry must play a core role in helping to address some of the problems. However, we will solve them only in an environment in which the consumer wants a healthier product and there is money to be made in delivering it. We must start the process with public health education.
The hon. Member for Dartford said that people are aware of the personal impact of eating less, being slimmer and having a healthier diet. We must extend that awareness to salt consumption; parents need to know that if they allow their children to consume excessive amounts of salt, they will be less healthy. Parents must want to take the purchasing decisions in the supermarket on a Saturday morning that will deliver healthier products to their children. That must be our priority.
There should be a national debate about salt, and better public health education about the implications of excessive salt consumption. An effective partnership with the industry would encourage it to push at the margins of the market to persuade consumers to try new products. Providing better labelling and information would mean that consumers were better able to take rational decisions by looking at the side of the pack and saying, "I want that, but not that". That is where the Government's priorities should lie.
I commend all hon. Members for their contributions to this extremely important public health debate. I hope the process will continue. I stand by the view "educate, not regulate", and I call on the Government to put real effort into the "educate" part.
10.50 am
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I congratulate the hon. Member for Totnes (Mr. Steen) on his success in securing this important debate. I also welcome the contributions of all who have participated.
High blood pressure, also known as hypertension, is common in the UK. It is a major risk factor for cardiovascular disease, stroke and premature death and a contributory factor in more than 170,000 deaths a year in England. The Government are committed to reducing deaths from heart disease. The recent World Health Organisation project on the burden of disease indicated
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that 50 per cent. of deaths and disability could be prevented by national and individual action to reduce major risk factors such as high blood pressure.
Reducing average salt intake is likely to decrease the burden of high blood pressure and improve public health. Our action to reduce the population risk of developing high blood pressure is multi-pronged. It touches on the contributions of a number of hon. Members, because it includes cutting the level of salt in the diet along with encouraging children and adults to eat more fruit and vegetables, maintain a healthy weight and be physically active. All those are needed, and education plays a role.
Sodium is an essential nutrient, and salt is the major source of sodium in our diet. Most people, however, consume more sodium than is required. The latest available data show, as hon. Members have said, that habitual levels of salt intake are high for both adults and children. For adults, average intake is two and half times the amount required, averaging about 9 g a day instead of 6 g. Although accurate data are not available for children, conservative estimates suggest that some children have intakes higher than those of adults.
There is one reassuring fact. Responses to the Food Standards Agency's consumer attitude survey of 2002 showed that 51 per cent. of consumers recognised that they should eat less salt. I shall come on to the point about how salt and sodium are identified in people's minds, but the points made by my hon. Friends the Members for Dartford (Dr. Stoate) and for St. Albans (Mr. Pollard), have been recognised, and that is important.
About 75 per cent. of dietary salt intake comes from processed foods, with the remainder added during cooking and at the table, under consumers' own control. The main sources of salt include cereals and cereal products and meat products, which together contribute more than 50 per cent. of the average salt intakes. I should make a point about the figures on what people buy and eat. One thing that has emerged from my discussions is that it is important to be aware of how much of certain things one eats. Although salt in bread has been reduced, bread can still be an issue because we eat a lot of it. Conversely, although some products contain a high concentration of salt, if one eats a small amount of them the fact that they are very salty might not matter.
Our target is a reduction from 9 g to 6 g a day, as recommended in the 1994 report by the Committee on Medical Aspects of Food and Nutrition Policy. A large body of opinion favours a general reduction in salt consumption, which we recognised in the White Paper "Saving Lives: Our Healthier Nation" and in the NHS Plan. We made a commitment in the plan to work with the food industry and the Food Standards Agency to improve the overall balance in the diet of salt, fat and sugar. That was endorsed by the Chief Medical Officer, and, in 2001, the Scientific Advisory Committee on Nutrition, which replaced the Committee on Medical Aspects of Food and Nutrition Policy, also made recommendations for children. Its report on salt and health was published on 15 May 2003. It concluded that the target intake of 6 g of salt per day for adults, set by the Committee on Medical Aspects of Food and

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Nutrition Policy, remained valid, and that the evidence that salt intake was directly associated with blood pressure was even stronger.
The Scientific Advisory Committee on Nutrition also concluded that lowering the average salt intake of the population would proportionately lower average blood pressure and confer significant health benefits. However, I understand that if someone lowers their salt intake, that will lower their blood pressure, but having had a higher salt intake will already have done some damage; they will not return to the levels that they might have done, had they had a lower salt intake throughout their diet.
For infants and children, significant health benefits would be gained from a reduction in average salt consumption. The Government accept the Committee's recommendations and have taken action to bring the report to the attention of all the stakeholder organisations known to have an interest in salt as a public health issue, including the European Food Safety Authority and all the EU food agencies.
The required reduction in average salt intake by one third is substantial and will need concerted action by all, including the food industry—manufacturers, retailers and caterers, all of whom have been well represented in contributions to the debate—and consumers, and will need support from a range of stakeholders including the Government.
The Government are taking action on three fronts: encouraging people to reduce the salt that they add to their food, encouraging them to reduce the salt content of the foods that they buy, particularly processed foods; and providing consumers with helpful information on food labels.
Labelling was raised by several hon. Members. I understand why that topic is important, although, judging by some hon. Members' remarks, I would guess that they have not often done the family shopping. I am an expert on doing the shopping, so I know a great deal about what is to be found in various stores and their labelling arrangements.
The current labelling arrangements require sodium, rather than salt, to be specified. We are making representations to the European Commission on changing those arrangements, which would need to be done on a single market basis. That would allow us to
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label products as containing salt rather than sodium. Negotiations are under way, but have not yet reached a conclusion.
Mrs. Calton: There is a problem with the term "salt". Perhaps "salt equivalent" would need to be used. Sodium ions cause the dietary problems, and if "salt" alone was used, sodium from other sources might be missed.
Miss Johnson: I thank the hon. Lady for her remark and for her contribution to the debate. It is also possible to use a separate labelling panel to indicate salt content, as several retailers and others have already done. We would be in favour of the salt content of foods being made clearer to consumers, and it is not currently illegal to use a separate labelling panel to do that. However, I accept that people have a problem in linking the sodium and salt contents. It is good news that people recognise that salt is an issue, but we need to make the link to sodium as strongly as we can.
Mr. Steen: What about a warning—a little sign similar to the ones that appear on cigarette packets—that salt may cause damage to health?
Miss Johnson: Many aspects can be included in labelling, but there is a problem with continually adding things to labels. One problem with reading labels in supermarkets is that they contain a lot of information, and the more that is included, the less space there is to include detail, particularly on smaller products.
Since 1998, the salt content of bread has been reduced by between 7 per cent. and 21 per cent., depending on the product. The largest salt reduction has been in white loaves—21 per cent.—and the salt in wholemeal bread has been reduced by 10 per cent. Considerable achievements have therefore been made. However, I agree with hon. Members that more work must be done on all those fronts. That is why the Government are pursuing the strategy of examining ways to reduce the salt content of individual foods, and to ensure that labelling, consumer education and healthy eating are at the top of our agenda.
Mr. Deputy Speaker: Order. May I ask hon. Members who do not wish to stay for the next debate to leave quickly and quietly? I hope that hon. Members can find their way back to the Central Lobby.

Access to the Countryside
11 am
Mr. Francis Maude: I am grateful for the opportunity to raise the case of my constituents Robin and Jane Loder and the experiences that they have had in relation to the Countryside and Rights of Way Act 2000. I have notified the Minister in advance of the case that I shall raise, so I hope that he is in a position to respond to the detailed issues.
Leonardslee Gardens in Lower Beeding in West Sussex is one of the wonders of England. Situated in the High Weald area of outstanding natural beauty, it has been created over 150 years by four generations of the Loder family and is home to one of the most interesting collections of flora in the world. It is especially famous for its collection of rhododendrons, which, in the month of May, flower so spectacularly that I would not be surprised if Leonardslee were visible from space. Indeed, the species rhododendron loderi was developed by Robin Loder's forebears at Leonardslee. Today, it is owned and managed by Robin and Jane Loder.
Like his forebears, Robin is a fanatical gardener and botanist, who has written extensively about natural flora. However, Leonardslee is no rich man's plaything. Open to the public—as it is for eight months of the year—it is the only source of livelihood for Robin and Jane, and for the eight full-time gardeners who work there. It also provides seasonal employment for a further 50 or so people.
Before 1987, only about half of Leonardslee's 200 acres was open to the public. The rest was very mature woodland, with many trees of such an age that they were a danger to the public. The hurricane of October 1987 changed all that. Standing four-square in the path of the storm, Leonardslee was devastated. In the 60 acre area of Leonardslee with which I am concerned today, 3,000 trees were lost; only 740 were left standing. The entirety of a unique 1902 pinetum was destroyed, and even in the least affected area, 75 per cent. of the trees were destroyed. Overall, Leonardslee lost 10,000 trees.
In the years following, Robin Loder repaired the damage and used the opportunity to revitalise an extraordinary, but completely artificial piece of English landscape to the extent that, in 1993, the 60 acre area joined the rest of Leonardslee in holding a grade 1 classification in English Heritage's register of parks and gardens. That accolade is a fair reflection of what generations of Loders—Robin certainly not the least among them—have accomplished. What has been done there is in every way admirable. Leonardslee is open to the public, it gives employment, it has added to the store of scientific knowledge, and it is organically managed. It is a unique, beautiful and magical place, which has become so, and remains so, through the expenditure of enormous amounts of hard work and considerable sums of money.
In November 2001, the Loders discovered—through the Countryside Agency's website, not through the courtesy of a letter or a telephone call—that two thirds of the area of Leonardslee currently open to the public had been mapped as open country with open access for
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the public. Open country is defined by the CROW Act as land that
"appears to the Countryside Agency to consist wholly or predominantly of mountain, moor, heath or down."
The 120 acres so mapped are intensively managed ornamental gardens, and parkland grazed by deer and, for more than a century—rather eccentrically—by wallabies. It is an area that was, until the 1987 storm, heavily wooded.
Following an initial response by the Loders, half of that area was removed from the provisional map. Some 60 acres remained in two adjoining parcels, which the Countryside Agency continued to maintain were open country within the meaning of the Act. The area was almost exclusively heavily wooded before 1987. In the past 10 years Mr Loder has allowed part of it to regenerate naturally as woodland in order to create a shelter belt, so that he can replant the 1902 pinetum, which contains a variety of more or less tender trees. That process has now started. That natural regeneration has been heavily managed, as it needs to be, to ensure that the trees that grow—mainly birch—are of good quality and enhance the aesthetic appeal of the place.
Leonardslee is plainly neither mountain, moor nor down. The argument is about whether any of it can sensibly be described as lowland heath. The only definition of heath appears in paragraph 68 of the Countryside Agency's mapping methodology, which says that heath is
"land of a generally open character, usually characterised by natural ericaceous dwarf shrubs."
The definition continues:
"The typical vegetation types are heathers, gorse, bilberry, mires, scrub, unimproved grassland, and bracken."
Area E, the smaller of the two parcels of land, cannot reasonably be said to display those characteristics—it is basically grassland and some regenerating woodland. However, that is the only relevant quality, as the Countryside Agency admits. Had that area been heavily wooded, as it was before the storm, it could not have been classified under the Act. Area F, the larger area, was also heavily wooded, and will be so again as a result of the progressive planting undertaken since. It does, however, contain a small area of some 5 to 7 acres that exhibits some of the characteristics of genuine lowland heath.
Robin Loder rightly appealed against the decision. The appeal was scheduled for August, and now, at the eleventh hour, the Countryside Agency has said that it will not contest the appeal, albeit on limited grounds, to which I shall return. I am especially grateful for the care and courtesy that Sir Ewen Cameron, the chairman of the Countryside Agency, has devoted to the case. It might therefore be thought that there has been a happy outcome to the episode. However, I cannot overstate what a torment the affair has been for Robin and Jane Loder. They have seen an arm of the state take an apparently arbitrary, almost whimsical decision that would, at a stroke, have deprived them not only of their livelihood but of the life's work of Robin Loder and his distinguished forebears. The situation has cost them many tens of thousands of pounds in professional fees even thus far; had the appeal continued to its contested conclusion, that sum would probably have been doubled. The financial cost has been severe enough, but

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the emotional and mental toll that the episode has taken has been immense. Robin and Jane Loder deserve recompense for what the state has subjected them to, and I intend to see that they get it.
I should like the Minister to respond to my concerns. First, the process has been appalling. There has been no consultation and no discussion. Whenever surveyors have visited, they have refused to enter into any discussion with the custodians of the property, and have therefore denied themselves the opportunity to understand the history and background of that certainly unique piece of land. The surveys have been cursory and poorly documented, and the report from the last survey, in March 2003, has neither been supplied to the appellants nor referred to in the agency's statement of case. I ask the Minister that that report be now provided.
These procedures are inefficient from the agency's point of view, because they inevitably lead to such expensive mistakes. However, it is also contrary to natural justice for the state to be able to intervene regarding private property without the owners' having any opportunity to make their case at an early stage. I ask the Minister to institute an urgent review of the procedures to ensure that the demands of basic natural justice are met.
Secondly, the decision to map the area as heathland is incomprehensible. The Countryside Agency's own survey map tells the whole story: area E is described as half acid grassland and half regenerating woodland. It is accepted that the presence of those two types of cover is compatible with an area's designation as heathland, but only in the sense that their presence does not stop the area being heathland overall. I know of no definition under which the presence of acid grassland and regenerating woodland on their own make an area heathland. According to the agency, area E and area F between them include only one small portion, which is no more than 13 per cent. of area F—the 5 to 7 acres to which I referred—which is described as "heathland/acid grassland mosaic." The term mosaic is important, because it clearly conveys that the land so described is only partially heathland. That clearly means that it is not "pure" heathland, if such a concept exists. In the tick-box survey form that the agency completed in May 2002, the box for heathland in the section on "qualifying land cover" was left unticked. The only type of cover that could definitively make the area heathland was not found. Other cover types that were ticked—acid grassland, bracken, scrub and scattered trees—are all compatible with heathland, but do not make an area heathland.
The agency's statement of case wilfully misstates the position by asserting that
"a mosaic of heathland and acid grassland is the predominant ground cover".
The agency's own plan, which I have to hand, gives the lie to that assertion. It makes it clear that only 13 per cent. of the area is such a mosaic, yet it stubbornly adheres to its original conclusion, even in the face of its own evidence. Even at the point of concession 10 days ago, it continued to maintain that the ground cover was heathland, with that dogged, dogmatic refusal ever to
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admit error so typical of Government agencies that so enrages law-abiding citizens and makes them utterly determined to pursue their grievances against the state to the last farthing.
The concession letter states:
"We would, however, wish to make it abundantly clear that the Agency does not accept the appellants' assertion that the land is regenerating woodland and, therefore, not heathland. The Agency maintains its view that the land cover is heath. In addition, the criticisms of the mapping methodology advanced on behalf of the appellants are rejected in their entirety."
That is not a way for Government agencies to behave. It is disgraceful. It avoids the issue of the agency's thoroughly dodgy methodology and definitions being ventilated and tested in a tribunal. The only conclusion that I can draw is that the agency plans to subject other landowners to the same appallingly arbitrary treatment. I hope that the Minister will commit to an urgent review of the methodology and definitions that govern the agency's behaviour.
The third issue relates to a deficiency in the 2000 Act. It is clear that Leonardslee is "park and garden". English Heritage's inclusion of it in its register surely puts that beyond dispute, and it would be "excepted land" under part 1, schedule 1 to the Act. There should therefore never have been a problem, except that the agency is entirely unable to make a definitive and binding statement declaring it to be excepted land, and thus to conclude the matter.
For Robin Loder to rely on the provision, the land would have to appear on the map, and it would be entirely on his shoulders to assert and to defend its "excepted" status against all comers—in the courts, if need be. How can that be just or fair? As it happens, the local chapter of the Ramblers Association strongly supports the Loders' case, but that might not have been so, and it cannot be right for matters of such importance to be left to chance in this way.
At the very least, I hope that the Minister will commit to amend the 2000 Act to enable exception to be dealt with at the mapping stage, so that land such as Leonardslee that is so obviously excepted can be taken out of the equation at the start of the process and so that people like Robin and Jane Loder will not be subjected to all these proceedings.
The fourth issue is that it is surely profoundly wrong that land to which the public already have access on payment of an entrance fee should come under the open-access provisions. Leonardslee could not exist without the paying public, and far from wanting to keep the public at bay, Robin Loder absolutely needs to entice them in. However, Leonardslee is an entirely manufactured landscape and can remain of interest to the public only if it is intensively managed, and that is expensive. Without replanting and intensive grazing by deer and wallabies, even the few acres of quasiheathland that the agency is so keen to get its hands on would swiftly revert to scrub. The type of management involved makes things even more expensive. Organically managing Leonardslee involves, for example, pulling ragwort by hand rather than spraying it, and I know from personal experience that that demands high levels of manual labour. Giving the public free access to land to which they previously paid for access would therefore be utterly self-destructive. The very qualities that made

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the area appealing would evaporate in the absence of the entrance fees that maintained them.
There is, however, a further objection, which, as far as I can discover, was never ventilated when the Countryside and Rights of Way Bill was scrutinised. It is surely objectionable in principle for an economic asset to be expropriated by executive diktat and without compensation. It is arguable that genuine heathland, downland, moorland and mountain, whose economic value lies primarily in grazing, remain economically unimpaired by the advent of open access. However, the entire economic value of such as Leonardslee would be confiscated.
When I raised the issue with the agency's chairman, he responded by saying that the agency would impose restrictions if such properties were mapped and failed to clear the excepted land hurdle. He said that the agency would expect the restriction regime simply to replicate the existing payment regime. There are two problems with that. First, that policy has not yet been finalised and promulgated, so landowners cannot plant on that basis. Secondly, it is a travesty that a landowner should have to go through such a protracted, expensive and emotionally gruelling process to win, at inordinate cost, the right to continue doing what he is already doing. That cannot have been intended in the Countryside and Rights of Way Act 2000. I therefore hope that the Minister will undertake to amend the Act to clarify that it is not intended to apply to land that is already open to the fee-paying public.
This has been a sorry episode, and there will be many others who, like Robin and Jane Loder, have had their lives turned upside down. I hope that the Minister can provide some reassurance that such manifest faults in the system will be put right.
11.17 am
The Minister for Rural Affairs and Local Environmental Quality (Alun Michael): I thank the right hon. Member for Horsham (Mr. Maude) for securing the debate and for giving us an opportunity to discuss the important points that he raises. It was interesting to hear of his experience of manual labour, and I am happy to commend his efforts in pulling up ragwort. As he knows, it is one of the issues that we are working on with the horse industry, because of its pernicious effects. I therefore very much admire the right hon. Gentleman's contribution to tackling the problem.
I shall not reopen issues that were debated when the Countryside and Rights of Way Act 2000 was scrutinised in this House and in another place. I shall, however, update hon. Members on the point that we have reached in implementing the new right of access to open countryside and registered common land. It is worth bearing in mind that some of the processes involved are complex, particularly because we sought fairly to balance people's understandable wish to access and enjoy the countryside against the needs of land managers, including farmers, in managing their land.
The right hon. Gentleman refers specifically to the Leonardslee gardens appeal, but he will be aware that I cannot comment on the merits of the individual appeal. As he said, the Countryside Agency has made it clear that it will concede the appeal. However, he will be aware that an inspector must still formally determine the
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matter on behalf of the Secretary of State. That is because the process is transparent.
The right hon. Gentleman made several criticisms, particularly of the agency and some of its approaches, and I will ensure that those criticisms are examined. I am keen for the agency not only to act fairly and efficiently but to be seen to act fairly and efficiently. I can reassure him that I meet the chair, the deputy chair and the chief executive regularly to discuss its policies and performance, and the implementation of the 2000 Act and the mapping exercise regularly figure on the agenda.
On the case to which the right hon. Gentleman refers, I can confirm that the Countryside Agency has written to the Planning Inspectorate and to the owner, Mr. Robin Loder, to say that it will not contest Mr. Loder's appeal against the showing of land at Leonardslee gardens on the provisional map. Further, I understand that the chairman of the agency wrote to the right hon. Gentleman earlier this month and in summary said that this had been a difficult case, raising issues that the agency had not encountered previously. For that reason it is not right to make a generalised risk assumption.
The agency remains convinced that the land in question met the vegetation criteria for the heath set out in the mapping methodology. It pointed out that there was a unique situation of land within a formal garden, which meant that the land did not meet the provision in the methodology that land should be of a generally open character, which is why the agency decided not to contest the appeal.
The chairman also said that the agency regrets the anxiety caused to Mr. Loder, but assured the right hon. Gentleman that agency staff had acted properly at each stage of the appeal. As I have said, it would not be appropriate for me to comment further as the planning inspector has yet to determine the appeal. I am happy to say more, once the appeal has been formally determined by the inspector. I am sure that the right hon. Gentleman will accept that these are formal legal processes and that in some ways it might have been helpful if we had had this debate after the formal determination took place.
Mr. Maude: Given what the Minister helpfully says—that this has been a test case, which has enabled a number of difficult issues to be tested and resolved within the agency—I hope that he will go on to say that it would be appropriate in the circumstances for the Loders' expenses, which are considerable, and have been incurred almost in the role of guinea pig for the agency, to be reimbursed.
Alun Michael: I think the right hon. Gentleman knows the answer to his own question, which is that I am not going to say more about this case until the appeal has been finally determined. I hear what he says and I have said that I will look at the case with the agency to see what wider lessons might be learned and what further can be said in response to the criticisms and points that he has made in the debate once the appeal has been determined.
It is worth making the point that the agency must map all land that appears to those undertaking the mapping to consist of open country or registered land. But the right of access will not necessarily apply to all the land

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that appears on the agency's maps; that is of the essence of the three-stage approach that is set out. The Act recognises that within areas of open country or registered common land there will be land that should not be open for public access. Such land is described as "excepted land": gardens, parks and cultivated land are among 13 categories of land specifically excepted from the right of access, even though they may be shown on the agency's maps.
The purpose of the excepted land provisions is to provide flexibility. The agency's maps will last up to 10 years. Over that period, land currently shown as open country or registered common land may become excepted, and excepted land may change its use so that the right of access applies to it. The agency has no power to remove excepted land from its maps of open country and registered common land. The agency's maps can only show the current extent of excepted land, so people walking in the future may be misled into thinking that land is open for access when it is not and vice versa.
In any case, I am not convinced that walkers will use the agency's statutory maps as their main source of information on land that is open for access. As a walker myself, I go to the source of Ordnance Survey maps, as I am sure most people do. However, I assure the right hon. Gentleman that we recognise the benefits for landowners and walkers alike of giving people as much information as we can to help them understand where they can and cannot walk. It is also fair to say that both the agency and the Department for Environment, Food and Rural Affairs are learning lessons as this unique process is carried through as a result of the CROW Act.
All the bodies involved in the roll-out of the new right of access will undertake extensive publicity to ensure that people understand the right and the accompanying responsibilities. We are working in partnership with our colleagues in Wales, the countryside bodies, the Ministry of Defence and Ordnance Survey to decide how best to identify excepted land in England and Wales. We are also looking to the main stakeholders on this issue, which include the Country Land and Business Association, the National Farmers Union and the Ramblers Association. It is good that those organisations are talking to one another.
That process will be enhanced by the committees at local and county level, which engage people who have traditionally been on different sides of the equation to try to secure a practical outcome for the implementation of the CROW Act and other access issues. We hope that those discussions will lead to a solution that is acceptable to all parties concerned with the implementation of the new right of access.
The right hon. Gentleman referred to landowners wanting to charge for entry to land shown on the agency's maps of open country and registered common land. Again, I stress that I am referring to the issue generally, although he referred to it in specific terms. The agency considers that there are circumstances in which a direction excluding access should be given to allow the owner of access land to charge an entry fee. One principle of the Act is that the right of access should
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not prevent landowners from managing their land. That said, it is important that restrictions and exclusions of access are not abused.
The agency is preparing guidance for the bodies responsible for granting directions restricting or excluding access. Clearly, that guidance must distinguish between cases in which there is a legitimate need to exclude access and those in which the intention may be simply to make access more difficult for walkers. I am sure that the right hon. Gentleman would accept that distinction.
I can assure the right hon. Gentleman and the House that we are making good progress towards implementing the new right of access by the end of 2005, as has always been the intention. I have announced that I intend to roll out the right on a region-by-region basis, starting in the summer of next year. We are on course to achieve that, but we cannot predict with certainty how long it will take to determine appeals against the showing of land on the maps. Everyone involved in the process is learning as it continues.
Last week, we laid regulations to give the agency powers to correct minor errors on its maps of open country and registered common land. Those powers will assist the agency in its determination to ensure that the maps are as accurate and comprehensive as possible. The powers will also, in a minor way, simplify part of the process. We aim to lay regulations shortly on exclusions and restrictions of access.
At every stage in the process, we have sought to balance the sometimes conflicting demands of land managers and users of any new rights of access. We consult widely on all our proposals and seek to include as many people as possible in our decision making.
We are working closely with the agency to consider how the new right of access should be managed and what funding streams are available to assist. This is not just a matter for central Government. We are encouraging local authorities to think hard about the benefits of the right that will accrue to local communities and about how to make the most of that exciting opportunity. It is significant for the economies of many areas. Access and things such as the national trails have an enormously important impact in drawing people to an area and enabling the local economy to benefit. We expect the new right of access to benefit local communities by bringing more walkers into the countryside and increasing local economic activity. I am convinced that local communities will see benefits as a result. What could be better than a walk in our glorious countryside followed by lunch in a village pub?
As the right hon. Gentleman said, the process is complex and individual cases raise important issues. I have given him an undertaking that I will consider the issues that he raised once the case to which he referred has been determined, and that I will respond to him further then. As I said, it would not be appropriate for me to say more during this debate, although I greatly welcome the debate.
11.29 am
Sitting suspended until Two o'clock.

Equal Pay
2 pm
Judy Mallaber: I am pleased to have secured this debate on equal pay for women and men.
What is today's debate about? It is simple to describe. The pay gap between women and men is 19 per cent. for full-time workers. For those working part time, the gap is 41 per cent. Hourly earnings of women part-time workers are just 59 per cent. of men's earnings, and the position has not changed for 25 years. The problem is much harder to eliminate. Even though pay discrimination has been illegal for 33 years since the passing of the Equal Pay Act 1970, inequality remains horribly stubborn. It runs from top to bottom and cuts across all sectors of employment. There are the well publicised cases of pay discrimination claims in City firms; for example, the share analyst, Julie Bower, won £1.4 million from Schröder Securities for a discriminatory bonus scheme, and the cleaner, Dawn Ruff, at Hannant cleaning was paid 60p less an hour than her male colleagues doing equivalent jobs.
That is why the all-party group on sex equality wanted this debate. Its chairwomen, my hon. Friend the Member for Cardiff, North (Julie Morgan), tabled an early-day motion on the subject, which has 129 signatures so far. It is such a wonderful a motion that, until I secured this debate, I was convinced that I had added my signature to it. To my horror, I discovered that I had not signed it, but now I have. I know that my hon. Friend hopes to intervene on this debate, but she must also attend a worthy Committee that is considering the Female Genital Mutilation Bill. I place on record our thanks to her for her work on the all-party group, and to the Equal Opportunities Commission for helping the group and providing briefings for Members today. I also thank my union, Unison, the TUC and firms in my constituency for providing information.
The all-party group welcomes the steps already taken by the Government to redress the pay gap, but we call for further action to give the strongest possible positive lead to employers and to highlight the problem, about which we have not done enough despite it being such a long-standing and deep-seated problem.
I am delighted to introduce the debate because I have worked on the issue of pay equality all my adult life, beginning many years ago—more than I care to remember—on the women's rights committee of the National Council for Civil Liberties with, among others, the Minister's boss, my right hon. Friend the Secretary of State for Trade and Industry. We were tackling pay inequality, and promoting equal pay for work of equal value.
At that time, I worked for the National Union of Public Employees and wrote its documents on a statutory minimum wage, until we finally persuaded our party that the principle was not an interference on free collective bargaining, but a positive measure in tackling injustice and poverty. It can be one of the most effective tools with which to tackle women's pay. Some 1.5 million people benefited from it when it was introduced. Some 70 per cent. of them were women and two thirds of them were working part time. For the most recent date for which figures are available, 1.8 million workers in Britain, of whom 1.35 million are women, were
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earning less than £4.50 an hour, which will be the minimum wage rate from October this year, as recommended by the Low Pay Commission. I welcome that increase, but my request to my hon. Friend the Minister is that the Government should ensure continued increases in the future. We need increases that are significantly above inflation to help to tackle the pay gap and promote improvements for those on the lowest pay.
I was proud to serve on the Committee that considered the National Minimum Wage Act 1998. I was on the Committee with the hon. Member for Buckingham (Mr. Bercow), and I hope that he will later recant the many hours that he made us spend, sitting through the night, telling us what an absolute disaster the minimum wage would be—the end of civilisation as we knew it. I know that he is an advocate of equal pay, so I look forward to his telling us that he now totally supports the minimum wage and the increases in it.
Pay matters. We all know that. It directly affects our standard of living. It shows how we are valued by our employers and society, and it can affect how we value ourselves. What does it say about the importance of women's work that they are paid so much less than men? How is that regarded? Pay inequality and secrecy about pay is bad for business. It can demotivate staff and lead to the loss of good, experienced staff. Pay inequality follows women into retirement and into pensioner poverty.
This is a complex issue that will require determined work on various fronts. We have seen the gap and how little progress we have made in the past 33 years. The causes of the pay gap have been and can be analysed under three main headings: straightforward discrimination, occupational segregation and the effects of the unequal impact of caring and family responsibilities. On pay discrimination, employers that I have asked have said to me, "We do not have a problem here, because we have equal pay rates. We pay men and women the same. There are no problems." However, employers often think that they are all right—that there is no problem—because they are looking only at basic pay and salary rates. Equal pay covers all elements of a pay package.
I am a strange anorak. I recall that, when I was working for the union, I used to love getting the pay statistics from local government employers. I would pore over those with great delight. At that time, the cook and the dustman, for example, were on the same basic rate, but the pay differences between them were substantial. One got a bonus and the other did not.
Other issues relating to unsocial hours payments, company cars, pensions and holidays all come into the pay package. Equal pay also means paying men and women the same, even if they do different jobs if they are jobs of similar worth, or jobs that can be evaluated as being equal.
Joan Ruddock: My hon. Friend is speaking about local government, so I wonder whether she has seen the excellent paper produced by the GMB, the Transport and General Workers Union and Unison on term-time working? That mainly affects women who are employed in term time, but who are

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often not paid for holidays and are on low rates of pay. Will she consider that issue, because it involves direct discrimination of the kind that she is discussing?
Judy Mallaber>: I thank my hon. Friend for her intervention. I used to help to negotiate pay rates and conditions for school meals staff and cleaners, so I am aware of that problem. Indeed, I recently attended the rally organised by the unions. I hope that we can take that point on board positively.
Because there are so many factors involved, we need employers to analyse their pay structures properly if they are to identify why men and women receive such different deals on pay. I welcome, as I am sure all hon. Members in the Chamber do, the Government report that has asked employers to carry out pay audits. I also welcome the development of the equal pay questionnaire to help employees to take up questions and concerns about unequal pay with their employers, and the Equal Opportunities Commission equal pay toolkit.
Julie Morgan: Does my hon. Friend not agree that it is important that help is given to small and medium-sized businesses, so that they are able to analyse their pay practices? Is she aware of the high-tech guide for small businesses issued in Wales by the EOC in conjunction with the Welsh Development Agency? That is aimed especially at such firms to help them analyse their pay practices and move forward. Such businesses do not always have the resources available to large bodies and public bodies. I am sure that she will recognise that that is important in Wales, because two thirds of the people there work in small and medium-sized enterprises.
Judy Mallaber: I thank my hon. Friend for her contribution. That is important. I did an interview earlier with my regional BBC. I was asked whether employers would say that that was just another burden on them. I do not think that it is a burden—it is useful for businesses to have a good, fair pay structure. However, they need help with that and it is important that we have guides to make it easy for them to produce one and that say that this is not a complex exercise and that they will be given as much help as possible so that they are able to carry out the audits.
There are several issues that I shall add to the debate and ask the Minister to consider. First, the recent research from the EOC shows that only 18 per cent. of large employers and 10 per cent. of medium-sized employers have embarked on pay reviews. But, if they do not do so, they may not realise that there is inequality in their organisation. The immediate reaction is for organisations to say that they do everything properly, because they do not obviously discriminate. I call on my hon. Friend the Minister to ensure that the Government make a great effort to highlight pay audits and the assistance and advantages available to employers. The Government need to put the same effort into this issue as they do in promoting tax credits, family friendly and flexible working rights and so on.
Secondly, it is important to monitor progress on the equal pay audits. I do not suggest that there should be compulsory pay audits, but if progress is not being
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made, we will have to consider what more can be done. Otherwise, closing the pay gap will take decades. We have already waited 33 years and we cannot wait for ever.
Thirdly, we should use the power of the public sector and ask all private sector contractors employed by the Government to complete a pay review before contracts are agreed. The growth in the contract culture makes it difficult to apply many of the employment practices and employment legislation in our economy. For example, the Equal Pay Act 1970 cannot be used if comparisons cannot be drawn because people are employed by different employers, even if they are carrying out work as contractors for the same organization.
Fourthly, I welcome the TUC equal pay pilot project, which has been funded by the union learning fund. In the Committee on the Employment Bill, which was enacted in 2002, Opposition Members were fine about family friendly flexible hours but what drove them doolally and bananas was funding for union learning representatives. They insisted that the Minister stayed in Committee for the whole day while we talked about a positive proposal that I thought was the obvious thing to do; the Opposition said that we were there only at the behest of the TUC.
It is important to help workplace representatives to find out how to do equal pay reviews. It is important, too, to promote partnership between workplace reps and employers to conduct those exercises jointly. At present, the project has trained 500 representatives to understand what the reviews are about. I ask my hon. Friend the Minister to ensure that funding is continued for that purpose, including helping people from the employers' side.
Fifthly, the Government must lead by example. We cannot ask everyone else to do what we are not doing ourselves. The Secretary of State said recently how embarrassing it was to discover that an equal pay audit had uncovered a serious problem of unfair pay in ACAS, the great arbiter that ensures that everything operates smoothly in the workplace and assists people to get things right. However, at least the audit was done. The Secretary of State said that money had been found to address the problem.
I ask my hon. Friend to ensure that the results of the pay audits carried out in other Departments and agencies following the EOC's "Just Pay" report are published as soon as possible, and that action is taken to provide the funding to rectify any problems that are uncovered. I hope that she will take note of the matters arising from the issue of pay audit and pay discrimination.
I want to give a positive example of my union's experience of the NHS agenda for change programme, which has been widely discussed recently in various contexts. It covers more than 1 million employees and brings together about 10 different pay negotiating groups. When I wrote pay claims for those groups, it was a nightmare because the structure was so complex. The programme covers ancillaries, admin and clerical, professional and technical, ambulance and nursing staff, midwives and senior managers. It has taken four years to do the evaluation, which includes equal pay and equal value principles. It has been a massive and amazing exercise, but it will benefit NHS patients as well as

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employees. Bringing those groups together will mean less rigid demarcation; it will allow employees not to be disadvantaged if they change jobs because they can move within the pay bands. That will be a lot easier and better for the NHS.
The unions have agreed to carry out the first pilot schemes to ensure that everything works smoothly. If the NHS can do that, it cannot be impossible for other employers, with far less complex structures, to take such measures on board.
Mr. Mark Francois: Will the hon. Lady allow me to make a constituency point? I have two major call centres in my constituency, one of which is unfortunately in the process of making most of its employees redundant. As she will know, the bulk of call centre employees have historically tended to be women. Does she have examples—not necessarily from my constituency, but from elsewhere in the country—of unequal pay in call centres?
Judy Mallaber: That raises the issue of occupational segregation, to which I shall come shortly. It is one of the difficulties that result from men and women working in specific fields. It is difficult to implement equal pay in call centres unless one can find comparators within the same employer, although I am sure that employers can take up such issues.
Let me return to my previous point and give an example from the NHS pay agenda. Following the pay review, domestic supervisors are moving into a pay band that includes building and maintenance craftworkers. Domestic team leaders are moving up into a pay band with porter team leaders, security officers and storekeepers. As a result of last year's local government pay dispute, the Local Government Pay Commission is now moving towards introducing a similar exercise in local government. I think that we shall find that the agreements that were supposedly introduced on single status have not all been implemented, partly because of funding issues.
I have one question for my hon. Friend the Minister on public service pay reviews. Again, it comes back to the issue of contracting out. There is currently a dispute at the Royal Bolton hospital about cleaners being contracted out to work for a private company. There are agreements made under the Transfer of Undertakings (Protection of Employment) Regulations 1981, but they do not necessarily apply to employees for ever and they do not apply to new employees. The agreement on tackling the two-tier work force in local government was welcome, and I ask my hon. Friend to do all that she can to ensure that such agreements are extended to the NHS and other public agencies. Again, it is often women who lose out and become second-class citizens when work is contracted out to voluntary sector agencies or private contractors.
I return to the point about call centres. I have talked about the various facets of pay discrimination, but another major difficulty is occupational segregation. Pay audits can help to identify the impact of what is a major factor in pay inequality. More than 60 per cent. of women's employment is concentrated in just 10 occupations. I ask the Minister to look again at a proposal contained in the report on part-time workers
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that was published by the Select Committee on Education and Employment in the last Parliament. We suggested that such workers could use the concept of a hypothetical comparator, because many of them do not have anyone with whom to compare themselves. That is another issue that I shall put on to the table in the hope that we can return to it at some stage.
I want now to go beyond the public sector. I was talking to an employer in my constituency last week. I thanked him for the excellent evidence that he gave to the boundary commission in a case that we won. I took the opportunity to ask him about pay structures in his company, Bowmer and Kirkland, which is the largest privately owned construction and engineering group in the UK. He is very keen to ensure that all its employees and contracted companies get their construction industry training board construction accreditation certificate. I went to give out certificates last year, and John Kirkland, the chairman, was brave enough to do the tests himself while 1 was waiting to give out the certificates. He thought that he should lead by example and that, if he could not do the tests, there was no reason to think that his employees should.
I was pleased to give certificates to two women quantity surveyors, who were also there. The company has done well at pushing women into such jobs. Its subsidiary KeyBemo, which manufactures roof sheeting, has a woman UK operations manager. About 20 per cent of such posts in Bowmer and Kirkland are held by women, which is a very high figure for the construction industry. I understand from the House of Commons Library that there are so few female quantity surveyors that they do not feature in the labour statistics as a category. My local company, which is working very hard on training and is keen to promote women, still has only a minority of women in the jobs that are likely to attract higher pay.
Joan Ruddock: My hon. Friend makes an extremely important point about the entry of girls into construction and engineering in this country. It is appalling. Given the shortage of engineers and construction workers—some 17,000 vacancies are unfilled every year—surely that is a sector in which women and girls could find jobs and receive equal pay?
Judy Mallaber: I agree with my hon. Friend. She will be interested to know that, this morning, the Equal Opportunities Commission launched a formal investigation into occupational segregation, focusing on modern apprenticeships in five sectors including construction, plumbing, engineering, ICT and child care. I want to see men entering the burgeoning child care market as well as female plumbers and quantity surveyors, so the EOC launch is good news.
The employer that I mentioned, Bowmer and Kirkland, is working on a project at Landau Forte college. While it is there, the 50-year-old male site agent and the 20-year-old female quantity surveyor are taking the opportunity to go into the college to talk to the students about opportunities in the construction industry. That is a very positive example and my hon. Friend is right to mention the matter, which relates to my next point for the Minister.
The skills White Paper will provide an opportunity for us to focus on the issues. I hope that my hon. Friend the Minister will be involved in that debate and that will

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pick up the point of my hon. Friend the Member for Lewisham, Deptford (Joan Ruddock) about how we can ensure that the matter is taken up in schools. Education work has been done, and we need to push that forward so that boys and girls know what opportunities exist and are not shoehorned into particular jobs.
I shall not have time to focus on the third issue, which is just as important. It concerns unequal responsibilities within families and the long hours culture, which we say is such a bad idea although we all go along with it. We do not seek to pressurise people about the choices that are right for their families, but we need to keep pushing to make it easier for women and men to share family and work responsibilities, whatever choices they have made. We are looking to improve further on the welcome changes that have already been made, for example by introducing paid parental leave.
There is also a need to do far more about child care. We have done a great deal but there is still a long way to go. I invite my hon. Friend the Minister to congratulate Naomi Compton, who runs the early years unit in Derbyshire. Last week, she was named UK public sector manager of the year. Child care is an important area on which we must keep working.
The EOC states in its manifesto that it wants to halve the pay gap in five years. Unless we act on the range of issues that I have outlined, we shall not get there; we have not got very far yet. We have made progress, some of the legislation is in place, and a number of schemes are under way, but we need to act with huge determination in all areas if we are to start to cut into the problem. Let us do everything that we can, so that we do not return in another 33 years merely to say that we have not got very far.
2.23 pm
Mr. John Bercow: May I begin by congratulating the hon. Member for Amber Valley (Judy Mallaber) both on securing the debate and on her excellent speech introducing it.
I would like to think that the time will eventually come—not least as a result of the pioneering work of the Equal Opportunities Commission and others—when the cause of equal pay will no longer be seen as a source of partisan division between mainstream political parties. There is no reason to suppose that it need be a continuing source of friction. In arguing in support of equal pay, I shall divide my comments into two broad categories. First I will briefly focus on what the Government are doing with the public sector. Secondly, and more substantially, I will focus on the commercial sector. I will not at this stage be tempted to reply to the little tease, or taunt, from the hon. Member for Amber Valley on the national minimum wage. However, I fear that it will not be long before the itch is such that I will have to say something in response before I sit down.
First, I turn to the public sector. The Secretary of State for Trade and Industry and Minister for Women has often emphasised the Government's commitment to, and progress in, the conduct of equal pay reviews
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across Government Departments, non-departmental public bodies, and so on. That work is welcome. Progress has not been as speedy as some thought that it should be, but I do not quibble with the seriousness of purpose that the Government have shown.
There are a number of points to be made in relation to that policy. First—I hope that the Minister for Industry and the Regions and Deputy Minister for Women and Equality will accept this is the spirit in which the point is volunteered—we must have transparency from the Government. No Government can be allowed to be the judge of their own cause. If we are to judge the quality of what the Government have done, and the significance of the findings of the reviews, we need those reviews to be published. We have been told that a summary of the findings will be published. I politely put it to the Minister that it would be helpful for us to have the full details of all the reviews and all the findings of all the Departments, so that individual Members can assess the significance of the evidence.
Secondly, according to the Secretary of State when she spoke in the House on 1 May, significant evidence of what she described as serious problems of unequal pay has been unearthed. It is useful to know that the Government propose to institute action plans to deal with that. However, we need to know what those action plans will contain. It will be in the interests of informed public debate if those plans are published, and there is an opportunity to exchange views on them. Where discrimination in pay is relatively subtle and insidious, there will be pressure—and rightly so—for realignments of posts and regradings both within and between different parts of the public sector. We can make a judgment on how robustly the Government are tackling that problem, and the speed with which they propose to even out the discrepancies, only if we see those plans.
Thirdly, I endorse the call made by the hon. Member for Amber Valley for a broadening of the scope of the reviews to cover contractors. The hon. Lady touched on that point, but it bears underlining and repetition. In many cases, there is a labyrinthine structure within the public sector whereby a Government Department contracts out certain services to a particular company, and that contractor subcontracts the performance of the function to another organisation. In the spirit of the request by the hon. Member for Amber Valley, which I support, we need to know whether both the first contractor and the second contractor have conducted, or propose to conduct, equal pay reviews.
If the Government are committed to equal pay, and determined to demonstrate that through their behaviour, they should regard it as axiomatic that anyone who works for them should sign up to, and operate by, precisely the same principle. That will involve a degree of additional work—it will take time to extend the pay reviews—but in a thoroughly worthwhile and beneficial cause.
Fourthly, it is fair to exhort the Government to promote the policy. Those of us who work within the narrow and hallowed portals of Westminster and Whitehall tend to think that there is a much greater awareness of what we do than is actually the case. In the

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wider world, vast numbers of people are completely oblivious to the vast bulk of what happens on a day-to-day basis in Westminster policy making.
Mr. Henry Bellingham: My hon. Friend's point about bidding for Government contracts is relevant. Many good smaller companies in my constituency have proactively and successfully addressed the problem of equal pay, but do not often get the chance to go anywhere near a Government contract, whereas larger firms that subcontract, or even sub-subcontract, do not take equal pay seriously, yet get a lot of Government work.
Mr. Bercow: That is unsatisfactory, and it precisely underlines the force of the argument for extending the scope of the reviews.
The commercial sector is facing a critical challenge and is being offered a critical opportunity. The reasonable argument has been advanced that personal entitlements, social justice and equal pay policy should be pursued. I do not dissent from that argument, which is persuasive. However, it is worth while underlining the other prong to that argument: in the end, it is in the interests of business to practise a fair and equal pay policy.
Ultimately, people can choose an employer. If they see that a company operates fairly, gives them their due, and does not discriminate between men and women but operates on the principle of reward for merit, they are more likely to work for such a company than to work for a backward-looking, narrow-minded and thoroughly discriminatory operation.
For the commercial sector there are serious risks, which will grow, if it operates unequal pay policies. In general terms, the risks fall into two categories: direct costs and indirect costs. If companies are drawn into litigation, there are the direct costs of having to appear in court, of acquiring specialist expertise to guide them, of paying for legal representation, and of having to make often substantially backdated pay awards to one or more member of staff. There is also the prospect that if companies are found to have transgressed the terms of the Equal Pay Act 1970, they will have opened up a can of worms that will cause their activities in relation to a far larger group of staff to be probed and scrutinised. To avoid that eventuality, a company should accept head on its responsibility to operate fairly.
In addition to the obvious and direct costs, bad practice gives rise to indirect costs. It is sometimes difficult to quantify those costs precisely, but it seems to me, as I hope it will seem to others participating in the debate, that those costs are so obvious that only an extraordinarily obtuse individual could fail to recognise that they will be incurred. One such indirect cost is the lower productivity of workers who feel hard done by and not especially motivated, and will not work as effectively for the organisation as they might otherwise.
A second, related indirect cost is the lower productivity of managers who have to wrestle with the consequences of the internecine conflict incurred by the organisation's bad pay policy, instead of spending their time driving the business forward. The third consequence, which must have a negative effect on the effectiveness and harmony of the company, is poor
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workplace relations—a climate of suspicion, a sense of uncertainty, and an air of curiosity and cynicism about what other colleagues are paid.
The consequence that should be the most palpably significant to a business is the loss of reputation that the company suffers. In the end, businesses depend on the good will of the people who work for them, of their existing customers and of those who might be their customers in the future.
For all those reasons, companies should resolve to behave in an honourable and proper way as a point of principle and practicality—to behave in a way, I should underline, that the law has required of them for 33 years. The essential element of protection has been on the statute book since Barbara Castle's 1970 Act. Too often it has been honoured in the breach rather than in the observance. Secrecy about pay, which the hon. Member for Amber Valley touched on in her remarks, has tended to disguise the significance and scale of abuse. The fact that there is a significant level of abuse is surely no longer in question.
Issues of retention and recruitment are also involved. I have implicitly acknowledged that a company will struggle either to recruit or retain staff—or both if it does not operate a fair pay policy. To place the matter in context, so that nobody underestimates the importance of the phenomenon that we are debating, I shall highlight a statistic that has come my way from the EOC that is as significant as any that I have encountered.
On the basis of the commission's assessment, based on labour force surveys and workplace trends that it has observed, by 2010 only 20 per cent. of the work force will be white, able-bodied, male and under the age of 45. I was very struck by that statistic. Already, 53 per cent. of women with children under the age of four and 70 per cent. of women with children under the age of 10 are in the workplace. It is right that we should focus on the issue as a mainstream subject of public policy; it is a matter to which great urgency should be attached.
I have tried to make a non-partisan speech, because I believe that the Government do a lot of good work in that area. It is entirely proper that Ministers should be probed, scrutinised, harried and tested at every turn; if they expect otherwise—and I am sure that the hon. Lady does not—they are in for a shock. None the less, good work is being done.
I shall now focus on the work of the EOC. Since December 2001, it has had targets for the conduct of pay reviews. That harks back to a point that the hon. Member for Amber Valley made. The EOC has suggested that by the end of 2003, 50 per cent. of companies with 500 employees or more should have conducted equal pay reviews, and 25 per cent. of the rest of the commercial sector should similarly have undertaken such reviews. I am sure that that target, and the moral force behind the EOC's pronouncement has had an effect; yet even in the light of that—and the publicity that it has sought for its campaign—by March this year only 35 per cent. of large companies had fulfilled the brief. They do not have long to catch up if the EOC target is to be met by the end of the year.
Only 27 per cent. of medium-sized firms have done the right thing. Worryingly and disturbingly, 54 per cent. of large companies and 67 per cent. of medium-sized

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enterprises have not done the right thing, and we are advised that they have no plans to do so. That underlines the importance of a political focus on the issue, and on the Government injecting a degree of oomph into the publicity, and the communication of their own policy, of which I wager that only a tiny fraction of individuals and businesses in the country are currently aware.
Many companies have done good work—HSBC, Procter and Gamble, British Telecom, Unilever, PricewaterhouseCoopers, Camelot and Nationwide to name but a few. There is anecdotal evidence that has impressed me that they have been impelled on to the path of righteousness by the propagation of the policy by the Government. If the Government and the public sector give a lead and suggest that that is to be the normal pattern in the future, there is reason to hope that the commercial sector will follow.
I should love to indulge myself, and Westminster Hall, by quoting all sorts of companies that have put their commitment on the record. However, I am conscious that other hon. Members with a longstanding commitment to the subject would like to speak, so I shall resist the temptation. Suffice it to say that over the years, many companies have taken the view, "We're all right. We'll sign up to the principle, but there isn't a problem, so we needn't be preoccupied with the conduct of a review." If there were nothing wrong with their conduct of pay policy and they had nothing to fear from the conduct of the review, perhaps—but if there is something rotten in the state of Denmark, the sooner it is discovered, identified and corrected, so much the better for all of us.
The hon. Member for Amber Valley legitimately teased me about the national minimum wage. I make no apology for detailed probing and extensive scrutiny of the Government's position on the minimum wage, time-consuming though it proved to be. However, if in my mind facts change, I am willing to change my position. I am more than happy to concede, four to five years on, that my anxieties about the national minimum wage have been overwhelmingly demonstrated to be incorrect. I thought that there would be huge job losses. That is not a particularly newsworthy revelation on my part, because I have said several times in the House and elsewhere that the great shakeout of jobs that Conservative Members predicted has not taken place. The Government introduced the wage at a relatively low level, and I am thankful for that.
I shall make an additional point that meets the hon. Lady at least part of the way. The logic of the existence of the minimum wage is that it will be periodically and affordably increased. The increase that has been announced and will take effect in October this year is based on evidence from, and endorsement by, the Low Pay Commission. Several business representatives form part of that commission. The proposed increase is worth while, but it does not strike me as excessive. If it is to be affordable in terms of the state of the economy, the calculation has to be based on what the benefit will be to the people concerned, and the benefit to some of the lowest-paid people in our economy will be enormous. The damage to the economy from an increase in the
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minimum wage would have to be considerable to outweigh the benefit to some of the most vulnerable people in our society.
The hon. Lady focused on the fact that many people in receipt of the minimum wage are women, and that it has done something to reduce the pay gap. It has also done a good deal to improve the quality of life of the people concerned. As a practical Tory, I have no hesitation in saying that I have looked at the evidence, and the minimum wage has proved to be beneficial. My anxieties have not been fulfilled. I am willing to change my mind. To persist in pursuing an incorrect policy when the evidence shows that it is incorrect is foolish. To admit that one was previously incorrect and to change one's mind is wise. That is my position, and it does not require further elaboration.
I am delighted to have participated in the debate. I look forward to the day when I have persuaded and educated the bulk of my right hon. and hon. Friends in the Conservative party to such an extent that we can become champions of the fair treatment of equal pay and anti-discrimination policy in this matter, as in others.
Several hon. Members rose—
Mr. Deputy Speaker (Mr. John McWilliam): Order. Two hon. Members are seeking to catch my eye. I need to call the wind-up speeches in 16 minutes, and I am sure that those Members can divide 16 by two.
2.44 pm
Sandra Osborne: Thank you, Mr. Deputy Speaker. I will attempt to be brief. It is a pleasure to follow the hon. Member for Buckingham (Mr. Bercow). It is refreshing to hear a Conservative Member giving such a commitment to equal pay. He certainly makes a good analysis of the business case for supporting equal pay and also of the changing structure of the work force. I agree with him that that is rather surprising and paints a very stark picture. Needless to say, it was also a pleasure to hear his description of his "road to Damascus" conversion in respect of the national minimum wage.
I congratulate my hon. Friend the Member for Amber Valley (Judy Mallaber) on securing the debate. It is an extremely important issue, in which unfortunately we have made little progress over the past 30 years since the Equal Pay Act 1970 was introduced. I argue, along with the EOC and others, that the legislation as it stands patently is not working and is in need of urgent review.
I shall endeavour not to repeat what has been said, because we are all working to the same EOC brief, for which we all grateful. Low-paid workers in our society are only too aware of the pay gap. As my hon. Friend outlined, they certainly benefited a great deal from the minimum wage, but not anywhere near enough to enable them to close the pay gap. I want to raise the issue of the pay gap suffered by young female graduates. They seem to be unaware of the gap and make the assumption that they will automatically be paid on an equal basis with their male colleagues. We know that that is not the case. The EOC has cited research that suggests that the annual salary of male graduates aged 20 to 24 is 15 per

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cent. higher than that of female graduates in the same age group, and that the gap becomes wider among older age groups.
For many of the younger generation of women, the old myth pertains that the battle for women's rights has largely been won. I believe that the secrecy in awarding salary packages perpetuated by many companies to which colleagues have referred, serves to obscure the reality that there is still a long way to go. The hon. Member for Buckingham described the process as subtle and insidious, which is a good way of describing the situation. We all know that it goes on, but trying to prove it and identify it is difficult.
The hon. Member for Buckingham also referred to statistics provided by the equal pay taskforce that, within eight years, the pay gap will be eliminated. However, we all know that that is not happening. We must make much more progress and we must review the relevant legislation. I understand that the Government pay reviews have been extensive and that a report is forthcoming by the end of July. Will the Minister confirm that when she sums up?
As the hon. Member for Buckingham said, many employers have no intention of conducting a review. That is not just complacent, but resistant. That is why the whole situation must be looked at again. My hon. Friend the Member for Amber Valley said no one wants compulsion, but I am not sure about that. If the present situation is not working and we find, while monitoring the position, that it is not getting any better, we should seriously consider that. We cannot wait any longer. We have waited 30 years and we must see much quicker progress.
Another issue that I want to raise is the single equality commission and the possibility of having a single equality Act. Perhaps the Equal Pay Act could be reviewed in that regard, but we all agree that the present equality legislation is piecemeal. It is not transparent. People do not know their rights or where to exercise them. I should welcome the Minister's comments on whether the Government will consider introducing a single equality Act.
In some respects, Scotland is leading the field with the help of some European funding. The close-the-gap initiative includes partners from Scotland, covering rural and urban areas. It has secured funding for three years to run an equal pay project in Scotland, which will work with employers to help them to institute pay reviews and to explode some myths about equal pay and related issues. Those involved in the initiative are also working with those affected by equal pay issues, and my main point relates to that. Those who are affected are women in part-time work, lone parents, women returners, ethnic minority women, women with disabilities, those who are disadvantaged through geographical location and those who live in areas of deprivation, or who are affected by a number of those factors. As my hon. Friend the Member for Amber Valley said, they are largely concentrated in female-dominated jobs, which have been traditionally low paid and regarded as secondary income to that of the main breadwinner in a household. However, we know that to be a complete myth, and out of step with the changes that have taken place in our society.
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I shall cite two examples, one of which affects the whole of the United Kingdom, and the other of which is currently taking place in Scotland. The two interconnected examples are of situations in which women, who are being discriminated against in pay and conditions, are fighting back, and I congratulate them on so doing.
My hon. Friend the Member for Lewisham, Deptford (Joan Ruddock) referred to term-time workers. I believe that a grave injustice has been occurring for many years in relation to term-time workers, who work mainly in education. Cooks, cleaners, teaching assistants, office and library staff are invariably low paid during term time and receive no pay during the holidays. They are a microcosm of women as the second sex in a labour market hallmarked by part-time, casual and temporary contracts and low pay.
Many hon. Members will be aware that, before the jobseeker's allowance was introduced, term-time workers could claim unemployment benefit during unpaid leave. However, they are now deemed to be in full-year employment but still receive only part-year pay. There is still a presumption that term-time jobs in education are for mothers making a bit of pin money to supplement another main breadwinner's wage. That is a vastly outdated and patronising view of women's place in the labour market and is highly discriminatory.
Every worker should get the rate for the job regardless of domestic circumstances. If we seriously accept that we need to tackle poverty pay and close the pay gap, the Government and employers must acknowledge their responsibilities towards that group. I congratulate the GMB, Unison and the Transport and General Workers Union on taking on that campaign, and I intend to support them.
I am very proud of the work that the Government have done in their introduction of universal nursery education for three and four-year-olds. That is one of our best achievements. However, as we know, nursery nursing is a job done almost exclusively by women, and nursery nurses have been very poorly paid for many years. There is, therefore, a contradiction between introducing universal nursery education and not addressing the issue of low pay among nursery nurses.
The hon. Member for Buckingham suggested that such issues can lead to a lack of motivation among the work force. The nursery nurses in Scotland have decided that they have had enough, and are currently taking industrial action in relation to their pay claim. However, perversely and unbelievably, not only are those nurses suffering from years and years of low pay, but their employers are considering introducing term-time working for nursery nurses, which would add them to the group of workers who are discriminated against on that basis. I believe that to be completely unacceptable, and I hope that the Minister agrees with me. I look forward to hearing her comments.
Mr. Deputy Speaker: Order. Before I call the hon. and learned Member for Redcar (Vera Baird), may I remind her that I have to reach the summing-up on the hour?
2.54 pm
Vera Baird: Thank you, Mr. Deputy Speaker. I will jettison a large part of what I intended to say, and will focus on one important issue. I echo the

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congratulations that have been offered to the Government on the many dimensions across which they have encouraged and enhanced equal pay, of which the pay reviews are the most important and central. I look forward to the results of those reviews.
I congratulate my hon. Friend the Member for Amber Valley (Judy Mallaber) on securing the debate, and I echo what she said about the need, before contracts are signed, to oblige contractors to commit themselves to equal pay and to carry out pay reviews, as a condition of working in the public sector. That falls short of the compulsion that has been referred to as an inevitable last resort if progress is not made, but is an appropriate, constructive and prudent use of contractual leverage.
Another issue, which is similar to but somewhat different from the position of contractors who are, for instance, being used by a public authority, perhaps to run its canteen or to do its cleaning, is the trend—indeed, the deliberate policy—of having public services as a whole delivered by bodies other than public authorities; that is, they are not delivered by the public sector. Such measures as public-private partnerships, private finance initiatives, large-scale voluntary transfer of council housing, the introduction of public interest companies to run foundation hospitals and the use of private contractors to deliver more and more public services will put more and more people outside the ambit of government and public sector pay reviews. Government and the public sector are being cut back. I am not especially complaining about that policy, but the impact seems dangerous. It is essential that public sector and government pay reviews should be repeated, in order to ensure that pay discrimination does not creep back into the system. As time goes on and that element of policy develops, it seems that such reviews will affect fewer and fewer people, and narrower and narrower kinds of employment. That must not be allowed.
By a mechanism similar to contractual leverage on the part of smaller contractors, it is eminently possible to stipulate as a standard term of every PPP and PFI contract—and of part of the memorandum of articles of every public interest company—that there should be equal pay and that reviews must be carried out to ensure that it occurs. I shall be happy to be reassured that the proposals do not represent a limitation on public sector reviews, but if I am right and there is a hazard, the example that I have given will be slightly more than worrying, and will, I fear, be an example of how far equal pay is from being mainstreamed. Policies such as PFI, PPP and the private delivery of public services flourish without any regard to the vulnerability to which, by a side wind, they have exposed women workers, in particular, by removing them from the public sector. If I am right, the realisation that the policy has developed without sufficient regard to equal pay by means of accessibility to pay reviews will, in a sense, come only after the event.
I again congratulate my hon. Friend the Member for Amber Valley on securing the debate. It is hugely important to keep the detail high on the agenda, but, equally, I cannot close without congratulating the Government. I had thought of saying something clever about the fact that Government have done 18 times more during their six years of office than the last
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Conservative Government did in the 18 years that they had in office. However, since the last Conservative Government did precisely nothing, 18 times nothing would still be nothing. I shall therefore conclude by congratulating my Government on the progress that they have made.
2.58 pm
Dr. Vincent Cable: I add my congratulations to the hon. Member for Amber Valley (Judy Mallaber). The subject is very serious and deserves far more attention than 10 minutes at the end of Department of Trade and Industry questions once a month, which is what we normally devote to it, so I congratulate her on securing the debate and on the way she presented it.
The facts are not in dispute. The gender gap has been quantified: it is 20 per cent. in relation to full-time income, which has declined from 30 per cent. in the mid 1970s, and 40 per cent. in respect of part-time income, which has not declined at all in the last 30 years. We are therefore talking about a big disproportion in payment and no improvement in part-time work.
In my short time, I want to concentrate on two or three questions. Why are there not more women fat cats? That might seem a slightly odd question, but during the recent controversy I was struck by the fact that a woman Secretary of State for Trade and Industry was pursuing a lot of rather dubious business people who were ripping off their shareholders and work force in large numbers and getting away it. All those business people, without exception, were men, which prompted me to look up some of the figures. Of the people in this country who earn more than £100,000 a year, which is probably not everybody's definition of a fat cat, but is the Liberal Democrats' definition based on our tax proposals, there are 285,000 men and 40,000 women. Only one in eight of the high earners are women. That is important statistically, because if 100,000 more women were earning £100,000 a year, the gender gap would close dramatically. More importantly, many of those people are employers, who will influence the ethos of hiring and recruitment in their companies.
I see this issue at first hand. My own family has a kind of reverse gender gap. My eldest son is an opera singer with an intermittent income. My younger son is a research scientist with no income, then there is me—I do not know whether MPs are regarded as highly paid. My daughter, on the other hand, is a high-flying commercial barrister. When she rolls up at the front door in her latest sports car, one is tempted to think, "Maybe gender does not matter any more." That makes her angry, and she explains, quite accurately, that there are probably three or four women in Britain of her age earning her salary in that occupation, whereas there are dozens and probably hundreds of men doing the same thing.
There were many obstacles on the way, from kindly barristers who metaphorically patted her on the head and said, "Don't you think you would be happier doing family law," to a macho culture that suggested that if you turned up for work later than 7 am and left before

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11 pm, you were some kind of wimp. Many obstacles, which are institutionally embedded, are preventing women getting into the high-flying, high-earning jobs.
Mr. Deputy Speaker: Order. I am not trying to be picky, but it is not really appropriate for the hon. Gentleman to use the word "you" in that context.
Dr. Cable: I apologise to you, Mr. Deputy Speaker; I appreciate that you are not a fat cat. I did not intend to imply that you were.
Mr. Deputy Speaker: Order. I was objecting that I was not a wimp.
Dr. Cable: Even more right.
Many of the problems arise in higher education. We have heard about some of the different levels of payment to graduates, but the problem is deeper than that. We know that more women than men are doing better at A-level and going into higher education. The question is, what do they do at university? An enormous amount of occupational segregation takes place at that stage. Women are highly disproportionately represented in the humanities, social science and certain kinds of bachelor of science courses, especially chemistry and biology. Men are heavily disproportionately represented in maths, computing, engineering and business studies. That matters.
Some useful research has been done for the university of Warwick, which suggests that people who do humanities—English literature and history—have a graduate income throughout their working lives of up to 10 per cent. less than they would if they had left school at 18 and gained a vocational qualification. In other words, although they may study an interesting subject, people who go through that kind of course penalise themselves financially by doing so. If we add the burden of debt, there are considerable financial penalties from making that choice.
It is possible, even in the professions, to see much occupational segregation that is damaging to women's career prospects. I have mentioned the law, but there is also the social sciences. I once taught undergraduates economics, and it always struck me that women were in the minority. An interesting article was published recently by John Kay, formerly the dean of Oxford business school, titled, "Why so few women do economics." He noticed that in a class of 100, it is typical to find no more than two or three women doing economics. On the other hand, in other social sciences, such as sociology and psychology, women are in the majority. He asks why that should be so, and what the consequences are.
Economics is not an intrinsically useful subject. Apart from John Maynard Keynes, few economists have gone on to make lots of money themselves. It is, however, a platform for a lot of highly paid jobs. Somebody with a good economics degree from a "good" university with a good maths background can go straight into a market analyst's job in the City with opportunities for a six-figure salary in two to three years. Without that background people will not get that kind of job. Women are completely out of that professional track. Many sophisticated choices must be made at A-level and at the
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point of university entrance. Those choices marginalise the vast majority of women from high-paid occupations—they will never be fat cats because they are making the "wrong" choices, although they might be right in other ways.
We need to address the issue of sending out the right signals. How many schools prepare young women for making certain choices at A-level, such as by steering them in the direction of studying maths? Maths opens the door to so many other things. Rather, they quietly encourage girls to study English literature, which might be interesting but does not hold the key to certain professions. That is just a thought. It is not at all clear that any progress is being made in addressing why women are not entering the highest paid occupations.
My second question is partly related. Why are there not more women academics? The answer is not obvious. Of all the careers that should be open to women with families, academia is an obvious attraction. It should be fairly flexible, as people can take work home—they can write academic articles there and read essays. One tends to assume that The Guardian-reading classes teach in universities so they will be fairly enlightened and there will not be any hidden prejudice.
However, the figures for the academic world are staggering. The gender gap is larger than average at more than 20 per cent. In the hierarchy of academic professions, 35 per cent. of all postgraduate students are women, and that goes down to 31 per cent. of lecturers, 16 per cent. of senior lecturers and 7 per cent. of professors. Those figures are not greatly different from those from before the first world war. For some reason, women are finding it extraordinarily difficult to make progress towards the higher rungs of the academic ladder in a profession that at first sight seems open, and in which large numbers of women are now becoming qualified because of their graduate status.
Mr. Bercow: I am rather shocked by what the hon. Gentleman said. Is there any evidence that the phenomenon that he describes is worse than average in the traditional universities, as one might suspect?
Dr. Cable: I do not think that that is the case. The university that comes out worst of all is the university of London, and in particular King's college. There might be all kinds of reasons for that, but that is what the figures show.
I do not know what the answer is. Nobody seems to be clear what it is. It might be something to do with the decline in specialist girls' schools and colleges at universities, which might prepare them for an academic life. It is most likely due to the fact that universities, like the civil service, operate on the basis of salary increments—an old-fashioned way of rewarding length of service rather than quality of performance or productivity. A man who has served 20 years without interruption will be on a higher rung of the ladder than a women who has served 10 years and has taken 10 years out to look after children. Women are therefore permanently depressed in the career structure. Since the Government are the main funding source for universities and will expect something back for their substantial contributions, I hope that they will examine that.

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My final point relates to what is happening in the civil service. The Government have carried out useful survey work in the civil service, and have found that the pay gap, at 27 per cent., is bigger than it is in the economy as whole. If the Government are driving a gender equality agenda, as they are and should be, why is more not being done in precisely the area over which the Government have some control, as opposed to the area of small business where their control is indirect? I do not know the answer to that, but I suspect that the Minister might be able to tell us. I suspect that it has a great deal to do with the nature of bureaucracy, which rewards long service and incremental progress through a 30-year service in full-time employment. That does not take into account the flexible work patterns that most women, reasonably, seek. If the Government are to make a breakthrough in gender equality, they must consider their own employees. I hope that the Minister will indicate how much progress is being made in that respect.
3.9 pm
Mr. Henry Bellingham: This is an important matter, and I congratulate the hon. Member for Amber Valley (Judy Mallaber) on the impressive way in which she opened the debate. I also congratulate the new Minister on her appointment. I have seen her in action in Committee and written her hundreds of letters, which have always received quick responses, so I can testify to the fact that she did a superb job in her previous post. I wish her well in her interesting new assignment and in her role as Deputy Minister for Women and Equality.
One of the most important points that has been made was voiced by my hon. Friend the Member for Buckingham (Mr. Bercow), who rightly pointed out that a contented work force will be motivated and satisfied, will create more wealth, and lead to a happier business community, whereas workers who feel hard done by will not realise their potential and will require a substantial diversion of management time.
The official Opposition feel strongly that the Equal Pay Act should be adhered to. It is more than 30 years old and it was the last Act of any significance passed by the Labour Government before they lost the 1970 election. The 19 per cent. pay gap for full-time staff and the 41 per cent. pay gap for part-timers have been mentioned. The hon. Member for Amber Valley pointed out that we hear a lot about the high-profile cases. However, there are cases every day throughout the country involving people who have suffered unfair discrimination. To an extent, they a re overshadowed by the high-profile cases that hit the news and make the headlines. A string of tribunal cases has featured in the tabloid press, some successful, others not.
Pay discrimination is sometimes stark and obvious, but it is often much more subtle. It can result from differential bonus rates or from anachronisms in the way in which posts are graded within an organisation. It is instructive to examine other figures. While 60 per cent. of women and 79 per cent. of men aged between 16 and 64 are in employment, only 48 per cent. of working-age women who have a child aged under two are in
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employment, compared with 90 per cent. of men with a child aged under two. That is a staggering difference.
The conclusion that I draw from those broad statistics is that, at any one time, many female employees are taking maternity leave—paid or otherwise—that, indirectly, their careers are being held back and that some loss of earnings does occur. Action is needed to protect women to the greatest possible extent from unfair discrimination on their return from maternity leave. It is vital that we have a flexible labour market that allows mothers to go back to work as soon as they feel able to do so. Firms should be more proactive in that respect.
It is interesting to look at some of the other statistics. The secondary education gap that used to exist has not just been closed; it has been reversed. Last year's figures show that 57 per cent. of girls but only 46 per cent. of boys gained five or more GCSE grades A to C. So far as A-level passes are concerned, the figures are 41 per cent. for girls and 32 per cent. for boys. It is, therefore, even more important that we address the gender pay gap.
One of the other interesting points is that women are twice as likely as men to work in the public sector. In fact, 32 per cent. of working-age women in employment work in the public sector, compared with 16 per cent. of working-age men. That is why it is important to focus on the public sector, and in my closing remarks, I will do just that. I would like to hear what the Minister has to say about that.
The hon. Member for Twickenham (Dr. Cable) said that the pay gap in the public sector is 27 per cent. I had no idea that the figure was as high as that. As my hon. Friend the Member for Buckingham pointed out—and it was also mentioned by the hon. Member for Amber Valley—the Government cannot be seen as a fair judge of the private sector until they can categorically state that they have got their own house in order.
There must be more transparency, and the Government must take the lead in that. I hope that the new Minister will work with the Secretary of State to ensure that Departments adhere to the best possible practice. I was in the House on 1 May. Department of Trade and Industry questions had just finished, and we then had questions to the Minister for Women. I was disappointed when the Secretary of State said that departmental reviews
"have revealed serious problems of unequal pay and we are putting in place the action needed to put that right."—[Official Report, 1 May 2003; Vol. 404, c. 422.]
The reviews have been promised, but will they be published? What will happen when various anomalies are identified? The Government promise action plans, but we need to know what those action plans contain. What regradings and realignment of staff pay will be recommended? Will the Government tell us where work of equal value is being unequally rewarded? Will the Government make it quite clear what remedies they will put in place to solve those problems?
Every hon. Member who has spoken has said that the scope of the Government's pay review must be broadened to go beyond the mainstream Departments. It must cover agencies, non-departmental public bodies, contracted-out staff, and, as was mentioned earlier,

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subcontractors and even sub-subcontractors. The Government are in a very important position as far as procurement is concerned. They procure billions of pounds of contracts every year. I do not wish to see another bureaucratic box-ticking exercise. I want an answer to a very simple question—has the firm in question conducted a pay review, and what were its results? There is an argument for the Government to disqualify certain applicants from the public procurement process. I would be grateful if the Minister would comment on that because it is vital that the Government promote equal pay more vigorously.
People in the top companies in this country and even those who know how Whitehall works have no idea that the Government have recently launched equal pay questionnaires. Why have the Government been so laid back about promoting their reviews? Why have they been so low key? Is it because the Government have been secretly embarrassed by their lack of progress? I would be grateful if the Minister could comment on that.
As at least four hon. Members have said, we support what the Government have done so far, but it is vital that they become more proactive and make an effort to put their house in order. If they do that, the Opposition will support them because we want to get on to the other agendas, particularly burdens on business, red tape and regulation. We will no doubt return to those matters for debate in this Chamber. However, today, we support what the Government have done, but would like to see them do a great deal more.
3.19 pm
The Minister for Industry and the Regions and Deputy Minister for Women and Equality (Jacqui Smith): I join in the congratulations for my hon. Friend the Member for Amber Valley (Judy Mallaber) on securing the debate, and I am pleased to have the opportunity to respond on behalf of the Government. This is not my first outing in my new ministerial role, but it is my first outing as Deputy Minister for Women. All hon. Members have identified today's debate as dealing with a crucial issue that must be addressed.
Time is short and I do not intend to repeat the statistics that hon. Members have rightly prayed in aid. It is not only morally right that men and women receive equal pay, but, as the hon. Member for Buckingham (Mr. Bercow) correctly pointed out, it is right for business and society.
Hon. Members have outlined the range of factors that contribute to the pay gap, which obviously means that we must take a range of action. Several Members have rightly turned the spotlight on to the Government. We take the findings on the pay gap seriously, which is why we are taking action to put our house in order. I was glad that my hon. Friend the Member for Amber Valley highlighted the considerable progress made in the NHS, where our approach to public sector pay enabled us to deliver on both the commitment to equal pay and the flexibility of public services, which is crucial.
Several hon. Members have referred to the cross-Government equal pay review in which the Cabinet Office is taking the lead. I can tell hon. Members that 79 Departments and agencies, representing 92 per cent. of the 500,000 civil servants employed by the Government, have already submitted their action plans to the Cabinet
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Office. The rest will be submitted shortly and are being chased vigorously by the Cabinet Office to ensure full coverage.
Without wanting to blow my new departmental horn, it is worthwhile pointing out that the Department of Trade and Industry HQ audit was one of the first to reach the Cabinet Office and that we have received very positive feedback. Likewise, all the DTI agencies and non-departmental public bodies have completed their plans.
The Cabinet Office is working closely with Departments over the details in their action plans and will—this relates to the transparency issue—publish a summary report of the findings by the end of July. The hon. Member for Buckingham pushed us on that issue, but it is for individual Departments to make the details of their pay reviews available given the delegation of pay responsibilities across the Departments. The Cabinet Office recommends that the details should be placed in the Library once discussion is completed.
The Government are also committed to encouraging the rest of the public sector to do likewise. On top of that, they have drawn together for the first time what Departments are doing to address gender equality as a whole. The report "Delivering on Gender Equality" was recently published, and we are introducing equality targets, which will be backed up by that action plan. The Government are showing their commitment to gender mainstreaming in all key spending Departments. That relates to the important issues raised by hon. Members about how we can ensure that those directly employed by the public sector benefit from the emphasis on equal pay and about how we can ensure that that is extended into the private sector.
My hon. and learned Friend the Member for Redcar (Vera Baird) made an important point about the relationship between Government policies for the private sector to build capacity and our ability to ensure equal pay. The issues around the use of procurement are tricky, but hon. Members have made a strong case. To ensure that the commitment to equal pay across the public and private sectors feeds through properly, we have set a target for the first time in the "Delivering on Gender Equality" plan. It says:
"The Government will work with businesses and trade unions, the Equal Opportunities Commission (EOC) and Opportunity Now towards ensuring that 35 per cent. of large companies have done pay reviews by 2006".
The hon. Member for Buckingham was overly sanguine about the current position, because that target would double the number of large companies that have completed pay reviews.
I acknowledge what hon. Members have said about the need for the Government to lead by example and to communicate what is happening. We need to do that in partnership with business and the unions, which is why we provided the EOC with £100,000 to prepare a toolkit for voluntary pay reviews, which was launched in July 2002.
I recognise the important contribution of my hon. Friend the Member for Cardiff, North (Julie Morgan), who chairs the all-party group on sex equality. She raised the issue of small businesses. A separate system is also being developed for small businesses.

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I take seriously the need to make practical what businesses do to address equal pay. We worked with the EOC in making changes to its code of practice on equal pay, and we support the equal pay forum, which is organised by Opportunity Now and the EOC and which promotes equal pay reviews among employers. Members must be committed to carrying out, or have already undertaken, an equal pay review in order to join.
My hon. Friend the Member for Amber Valley is right to highlight our work with trade unions. We gave more than £250,000 to the TUC to train workplace equal pay representatives. I am sure that my hon. Friend understands that I cannot pledge money far into the distance, but I hope that the fact that we extended the project from one year to two years and have given a commitment to working with trade unions will give her some reassurance.
Hon. Members have also rightly identified pay segregation as part of what leads to a pay gap. More than 60 per cent. of women are still concentrated in just 10 occupations. Those occupations are typically the ones that pay the least: for instance, sales assistants, secretaries, child carers, cooks and caterers. If those 10 occupational groups are taken out of the equation, the pay gap in relation to the other 40 per cent. of women closes dramatically to just 8 per cent. That is why I warmly welcome the EOC's general formal investigation into occupation segregation in training and work. I look forward to seeing the result. I note that the Under-Secretary of State for Education and Skills, my hon. Friend the Member for Bury, South (Mr. Lewis), who is the Minister responsible for skills, also welcomed that investigation today and said:
"We are committed to creating far more high status vocational learning opportunities for young people. Therefore we'll be interested to consider any barriers which may inhibit this ambition."
I have covered some of the concerns raised by the hon. Member for Twickenham (Dr. Cable). His contribution made me wonder whether, given that I chose economics over English literature at the age of 18, I should be
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benefiting more in terms of pay than I am. However, the importance of my current role is far above the financial recompense that I receive for it.
Another important point was made by several hon. Members, including my hon. Friends the Members for Lewisham, Deptford (Joan Ruddock) and for Amber Valley. It relates to how we encourage women—and indeed men—into sectors of employment in which they are under-represented. In delivering on gender equality, for the first time, we are setting a target and taking action in relation to that area. That is an important way in which to ensure that we address the gender pay gap that stems from job segregation and the historic approach to where men and women work. We should break down assumptions about men's and women's jobs.
I was glad that hon. Members on all sides referred to the national minimum wage. The national minimum wage—now welcomed by converts on the Opposition Benches—has been extremely beneficial to women at the lower end of the pay range. Some 70 per cent. of the beneficiaries are women.
My hon. Friend the Member for Ayr (Sandra Osborne) raised the important issue of term-time working. Colleagues in the Department for Education and Skills are currently considering future roles and career structures for school support staff. They are working closely with local government employers and with support staff unions.
The hon. Member for Twickenham asked how we could ensure that there were more women at the top. I am sure that he will be aware of the report published by Laura Tyson last week. We welcome that and want to build on its recommendations.
Unfortunately, I do not have time to talk about the other important ways—promoting flexible working, extending maternity pay and ensuring that women, and men, have the choices that they need to balance work and family life—in which we can tackle some of the issues of discrimination.
Mr. Deputy Speaker: Order—or indeed anything else. Time is up.

Stroke Care (Young People)
3.30 pm
Helen Jones: I welcome the Minister to what I believe is his first debate in Westminster Hall. I am glad to have obtained the debate, because it is important to remind ourselves that stroke does not affect the elderly only, and we must tailor our services to reflect that fact.
We are used to thinking of stroke as an affliction of the elderly, but every day 30 people of working age in this country have a stroke—10,000 a year, more than 1,000 of whom will be under 30. It is estimated, too, that between 250 and 400 will be children. However, the fact that we cannot be absolutely clear about the figures reflects the fact that very little money is spent on research into stroke, and particularly its incidence among younger people.
The Stroke Association, which I commend for its work, is currently funding a research project into the incidence of stroke among children, but its research budget is only about £2 million a year, and that is the bulk of money spent on stroke research in this country. If we compare that with the £50 million a year spent on research into heart disease or the £200 million spent on research into cancer—vital research in both cases—we see the extent to which stroke is the poor relation in funding terms. Yet stroke is the third most common cause of death in England and Wales and the largest single cause of disability. Despite the Government's efforts, it remains in some respects the Cinderella of the health service. That is particularly true of stroke services for younger people.
A stroke can be devastating at any age, but particularly when it strikes a younger person out of the blue. Younger people need special services. They often find it difficult, for instance, to get access to the right rehabilitation facilities, which are often designed for elderly people. They may also need family support—in relation to what has happened to their children or with parenting. The family may also suffer economic consequences if the wage earner has a stroke. Yet support for dealing with benefits, retraining and employment advice is thin on the ground.
I readily acknowledge the work that the Government have done to improve stroke services. The national service framework for older people, which contains the NSF for stroke, makes clear what we want to do to improve services. In particular, I welcome the requirement for all hospitals to develop specialist stroke units and for primary care trusts to ensure that all general practices have protocols in place to identify those at risk and to take preventive measures.
I know from my own experience how much our medical services have improved. My father suffered a stroke in his early 50s, 20-odd years ago. I can compare that experience with the recent experience of a friend of mine who suffered a stroke at a comparatively young age, and I know that things are getting better. However, my friend was lucky to be treated in a hospital with a specialist stroke unit run by a professor, and I think that the Minister will accept that not everyone is so lucky. We still have a long way to go.
For instance, the Commission for Health Improvement recently said that stroke patients are often at the back of the queue when it comes to access to
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medical care. Professor Caroline Watkins from the north-west regional stroke taskforce has estimated that less than 30 per cent. of hospitals have a specialist stroke unit, and less than 70 per cent. have a proper rehabilitation unit. We could have a debate on what constitutes proper rehabilitation facilities because they can be variable.
That all accords with the recent sentinel audit of stroke services carried out by the Royal College of Physicians, which estimated that only 27 per cent. of people get treated in a specialist stroke unit. That causes 6,000 unnecessary deaths every year. Improvements can be made and it is important that as we improve services, we ensure that they cater for all age groups, including younger people. The very fact that the NSF for stroke is contained in the NSF for older people—although it says it applies to all age groups—means that often when people are designing services they forget about the needs of younger people. The result of that can be seen in a survey that the Stroke Association carried out among the younger client group, their families and carers.
The survey showed that the issues for younger people were: insufficient information at the time of diagnosis, a failure to assess properly the need for continuing care and treatment, and feelings of helplessness not just for the person who had had a stroke, but for their family. People found it very difficult to access the support they needed to deal with what is a life-changing situation.
The survey also showed clearly that there are often failures of communication among health professionals that make it very difficult for people to access the services that they need. As a result, that age group often feels marginalised and struggles with services that are not designed for it. The medical care of that age group in hospital is affected. Young people are still treated on wards that are designed for the care of the elderly. What happens when they come out of hospital is also affected. When the Stroke Association held a conference in 1999 among young stroke victims, some of the comments made were very revealing, and they still apply today. One participant said:
"If I were over 65 the care I receive would be great."
He added that there are no facilities for helping younger people with strokes, such as child care or even a child-friendly visiting area when one goes to a clinic.
The result of that conference and the surveys show that when dealing with younger stroke victims, we must look not just at the person but at the family situation because, according to the Stroke Association survey, 32 per cent. of young people who have had a stroke experience the failure of a close relationship afterwards. Problems with parenting are experienced by 70 per cent. of that group.
However, we provide very little support for families to help them get through that difficult time. I remember how difficult it was to adjust when my father came home from hospital, and I was grown up. How much more difficult it must be for a young child who cannot understand what is happening, or for a teenager who is going through a difficult phase of their own life. Of all those people who reported problems with parenting, 76 per cent. said they got no help or support to enable them to cope.

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There is a difficulty, too, for the carers of people who have suffered strokes, particularly younger people. Often they are not only trying to care for their partner, but trying to cope with child care as well. Little help is given with respite care or child care.
Another problem, according to what I have seen and the evidence, is that people often experience difficulty in obtaining the aids that they need to help them to function and in having adaptations made to their homes. It emerged clearly from the Stroke Association survey that many younger people do not even receive a full community care assessment on leaving hospital. The sad fact is that many people can rebuild their life and lead a productive and useful life if they are given the right help and support. That entails not only ensuring that they receive the right medical care and rehabilitation facilities, but giving them facilities to help them to plan their future life when they are ready to do so.
It is striking that the Stroke Association's survey showed that among the younger age group 80 per cent. had lost their job and had not found other employment. Only 10 per cent. remained in their previous employment and 10 per cent. had lost their job but had found other jobs. Very little advice is on offer about employment retraining, employment facilities or, for those who cannot return to employment, educational facilities or suitable voluntary activities that can help them to rebuild their confidence and self-esteem.
It is not surprising that 76 per cent. of the people in the survey said that they had received no help with retraining or employment and that they felt discriminated against in the employment market. That is devastating for younger people, who feel that they have been put on the scrap heap at a young age, and economically devastating for their families because 58 per cent. end up relying on state benefits, which means not only that they are in poverty, but that more children are growing up in poverty.
I want to make a plea to the Minister, who has an interest in such matters, for our old friend joined-up government. Will he seriously consider funding for stroke research, and particularly into the incidence of stroke among young people? I know that it takes time to find more money and that there are always competing priorities, but I hope that in the next spending round the Department of Health will consider the issue seriously when it negotiates with the Treasury. There is a moral argument because of the amount of death and disability that stroke causes, but there is also an economic argument because it was estimated that the cost of stroke to this country in 2002 was £2.3 billion a year and that is rising every year.
May I also ask the Minister to look carefully at the care people receive in hospital and the progress that is being made towards providing proper stroke units? In the meantime, will he look seriously at the problem of young people being treated on elderly care wards? That is not beneficial to patients or staff because it does not allow staff to do their job properly and is not comfortable for patients. Will he see what can be done to end that practice?
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In addition to care in hospital, will the Minister consider what happens to people when they leave hospital? What is needed is what we have tried to achieve in so many areas: a breakdown of the barriers between primary care trusts and acute trusts, and between health and social services. People who have had a stroke may need a whole package of services according to their condition: physiotherapy, speech and language therapy, aids to help them to cope with their daily life, family support, help with retraining and so on. In common with everyone else that I have met in similar circumstances, they do not want to traipse between different departments. They do not care which part of government delivers the services, but they would like them delivered in one easily accessible package.
May I suggest to the Minister that primary care trusts should work with acute trusts to ensure that when people leave hospital following a stroke, they receive a whole package of information on the services that they may need to access as time goes on. That may be in a booklet or some other form but it should tell them about their diagnosis, the preventive measures they can take and how to access other services that they might need, either immediately on leaving hospital or later on.
I suggest to the Minister that the services need to consider the cross-boundary issues carefully, as people who have suffered a stroke are often treated in a hospital that is in a different PCT from their home. It is no use giving people information about services in an area where they do not live. I suggest, too, that we try to ensure that everyone who leaves hospital after a stroke has a named key worker, so that they know whom to contact for information on the services available to them. People should be told when they leave hospital of their right to a proper community care assessment, as many people do not know that they are available and fail to have such an assessment.
In conclusion, I ask the Minister to examine the links between primary care trusts and social services in respect of providing help with child care and respite care for the families of stroke victims. We owe a tremendous debt to carers, as things can be particularly difficult for the families of younger stroke victims. A little respite care and time to oneself can make all the difference to the people involved and help them to keep going, but the contact that would enable that care to be provided does not exist.
We should consider liaison with the Department for Work and Pensions to educate personal advisers in the effects of stroke and in knowing how to give the right advice to people as they recover and rebuild their lives. Of course more money is needed, but we must carefully consider how the resources already available are being used.
The key to the issue for younger stroke victims is, first, remembering that they exist; it is not only elderly people who have strokes, but middle-aged and young people and children. When those groups cease to be invisible it will be easier to think about their needs and thus produce better services for them.
I hope that the Minister will take note of what I say and do what he can to help this large but neglected group of people.
3.47 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I commend my hon. Friend the Member for Warrington, North (Helen Jones) for securing this Adjournment debate. There are two types of Adjournment debate: those that are a continuation of the party political battle and those that are about genuine issues of interest to hon. Members' constituents. This debate clearly falls into the latter category. I congratulate my hon. Friend on bringing the matter to the attention of the House and I thank her for giving me the first opportunity to appear at this Desk in Westminster Hall.
The real benefit of an Adjournment debate is not what happens in the Chamber but the fact that it forces Ministers to do some homework and focus on an issue before they respond to the debate; that is certainly true in this case. I was astounded by some of the figures that my hon. Friend drew to my attention. About 10,000 people under the age of 55 have a stroke every year, 1,000 of whom are under the age of 30. That brings home the scale of the problem. My hon. Friend is absolutely right that the consequences of a stroke and the process of recovery are different for a young person. The stroke survivor and their family have to come to terms with the physical and emotional changes as well as making significant lifestyle adjustments, which can involve issues such as mobility, employment, income and dependence. As my hon. Friend rightly points out, there can be a severe impact on relationships. It is important that stroke rehabilitation services for younger people focus on the goals that young people want to achieve. Those will include vocational rehabilitation so that ultimately and if possible, the person can return to work. Clearly, those issues are different from the issues that may affect older people who have strokes.
Stroke is the third biggest killer and the largest cause of serious disability in the United Kingdom. In the 1990s, age-standardised rates of mortality from stroke in people aged under 75 in England fell by just over a third, from 30.3 deaths per 100,000 of population in 1990 to 19.9 deaths per 100,000 in 2000. That continues the declining trend that we have witnessed in the rate of mortality from stroke since at least the 1960s, and demonstrates that our understanding of the causes of stroke and the best way to treat it is improving.
I listened carefully to what my hon. Friend said about the need for research and the disparity between the amounts going into research into certain conditions and the amount going into stroke research. Last year, the Medical Research Council invested more than £3 million in stroke research. That council responds to bids for research, so if someone puts together a good bid for a research project, it will consider funding it, but it does not necessarily seek new bids and try to ramp up the level of spending. My hon. Friend made points on which my Department needs to reflect, and we will ensure that the Medical Research Council is aware of her comments. If we are to continue the drive to improve care and treatment for people who have suffered stroke, we need to do the research that my hon. Friend identified.
The Government are committed to reducing the number of disabilities and deaths resulting from stroke. We are making changes and improvements in access to,
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and delivery of, care and treatment. That includes the key areas of prevention and education about risk factors and the care and rehabilitation services that people receive immediately after a stroke.
When we launched the national health service plan in 2000, we said that it would take time to deliver a genuinely patient-centred service. That is why from the start it was a 10-year programme of investment and reform. The extra investment that we are making will help the NHS to deliver on the plan. I am referring to the money to increase capacity and recruit extra staff, and the tools to deliver far-reaching reforms. We want to ensure that people who have a stroke can return, as far as possible, to the lifestyle that they enjoyed before. The needs of stroke patients span a wide variety of services, and we recognise that younger patients have different needs from older patients.
The development of stroke services has brought about an enormous change in the care of stroke patients. There is growing evidence that dedicated stroke care greatly improves outcomes, reduces mortality and is cost-effective. A specialist multidisciplinary team is a key factor in providing successful stroke care. My hon. Friend pointed out the success of the treatment that her father received as a result of being able to access specialists.
The national service framework for older people, published in March 2001, provided a major driver for improved stroke services. It set specific standards and milestones and established the development of integrated stroke services and improvements in the delivery of stroke care as a priority. It is important to note that although the risk of having a stroke increases with age, stroke can affect younger people, so the standards of care and service models in the framework apply equally to young and old. I accept my hon. Friend's point that as the standards are incorporated in the national service framework for older people, we may sometimes miss the emphasis that should be placed on the needs of younger people. I shall ensure that the Department reflects on that problem to see how we can deal with it.
The implementation of specialist stroke services is required in the document entitled "Improvement, Expansion and Reform". That is the priorities and planning framework for 2003–06. It makes it clear that implementing the older people's national service framework is a top priority, and that the 2004 milestone relating to specialist stroke services is a key target. The document also includes important milestones to assess the improvements in stroke services that are required. From monitoring against the April 2002 milestones for the national service framework, we know that 83 per cent. of hospitals plan to have a specialist stroke service in place by April 2004. Although we recognise that some services need to increase their capacity, significant improvements have already been made and stroke patients of all ages are already feeling the benefits.
The aim of the national service framework stroke standard is to reduce the incidence of stroke in the population and ensure that those who have had a stroke have prompt access to integrated stroke care services. The stroke standard requires:
"The NHS will take action to prevent strokes, working in partnership with other agencies where appropriate. People who are thought to have had a stroke will have access to diagnostic

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services, will be treated appropriately by a specialist stroke service, and subsequently with their carers, participate in a multi disciplinary programme of secondary prevention and rehabilitation."
Implementation of the national service framework stroke standard will achieve the situation in which fewer people will have a first or repeat stroke; there is early identification and preventive action for those at risk of stroke, and general advice and support on how to reduce risks; there is access to specialist stroke services based on best evidence, better care, better outcomes, reduced death and disability from stroke; there is co-ordinated rehabilitation and improved chances of regaining independence; and there is support for carers.
My hon. Friend made a valid point about the need to deal with respite care for the carers of people with long-term disabilities or those who have become disabled. I have a personal interest in that matter and I shall be following it up. We must not overlook the possibility that, without those carers, we could not provide the standard of service that people need. In the coming months, I shall certainly be looking closely at the issues that my hon. Friend raised.
However, we are aware that the organisation of stroke care throughout the country remains variable and that there is still much to do to ensure that the standards in the national service framework for older people are met. The third national sentinel audit of stroke, carried out by the clinical effectiveness and evaluation unit of the Royal College of Physicians and led by the intercollegiate working party for stroke, has given a detailed picture of the way in which hospitals provide care for stroke patients.
The audit demonstrates that 73 per cent. of hospitals now have a stroke service, which is an increase from 43 per cent. three years ago. However, there is still insufficient capacity in that 36 per cent. of patients admitted with strokes spend some of their time on a stroke unit. There have, however, been increases in the number of stroke physicians and the number of patients returning home following hospital treatment. The next audit is planned for April 2004, in partnership with the new Commission for Healthcare Audit and Inspection.
Currently, many initiatives to help develop stroke services are supported by the Department of Health. Last year, the Department carried out a mini review of
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what makes a good stroke service, following visits to several sites throughout the country. The results of that review are available on the Department of Health website. The report sets out key elements that need to be in place to establish good stroke services and provides examples of good practice.
"Pursuing perfection" is a project that is managed through the Modernisation Agency. It involves communities that are aiming to transform the levels of care that are currently provided to patients and service users. Four communities are involved at present and they are expected to seek out current levels of good practice to help them frame their goals. The stroke pilot is in Devon. By setting stretching targets and, it is hoped, reaching them, Devon will set a model for others to follow.
The Bradford changing work force pilot is exploring new ways of working in the care of stroke across health and social care teams. The principal players are the Bradford hospitals NHS trust, the three Bradford primary care trusts and Bradford social services. The benefits expected from new ways of working are greater continuity of care for patients, faster access to treatment, fewer communication problems and unnecessary reassessments, less pressure on scarce staff resources and greater staff satisfaction. The lessons that come out of that project will go a long way to deal with some of the issues raised by my hon. Friend in respect of what happens after the discharge and the need to receive the joined-up government response.
The Department of Health and NatPaCT—the national primary and care trust development programme—are working with seven pilot primary care trusts to help them to commission in order to deliver on the requirements of the older people's NSF. One of the projects is looking specifically at commissioning to deliver on the stroke standard. In 2001, the National Institute for Clinical Excellence was commissioned to develop guidelines for the management of hypertension in primary care. When published, the guidelines will help to ensure that the treatment that patients receive is of a consistent standard, and will identify cost-effective approaches to managing patients with hypertension, including the threshold for initiating drug therapy. High blood pressure is a risk factor in stroke, coronary heart disease and chronic renal failure, and the guidelines on that are expected in February 2004.
Mr. Deputy Speaker: Order. Time is up.

Dr. Adrian Garfoot
4 pm
Mr. Henry Bellingham: I am conscious of the fact that this is the Minister's first appearance on the Front Bench in Westminster Hall with her current brief. [Interruption.] It seems that it is not. Well, I should like to congratulate her on her move anyway—she has been kept busy. I had the pleasure of seeing the Minister in action when she was at the Department of Trade and Industry and was most impressed by what I saw. I wish her well with her new post.
I should like to examine not only the case of my constituent Dr. Adrian Garfoot, but the Government's wider drugs policy. The tragic, sad case of Dr. Garfoot has received a great deal of local publicity but must be aired in Parliament, at least to record what marvellous work he did and what has happened since.
Dr. Adrian Garfoot was trained at the Royal Free hospital school of medicine. He was a general practitioner in Great Yarmouth and Kilburn, and during that time he developed a deep interest in and awareness of the drugs crisis and the plight of drug addicts. In 1990 he opened the Laybourne clinic in east London. He was brought up in Norfolk and his father is the well known Methodist minister in King's Lynn, the Reverend John Garfoot.
The Laybourne clinic soon became a renowned centre of excellence. During the 10 years from 1990, the clinic treated more than 1,200 patients, the typical age of whom was 37 and a half, which was substantially older than the average age of patients in NHS drugs clinics, which was 29. The overwhelming majority of Dr. Garfoot's patients were long-term addicts who had been injecting themselves for anything between 20 and 30 years, and maintaining their habits through crimes, such as theft, burglary, dealing in drugs, prostitution and so on.
4.2 pm
Sitting suspended for a Division in the House.
4.16 pm
On resuming—
Mr. Bellingham: I had made a bit of progress in my speech; I had spoken for two minutes when the Division was called. I had said that the overwhelming majority of the patients whom Dr. Garfoot was treating had been injecting themselves for between 20 and 30 years, and had maintained their drug habit through a life of crime. Most had already spent lengthy periods in prison; at one point, it was calculated that 270 patients had, between them, spent more than 600 years in prison—a pretty staggering figure. Many had been committing up to four crimes a day—well over 1,000 crimes a year.
However, what is interesting about the Laybourne clinic is that the recidivism rate for the drug addicts at the end of treatment was only 7 per cent., whereas for those coming out of the Prison Service, recidivism was more than 50 per cent. Dr. Garfoot was able to rebuild
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the lives of many people, deal with serious medical conditions and restore family relationships. Most important, he enabled those people to get on with a normal life and keep out of trouble. I calculated, with the help of several independent experts, that Dr. Garfoot probably saved the country more than £10 million. Many testified that he saved their life in the process.
I shall mention some of the achievements of addicts who underwent treatment at the Laybourne clinic. One reformed addict ended up playing the violin in an orchestra, another founded a national charity, another completed an MA degree in computer studies at the age of 30, several ran in the London marathon and two gained places at medical school. Those are remarkable achievements.
I should like to read to the Chamber a tribute paid by Gary Sutton, who was one of the addicts treated at the Laybourne clinic. I met him on one of my visits to the clinic. His account refers to a particular occasion in 1996. A patient who was in the clinic with him was, at that juncture, being treated at St. Mary's hospital, and discharged himself with a butterfly needle still in his arm. A few hours later, laboratory results were returned showing that he had a potentially life-threatening infection. The police were alerted and called to the patient's address, but were unable to find him. The hospital rang up Dr. Garfoot; as it was a Sunday morning, Dr. Garfoot was at his home in Sevenoaks. He drove from Sevenoaks to London and spent seven hours trying to track the patient down. He eventually found him, and took him to Homerton hospital. The following day, the consultant rang up Dr. Garfoot and personally commended and thanked him for saving this person's life. That is one example; I could give many others.
Dr. Garfoot had a prescribing policy that was based on harm reduction and non-coercive user-friendly protocols. Above all, he used his clinical independence. What he was putting in place were voluntary and supervised withdrawal programmes, and, yes, methadone was often used. It is interesting to examine the latest May 2003 guidelines from the National Treatment Agency for Substance Misuse. When they refer to injectable prescribing, they make it clear that the recommended daily dosage of between 60 and 120 mg is within the effective therapeutic range. Certainly, what Adrian Garfoot prescribed was within that limit. No patient died of an overdose during his time at Laybourne clinic. There was one suicide when medication was seized by the police, and the result was that the local hospital refused help. That was, of course, tragic, but no patient died from overdosing.
The doctor's philosophy was one of maintenance prescriptions with gradual reductions. Let us not forget that many of his patients had been on 12 or more failed oral treatment courses over periods of addiction of up to 25 or 30 years. It is worth examining exactly what the National Treatment Agency for Substance Misuse has said in its recent guidelines and press releases. Professor John Strang, the chair of the NTA heroin expert group, said:
"The message for specialist clinicians is that yes, injectable heroin and injectable methadone have a role to play in the treatment of drug misuse—but it's a limited role and one that needs to be developed very carefully".

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The NTA's press release states that the guidance now offered is
"based on a fresh examination of the latest national and international evidence and best practice and represents a consensus of expert opinion on injectable prescribing".
The summary to the guidelines states, first, that
"injectable maintenance treatment is most appropriate for long-term heroin addicts who have not responded to oral maintenance treatment";
and secondly, that
"where injectable heroin and methadone maintenance prescriptions are provided as part of a comprehensive treatment programme, both may have beneficial effects on health, social functioning and crime reduction".
Those guidelines entirely sum up and endorse what Dr. Garfoot had been doing in his clinic.
There was no evidence at all, during Dr. Garfoot's time at the clinic, of any diversion of drugs. He was always incredibly assiduous in preventing the diversion of prescribed drugs to the wider community. That was recognised on a number of occasions when he had clashes with the authorities. Back in 1992, there were complaints. Later there were further allegations, and he was summoned before a Home Office misuse of drugs tribunal on charges of alleged irresponsible prescribing. There was a disgraceful raid on the Laybourne clinic that was heavily criticised at the time, in Parliament among other places.
After the analysis of 1,500 prescriptions, there was no sign of any discrepancies whatever. Dr. Garfoot was cleared by the Home Secretary, and there was also a finding of "abuse of process" against his accusers. The cost of that case ran into thousands of pounds. In 2000, the interim orders committee of the General Medical Council imposed serious restrictions on Dr. Garfoot. He then went to the professional conduct committee of the GMC in September 2001, and there was a finding that he should be erased from the medical register on the grounds of serious professional misconduct. He took the decision to appeal to the Privy Council, and unfortunately lost. It is worth pointing out that more than 20 other doctors were also struck off in 2001.
It goes without saying that this has been a total disaster for Dr. Garfoot. I shall return to that in a moment. It has, however, been an even bigger disaster for the patients of that clinic. The clinic carried on for a while after Dr. Garfoot left, but it was unable to continue providing the same level of treatment. A number of patients left. Six of those have subsequently died. Many others have gone back into a life of crime and prostitution and are now back on the conveyor belt that leads to crime, inadequate treatment and back to crime again. There have been six tragic deaths as a consequence of that. I could outline all those, but the hon. Member for Bolton, South-East (Dr. Iddon) has mentioned them in a previous debate in the House.
One should also consider the tragedy affecting Dr. Garfoot. He has been struck off. It is extraordinary that
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in Norfolk, in my constituency, where there are many GP shortages—in the Heacham, Dersingham and Snettisham practice there are two—Dr. Garfoot is living in Gaywood with his father, a Methodist minister, and doing his best to find ways of earning a living, although he is finding it difficult. He would love to do locum work and help in the community.
The extent to which the goalposts have been moved is absurd. Dr. Garfoot could have been reinstated after 10 months, until the new guidelines were issued by the Secretary of State in April 1999, when that period was altered to five years. That is the case, even though the GMC dealt with the alleged offences in a tribunal that was, in my opinion, flawed in many ways—and that decision was upheld on appeal by the Privy Council, with procedures that were likewise flawed. The alleged offences related to events and incidents that took place before the Secretary of State changed the guidelines.
There is an overwhelming case for natural justice; for the Secretary of State to say, "Look, the old 10-month rule can apply to those doctors whose alleged offences were complained of and dealt with by the GMC before the guidelines were changed." I ask the Minister to consider carefully the situation of doctors like Dr. Garfoot, who is badly needed back in the community dealing with drug addicts. That is vital. He also needs to earn a living. It makes no sense for him to be sitting around not helping patients in the community when we have GP shortages.
There are a number of flaws in the way in which the GMC conducted the hearings and the Privy Council conducted its hearing. I will not deal with those now, because they are detailed and complicated. I shall give just one example. One of the allegations made to the GMC was that Dr. Garfoot's patients were very different from others and difficult to treat, but it heard from non-expert witnesses, who gave evidence that I find totally unconvincing. The fact is that many of Dr. Garfoot's patients were much older than those attending NHS clinics. Consequently, they had a longer drug-taking history and a much more severe set of conditions. None of the so-called expert witnesses examined during the hearings had any contact with people who had seen the patients. They did not look at any independent evidence that was made available to the hearing. That was just one example of how slapdash the committee was, and how unprofessionally, in my judgment, it dealt with Dr. Garfoot. There were many other procedural flaws, which I will not trouble the Chamber with now.
I would like the Minister to say clearly that she will consider this case. We have a drugs crisis in this country. The Government are making some progress, but we dearly need people like Dr. Garfoot to be rehabilitated from the appalling slurs on his character. He needs to be allowed to go back into general practice, and the drugs communities in this country certainly need him to set up another clinic like the Laybourne, which did so much to help its patients and saved so many lives.
4.29 pm
Dr. Brian Iddon: I will not hold up the Chamber for long.
We must remember that this doctor was practising before the National Treatment Agency for Substance Abuse was set up. Only 6 per cent. of heroin addicts were

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in treatment at that time and they were mainly desperate people. It is not often that I would defend a doctor practising in the private sector, but in this case I do. Without Dr. Garfoot and the 18 or 19 other doctors who have similarly been struck off, we would have had some very chaotic heroin addicts wandering around places such as London. Everything went wrong after the Shipman murders. He was correctly convicted of misusing opiates, but the General Medical Council then set up the interim orders committee, which started to pick off those doctors one by one. That has been very unfair. Will the Minister look at the case of Dr. Adrian Garfoot and the procedures adopted by the General Medical Council to pick off those private doctors one by one?
There has been nowhere else for such patients to go. They are chaotic patients. I know Dr. Adrian Garfoot personally and I defended him at the interim orders committee of the General Medical Council, which shows how strongly I felt about his case. Dr. Garfoot told me that one of his patients came at him with an axe one night. He talked him down, got him stabilised and kept him that way.
The national health service was not—at that time—capable of dealing with that type of patient. I do not believe that it is capable of doing so now. We are talking about long—standing heroin addicts, many of them middle-aged. As soon as the doctors, including Dr. Adrian Garfoot, stopped practising, one by one their patients began to die. Within a few days, certainly under two weeks, at least three of Dr. Garfoot's patients were dead because he was no longer available to treat them. I make the plea again to the Minister to look at this case, but also to examine why the General Medical Council is taking that action.
4.31 pm
John Mann: Only 5 per cent. of all drug addicts currently receiving treatment are being treated by doctors, according to a response that I received from the Department of Health only two weeks ago. I have three points to make. The first is that this is an individual case, but at the heart of it is the philosophy that we have in this country about drugs treatment. In congratulating the Minister on her new post, I urge her to look at a fundamental overhaul of the National Treatment Agency for Substance Misuse and the philosophy behind it. I question why there is no medical majority on the agency's board, which I think is a fundamental flaw.
Secondly, only two weeks ago a GP in my constituency, where we have above the average number of heroin addicts, told me that she was not prepared to prescribe, because she was terrified of being struck off. That is something that I have heard repeatedly throughout the country. Instead, social workers and psychiatrists are taking medical decisions in the place of GPs.
My third point is that, at a conference on this subject attended by 200 people three weeks ago, the prescribing of methadone cited ranged from 25 to 50 mg. The Government recommend a minimum dose of 60 mg. The Dutch suggest that 80 to 100 mg should be the minimum dosage prescribed. That is happening under our system at present and we must look at that, rather than penalising those GPs who are valiantly battling to
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keep people out. The alternative happens in my constituency. The drug action team and the treatment agency have achieved 0 per cent. success. They cannot cite one person that they have successfully treated during their existence. That is the fundamental flaw. The case, which has been most eloquently put forward, has much wider implications.
4.33 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I congratulate the hon. Member for North-West Norfolk (Mr. Bellingham) on securing a debate on this important topic and my hon. Friends the Members for Bolton, South-East (Dr. Iddon) and for Bassetlaw (John Mann) on their contributions. I hope that I can reassure the hon. Gentleman and my colleagues that the Government are committed to tackling drug misuse with all the resources at their disposal.
First, I must make it clear that I cannot make comments on the individual case of Dr. Garfoot. I understand that the case has been subject to disciplinary proceedings at the General Medical Council, as the hon. Member for North-West Norfolk mentioned. It was subsequently looked at by the Privy Council. Therefore, it would be inappropriate for me to comment or to intervene.
I understand, however, that the issue underlying the case was one of prescribing to drug misusers. I will give more detailed information on what is being done by the Government to support those GPs and other professionals who are involved in that activity. The remarks of my hon. Friend the Member for Bassetlaw are relevant to the concerns that people have expressed.
In Government, we recognise the challenges for health professionals in engaging with drug misusers. Many of those drug misusers have chaotic lifestyles associated with their addiction. The benefits of successful engagement with treatment services are enormous, both for the individual and for their community. We have no doubt that treatment works, and that view is supported by research. The national treatment outcome research study—the most important United Kingdom research into drug treatment—shows the enormous benefits to individuals who have completed treatment. We know that most drug misusers who are retained in treatment show a significant improvement in health and social functioning, and reductions in criminal activity and drug use. In addition, from an economic perspective, the findings show that every£1 spent on treatment saves£3 of expenditure within the criminal justice system.
We are the first Government to allocate substantial funding for the purpose of treating drug misusers. In this financial year alone, the pooled drug treatment budget has risen to £243.1 million, allowing an average increase to primary care trusts of 23 per cent. That supplements minimum increases of 30 per cent. in the previous financial year. I am pleased that Norfolk primary care trust has benefited greatly from the increased funding, receiving an increase in its pooled drug treatment budget of 33 per cent. in 2002-03, with a further increase in excess of 20 per cent. in this financial year.
As the hon. Member for North-West Norfolk must be aware, the additional funding for treatment has a target attached to it, which is to double the number of drug

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misusers in treatment by 2008. There is also an interim target. Although there is no room for complacency, I am pleased that the latest figures show that we are currently on track to meet that target. We also recognise that it is not enough to get more people into treatment; we must also improve the quality of treatment and, for that reason, have also set a target to increase the numbers who successfully sustain or complete treatment programmes. To support the Government's commitment to increasing the quality and availability of drug treatment services, in April 2001 we set up the National Treatment Agency for Substance Misuse, which has the specific remit of driving forward improvements in the quality, availability, accessibility and effectiveness of drug treatment in England.
I listened carefully to the points made by my hon. Friend the Member for Bassetlaw, and his comments on the treatment services available through his local drug action team. I give him an undertaking to look closely at what is happening in his area. He has been a passionate advocate of the need to tackle the problem of drug misuse in his community.
However much money the Government put into drug treatment services, it can be effective only if we can meet the demand for treatment in every area of the country. One of the biggest barriers to increasing both the quality of, and access to, drug treatment is the need for sufficient trained staff to work within treatment services. That should not surprise us, as shortages of staffing are experienced in many other areas within the NHS. The National Treatment Agency for Substance Misuse is implementing a work force strategy to encourage professionals to work in drug treatment, and I am pleased to inform you, Mr. Deputy Speaker, that drug action teams have reported an increase of 1,088 people working in drug treatment services in 2002-03 and are projecting a further 680 between 2003-04. That is ahead of expectations.
The hon. Member for North-West Norfolk will appreciate how important it is that the medical profession is fully trained to respond to patients with drug problems. The Royal College of General Practitioners has been funded by the Government, with a total of £3 million being made available to provide accredited training for GPs and other health care professionals to help them in their work with drug misusers. In the first year, 440 GPs completed that course, and with the additional funding that the Department of Health has made available, more than 1,000 health care professionals will have completed the course by the end of this year. I am particularly pleased that the course has been adapted to allow other groups supporting primary care—such as pharmacists and nurses—to take part.
To ensure that treatment is available to those who need it, we must also reduce the time that anyone who needs drug treatment has to wait before that treatment begins. That is crucial, as a delay in being able to offer treatment can lead to the drug user losing their
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motivation to enter treatment, with the result that, by the time the place is available, they are no longer interested and it is a missed opportunity. That is why the NTA set maximum waiting time targets against which DATs will be measured.
I should say a few words about prescribing, as hon. Members have focused on it. We place importance on the role of safe and effective prescribing in the delivery of drug treatment services, and that is particularly pertinent here. Research evidence clearly shows the effectiveness of prescribed opiate substitutes to replace the need for illicit heroin. Oral methadone maintenance treatment has the strongest evidence base in the treatment of heroin addiction in order to reduce harm and is recommended in Department of Health expert guidelines on the clinical management of drug misuse and dependence. The guidelines also include recommended dosages of methadone and other treatments, based on the evidence of their effectiveness.
We recognise that health professionals require support when delivering services to drug misusers. That is why the various initiatives that I have mentioned have been put in place. In addition, the NTA and Department of Health are currently developing support networks for specialists in the field.
We recognise that, while stable abstinence is the preferred goal of treatment for opiate addiction, patients may require prolonged maintenance treatment with oral opiate substitute medications as part of an overall package of care. A small number of heroin users who require treatment are currently stabilised on injectable methadone or heroin. That is accepted clinical practice in the UK in a group of about 350 severely dependent heroin addicts who have not responded to treatment and care with oral medication.
Mr. Bellingham: If I had had more time, I would have elaborated on this point in more detail. The Minister is now referring to the NTA recommendations on prescribing contained in the report published in May. If those guidelines had been in place when Dr. Garfoot went before the GMC, surely the outcome would have been different. I am not asking the Minister to comment on a specific case, but a number of doctors have been judged on the established thinking and philosophy at the time in cases of so-called prescribing offences, but the world has moved on. It is vital to bear that in mind.
I should be grateful if the Minister would touch on one other point in the closing few minutes. Could she consider the possibility of the Secretary of State examining the cases of the 21 doctors, who in the past have been struck off for only 10 or 12 months rather than five years?
Miss Johnson: The hon. Gentleman is trying to tempt me down a path that he knows I cannot go down. I have already said that I cannot comment on the judgment that was made and the GMC's decision. That is a matter for it, as I am sure the hon. Gentleman is aware.
The decision to prescribe heroin is based on the clinical judgment of the prescribing doctor, who must be licensed for that purpose. The Department of Health's clinical guidelines recommend that it should be initiated by a specialist practitioner.

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In the last year, at the request of the Department of Health and the Home Office, the NTA has convened a consensus group of national and international experts to help it to develop guidance for practitioners on injectable heroin prescribing and to assist local DATs, commissioners and service providers. As a result of that work, the NTA issued guidance on the prescribing of heroin earlier this month.
I appreciate that the prescribing of heroin raises some concerns with those who believe that the aim of Government policy is substantially to increase the number of drug misusers who are prescribed heroin. In fact our aim is to ensure that the small number with a clinical need for heroin treatment can access it.
Local DATs and commissioners of services, including primary care trusts, are responsible for assessing local needs for GP involvement. That includes such issues as
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supervised consumption schemes, availability of the range of opiate treatments and the most appropriate service configuration.
I have described in detail how the Government have gone about providing drug treatment and guidance and training for doctors. While I cannot comment on the individual case, in the rare and unfortunate event that a medical practitioner appears to have failed to maintain the high standards expected of their profession, they are likely to be suspended and investigated by the GMC's professional conduct committee, an independent process over which, quite properly, I have no influence. It exists to ensure we can expect the highest standards from our medical practitioners.
It being fifteen minutes to Five o'clock, the motion for the Adjournment of the Sitting lapsed, without Question put.