Westminster Hall Sitting of 12 March 2003

Preamble
[MR. EDWARD O'HARA in the Chair]

Community Pharmacies
Motion made, and Question proposed, That the sitting be now adjourned.—[Dan Norris.]
9.30 am
Mr. Deputy Speaker (Mr. Edward O'Hara): Before I call the initiator of the debate, may I point out that 16 hon. Members have expressed in writing their desire to speak in the debate, and they will have priority? Others may hope to make a contribution, so Members who speak should take that into account and tailor their speeches accordingly.
Mr. Anthony Steen: The timing of this debate is critical, because the Government have to respond to the Office of Fair Trading report on "The Control of Entry Regulations and Retail Pharmacy Services in the UK" by 17 April. I thank the Speaker for selecting this morning's debate. The Government will have adequate time to hear from both sides of the house. In view of how many hon. Members wish to speak, would colleagues consider adopting a five-minute limit? I shall speak a little longer than that, but not much.
Mr. Deputy Speaker: Order. I should point out that the Deputy Speaker has no power to curtail contributions, but I am sure that hon. Members will take note of what the hon. Member said.
Mr. Steen: I was not suggesting that you should curtail contributions, Mr. Deputy Speaker, but I am sure that hon. Members will respond to that request.
What should the Government say in response to the Office of Fair Trading report, which in effect recommended the wholesale deregulation of pharmaceutical services in England and Wales? I like to think that I am a model of a modem deregulator: I dislike unnecessary rules and regulations, and I chaired the Conservative party's committee on deregulation in the 1990s. I believe that our business ethos has been hijacked by a culture of overregulation, which has resulted in batteries of officials, all armed with handbooks and directives, justifying rigid adherence to a bureaucratic straitjacket in the name of public protection.
The purported liberation of the pharmacists by removing the sluice gate currently operated by the local primary care trusts is not deregulation at all. The Office of Fair Trading proposals are not deregulatory: they are more about competition and price considerations. The report concludes that the public will be better off if the primary care trust is no longer involved. I do not believe that. Although a balance is needed between a planned and centrally controlled NHS and locality pharmacists, an unrestricted free market is neither relevant nor desirable in this instance.
We must consider whether the small amount of money saved by the consumer justifies the impact on existing Government policies. I cannot believe that the
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progressive closure of neighbourhood pharmacies will fit into the Government's aims of social inclusion, urban renaissance and sustainable development.
Mr. Adrian Sanders:Will the hon. Gentleman give way?
Mr. Steen: Not quite yet.
Furthermore, the closure of neighbourhood pharmacies would be counter-productive to patient welfare, as I shall explain. About 80 per cent. of a pharmacist's income comes from their contract with the local primary care trust to dispense NHS medical prescriptions. They assume a satellite role in relation to the NHS. The remaining 20 per cent. of the income of most pharmacies comes from marketing and selling other goods in their shops.
Mr. Sanders: Will the hon. Gentleman give way?
Mr. Steen: No, not yet. I know that the hon. Member for Torbay (Mr. Sanders) is my next-door neighbour, but I should like just a little longer to get the argument going.
It must be made clear that NHS prescriptions will cost the consumer the same amount, wherever purchased. I want to ensure that hon. Members understand that. Wherever people buy their NHS prescriptions, whether in a supermarket or a high street chemist, they will cost the same. Supermarkets will not be able to undercut their competitors' prices for prescriptions. The Office of Fair Trading report argues that, if supermarkets provide the NHS prescription service, they will also attract unprescribed, over-the-counter sales of items such as aspirin or cough mixture. Although supermarkets can sell such general items without the presence of a qualified pharmacist, they cannot sell what is known as P-list medicines without a pharmacist on duty.
However, the OFT argues that supermarkets should automatically be able to supply NHS prescriptions with a pharmacist on duty, and that they should not have to be regulated by primary care trusts. Supermarkets cart apply to the PCT for a contract to dispense NHS prescriptions, and their applications, like any others, are considered according to the desirability of having another chemist in the locality. Many pharmacists with NHS contracts are based in supermarkets. That is just one of the factors that the local PCT considers.
The OFT says that the consumer will be able to save some £30 million each year, but I am not quite sure why. The industry says that the figure is nearer £8 million, or 0.08 per cent. of the £8.6 billion drugs budget. I am told that, if supermarkets open up NHS-subsidised pharmacies, more than 50 per cent. of the 12,250 community pharmacies are likely to be phased out over the next five years.
Mr. Sanders: The hon. Gentleman has made the precise point that I was going to raise. He mentioned that there would be savings for the consumer, but rightly

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referred to the evidence that throws the figures into doubt. There may be no saving whatever for the consumer.
Mr. Steen: I expect such a sensible remark from the hon. Gentleman, as he is a next-door neighbour of mine and benefits from all the good sense that I put out at my end of the bay.
Mr. Patrick McLoughlin: If the Government accept the report, they will be doing to community pharmacies exactly what they have done to our rural post offices. It will be seen as yet another death nail in the coffin of village life and local shops. This situation is exactly the same, and it worries a great many people.
Mr. Steen: My hon. Friend is a clairvoyant, because he anticipates the closing lines of my speech. Having taken those interventions, I shall deal with the points that have been made. If community pharmacies go, some could relocate to health centres. That has already happened, but it would be detrimental to the high street, because they would cream off NHS prescriptions, taking away the 80 per cent. of business that high street chemists need to survive.
One concern is the extent to which NHS money could be saved by eliminating the contract with local pharmacists. That costs £18,000 per year per pharmacy. If that £18,000 retainer is to be extended to all new outlets as a result of the so-called deregulation, it must end up costing the NHS more. In fact, it could cost the NHS a fortune, because every time a new outlet opened, with no regulation to prevent that from happening, it would require another £18,000 per pharmacy. However, that is unlikely to happen. It is more likely that the £18,000 retainer will be discontinued. If it is discontinued or reduced, that will lead to the collapse of the local community pharmacy, so either way there will be a knock-on effect if the PCT no longer hands out licences. The Minister is in a Catch-22 situation: he cannot win either way.
Mr. David Drew: I am sure that the hon. Gentleman is aware of the long-standing dispute between the British Medical Association and pharmacists over rural dispensing. My worry, which I am sure that he shares, is that that dispute, which I gather was close to being settled, is likely to break out again on the back of what we are discussing. What are his views on that?
Mr. Steen: I am quite sure that once the Minister has heard all the views of hon. Members this morning he will be able to say something that will prevent any further disagreement between the BMA and the local rural pharmacists. If he does not do so today, I am sure that he will do so very shortly.
That brings me to the nub of my speech. What is the role of local pharmacists and how do they protect the quality of life for the elderly, the poor, the handicapped and other vulnerable people in our society? I approach this issue as a representative of one of the most beautiful rural constituencies in England, according to the House
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of Commons Library. It is scattered with historic towns, market towns, villages and hamlets. The vagaries of public transport and the cost of private travel for an ever-increasing retired population, many of whom lack mobility and suffer from physical frailty, make neighbourhood pharmacies essential.
Given the current location of our pharmacists in the South Hams, people living in villages and hamlets can include their visit to the chemist as a part of their weekly trip into the nearby town. However, a journey to the supermarket is often a much more difficult manoeuvre, and hazardous to arrange if public transport is involved.
Mr. Adrian Bailey: Will the hon. Gentleman give way?
Mr. Steen: If I must.
Mr. Bailey: I concur with the hon. Gentleman's judgment about his constituency. I understand the particular problems that arise in rural areas. Would he not agree that the problem of accessibility is equally great in some inner-city constituencies with a disproportionate number of elderly people on low incomes and low car ownership?
Mr. Steen: I am glad that I gave way. As the hon. Gentleman may know, I represented an inner-city seat in Liverpool for nine years. I am familiar with the points that he makes. The major supermarkets are on the outskirts of Liverpool, and to get there from the inner city is a day's job. The hon. Gentleman's point is extremely valid.
Mr. Paul Tyler: Will the hon. Gentleman give way?
Mr. Steen: Once more.
Mr. Tyler: I am extremely grateful. I entirely endorse the hon. Gentleman's view that this is an inner-city, outer-city and rural problem. Would he have time to address my concern that the professional pharmacist in a community pharmacy often gives a whole range of free advice, particularly to elderly people, that simply would not be available in a supermarket?
Mr. Steen: I know that Conservatives are clairvoyant, but I did not know that Lib Dems were too. The point I was making is that if the convenience of the old, the infirm and the handicapped is regarded as important by the Government—I do not know whether it is—especially in rural areas but not exclusively, supermarket shopping is not the answer. In my area of south Devon, the major towns of Totnes, Kingsbridge, Dartmouth and Brixham are all convenient, whereas the outer town supermarkets are extremely difficult to get to. They may be more convenient for city dwellers. I often wonder why reports tend to liberalise regulations for the people who live in urban areas rather than concentrate on the mainstream needs of rural England.
Mr. Mark Todd: Will the hon. Gentleman give way?
Mr. Steen: Not at the moment. I should just like to finish this point.

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Lord Borrie, the former director general of the Office of Fair Trading, said:
"I think the risk of ending the entry regulations would mean competition from supermarkets that could not be with stood very easily by pharmacies in the High Street."
How is the service provided by high street chemists different from that which could be provided by the supermarkets? First, it is personal. John Burkimsher's pharmacy on Bolton street in Brixham has a continuity of staff and delivers medication free of charge to elderly and housebound NHS patients. He is familiar with his local customers, and is able to provide a weekly medicines management system if they find it too difficult to control their own medicine intake. He offers a whole range of services that sadly are increasingly rare in today's world. Pharmacists such as Karen O'Brian in Torbay, who has been of great assistance in preparing this speech, work closely with local doctors, forming a bond of trust and reliability. She will go out at unsociable hours to supply crucial medicines in difficult circumstances.
Mr. Mark Francois: That is a very important point. There is a national shortage of general practitioners, as the Minister well knows. Community pharmacists can provide a valuable service by dealing effectively with minor ailments, so that people do not need to see their doctor. That eases pressure on our already hard-pressed GPs. Surely we should bear that important point in mind when discussing this subject?
Mr. Steen: The problem about giving way is that my speech is being undermined by the tremendously insightful interventions of my colleagues.
There is a shortage of pharmacists. If supermarkets provide pharmacists with a national health contract, two pharmacists will be needed because of supermarket hours, thus taking them away from the high street.
The Office of Fair Trading suggested that access to pharmacies would be enhanced by the removal of the primary care trust's involvement in the entry regulations. It claimed that supermarket pharmacies were open more regularly and for longer than high street stores, so more of them would mean greater convenience.
Linda Gilroy: Will the hon. Gentleman give way?
Mr. Steen: Plymouth will have to wait a moment.
Strangely, the Office of Fair Trading's own findings dispute the supermarkets' claim about opening hours. Its polling showed that 90 per cent. of respondents had no difficulty accessing pharmacies when required, largely because the current regulations allow for a good distribution of pharmacies. Community pharmacies keep irregular hours. They co-ordinate their hours with local GPs, and ensure that they are open up to an hour and a half after the surgery closes, so that patients can pick up their prescriptions straight away.
Linda Gilroy: Will the hon. Gentleman give way on that point?
Mr. Steen: On that point.
Linda Gilroy: I am most grateful to the hon. Gentleman.
Mr. Steen: The hon. Lady should be.
Linda Gilroy: I hope that the hon. Gentleman does not have experience of this, but some of Plymouth's inner-city pharmacies play a key role in supervising the self-administration of methadone and other drug substitutes. Does he believe that such a service could continue in a deregulated market?
Mr. Steen: That is a rhetorical question, to which I am sure that the hon. Lady knows the answer. Clearly, that service will not continue in a deregulated market. [Interruption.] I shall not repeat what my hon. Friend the Member for East Devon (Mr. Swire) just said, as it would be totally unparliamentary.
Pharmacies are not just distributors of NHS prescriptions. My hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is a distinguished dental surgeon, told me that his local pharmacies also provide other essential services, such as running a grocery store or even a post office, which are maintained solely because the pharmacist has a guaranteed income retainer.
The Government's strategy document "Pharmacy in the Future" suggests that the Department of Health is considering radical options for innovation. The pharmaceutical industry has proved willing to support and work alongside the Government in trying to achieve such objectives. When considering that report, the Department of Health should examine the system on the continent or the pilot schemes in Scotland, where community pharmacists have been allowed to treat minor ailments and have responsibility for repeat prescriptions. If the Government want to save money, those reforms should do just that.
The regulatory impact unit of the Cabinet Office calculated—I do not know how—that transferring responsibility for repeat prescriptions could save GPs up to 2.74 million hours. Perhaps that is why there are so many civil servants: they have been counting the number of hours that GPs could save if the responsibility for repeat prescriptions were transferred.
Estimates suggest that the NHS could save £380 million each year if only a quarter of all patients went to see their local pharmacist about their ailments instead of their doctor. I agree with the Office of Fair Trading report that competition, innovation and quality improvements are important measures of progress and desirable objectives, but the question is whether abolishing the current control of entry regulations in favour of an unregulated market will be more conducive to achieving those objectives. I do not believe that it will be.
Pharmacies are committed to providing health care to all at the point of delivery. The NHS is a centrally controlled body. Therefore, pharmacies cannot be

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based on a free market model, as that would clash with NHS objectives and the principle of delivering access to all who need it when they need it.
Mr. Swire: That is precisely the point in a rural area such as ours in Devon. There is a disproportionate number of elderly people in Devon, and they need to get to their local pharmacies but can do so only on foot. They might need transport to get to a supermarket, and we all know the state of the transport system in Devon.
Mr. Steen: I am grateful for that comment. Some of my constituents live in far-flung areas such as East Prawle, which is three-quarters of an hour by car to the nearest town. It takes some people living on Dartmoor up to an hour to get to a supermarket, and the cost of doing so is prohibitive. I agree entirely with my hon. Friend.
An important point about prescriptions is that 85 per cent. are free of charge; they are free of charge to the elderly, so the fact that there are cheaper over-the-counter medicines available at supermarkets is not a great help to many people compared with the advantages of location and access to pharmacies. It is not relevant to elderly people to know that aspirin is 2p less in a supermarket than in their chemist.
Mr. Todd: Will the hon. Gentleman give way?
Mr. Steen: I will give way to the hon. Gentleman, but I will not take any more interventions.
Mr. Todd: Would the hon. Gentleman be surprised to know that the OFT report provides the data to back him up? In the survey, 89 per cent. of people said that they found it easy to get to a community pharmacy from their home and 86 per cent. said that they found it easy to get there from their GP's surgery. The report addresses the point of access, but does not follow it through in its conclusions.
Mr. Steen: I said that a moment ago, but I am grateful for the hon. Gentleman's confirmation of the point.
Change for change's sake has little merit. I do not believe that most consumers aspire to shop in out-of-town shopping malls, nor do they want to see skyscrapers where there are now supermarkets, with one-stop shops providing every facility. That would lead to the collapse of the high street and the high-street chemists, and would result in deteriorating, soulless neighbourhoods.
It may sound as if I am pleading for a return to the past, but that is not the case. I am a moderniser and I recognise the need to move forward and respond to the times in which we live. However, not everything new is better, and innovation is not always progress. The existing arrangement gets the balance right. We are talking not about deregulation but about the destruction of the high street as we know it and the quality of life of existing neighbourhoods. Destroying a community and neighbourhood facility, a network for people's care and health, and replacing it with an impersonal, off-the-shelf facility in a supermarket will bring little comfort and solace in an increasingly uncaring world.
9.52 am
Dr. Howard Stoate: I congratulate the hon. Member for Totnes (Mr. Steen) on securing the debate. All credit to him for doing so; it is an extremely important issue.
I met the Minister in the Library last night when I was preparing for the debate. He said that I was the parliamentarian whom he seemed to run into more than any other. That is a reflection of how seriously he takes his role as the Minister responsible for pharmacy, given that it is a small part of his wide brief. He regularly attends meetings with me to discuss these issues. It is also a reflection of how seriously I, as chair of the all-party pharmacy group, take the OFT report on an issue that affects many people.
The fact that so many hon. Members wish to speak in the debate also reflects how important this matter is, and it must not be underestimated. It hinges on three issues: first, whether any changes are necessary to the control of entry regulations for pharmacies; secondly, whether the OFT report is the way to go if such changes are necessary; and, thirdly, and most importantly, the role of community pharmacies in an ever-changing world. The fast-developing NHS needs to become much more consumer-responsive, to deliver more front-line patient services and to develop in a way that improves patient access to vital services.
The first thing that the all-party group on pharmacy did when the report was published was to hold an inquiry. There was a proper debate and consideration was given to all aspects of the report to see whether we could enlighten Ministers in their decision making. The debate was extremely well attended: more than 200 people turned up, including a large number of parliamentarians. There was a first-class discussion, and we examined both sides of the argument in as much detail as possible to see what, if anything, the OFT report could do for pharmacy. We found that changes in the control of entry regulations were needed. We are not opposed to change, because it is often an important way of improving service. I want briefly to read from some of the conclusions in the report that we produced, which has been circulated widely. If anyone who has not seen a copy of the all-party pharmacy group report speaks to me after today's debate, I will ensure that they get one.
The report says:
"The OFT in its report has sought ways of increasing access, choice, competition and quality. We have no dispute with these objectives, indeed we share them. If achieved, they would bring tangible benefits to patients. However, we are not convinced that outright de-regulation would achieve these outcomes.
We therefore recommend that the Department of Health works together with the NHS Confederation, on behalf of PCTs, and the PSNC, on behalf of the community pharmacy sector, to identify ways of achieving improved access, more choice, service development, competition, and quality improvements."
Pharmacists are very much in favour of improving choice, quality and access for patients. The report continued:
"We also recommend that, as part of that collaborative process, problems caused by the current control of entry arrangements are identified and proposals developed for resolving them…We recommend that the collaborative efforts we have described, and consequent changes to control of entry, take place in the context of changes to the national contractual arrangements, since the issues are so closely linked."

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Pharmacists are currently in negotiation on their contract to see how they can improve their services and access for patients. This is a critical time in the history of pharmacy, because such wide issues are being discussed at the same time. It is important that any changes take place in the context of the overall changes to pharmacy arrangements needed to ensure that patients get the best possible access.
In the meeting, there was an interesting contribution from Dr. Peter Fellows from the British Medical Association. He made an impassioned plea, which has not been fully recognised but which adds to the debate, about the relationship between pharmacists and GPs. We are not just talking about large supermarkets opening shops in out-of-town centres and sucking the high street dry, although that is an important issue. There is another, even more important, issue.
I have been a GP for more than 20 years, and the relationship between pharmacists and GPs has changed immeasurably in that time. When I first started, it was unusual for GPs to have much respect or time for pharmacists. There was certainly little contact between the two. Pharmacists were seen as just the shopkeepers who handed out the drugs that we prescribed. However, we have developed a much closer relationship over the years. They regularly come into my practice to look at patient notes and suggest how we can improve access to medicine, medicines management and concordance with patients. They make proposals about rational prescribing, improved drug regimes to make it simpler for patients to take medicines and so on. There is wide interaction.
The BMA representative said that that relationship could be put at severe risk by the regulations. It has not been mentioned that many GPs may decide to open pharmacies in their GP practice. That may be good news for them and, on the surface, for their patients, but it would not be good news for their relationship with pharmacists. It would have many unpleasant repercussions, and the damage could be immeasurable. That has not been significantly brought out in this debate, and it is important to put that on the record. I would hate to see the return of the days when GPs were suspicious of pharmacists and vice versa. That would be counter-productive.
A measure of how seriously pharmacists took that view was the large round of applause for Dr. Fellows when he made that comment. As I said at the time, I never thought that I would see the day when 200 pharmacists applauded the BMA. That is a reflection of how times have changed and how important it is for the relationship between pharmacists and GPs to be fostered and improved.
That brings me on to my third point, which is to ask about the future role of community pharmacists. I travel round the country and meet many pharmacists. I contact them in my constituency, and they come to many meetings of the all-party pharmacy group. It is clear that there is an enormous amount of good will and professional expertise to improve patient services. In meeting after meeting, I am made aware that pharmacists have set up patient group directions and are dealing with emergency hormonal contraception, antismoking mechanisms, lipid management and watering clinics, which takes some of the strain off GPs and frontline hospital services. That is to be welcomed. We are
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only just beginning to tap the role of the pharmacist. They have huge expertise, as they are highly qualified and dedicated. They do an enormous amount for the NHS, and we must ensure that that is not damaged.
The debate hinges on whether the Office of Fair Trading sees the pharmacy as a high street shop or a front-line NHS primary care service. Unfortunately, as the hon. Member for Totnes said, the OFT is far more interested in retail competition than professionalism and the front-line delivery of NHS services. I shall give a few examples of what might happen if the pharmacy becomes nothing more than a high street shop.
How many high street shops would telephone patients on a Sunday to make sure that they are okay? How many would deliver an oxygen cylinder late on a Saturday night to someone dying of lung disease? How many would tell a GP, "We are worried about Mrs. Smith, she is not a good colour today"? How often does that happen? It does not happen with retailers, but it does with pharmacists.
The level of service could easily be put under threat. We have already heard that as many as 6,000 of the nation's 12,000 pharmacies could theoretically be threatened. That may be slightly alarmist, but even a small proportion is not acceptable. As we have heard, access for people living in inner cities and in rural areas is difficult, and it is much more problematic for people who are housebound—the elderly, the frail and the infirm.
I agree that we need changes in control regulations, but pharmacy services are already being improved and there is already market competition between pharmacies. However, we must not undermine the close relationship between pharmacists and GPs. The report deals only with competition but, for the reasons highlighted by the hon. Member for Totnes, competition is far less important than in other retail sectors, because as much as 80 per cent. of a pharmacy's income comes from the NHS. For all the reasons that I and the hon. Gentleman have outlined, it would be dangerous to follow the report.
More than one Minister is involved. The lead Department is the Department of Trade and Industry, but the Department of Health will of course have an input. However, I gather that the final decision rests with the DTI. When Ministers meet to deliberate the Government's response, will the Minister ensure that the main point to be raised—it is the main reason for having community pharmacies—is the professionalism and the delivery of front-line NHS services? The competition issue, although important, is not paramount. Above all, patients want first-rate, frontline NHS services, as the hon. Gentleman said, rather than tuppence off the cost of aspirin.
10.2 am
Mr. Robert Syms: I congratulate my hon. Friend the Member for Totnes (Mr. Steen) on making a compelling case in his own particular style. I shall not repeat the arguments that he adduced. Instead, I shall concentrate on a few points. Most of my constituents have pretty good access to pharmacies, but they are worried about the impact that the changes may have. As the hon. Member for Dartford (Dr. Stoate) said, it may be alarmist to say so, but if 6,000 of our 12,000

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pharmacies close, my constituents will not have access to a local pharmacy. I have received many petitions, letters and telephone calls on the subject. Attendance at today's debate by Members from all parties proves that there is genuine concern.
Many of us have seen the closure of local post offices, the removal of public telephones, and the diminishing of general services for our constituents. This is the one area in which most of us are determined to do our best to ensure that our constituents, many of whom are elderly or not mobile, have access to that very important service.
As my hon. Friend the Member for Rayleigh (Mr. Francois) said in an earlier intervention, the key to the future is innovation. It is important that pharmacists are given more responsibility for treating minor ailments, and a number of tests have proved successful. Another question is the issuing of repeat prescriptions. Various assessments have been made of the savings, but we all know about the tremendous shortage of GPs. The Government have a number of targets for recruiting and training people, but it seems sensible, when possible, to relieve some of the burden on GPs and to provide a greater service.
Mr. James Gray: My hon. Friend comes from an urban constituency, but does he agree that in a rural constituency such as mine repeat prescriptions are particularly important? The GP's surgery may be some miles away from the patient's home, and it would be a huge help if the patient could nip down to the local pharmacy—for instance, in Box, a village in my constituency. The argument on repeat prescriptions is one of the most important in the debate.
Mr. Syms: My hon. Friend reinforces what I said. It is a very important point. Many measures could be taken to improve the service that pharmacists provide to integrate them into the NHS without necessarily going clown that route. We have already heard about the close relationship between many GP practices and pharmacists, who sometimes go the extra mile if people need oxygen or additional help. That service might not be offered by a supermarket.
There is also concern because the pharmacies that have been opened in several supermarkets are not necessarily open during the same hours as the supermarkets, sometimes for the understandable reason that they have difficulty recruiting pharmacists. We have already heard that there is a shortage of pharmacists.
I want to put on record the concern of my constituents in Poole, who are determined to fight substantial change. If the Minister is unable to give us a full answer, I hope that he will give us substantial reassurance. This issue will become very important for my constituents over the next year.
10.5 am
Mr. Tom Cox: All of us here today know from our correspondence of our constituents' deep concerns about the future of the typical pharmacy shop that we have in our constituencies. I totally reject the Office of Fair Trading's proposal that the regulations
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that control pharmacies should be abolished. On issues of fair trading, I always want proposals to be for the benefit of the consumer. Should these proposals be introduced, in my view they would most certainly not be for the benefit of the general public.
As we know, the general public very soon understand if a proposal meets with their approval, and these proposals most certainly do not meet with the approval of our constituents, from whichever part of the country. All of us have used and still use our local pharmacist. I stress the word "local", because that is what they are. They operate in the area where most people live. We get to know, trust, respect and listen to the people who run pharmacies. Opening up such services to supermarkets would, without doubt, present several concerns and problems.
Mr. Swire: Will the hon. Gentleman give way?
Mr. Cox: No, I do not intend to give way.
Many people do not shop in supermarkets. As we have heard, many retired people do not drive, so what has been a local service often becomes a service that is nowhere near where the person who needs it actually lives. The personal relationship no longer exists. As people have said to me in letter after letter, "I know my pharmacist, and they know me. They know who my doctor is, and I can talk to them in confidence about myself and my health. I would not feel confident trying to do that in a large supermarket." Pharmacists know their area and community, but I doubt that that knowledge would still be found if services were transferred to large supermarkets.
I also believe that the proposals would lead to many shop closures in our communities. As all of us have seen over the years, when large supermarkets open up, local shops, many of which have been in the local community for years and have been very popular, can no longer survive and compete against the supermarkets, given the opportunities and trade that they develop. That is what would happen to pharmacists in many areas of the country. Is that what the Government and the Department of Trade and Industry want? I do not want that to happen, and neither do the general public.
When the Minister replies to the debate, it would be very interesting to hear about the thinking behind the Department's policy on the issue. It would also be interesting to find out what the Department of Trade and Industry thinks. What complaint is made against local pharmacists? I get many letters of complaint about many issues, but I must say to my hon. Friend that, despite many years in the House, I have never received even one letter from a constituent complaining about the service that their local pharmacist provides.
The control of entry regulations have been in force for some years. Why seek to change them now? I am not opposed to change when it is of clear benefit to the consumer who wants it. However, these proposals for change are being strongly opposed across the country by the people who use pharmacies every day. The Government have enough problems already, and I do not mean Iraq. Like me, the Minister is a London

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Member, and he knows his constituency as I know mine. He knows that the Government will face problems if they push ahead with these proposals against the will of the people whom we represent, be it in London or in any part of the country.
10.11 am
Mrs. Annette L. Brooke: I, too, congratulate the hon. Member for Totnes (Mr. Steen) on securing the debate. Judging by the size of our mailbags, this is a most pressing issue.
I should like to start by considering the motivation for change. It is worth while considering the arguments for removing the barriers to entry: excessive profits is the obvious one. However, there is no evidence that pharmacists make excessive profits. There is a claim that consumer choice is restricted. The difficulty with that argument is identifying the consumer. In a sense, the national health service is the main consumer, but the front-line consumer is the patient, and one must distinguish between the two.
How would the patient benefit if the barriers to entry were removed? There would be changes; there may not necessarily be fewer pharmacists, but they would be in different places. There is no evidence that removing the barriers to entry would lower prices, because, as the hon. Gentleman pointed out, many elderly people are exempt from prescription charges. We must consider whether there would be net gains from removing the barriers, and we must admit that that is very difficult to establish. It is significant that the former director of the Office of Fair Trading, Lord Borrie, opposes the change. He spent many years introducing more competition so that there would be more choice and lower prices, and he says that it is not appropriate to remove the barriers.
An argument for retaining the barriers to entry is to create a climate for investment, and this is an instance of when we need a climate for investment. The NHS plan proposes a greater role for pharmacists, which we all welcome. In fact, some of us would like pharmacists to do even more. For example, when one goes to one's GP for a blood test one is often sent to hospital. Many believe that, given our lifestyles nowadays, it would be better if such minor matters could be dealt with by a nurse based in a pharmacy.
Weighing the arguments for and against barriers to entry, one comes down in favour of retaining them. We may not want to keep them in exactly the same form; that could be an issue for future debate. The important thing is that there would be a net welfare loss if they were swept away. I concur with other hon. Members that there does not seem to be much evidence that patients want the change, and that is the critical point. The statistical survey that was mentioned showed that over 80 per cent. of patients do not want a change. I am sure that other hon. Members have, like me, received petitions, letters and surgery visits on the matter.
I represent a diverse constituency with pharmacies in many settings—supermarket, village, market town and neighbourhood urban shopping centre. I have been receiving representations from all quarters. In the village, the petition has been signed by nearly every resident, because for elderly people and mothers with young children, for example, the GP's surgery will be very far away. The pharmacy is their first stop-off and it
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is vital to them. Devon is a similar case. Dorset is renowned for having exceedingly poor public transport outside its conurbation, and, in contrast to some areas, our senior citizens' concession is only for half-price, rather than free, travel, so any savings that they make will soon be swallowed up by the costs and difficulties of travelling.
At my surgery on Saturday I met a pharmacist who works in Upton, an area attached to the main conurbation. I asked him what he does that supermarket pharmacies may not do. We should not suggest that supermarket pharmacists are in any way less qualified. He ran through a long list of what really amounted to voluntary work: home deliveries after 6 pm, which is an excellent service; making up the weekly medicine dosage tray; visiting a home if a doctor rings to suggest a change to a prescription; and taking oxygen out to people.
Sandra Gidley: As the only pharmacist present I have listened to the debate with interest. I am the villain of the piece, having worked as a pharmacist in a supermarket, when I provided all those services—they are not unique to community pharmacies. However, that does not mean that we should deal with supermarkets in a way that enables them to deprive community pharmacies of the opportunity to do that work.
Mrs. Brooke: I thank my hon. Friend. The point that we are making is that the relationship with the pharmacist in the community is a much closer one, involving continuity of contact with people. People prefer their local service to that provided in a supermarket, which may not be so near to them.
As time is short, I conclude with a summary provided to me by the Dorset local pharmaceutical committee. It argues that the change
"would create unnecessary and untimely instability in the pharmacy sector",
which is an important point. In addition, it would
"jeopardise pharmacy investment and developments in primary health care planning. It would delay the process of recognising the potential role community pharmacy can play in primary health care provision. It would have a seriously adverse impact on local community services".
A whole neighbourhood centre can be affected, as we know, which is why the supermarket issue is cause for concern. The summary continues:
"The public would not be able to enjoy the benefits offered by the enhanced services at their local pharmacy. This would particularly affect those living in rural areas or isolated housing estates who rely heavily on their local pharmacy. It will be the elderly and mothers with young children who will suffer most."
Several hon. Members rose—
Mr. Deputy Speaker: Order. Before I call the next hon. Member to speak, it may be helpful if I point out that it would be desirable for the first of the three Front-Bench spokespersons to be called not later than 10.30.
10.18 am
Linda Perham: I congratulate the hon. Member for Totnes (Mr. Steen) on securing this timely debate. I am interested in the issue as a member of the

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Trade and Industry Committee and of the all-party group on pharmacy. I am motivated also by the concerns of pharmacists in my constituency, who were among the first groups to contact me when I was elected. I met them in June 1997 and have remained in contact with them ever since.
My hon. Friend the Member for Ilford, South (Mike Gapes) received a petition last week with 20,000 signatures from our area alone. I expect one to be delivered today. A key issue for community pharmacists and patients in my constituency is access and convenience of location. That point has been well made by other hon. Members. Elderly people and those without access to private transport do not want to travel to supermarkets for their prescriptions.
Community pharmacists are not afraid of competition. For many years two pharmacies have been practising successfully opposite the health centre in my constituency, and another, closer to where I live, is just 10 or 15 minutes' walk from t hose two. Those pharmacies have been thriving for many years. Local pharmacists are approachable and knowledgeable, and they have forged a key role in delivering NHS services. As the Secretary of State said at the Labour party conference in October, pharmacists are clinicians, not shopkeepers. I would say that they are not retailers but rigorously trained professionals.
Marshall Davies, the president of the Royal Pharmaceutical Society, said in January:
"We know that nearly 2 million people seek healthcare advice from their community pharmacist."
Community pharmacists play a vital part in treating a range of illnesses, in managing chronic diseases and in complementing and alleviating the work of GPs. My hon. Friend the Member for Dartford (Dr. Stoate) made that point and it was also highlighted by the King's Fund, with which I spent a year on a National Council for Voluntary Organisations secondment. The fund's report, "Developing Community Pharmacy", found that community pharmacists were keen to play a greater role in the NHS.
I cannot emphasise enough the importance of community pharmacists in providing for the health and social needs of local communities. Today, on national no-smoking day, I pay tribute to their work in combating the scourge of smoking. Many community pharmacists work in partnership with smoking cessation services, and they can train to become community smoking cessation advisers, of which there are 18 in the boroughs of Redbridge and Waltham Forest. Some 260 people were helped last year, with a 50 per cent. success rate. For national no-smoking day today, pharmacists in my constituency are putting up posters and displays in their windows offering nicotine replacement therapy.
The help given to people to overcome that addiction and all the other vital services that pharmacists provide reinforce the crucial role that pharmacists play in their local communities.
Mr. Gareth Thomas: My hon. Friend has, like me, the good fortune to represent a suburban constituency in outer London. Given that we have heard
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much about the impact of the proposed change in regulations on rural and inner-city areas, is it not also important to recognise the impact that the implementation of the Office of Fair Trading report would have on secondary shopping centres that provide a crucial sense of community in such constituencies?
Linda Perham: My hon. Friend is right. That affects us all. Other hon. Members have made that point and will continue to reinforce it for the Minister. I am sure that the Minister, to whom I pay tribute for his willingness to listen, will consider carefully the representations from hon. Members today on the necessity of encouraging community pharmacists to continue their positive contribution to primary care services and to the improvement of the nation's health.
10.23 am
Mr. Roy Beggs: I congratulate the hon. Member for Totnes (Mr. Steen) on securing this debate, which enables many of us to convey our views and those of our constituents to the Minister before the Government act on the report.
The proposal of the Office of Fair Trading to deregulate pharmaceutical dispensing is vigorously opposed by all my hon. and right hon. Friends. We believe that the OFT report is entirely misguided, and that its recommendations will impede access to, and the provision of, pharmaceutical services.
The New Economics Foundation recently raised the prospect of Britain as a nation of ghost towns. In its report "Ghost Town Britain: A lethal prescription", the foundation highlighted the negative impact that supermarkets, hypermarkets and out-of-town shopping centres have had on local services in our towns and villages. That might still be a relatively new phenomenon in Northern Ireland. The development of stores previously seen only on mainland Britain has occurred largely from the peace process of the last decade, yet our villages and towns are already witnessing the virtual disappearance of the high street. Our corner shops, post offices and banks are finding it increasingly difficult to compete with the large one-stopshop supermarkets in out-of-town venues.
Clearly, such supermarkets provide many advantages to the consumer, such as greater choice and more competitive prices—not to mention the convenience of being able to buy all one's necessities in one place. However, people must be able to get to such facilities if they are to take advantage of them. What about the elderly, the disabled, single parents, young mothers and those without access to private transport? The high street is their lifeline. In a country such as Northern Ireland, whose economy and geography are predominantly rural, the local high street remains vital.
Mr. Swire: Is not there an inherent contradiction between the Government's sponsorship of the legislation, which will lead to more people having to use cars, and their attempts to persuade people not to use them?
Mr. Beggs: The hon. Member takes a keen interest in Northern Ireland affairs. He makes a valid point, which the Minister will have noted.

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The community pharmacy will become unsustainable in the face of competition from the pharmacies that spring up in our supermarkets. The Office of Fair Trading estimates that deregulation will result in 900 new pharmacies in large supermarkets and a further 2,127 in medium-sized stores across the United Kingdom. I sincerely hope that that does not happen.
Rev. Martin Smyth: Is my hon. Friend aware that GPs in Northern Ireland have said that they will be unable to give their attention to the anti-smoking campaign, which will therefore depend largely on community chemists? Given that today is no-smoking day, should not that issue be borne in mind?
Mr. Beggs: I thank my hon. Friend for that valid contribution, which highlights the fact that pharmacists' activities involve much more than just dispensing.
Research conducted by Lloyds Pharmacy at the beginning of the year estimated that more than half the pharmacies are in the catchment areas of two or more supermarkets, so the potential for many of them to fall by the wayside is high. Northern Ireland may be predominantly rural, but it is also small, and our pharmacies will inevitably be within the catchment areas of supermarkets. The number of community pharmacies lost could therefore be huge.
Why should we make people who are disadvantaged suffer increased inconvenience by forcing them to travel further to see their local pharmacist? Many people already have to wait a week or 10days to get an appointment with their doctor. However, they can get instant access to the local pharmacist, who can often prescribe something for their ailment. Is the creation of such problems what the Government have in mind when they speak about access to health care for everyone?
The proposals will have an enormous impact on the delivery of health care. The OFT report fails to acknowledge that pharmacies provide much more than daily necessities. They are not there just to sell toiletries—they are more than a convenience store. According to the National Pharmaceutical Association, 80 per cent. of a typical pharmacy's turnover comes from providing NHS services, particularly from dispensing NHS prescriptions. The community pharmacy cannot be regarded as a typical high street shop. We cannot realistically subject health care to the free market.
Community pharmacists do more than dispense drugs. Many provide a very personal delivery service for prescribed medication, and often respond to patients' requests outside normal working hours. They are almost part of the family. They are trusted members of the local community, and provide health advice for those who cannot or will not see their GP. People are much more likely to seek advice from someone they know, trust and see often than from an unknown individual sitting behind a busy supermarket counter.
Face-to-face contact with patients, and the delivery of primary health care, encourage many young students into the pharmaceutical profession in the first place. Northern Ireland is already facing a shortage of qualified pharmacists, and students who decide to study in other areas of the United Kingdom invariably do not return. If we replace the essential caring element of the
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profession with a concern for profit margins over consumer health, it will be even more of an uphill struggle to entice young people into pharmacy in Northern Ireland and elsewhere in the United Kingdom. My party urges the Government to reject the proposals and to continue to support the present network of community pharmacies as an essential mechanism in the provision of health care and a vital part of community life.
10.29 am
Dr. Evan Harris: I pay tribute to the hon. Member for Totnes (Mr. Steen) who introduced the debate in his typically clear way and was generous in giving way to interventions by hon. Members from all parties.
I do not have time to comment on all the points that have been made, and I have others of my own to add. There is a great deal of interest in the subject, as evidenced by the record numbers present from all political parties—13 Labour Members, nine Conservatives and nine Liberal Democrats, or 3, 5 and 17 per cent. of each party's respective parliamentary strength. On occasion, among all its disadvantages, the first-past-the-post system works to our advantage.
The hon. Gentleman pointed out, rightly, that there is a difference between deregulation and the need for increased competition. I was pleased to hear him say that a free market is not always appropriate, even in the retail environment. The Liberal Democrats strongly support deregulation if it means that every effort will be made to reduce the burdens on business. However, that does not mean having completely free competition.
Mr. Michael Weir: On deregulation, does the hon. Gentleman accept that the original reason for introducing regulations was to avoid the situation in which pharmacies clustered around doctors' surgeries and health centres and to ensure a wide spread of pharmacies throughout the community? The OFT report would reverse that process.
Dr. Harris: That is a fair point. It should be borne in mind that even if the OFT report were implemented, there would be other restrictions that none of us would want to lose. For example, planning restrictions impact on the number of retail outlets, especially supermarkets. The OFT seems to consider that, in the name of advantage to consumers, there is automatically a good argument for the abolition of any regulation. However, we should consider planning. To give just one example, removal of regulation would mean the abolition of controls on out-of-town supermarkets. In paragraph 1.11 of its summary, the OFT claims that
"the regulations have acted to impede entry and expansion by pharmacies that offer consumers lower prices, more convenient opening times, or valued and innovative services."
Even having read the report and the responses to it, I do not think that the case has been made.
Brian Cotter: Does my hon. Friend agree that it is striking that the OFT report says that there is clear evidence that the current system works

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well in terms of locality? The OFT itself draws attention to the importance of the fact that there are local pharmacists where people actually vivant them.
Dr. Harris: Yes, indeed. I pay tribute to my hon. Friend, who is probably more in touch with small business interests than any other hon. Member. He has done a huge amount of work to protect the interests both of consumers and of those who run small businesses.
It is argued that there are lower prices in supermarkets. However, where that is so—andit does not exist everywhere—it is not clear that it is anything other than loss-leading intended to increase footfall for the much wider range of goods that supermarkets can offer in comparison with pharmacies. Those goods include—even today, on national no-smoking day—cigarettes. Supermarkets want people to buy cigarettes and other products whereas community pharmacies, which do not sell such products, do not have that need.
The abolition of resale price maintenance has not necessarily and invariably led to maintained reductions in prices of over-the-counter medicines. I am concerned about the way in which the OFT report deals with international comparisons. It states, almost parenthetically, that Britain does better than average in the number of pharmacies per head of population—which counters its own case—and then lists only those countries that do better than this country. If one claims that an investigation is impartial, one should set out both sides of the argument.
There is inadequate consideration of work force issues, which are important. There is not a free labour market in the area, because it is comprised of professionals, and it does not follow that there should be a free market in retail if the work force does not have that freedom.
Throughout, the report refers to the people who rely on pharmacies as consumers. Many of us are concerned about the increasing redefinition of patients as consumers. Not all consumers and their interests should be considered equally. There are equity issues. It is not simply a matter of consumer choice but of ensuring that we give sufficient regard to those who are especially vulnerable. We must ensure that choice for the many is riot increased at the cost of choice for the vulnerable few, such as low-income groups, the elderly and the sick. We should bear that principle in mind, although it is not endorsed by the OFT, which says that there should be no barrier to entry that does not best serve the interests of consumers.
The OFT mentions that it wants to be mindful of the public policy objectives of health departments. That will mean having regard for access by elderly people. The report found no sign of profiteering, although that usually follows when there is an inadequate market. The failure to find evidence of profiteering is a strong argument against the report's recommendations.
I want to say one word in defence of pharmacists who work in supermarkets, as did my hon. Friend the Member for Romsey (Sandra Gidley), because they, too, are professionals. They know local people, can assist with medicines management and do all the other
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things that we want them to do. The question is not about the professionalism of pharmacists employed by supermarkets, but the impact that greater competition in our supermarkets will have on the viability of local stores. I want all pharmacists to take part in medicines management work.
Finally, I want to offer the Government some better ways to reduce costs than those suggested in the OFT report. Clearly, more intervention by pharmacists actively to manage the way in which patients—consumers, if it wants to use that word—take their medicines will reduce costs, because there is much waste in prescribing. Increasing the supply of pharmacists will also ensure that there is more and better medicines management.
I want to suggest three better ways to increase access. The first is to freeze prescription charges, which, for many people who fall just outside the exemption, are a barrier to accessing medicines. The Government should ensure fair remuneration for pharmacists, so that they are able to do all the things that the Government want them to do without finding that they are unable to do the work that makes them viable. Pharmacists receive no money for making up dosage boxes, although that is time consuming, but we know that compliance with medicines is a critical factor in effective medical treatment—no medicine works if it is not taken.
The Government must do something to improve the supply of pharmacists and to ensure that supermarkets and independent pharmacists do not have to shop around for locums, because, in the current labour market, community pharmacists will always lose out against the wider multiples. Although the Liberal Democrats are in favour of greater deregulation, we do not believe that the OFT report makes an adequate case. The interests of vulnerable patients and consumers will not be safeguarded if community pharmacists are driven out of business by increasing competition from supermarkets and large multiples.
10.39 am
Chris Grayling: I, too, congratulate my hon. Friend the Member for Totnes (Mr. Steen) on securing this extremely important debate on an issue that is clearly of concern to hon. Members from all parties. The fact that he initiated the debate emphasises the Conservative party's concern about the future of community pharmacies. It comes at a time when local centres, stores and communities are, increasingly, under threat from the Government's policies. Thousands of post offices are already disappearing throughout the country. There is now the risk of local pharmacies doing the same, the consequence of which would be devastating for local communities. That is why I am extremely concerned about the impact of the OFT recommendations and why I believe that the Government should scrutinise them fully before they consider adopting them.
A local pharmacy is important for several reasons, which Ministers must not forget as they set about studying the detail of the OFT report. The first reason is access, to which many hon. Members referred. The elderly and the infirm have always relied on going to their local chemist to get the drugs and treatments that they need. They have also relied on a friendly and

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supportive word from their pharmacist, whose professional skills contribute significantly to health care in today's world, as several hon. Members have said. The hon. Member for Dartford (Dr. Stoate) made that point especially well. As chairman of the all-party group on health, he, perhaps more than most, recognises the importance of the role played by the local pharmacist in our communities.
Many families also need the local pharmacy for treatment for their children. The reality for many families is that one partner takes the family car to work, and the other is at home with the kids. He or she will walk to the local centre and pick up the necessary drugs from the local pharmacy. We must not run the risk of that disappearing. The damage that that would do to the fabric of local communities would be enormous.
Mr. Henry Bellingham: My hon. Friend may be aware of a village in my constituency called Snettisham. It has an excellent pharmacist called Alan Stockley who does a superb job serving what is now a predominantly ageing community. That community is very worried about the report, and I am glad that my hon. Friend mentioned elderly people who need advice from their friendly local pharmacy.
Chris Grayling: I thank my hon. Friend for his comments, which speak for themselves. They reflect the strength of feeling across the House about the risk to our community pharmacies.
There is a practical point to be made about the viability and future of local centres. As I said, post offices and banks are disappearing, and local food stores have gradually moved out of local communities. In many places, the local pharmacy is the anchor store on a small parade. Its disappearance will not only cause a reduction in local services but kill other businesses. The consequences of that to the people who live in those areas could be very significant.
It is interesting that planning policy guidance 6 sets out to protect the local pharmacy and post office as an important part of the fabric of those local centres. In many ways, it seems, the OFT is arguing against established Government planning policy, and the Government should think carefully before they go against their own planning policy.
As many hon. Members have said, the local pharmacy has a role in supporting the national health service. Pharmacists have profound skills and years of experience with individual patients and the treatments that they dispense daily. Those skills can and must be an important part of the provision of health care in the future. There is a clear role for the pharmacist as our society looks to new ways to deliver health care closer to the communities that benefit from it. There is also a clear role for the pharmacist in providing more of a gateway to our over-pressed GPs by giving basic advice and guidance to people about ways to tackle their health problems. That role must not be undermined by local pharmacies in local communities disappearing as a result of these measures.
The OFT report will clearly open up the market. It will allow supermarkets to move into the market in a big way. I accept the professionalism of the pharmacists
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who work in our supermarkets. None the less, I was surprised to hear the two Liberal Democrat health spokesmen weighing into the debate in defence of supermarket pharmacies. We must be careful before we see significant additional provision of pharmacies in supermarkets. There is no doubt that supermarkets play an important role in our society, and there are places where supermarkets can and do provide good pharmacy services, but we must be careful about giving supermarkets the opportunity to have an additional and substantial presence in this market.
Sandra Gidley: Will the hon. Gentleman give way?
Chris Grayling: I have only a minute left, so I hope that the hon. Lady will forgive me if I do not give way.
Before I give the Minister a chance to wind up the debate, I shall refer to the nature of the market with which we are dealing. In recent months, we have had a debate on the over-the-counter market. Many pharmacists told hon. Members on both sides of the House that, if they lost the resale price maintenance that applies to over-the-counter drugs, they would lose an important part of their business. They said that there would be price cutting and that they would be unable to compete with supermarkets. To a significant degree, however, that has not happened. There was some crying of wolf in the pharmacy industry. I have talked to many local pharmacists who say that the situation has not proved to be as bad as they thought.
However, that experience does not justify deregulating the NHS prescription dispensing market, because that market does not depend on excellent service, innovation and competition. It is largely a fixed market. It is not as fixed as Ministers might like, given its escalating budgets, but we are talking about a fixed cake. If we allow new entrants into the marketplace to take a share of that cake, some of those who are there today will inevitably lose. That is basic economics; it cannot be any other way. Given the fixed or limited prescription market for those businesses to draw on, a significant expansion of the number of pharmacies, as the OFT envisages, cannot but ensure that pharmacies in local communities throughout the country will disappear. That must not happen. It would be a devastating blow to those communities, so the Government must think carefully about what lies ahead.
I know that the Minister is in the middle of consultation and likely to be reticent about anticipating the results of that consultation, but my message to him is that we have heard from hon. Members on both sides of the House who come from different backgrounds, persuasions and viewpoints. The views of the hon. Member for Tooting (Mr. Cox) are well known, and I respect him for his long service in his constituency. He made an impassioned plea from his political perspective about the importance of local pharmacies. My hon. Friend the Member for East Devon (Mr. Swire), who represents rural communities—small villages in the countryside—also saw as enormous the dangers that could result in those communities from the disappearance of local pharmacies.
As I have said, the Minister has heard views from hon. Members on both sides of the House, from different types of constituency and political perspective. I very

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much hope that he will take from the debate a clear understanding that the House does not want local community pharmacies to be undermined. He must not take decisions in the wake of the OFT report in a way that is likely to cause further damage to the people who most depend on the services that community pharmacies provide.
10.47 am
The Parliamentary Under-Secretary of State for Health (Mr. David Lammy): I congratulate the hon. Member for Totnes (Mr. Steen) on securing the debate and on the spirited way in which he made his contribution. A wide cross-section of Back Benchers have made quality contributions. I am particularly grateful for the views of my hon. Friend the Member for Dartford (Dr. Stoate), the work of the relevant all-party group and the powerful contribution from my hon. Friend the Member for Tooting (Mr. Cox).
Ms Joan Walley: Does my hon. Friend accept that many more hon. Members wished to contribute to the debate? We want him to take away the strong message that this issue is about public health. We want primary care trusts to consider health planning and community pharmacies, and we want a deal negotiated with the pharmacies for the new contract. We do not want medicine to be treated as an ordinary item of commerce.
Mr. Lammy: My hon. Friend is right to point out that many hon. Members have spoken on this subject in this Chamber, and many are concerned about the report and anxious to express their views. We heard from constituencies as far apart as those of the hon. Members for Mid-Dorset and North Poole (Mrs. Brooke), for Rayleigh (Mr. Francois), for East Antrim (Mr. Beggs), for Belfast, South (Rev. Martyn Smith) and for East Devon (Mr. Swire), and of my hon. Friend the Member for Harrow, West (Mr. Thomas). Hansard will also contribute to the Government's deliberations.
Much has been said about the contribution of community pharmacies in rural, suburban and inner-city areas. All Ministers, of whatever Government, are also informed by their constituency experiences. From the inner-city constituency that I represent, and in which I grew up, I know that people in deprived communities rely on three people in authority. They rely on the general practitioner and often on the local priest. However, they traditionally have to get an appointment to see the GP, and the priest is not to everyone's taste, so they most definitely rely, as my family did, on the work of the community pharmacist at the bottom of the road.
In preparing for a speech that I made to the pharmaceutical services negotiating committee eight days ago, I spent Saturday not only rushing to the bank and paying the bills as one does, but also incognito in north London in some of my community pharmacies.
Chris Grayling: The mystery shopper.
Mr. Lammy: The hon. Gentleman is right—I watched what was going on in our community pharmacies.
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During the day, I saw a desperate father rush in to get drugs for his epileptic son, a bus driver who was worried about shortness of breath, and many mothers, with children who had sticky fingers and runny noses, looking for cold medicines. What struck me was the fact that the community pharmacists knew the name of the epileptic son of the man, and that they came from behind the counter to help the mothers with their children and advise them what cold remedies to buy. Importantly, they knew people's histories—for example, the bus driver's grandmother had a history of high blood pressure.
Mr. Paul Truswell: Does my hon. Friend appreciate the concern shared by hon. Members throughout the House that when the Government come to take a decision, the Department of Trade and Industry tail will wag the Department of Health dog? Will he give a categorical assurance that he and his colleagues will do their utmost to ensure that patient care and public health take precedence over any considerations of commercial practice?
Mr. Lammy: My hon. Friend will know that the Government will deliberate on the issue in the usual way.
Mr. Eric Joyce: Further to that point, my hon. Friend will know that whether this matter is regarded as a health or consumer protection issue is important in Scotland, as one matter is devolved and the other is not. There is a Scottish health and medicines plan, called "The Right Medicine". A Health Minister is responding to a debate in Scotland today, and the argument deployed in Scotland is that we are discussing what is essentially a health matter. That is also the general view of hon. Members present today, so will my hon. Friend convey that fact to Ministers at the DTI? I appreciate that Ministers have to consider important competition points, but this is an important issue for the Scottish Executive and for people with the same interests.
Mr. Lammy: I am grateful for that, and as I have said, many Departments have a stake in the issue. We will deliberate and make our response as a Government in due course.
My ministerial portfolio is very diverse, but in the past few weeks and months, pharmacy has taken up the lion's share of my diary. With officials from both the DTI and the Department of Health, I have met a wide range of stakeholders and interest groups to listen to their points of view. I know that hon. Members have also been lobbied intensely, and for me, to go through a Division Lobby at the moment is to run the gauntlet.
Mr. David Lepper: Does my hon. Friend acknowledge that the importance that so many of our constituents attach to maintaining community pharmacies is shown, for instance, in the petition that I received this week from Fields pharmacy in Eldred avenue in my constituency with 400 signatures and the petition that I received this morning from Stallion's pharmacy in Preston Drove in Brighton with 960

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signatures? That was received in one week, and I am told that other pharmacists have similar petitions awaiting collection.
Mr. Lammy: Democracy is alive in this place. I know that as I walk through the Lobby and receive advice from hon. Members of all parties.
It is important that I set out the course of events. The remit that the director general set himself was to examine the UK market for retail pharmacy services, and to consider whether consumers are best served by the current statutory controls under which pharmacies can dispense NHS prescriptions. His conclusion was that they are not. He therefore recommended abolition of controls to improve competition, to reduce prices for over-the-counter medicines and to improve access to and the quality of pharmaceutical services.
Ms Walley: Is my hon. Friend aware of studies made in Stoke-on-Trent by local pharmacists that show that the basket of different items is cheaper in independent pharmacies? Will he accept that even where the OFT report says that there are reductions, that is not necessarily the case, particularly when one takes transport issues into account?
Mr. Lammy: I am aware of that study. There are many studies in this area.
We recognise that the report marks a significant watershed, but its implications go wider than community pharmacy. They involve GPs, the NHS more widely and—most importantly—patients. We have therefore made it clear that we would study the report carefully, canvass views, and consider the impact on our plans to improve services. I wrote to all hon. Members in England and, as I said, I have met leading professional bodies to hear their reactions. Those include the pharmaceutical services negotiating committee, the National Pharmaceutical Association, private companies, the British Medical Association, the all-party pharmacy group and a cross-section of supermarkets.
Mr. Steen: Having met all those key people, what is the Minister's conclusion?
Mr. Lammy: As I have said, the Government will let their views be known in due course, as the hon. Gentleman knows very well.
My officials have also met representatives of patient, consumer and NHS groups. I understand that the
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Health Committee wants to undertake a one-day inquiry on 3 April into the possible impact of the OFT report on community pharmacy services, and I urge Members to feed into that very useful inquiry. We are giving the report and the many hundreds of responses careful attention. We have heard a wide range of views. I have listened keenly to all the arguments. I wish to assure the House today that I, my colleagues across Government and the devolved Administrations will give them the fullest attention when we consider our response to the report.
Mr. Tyler: In the final moments of his speech, will the Minister tell us whether he expects legislation to be required? What sort of legislation might it be, and what priority would it be given in view of all the other pressures should the Government eventually decide to activate the OFT recommendations?
Mr. Lammy: I am advised that if the Government accepted the report's recommendations in full, primary legislation would be required.
In the remaining time available I am not able to talk about the other important things that are taking place in pharmacy across the board. I should have liked to set my remarks in the context of pharmacy in the future, which includes local pharmaceutical services projects, medicines management, repeat dispensing and supplementary prescribing. I accept that the OFT report has an important bearing on all those issues. However, I encourage hon. Members to make their views known. I can tell them that the Government are taking the report, and their views, seriously.
Ms Walley: On a point of order, Mr. Deputy Speaker. In view of the obvious cross-cutting issues relating to the Department of Health and the Department of Trade and Industry in the light of the OFT report, what powers do you have to recommend a cross-cutting debate in Westminster Hall so that we can consider the issues in relation to both Departments?
Mr. Deputy Speaker: I have no such powers, but I am impressed by the amount of interest in the debate. I am concerned that so many Members wish to participate in the debate, but cannot, and I shall certainly draw that to the attention of the Speaker.

Fruit Farming
11 am
Hugh Robertson: May I begin, Mr. Deputy Speaker, by saying what a pleasure it is to sit under your chairmanship" Unless I am much mistaken, I note from your curriculum vitae that you are vice-chairman of the National Wildflower Centre. It is a particular privilege to be under the chairmanship of someone who is clearly such a horticultural expert.
I thank the Minister for the Environment for taking the time to respond to the debate on behalf of the Government. I am particularly pleased to see him here today. I say that in all honesty, because his knowledge of, and concern for, the environment is well recognised. Fruit farming makes an important contribution in that regard. This is also the first debate to be held in Westminster Hall on that important, subject.
I have asked for the debate to highlight fruit farming and the wider horticultural sector and to raise a number of current issues. I do so both as secretary to the all-party group on the fruit industry and as one of the few Members who represents a constituency in which fruit farming predominates.
My starting point is that we should all support fruit farming. The industry is wholly unsubsidised, produces high-quality produce close to the marketplace and is good for the environment. It is largely thanks to fruit farmers that Kent enjoys its reputation as the garden of England.
Fruit farming also has a disproportionate effect on the local economy in those areas where it is the main type of agriculture. In my constituency, it is a key employment provider on farms and associated industries such as packing and transportation. Shepherd Neame, the oldest family brewery in the country, is based in my constituency and exclusively uses Kentish hops. As I have hinted previously, jobs in the tourist and leisure industries also rely on fruit to shape the landscape.
Fruit farming is a significant contributor to the agricultural sector as a whole. According to figures produced by the National Farmers Union, horticulture accounted for 13 per cent. of agricultural output in the year 2000. If direct subsidies to other sectors are disregarded and packing is added, the figure rises to 19 per cent. However, the growers are deeply troubled; their sector is in decline, and they are voting with their feet.
Figures from the Department for Environment, Food and Rural Affairs, revealed to me in a parliamentary written answer on 23 October 2001, show that 10.8 per cent. of the national orchard has been lost since 1997. That is a staggering figure, and one that would not be tolerated in any other sector of the economy, particularly when the environmental impact is taken into account.
So, what has caused the decline'? The answer is, of course, a variety of factors. The actions of supermarkets, increased regulation, climatic changes and a huge increase in imports have all played their part, but there are several areas in which we could offer the sector worthwhile help. Before I outline those, however, I want to thank the Minister for the Government's help
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to the sector, even in the short time that I have been a Member of Parliament. The climate change levy rebate for horticulture has been a considerable boon, and it is vital that it continues.
The increase in the seasonal agricultural workers scheme to 25,000 this year, and the move to an open bidding system next year, provides the key to the whole sector. I want to flag it up to the Minister that any proposal to widen employment opportunities under the scheme would be the death warrant for fruit farming. Proposals to amend the EU marketing standard for apples and pears have disappeared off the radar—and long may it remain that way. Finally, having debated the issue with the Under-Secretary of State for Environment, Food and Rural Affairs, I want to express my gratitude to him for securing an exemption for orchards from the environmental impact assessment.
I should like to enlist the present Minister's aid on several fronts. First, what do the Government want from horticulture in general, and fruit farming in particular, over the next five to 10 years? What is their strategic vision for the sector? Many growers were deeply concerned by a letter, written on 12 February, from DEFRA's horticulture division to John Breach, chairman of the British Independent Fruit Growers Association. DEFRA states:
"The future of the British industry appears to lie in serving niche domestic markets".
DEFRA's red book on horticultural statistics shows that home-produced marketed apples account for 31.2 per cent. of total supplies and the figures for pears and plums are 24.6 per cent. and 13 per cent. In all honesty, that is hardly a niche market. Will the Minister deal with that problem and articulate his vision for the sector's future?
Secondly, I am concerned about the activities of the agricultural wages board and it is difficult to overstate its importance to growers. Wages account for between 40 per cent. and 60 per cent. of the average grower's cost base, so when profits are tight, any increase will have a disproportionate effect. This is not the time to reprise the events of last summer. Two independent members of the board, who each attended only one meeting in four last year—the critical year—and the chairman have now resigned, and a new settlement will be on us next month.
May I ask the Minister to take home the following three points? First, the key figure for growers is not the headline rate but the casual workers' rate, which rose from £4.30 an hour last October to £4.91. Any repeat would simply break the sector.
Secondly, the agricultural wages board looks increasingly anachronistic. We rightly have a national minimum wage, and it should provide the basis for future wage settlements. As the Minister will understand, when farm profits are at rock bottom, growers feel increasingly discriminated against because only the agricultural sector is treated in this fashion. If abolition is politically unacceptable, will the Minister consider offering some special treatment for casual workers in the horticultural sector, who are, after all, increasingly from eastern Europe? The scheme that brings them here is terrific and is vital to the horticultural industry, but it is clearly daft if the price of implementing it is grubbed orchards.

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Thirdly, I am concerned about the future of Horticulture Research International, East Mailling. The Minister will understand that a vibrant research base is crucial if horticulture is to have a viable future. HRI East Malling has an unrivalled reputation worldwide as a provider of high-quality and commercially relevant research. It is a national treasure, and we should do everything possible to ensure its survival.
Many of those points, and other more detailed ones, were discussed in a separate Adjournment debate sponsored by my right hon. Friend the Member for Tonbridge and Malling (Sir John Stanley). The quinquennial review has reported, and DEFRA is considering its position. The Government's plan, in outline, is to transfer the research station to the East Malling trustees, who will run it on a commercial basis. That will work only if the Government are prepared to back that outcome and, at least initially, to provide hard cash to ensure that the transfer and start-up costs of the new East Malling are met in full. Unless a proper business case is presented, the East Mailing trustees cannot, under their agreement, agree to the proposed transfer. However, if it can be achieved it is perfectly possible that a new, independent East Malling will emerge to continue the best traditions of the current station.
I should add that there are several specific concerns about DEFRA research grants. The quinquennial review group recommended that at least 40 per cent. of income for research should be provided as a core grant to ensure that core skills are retained and developed. Will DEFRA provide that? Will it continue to place DEFRA-commissioned projects at the new East Malting? Will the new East Malling still be able to bid for open competition funding from DEFRA and for competitive funding from the Biotechnology and Biological Sciences Research Council?
It would be unfair of me to expect the Minister to answer those detailed questions today, but perhaps he could relay the contents of our debate to his noble friend Lord Whitty, the Minister responsible.
I hope that the Minister will not consider me churlish if I say that considerable offence was caused by the review team's decision to define East Mailing's commodity base too narrowly as top and soft fruit. East Mailing's work encompasses all perennial crops grown in the UK, and it would be reassuring to know that that wider role is recognised, particularly at a time when such serious structural change, with its impact on jobs and livelihoods, is being undertaken. However, the key point is that horticulture needs research as never before if it is to succeed. In East Mailing, we have the world's foremost research station. I therefore urge the Government, in the strongest possible terms, to provide the transitional funding necessary to allow its tradition of excellence to continue.
Fourthly, the Minister is aware of the controversy about the French grubbing and replanting scheme. I understand that France applied for, and got, state aid for the scheme, which allows French farmers to claim a grant for switching from other agricultural sectors into horticulture.That means that they can replant orchards in such a way as to give them an unfair competitive advantage over their English counterparts. At the risk of
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giving the Minister too much homework, I ask him to look into that to see whether any protection can be offered to English growers.
Finally, I want to flag up the industry's concerns over the new Water Bill. Trickle irrigation is of particular importance to many growers who have previously been exempt from the abstraction licensing system. That will change under the new Bill. The Government have signalled their intention to consult the industry about the issue, which is greatly welcomed. It is important that trickle irrigators are treated equitably within the system.
Time constraints have necessarily resulted in a fairly rapid canter through the main issues affecting the fruit farming sector. It is right to finish where we started: fruit farming is an activity that we should all support. It is wholly unsubsidised, produces high-quality food close to the marketplace and is good for the environment. It also has a disproportionate effect on the rural economy in those areas where it still predominates. However, it sits on the cusp; some of the reasons for that are outside our control, but others definitely are not. I hope that the Minister will confirm the Government's commitment to the future of East Mailing and reassure me that they fully understand the difficulties caused to growers by the recent agricultural wages board settlement. I hope that the Minister will be able to articulate his vision for the future of horticulture and that he will take note of the detailed points on East Mailing, the Water Bill and French grubbing and replanting grants.
Growers in my constituency want no more than to run their farms as small businesses, free from overregulation with an achievable vision for their future. In my part of Kent they also have a vital role as guardians of the countryside. I hope that the Government will help them to achieve those aims.
11.14 am
The Minister for the Environment (Mr. Michael Meacher): The hon. Member for Faversham and Mid-Kent (Hugh Robertson) made a thoughtful and serious speech. He made an important case, which is of great concern to the Government, and I will certainly try to satisfy the hon. Gentleman on the points that he raised.
The hon. Gentle man is quite right to say that there has been a marked decline in our orchard fruit area in the past few years, and he gave some of the reasons for that. The market for English apples has faced tough competition from imports for many years. I regret that our climate does not allow us to grow high-yielding varieties such as golden delicious, which have the advantage of storing well and being cheap. Costs have risen, but prices have not, and that has led to many growers leaving the market. We are not satisfied with that, and I am as determined as the hon. Gentleman to deal with it.
The hon. Gentleman asked several questions that I shall try to answer. First, I would like to say something about the Government's strategic vision for horticulture. Eighteen months ago, in response to a Select Committee report on Horticulture Research International, DEFRA commissioned a report from Sir Colin Spedding on the objectives of horticultural

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research and development in the UK. He called his report, which was published early last year, "A Vision for Horticulture", and it identified a need for
"a vision for horticulture, to guide and inform the industry, its stakeholders and Government."
That was to be produced by a forum made up of people who were capable of taking a broad view of the needs of horticulture. The Government are pleased that such a forum was set up by key horticultural bodies towards the end of last year and that it is working on some of the issues that Sir Colin identified.
Sir Donald Curry's report on sustainable food and farming is equally relevant. It too articulated a vision of a profitable and sustainable farming and food sector that can and does compete internationally, is a good steward of the environment and provides good food and a healthy diet for people in England and around the world.
That is the vision. However, I am the first to say, "That is fine, but how do we deliver it?" That, of course, is exactly what my Department has spent a great deal of time and effort on over the past year, and it will continue to do so. That vision forms the basis of the sustainable farming and food strategy that we published before Christmas. To answer the hon. Gentleman, it informs our approach to agriculture just as much as it does our approach to horticulture.
Our vision of the future does not involve Government in prescriptive control of the productionindustry—not that the hon. Gentleman was suggesting that for a moment. That is not a policy that we would support. It is not for Government to decide what will be produced or where. Instead, with Sir Donald Curry, we envisage a Government who support the industry and who facilitate the business decisions of others by improving the implementation of regulation and by clearing the path if anything blocks the functioning of the market. We want that to be achieved as smoothly and as effectively as possible and to be in no way burdensome.
I do not have the time to go into detail on the vision, but the essential document is the strategy for sustainable farming and food. If the hon. Gentleman has issues that he wants to raise concerning horticulture, the Department and I will be more than pleased to work with him.
The hon. Gentleman expressed concern about the agricultural wages board for England and Wales, about the wages that it sets and about the effect of the recent rise in certain aspects of those wages. We consulted on the future of the board in 1999–2000, and that provided an opportunity to see how the national minimum wage, the working time regulations and the agricultural minimum wage were working alongside each other. In general, the review concluded that the current arrangements were working well.
The hon. Gentleman asked about the continuing relevance of the board. The close link between job and home evidenced by the fact that 60,000 agricultural workers or managers are in accommodation provided by the employer reinforces the view that it is difficult for agricultural employees to conduct meaningful direct negotiations with their employers. I do not say that they are in hock to their employers, but they do not have the
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degree of independence that most other employees enjoy. That is why we believe that there is still a rationale for retaining the agricultural wages board.
The hon. Gentleman also asked me to consider the points that he made about the wages of workers recruited from eastern Europe. I accept that that is an important point. He said that the scheme was good, but that it undermined the future of horticulture in the UK, and we should take that into account.
We are committed to the programme of modernisation that we announced following the review of the board in 1999. My noble Friend Lord Whitty will take the matter forward and will arrange further discussions with the employers' and the workers' sides on the scope of any changes to be introduced. Those discussions will also provide an opportunity to consider the NFU's suggestion that changes to the negotiation process should be introduced as part of the modernisation package.
At this point, that is all that I can say about the agricultural wages board. However, I understand the significance of the points raised by the hon. Gentleman, and they will be pursued during the current review process.
I will address the question of research and development and the future of East Mailing. In horticulture in particular, research and development plays a vital part in determining future possibilities for the sector. As part of DEFRA's work on a science and innovation strategy, we have invited industry stakeholders to help us to identify, evaluate and prioritise opportunities for and threats to future competitive production, storage and distribution of horticultural produce. We seek to commission work that will make a real difference to our industry and that will be complementary to the work funded by the industry through the levy bodies.
The East Mailing research station, which is currently part of Horticulture Research International, has, as the hon. Gentleman said—and I would be the first to endorse it—a proud tradition of work that is highly relevant and valuable to the fruit industry. The station was originally set up by far-sighted growers who knew that an effective research programme was vital to a successful future. The East Mailing site is still owned by the original trustees and, following the quinquennial review of HRI, we are discussing the future of that site. The review concluded that HRI was not sustainable in its present form and that the East Mailing research station should either close or, preferably, be established as an independent research station under the aegis of the East Malting trust for horticultural research. We very much hope that negotiations with the trustees will result in a positive outcome that combines DEFRA funding for strategic research, industry funding and work from other sources.
Like other bodies, East Mailing will be able to bid in competitions. We recognise its role, particularly in relation to hardy nursery stock. Details of the work to be done and of the funding are being examined as part of the negotiations, and we will be happy to contact the hon. Gentleman about that.
The hon. Gentleman raised a couple of other issues, and I shall deal briefly with them before saying a further word about the sector's future. First, he mentioned

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French grubbing grants. I do not carry knowledge about that issue around in my head, but he was good enough to give me advance notice that he was going to raise it, so I can give a slightly more informed reply than I might have done.
My Department is aware of the French orchard grubbing scheme, which provides national aid of 74.5 million euros over four years to producers of apples, peaches and nectarines. That aid is for grubbing up orchards and planting new varieties that are better adapted to market needs. As the hon. Gentleman rightly said, the scheme has been submitted to the European Commission for approval and has been approved as consistent with the objectives of the common organisation of the market in fruit and vegetables. It is designed to deal with a particular problem of overproduction in France. The hon. Gentleman's point is that that is all very well but that the extra money could be construed as giving French growers an extra advantage over English growers. I am happy to take his point that we should consider the problem to see what, if anything, we can do about it.
The last issue that the hon. Gentleman raised was trickle irrigation and the Water Bill. We accept that future arrangements for licensing trickle irrigation are a matter of concern to growers. The Bill is going through Parliament and is needed to implement our commitments under the water framework directive. It contains new powers, which are necessary to manage water resources effectively and to prevent environmental damage. We expect new controls on trickle irrigation to be introduced in 2005 at the earliest. Again, however, we will consult further before new regulations set out detailed licensing arrangements. We are well aware of the concerns, which are justified by the
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overriding need to protect the environment. We are prepared to consult further and to listen to those who have concerns.
Let me conclude with a few words about the state of the sector. The present review of the common agricultural policy is geared towards making agriculture less dependent on subsidy. The horticulture sector, of course, receives very little subsidy and already relies on efficient and competitive production to meet its customers' needs.
The industry is to be congratulated on the work that has gone into developing the assured produce scheme, which now covers the majority of UK fresh produce The scheme provides traceability and the assurance that production has met high standards of quality and safety.
From May, the organic farming scheme will be amended to provide conversion aid of £600 a hectare for top fruit production. That will help English growers meet consumer demand for organically grown fruit.
The Government are working with their own procurement agencies—I chaired one of two seminars on sustainable food procurement for the public sector—to identify opportunities to supply more English produce under public contracts. Under EU procurement rules, the Government may not specify local or UK sources. However, such sources may be able to play a greater role in meeting UK needs as part of a sustainable procurement strategy. That is certainly our wish.
I congratulate the hon. Gentleman again on expressing the concerns of his constituents and of this important sector of agriculture. The Government are as keen as he is to support it.
11.30 am
Sitting suspended until Two o'clock.

Supporting People
2 pm
Mr. David Drew: I am delighted to have secured this debate because we are less than a month away from some momentous changes. I congratulate the Government on the initiative that they have taken in pulling together services for vulnerable people. Many older people are not vulnerable, but the changes will impact most on the older generation. The debate will give us the opportunity to discuss both the principles and the detail of the changes.
I have just returned from a conference this morning organised by the Hanover group, al which I chaired a meeting on the single assessment process. It is quite difficult to separate the supporting people initiative from the single assessment process, which I shall mention again later. The keynote message that I received from those at the conference was that they welcomed the changes, but they were worried that the profile was not as high among the general public as it could and should be. I hope that, with this debate, we can put that right.
I would not pretend that I have a considerable background in this area, but I have a long relationship with Care and Repair, the main home improvement agency in Stroud, and I am a long-standing committee member of Stroud Age Concern. Towards the end of my remarks, I want to discuss mental health and disability issues, although those are not the Minister's main concern. I shall mainly address the way in which the changes will affect housing, and home improvement agencies in particular.
I thank the Government for entering into a long period of consultation. I was pleased that Bert Provon, who is, I understand, head of the supporting people initiative within the Office of the Deputy Prime Minister, was able to visit Stroud about 18 months ago, at the instigation of the Minister's predecessor, now the Under-Secretary of State for International Development. Mr. Provon met people from the sheltered housing community, which will undergo some fairly considerable changes as a result of the initiative.
I should like to thank the people who helped me to prepare for the debate: Sue Adams and Jane Creed of Care and Repair, Jon Shaw of Stroud district council, Alistair Shute and Gary Thorogood, who work as part of the supporting people team in the county of Gloucestershire, and my friend Chas Townley, who was involved in the South Gloucestershire supporting people team.
I shall first map out the context fairly quickly, then I shall look at the progress that has been made and the implications of the changes, and finally I shall examine some issues in greater detail, starting with the impact of what I see as the key vehicle for change—housing. The original document, "Supporting People", published in December 1998, was a pioneering piece of thinking. It has taken us four and a bit years to get to the stage that we are at now, but we must look back and remind ourselves how important those statements were.
The system will change according to four key principles. First, people will be put first, so that the funding is with the people rather than with the system.
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Secondly, the needs of the most vulnerable people will be highlighted, which will include those outside the normal group, such as rough sleepers, drug users and ex-offenders. Such people do not necessarily fall under the catch-all phrase of vulnerable people, but they will now be part of the changes relating to supporting people. Thirdly, there will be reprioritisation of high quality services and clarification of funding arrangements. Lastly, there will be a logical and transparent approach to planning those services, which will be done in a much more rational, consistent and, dare I say it, integrated manner.
I shall consider those principles in more detail. First, the idea of putting people first is being handled through major budgetary changes. Transitional housing benefit levels determine the size of local funding. It is pleasing that the criticisms that I have heard voiced have not been over that issue. This matter is complex, and the criticisms are mainly detailed. The overall question is what will happen after the transitional period. Perhaps the Minister can give a guarantee that once we get through that period there will be no attempt to claw back resources.
Secondly, the reprioritisation of what is meant by a vulnerable group is obviously a grey area, because it is always possible to include some groups and exclude others. I shall say more about how one can begin to find more moneys for such groups. However, the main argument that has been made to me is that financial help for those groups should not be found at the expense of existing arrangements. Perhaps the Minister will say something about that too.
The third point, about high quality services, pulls together the first two points and the argument that I am advancing, which is that we need to clarify the funding streams after the transitional period to make it clear that those local pots of money will be sacrosanct and will, I hope, increase over time. However, I should like to know to what extent, once there is even greater devolution of responsibility to the local level, the Office of the Deputy Prime Minister will continue to monitor individual cases to ensure that the money reaches the front line, rather than getting lost somewhere in the system.
That links directly to the last point, which is about how we can make the planning system more integrated. I suppose that the matter will come to a head when we consider the introduction of the needs-based formula, which, I understand—the Minister may correct me—will come into play in 2006. Again, some important changes relating to overall funding are under way, and they will impact on planning.
A considerable sum—in the order of £1.4 billion—has been set aside for the supporting people initiative. There is some tension between the centre and the localities about how much direction there should be. There is evidence that some of the new arrangements are already causing difficulty. There is, for example, an implication that to find new moneys one has to go along with the Government's idea that savings of 2.5 per cent. must be found. I accept that money can always be reallocated, but there are many differences around the country, and local authorities operate in a variety of ways. It is questionable that all of them can find the money and whether that is the best way to pump-prime new

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initiatives. I hope that the Minister will tell us how the savings situation will relate to the funding of local authorities.
There is some concern, as is evident from numerous websites that I have consulted, about the readiness of each area for the start of the initiative, which is now only weeks away. The problem is not how we communicate the fact that the changes are taking place but how we simplify their complexity to reduce the risk of people feeling that they are not for the better. It would be a shame if that were the feeling because most people in the field are very supportive in principle. We must try to get right our communications strategy.
Looking specifically at home improvement agencies, we welcome the fact that the money is being ring-fenced from the outset, but it is not entirely good news. I have been, as I mentioned, at Hanover housing association conference, looking at changes in the way that we assess the needs of people in hospital. It was bluntly put to me that the housing association, one of the smaller providers of home improvements, with 10 or 12 schemes, is in deficit. Because it is now clearer about the likely funding stream, it is threatening to pull out of home improvement. That is not good news, and I hope that the threat is designed to sort out the problem, rather than to be carried through. As I said, Hanover is a small provider; most home improvement agencies are sponsored directly by local authorities. The biggest provider is Anchor Housing Association, which has not made any criticisms. We should be aware that in one of the key areas of delivery there is concern among those through whom delivery will take place.
There is a link to another problem. Under the previous Government, there was a view that home improvement agencies would largely be funded by the state, but that there would also be some attempt to derive income from fees. I can give a clear account of how difficult it has been to organise that in my local care and repair agency. The assumption has been that some £6 million will be raised nationally through fee income, and in a sense it is pleasing that that is no longer the case—the £6 million appears somehow to have been lost amid the calculations. Unless the Minister tells us otherwise, agencies will lose the ability to raise money through fees, and that is probably right, but it could add to the pressure on them, with adverse consequences.
Although I am talking principally about the tenancy sector, I shall spend a little time discussing sheltered housing. I am a great advocate of sheltered housing as the answer to many of our problems in this regard. I have debated it before; it is moving with the times and is becoming more attuned to the need to link with social services and health. Some areas use the term "ultra-sheltered housing". In my area we call it very sheltered housing. Both are important in the context of supporting people schemes, because the funding stream, although it now comes under one heading, will be split between the different functions of sheltered housing. There will clearly be some difficulties because new tenants will be treated differently from existing tenants. As with all changes in regulations or in Government policy, the initiative cannot be retrospective; nor can we pretend that it should be rolled forward indefinitely.
I am a little concerned that trying to disaggregate some of the costs to make it clearer what people are paying, and why, will make it more difficult to cross-
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subsidise, which is not always a good thing. More particularly, I am worried that people will end up facing a stark picture of what they will have to pay for each of the various services, which could be rather a disincentive for them to go into sheltered accommodation. That is the last thing that the Government would want. They, like me, see such accommodation as an important route for people who went to move away from owner-occupier status or some forms of renting into a more appropriate property—usually something smaller. Again, I would like an assurance about whether new tenants will be treated in a similar way to those who have that protection under existing arrangements.
Rents have risen. In my area, that is partly because we are also undergoing rent restructuring—another reason why the picture is so complex. A whole raft of changes is being made at the same time. The supporting people budget includes everything except accommodation—I am sure that civil servants will find that far too simple an explanation—and we must ensure that everything else, such as payments for those who manage the facilities and other associated expenses, will be treated separately. However, we must remember that making the different streams of funding more obvious could put people off.
Having spoken to many people, I find that the danger of disaggregation is worst for those who do not receive housing benefit. I am aware that some of those people will still be helped under the supporting people budget because of the different ways in which it will be able to measure who is eligible for help. The last thing that we want is for people who are not eligible for help to be asked to pay such steep charges that they might think it wrong for them to be housed in sheltered accommodation. More important, such people may not go there in the first place. I am sorry to have taken so much time to make that point, but it is crucial. We are talking about a significant number of people. It is a route that we should explore again; sheltered accommodation is a highly sensible and sensitive way to house older people and other vulnerable groups, and we should not make it prohibitive.
By chance, the conference made clear the link between the supporting people programme and the changes involved in the single assessment process. I know that the Minister is not solely responsible for the initiative, and he may be grateful for that because it is complex. However, the overlap with the changes involved in the single assessment process adds to the complexity, and we should try to cut through that complexity.
I hope that individual assessments will be conducted with due regard to the supporting people arrangements. More particularly, I hope that the professionals involved will meet to exchange information. The question of what information may be exchanged is one that has recently emerged for society to deal with, and we shall have to be careful about that in the present context. Data protection is relevant, as is the natural resistance of some people to undergoing the assessments. I know that concern has been expressed about the reason for the review process. There is obviously a conspiracy theory, but people who will clearly remain within the criteria for the funding that the state has always provided are concerned. Some people are suspicious and will not, therefore, willingly participate.

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If nothing else, we need to make sure that the teams doing the work—and they are teams—communicate with one another and share information. The aim is to make the arrangements as seamless as possible for those to whom they will apply. Not only should people be in the most appropriate accommodation, but, for those who spend time in hospital, we should be studying approaches to their leaving hospital. We need to get rid of the dreadful notion—I never want to use the term, but there is no better one—of bed blockers. Help should be provided in discharging people from hospital and ensuring that they go to the best, most appropriate accommodation.
That is the essence of the single assessment process. In its broader approach, which needs to be improved, it provides links and support. It is a matter of diversity and choice, to use the terminology regularly used by the Government. People must have choice, so a range of different services must be available.
I said that I would comment on mental health and learning disabilities. One of the best aspects of the initiative is that it does not only involve changes to funding for older persons' care; as well as considering groups that have traditionally fallen outside the net, we are also thinking about groups that never did, but were probably dealt with in the Cinderella part of the service. Those groups include people with mental health difficulties and people with learning disabilities.
I have noticed that residential homes meant principally, but not entirely, for those with learning disabilities, have reclassified themselves to enable people to claim transitional housing benefit. That is a good thing. It encourages independence and new ways of going on and living life. All that I ask is that the Government make it clear that they do not intend suddenly to drop the portcullis and try to reclaim money. The arrangement is expensive. It applies to people who, traditionally, have not been able to obtain additional funding by using housing benefit avenue. We need to make it clear that we shall continue to treat it as appropriate and allow them to draw those funds.
I welcome the permitted earnings changes that the Government have pioneered to allow people with mental health difficulties to earn money and to go through a transition back to work. I should like things to be made clear. Housing benefit should not be affected, but other benefits are. I mention the matter to the Minister, although it is not his responsibility but that of the Department for Work and Pensions. We need to ensure that Departments are talking to one another.
We are talking largely about people in some form of specialised housing, and we must ensure that they continue to receive support and that assistance is not taken away from them as a result of any reduction in the supporting people budget. There is much detail to consider, and I make no apology for doing so. If my constituency can be used as an exemplar, I am pleased, because we have found more accommodation in supported lodgings. However, that comes at a price and we must ensure that the stream of money is not suddenly cut short for any reason. The Minister will need to have a dialogue principally with his colleagues in the Department for Work and Pensions, although there
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could also be health-related matters, depending on the nature of the illness from which a person suffers. I hope that the matter can be clarified.
Some of the Government's motives, including those concerning the amount that they are contributing, have been questioned, but I think that they should be congratulated. The saddest part of the process relates to the notion of pipeline schemes, whereby we would find new ways of arranging care and would encourage health, service services, housing and, under its aegis, the voluntary sector, to work in different ways.
By chance, I was talking to the director of social services for Leicester city council, Andrew Cozens, who is an old friend of mine because he used to be the director of social services at Gloucestershire county council. He said that the council bid for £4 million for pipeline schemes and received £40,000. He felt that social services could find some money through savings. He said that he had set great store by some of the new initiatives that he wanted to undertake, but that was the response that he received. I would like some guarantee that the pipeline schemes, which are at the really innovative and integrative end of the work that needs to be undertaken, will not be denuded of funds, because that would prevent the implementation of the changes of which the Government have spoken.
To conclude, I hope that the Minister will respond to the following issues that I have highlighted. First, how are we trying to improve co-ordination between at least three Departments, and local authorities and the voluntary sector? As I have said, the complexity of the issues is causing confusion and the message is not getting across. That is true not only of the supporting people initiative but of the single assessment programme.
Secondly, to take matters forward, we need security of funding into and after the transitional period. Many of the people to whom I have spoken told me that they are holding fire and have negotiated one-year contracts. With the best will in the world, because of the nature of the work that is being undertaken, they cannot keep renewing one-year contracts. We need some guarantees about where funding will come from. We need to know what shape the new funding formula will take, how we will consult on it and whether 2006 is a realistic deadline for putting it together.
Lastly, there is the fact that we are trying to change the whole working culture of the various professions involved. The area has been bedevilled by people working in their own particular field and not sharing information more widely. How can we make progress on that, given the problems that I have highlighted, including information sharing and the operation of different budgets? How can we overcome those problems?
I will finish as I started by saying that the Government should be congratulated on taking the initiative. The move is long overdue, and they have a lot of guts to see it through, because we can see why it has not been done before. If the Government communicate more widely to the general public why and how the programme is happening, today's debate will have served a purpose. I hope that, with the other contributions, we can use today as an opportunity to take forward this important change.
2.30 pm
Matthew Green: I congratulate the hon. Member for Stroud (Mr. Drew) on securing a debate on an important and complex subject. He has shown a detailed mastery of the complexities of a subject with which, I suspect, few people could cope.
We welcome the steps that the Government are taking. The ideas of inter-agency work, putting funds into a single budget and bringing the management under a single committee are welcome. I remember early steps towards such a system in Herefordshire when the Liberal Democrat-controlled council merged the social services and housing departments. The council chief executive became the joint chief executive with what was then the Herefordshire health authority, which worked well until the health authority was abolished to make way for the strategic health authorities. The general principle of trying to bring the various agencies together to secure support in housing vulnerable people is welcome, and the Government have taken a bold step towards it. In the light of that, I hope that the Minister will take my questions as an attempt genuinely to be helpful in teasing out some of the problems. [Interruption.] The Minister shakes his head, and he probably suspects that I never aim genuinely to be helpful. He will have to take it on face value that I am.
The primary area of concern is about the budget. Age Concern, and other bodies, have expressed unease since the beginning of the consultation stage about the introduction of a cash-limited budget compared with the previous open-ended funding through housing benefit. There is a contradiction between a needs-led approach, which is welcome, and a cash-limited budget, so will the Minister assure us that it will not lead to problems for the agencies?
The Minister may recall that I wrote to him recently, after I received a letter from Bridgnorth district council. In the letter, Councillor Jenny Collingridge, who is chair of the council's community improvement programme, raised the problem of the budget. She wrote:

"This concern is exacerbated by the very real concerns that Members have over the adequate funding of the Supporting People programme from 1st April 2003. The basic pot is being determined by the current contributions to Supported Housing Services from the public sector, which in this County—
Shropshire—
"accounts for less than 25 per cent. of all the households; yet is eventually expected to cover all tenures. Unless there is a process for identifying and making available continuing adequate resources from Central Government Supporting People will not achieve its intended aims. Past experiences of Housing Benefit administration for Council tenants and Care in the Community, where there have been effective year on year cuts do not auger well for Supporting People. Many potential recipients of Social Care are excluded from the process at the assessment stage, not because they would not benefit from the services but because there have never been sufficient resources to fund all that is required. Services are rationed and some clients do not receive services that they would clearly benefit from."
That is an important concern that is not being taken into account. Perhaps the new funding formula will solve that by 2006. I hope that the Minister will deal with that in a bit of detail.
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The Minister's reply dated 10 February reads:
"Dr Collingridge also sought clarification on the funding arrangements for Supporting People. Announcements on the Supporting People pot will be made in February."
I had a meeting with Bridgnorth district council officers and members on Monday and they have not heard anything. I asked my researcher to delve around and her note presciently says;
"We can't find any announcement."
We are now in March. Perhaps there has been an announcement and the Minister will leap to his feet to tell me that I am wrong. We would obviously welcome that information as soon as possible so that the councils can focus on implementation.
My second area of concern, which again was raised by Age Concern, is how support needs are prioritised. The fear is that certain vulnerable groups, which have traditionally been a low priority for local authorities such as ex-offenders, young people leaving care and single homeless people, will lose out in the allocation of resources because of the pressure on local authorities' budgets. In a sense, that comes back to the concern about the cash limiting of the budget. I realise that there have to be limits on how much can be spent in broad terms but budgets are now defined and the housing benefit budget, which previously was open ended, will not be available in quite the same way.
My third area of concern, which I have also written to the Minister about, is the constitution of the committee that will administer these matters. I shall quote from a letter written last February to the former Secretary of State for Transport, Local Government and the Regions, the right hon. Member for Tyneside, North (Mr. Byers), by Roger Walker, the Labour leader of Shropshire county council. He wrote:
"The guidance issued by your Department in December is inconsistent with our respective obligations under the Local Government Act 2000 and these inconsistencies need to be eliminated as soon as possible and revised guidance issued. We hope that you will be able to arrange for this to be done and revised guidance issued as quickly as possible.
Our ideal model would be for there to be a Joint Committee with formally delegated Executive responsibilities. This Joint Committee—drawn from the membership of each of the Partners—would take decisions in relation to the Strategy and Implementation Plans. We would, of course need to build in a form of joint scrutiny for decisions made."
Shropshire is obviously a two-tier area. The letter continues:
"Your Department's December guidance suggests Partners set up a Commissioning Body, comprising officers, this Body to take all strategic decisions. We are concerned at this on two counts. First, such decisions are more properly the province of Elected Members … and secondly, it appears unconstitutional for formal decisions … to be delegated to a collective Officer Body. Officers can be empowered to take single Council decisions only. Our preferred model would overcome this democratic deficit of an Officer Body but it also is constitutionally impossible at present. A key element of this model would be equal status for all representatives and at the moment, Health and Probation colleagues would have to be non-voting under the Local Government Act 2000, despite their financial commitment to this programme. We would therefore press for legislation to be changed to permit our preferred model with all partners having voting rights."
That letter is a year old, but the letter from the Bridgnorth district council is only a couple of months old. That council makes the same point about the role

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of elected members and the voting rights of officers. The Minister's response confused us. In his letter of 10 February, he says:
"I agree that setting priorities for Supporting People strategies is something that elected members must be fully involved in. Senior officers who attend meetings of the Commissioning Body can only act in accordance with the wishes of elected members and the level of authority that has been delegated to them."
However, we learned from the other letter that they can act only for each authority rather than voting for the body as a whole. The letter continues:
"There is no reason that elected members should not themselves sit on the Commissioning Body, should they wish to do so.
That is fine, but unless the voting rights are sorted out, the body cannot take strategic decisions effectively.
We continue to seek clarification from the Minister, because we want this Government initiative to work. We want to help it to work, but there are genuine concerns about whether it will be the success that it deserves to be in the long run, or whether it will not deliver in the way in which many of us, including many organisations and agencies, hope it will. For the sake of vulnerable people and their needs, I hope that the Minister will address my points and the detailed points made by the hon. Member for Stroud in his thoughtful contribution.
2.41 pm
Mr. Desmond Swayne: I congratulate the hon. Member for Stroud (Mr. Drew) on securing the debate and on the comprehensive way in which he dealt with a complicated subject. Both he and the hon. Member for Ludlow (Matthew Green) have done the House a service by covering the subject in such detail. I shall therefore be able to reduce considerably what I was going to say. However, I fear that form and convention require me to say something.
The debate is welcome, and I am glad that it was selected, but we would have benefited from a statement, as their lordships did on 20 February during the recess. After all, the programme affects the housing of 1 million people, and has a £50 million impact on local government funding. There is bound to be a huge consensus throughout the House, and I do not disagree with anything that has been said so far.
The programme is a great opportunity to improve the quality of life of vulnerable people by providing a stable environment and greater independence. I wholly support that laudable objective. The existing system for providing services is hampered by overlapping and complex funding streams. It is much easier to secure funding for some forms of housing, but much more difficult for others. There is a lack of focus on quality, and a lack of ownership and responsibility. There is certainly no transparency in the allocation of funds. Therefore, there is no question of the need for this reform and the opportunity that it affords. There is, however, a question of whether we are ready for implementation from 1 April. We seek reassurance from the Minister about how ready we are.
I would like the Minister to answer several questions that I fear overlap with questions that have already been asked, but I would be interested to hoar his responses. I fully understand that he might not have all the answers
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to hand this afternoon, but it may be possible for him to write to hon. Members with the answers afterwards. Will he tell us how many significant changes have been made to the guidelines and the guidance issued to local authorities in, say, the past four months? Will he also say what the implications of those changes are? How many local authorities have and, perhaps even more importantly, have not yet agreed contracts and pricing schedules with service providers? Can the Minister reassure us about the robustness of estimates of support costs? I ask that as there is evidence that providers have been underestimating those costs to maximise the receipt of housing benefit subsequently. That will clearly have implications later for the adequacy of funding.
The announcement of 20 February arrived with an appendix listing the grants, which is now available in an excellent document produced by the Library in preparation for this 90-minute debate. Unfortunately, I was handed it only as I sat down for the debate. That strikes me as extraordinary, because I visited the Library on Monday evening to ask for a briefing for the debate, and was directed by e-mail to a couple of websites, which I subsequently visited. As I had asked for a briefing for the debate, surely it should not have been beyond the wit of someone to let me know subsequently when the briefing was available.
Setting that aside, I have a question about the list of grants to local authorities. I wonder whether the Minister might answer it. I did a little number crunching, and it appears that the grants available to Conservative-controlled county councils are, on average, £1.3 million lower than the grants available to Labour-controlled county councils. That disparity is even greater for London boroughs. Conservative-controlled London boroughs are, on average, £4 million worse off than Labour-controlled London boroughs. The Minister might be able to deal with that when he sums up.
The supporting people programme does not stand on its own as an isolated programme. Each of its component parts fits within a wider strategy to address the needs of specific groups. I said that the announcement of 20 February had an implication of £50 million for local government funding, but we discovered in that week or the following week that at the same time, on 1April, £400 million is to be taken away from it as a consequence of the abolition of social housing grant. It was always expected that social housing grant would go, but everyone believed that it would go on 1 April 2004.
That is a significant cost to local authorities, which by and large had already set their council charges before that bolt from the blue arrived. However, it will have a particularly deleterious effect on a particularly vulnerable group of my constituents who certainly require support. The occupants of dwellings in mobile home parks are among our most vulnerable people. They suffer as a result of a form of tenure that has to be less eligible than any other. The law is stacked against them in terms of the power of the landlord. Perverse incentives are almost built into the law to maximise turnover by making, in the case of unscrupulous landlords, tenants' lives unbearable.
In my experience, a significant minority of landlords of mobile home parks have neither the social nor the managerial skills to make a success of them. We await

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the implementation by Ministers of the findings of the working group and a comprehensive reform of the law on mobile home parks.
I shall exemplify the fear of the owners in some mobile home parks. In Ringwood in my constituency, the district council was required to realise its assets and sell a mobile home park. The mobile home owners, determined not to be owned by some ghastly private landlord, having seen examples elsewhere and not wanting to be at such a disadvantage, and horrified at the prospect of being owned even by a social landlord who was one of the bidders, struggled to find a £1 million mortgage to buy the park themselves. The attendant stamp duty and other costs are loaded upon them but they do it and the deal is in train. Suddenly, however, the social housing grant is withdrawn, pulling the rug from under them. Can the Minister guarantee that the undertakings that have already been entered into under the terms of the grant, those that are in the pipeline, will be guaranteed to continue even if the contract cannot be exchanged by 1 April?
Homelessness has risen by 15 per cent. from 1997 to the end of last year. The Prime Minister promised
"a society where we don't spend millions on bed and breakfast for families, but spend it on housing them instead."
In the New Forest, although there was a period about three years ago when there were no families in bed-and-breakfast accommodation, there is now a considerable increase in the numbers. A gentleman, who I hope will benefit from the supporting people programme, came to my surgery recently complaining that he had been to see a house in Ringwood that suited his needs absolutely, as it had been converted for people with a disability and problems like his. He said, "Why can't there be a house like that for me? Why can't more properties like that be built to accommodate me?" He told me about the appalling circumstances in which he had to live because there was no such provision.
Part of the answer is that the district council is not allowed to use its funds to build such dwellings because it is required by the Whitehall-imposed policy to use its budget to renovate its existing housing stock rather than building new houses. I have raised the matter with Ministers in written questions, in oral questions and in debates on the Floor of the House in the hope that the Minister would address the issue on summing up. I have even raised the matter in Standing Committee, but it is like having a dialogue with the deaf. Perhaps this afternoon the Minister will break the mould and answer my question directly.
I fully understand the motive that underlies the policy; there are local authorities in this realm that have so neglected their housing stock over a number of years that some of it has become uninhabitable. Of course, those local authorities should be constrained by Government policy to do something about it. However, not all local authorities are in that position; there are beacon local authorities that do not have that problem. One size should not fit all; one policy should not be applied to all local authorities irrespective of the needs of their housing stock.
The tragedy is that New Forest district council will not be able to build properties for the vulnerable people I have described. Instead, it will have to rip out perfectly good kitchens from its existing properties and replace
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them with new ones in order to abide by the Government's policy directives. I believe that local councillors should take those decisions and be accountable for them; they should not be imposed by Whitehall.
Matthew Green: The hon. Gentleman is making a very good point, although perhaps it is a little off the subject of supporting people. Is he aware that the Conservative Government introduced the policy that he is talking about? It is a shame that the Labour Government have not altered it, but the reality is that it is a Conservative Policy. Is the hon. Gentleman now saying that he regrets it?
Mr. Swayne: No, I am saying that it is horses for courses. This was once an enormous problem, but we have now dealt with it and moved on. The hon. Gentleman might recall that some time has passed since the last Conservative Government—though it might not be so long before we have another one. As for the hon. Gentleman's other point, I am confident that if I had strayed beyond the confines of the debate, you would have called me to order, Mr. Deputy Speaker.
Finally, I entirely support the objectives of the programme. It is time that we did something like this. An opportunity is to be had, but I caution hon. Members in the way that I caution my constituents that not all expectations can ever legitimately be met.
A lady came to see me recently to complain about the provision made for her son, who requires supported housing. She complained that he did not want to live in residential care, but on his own in the community. After all, the cost of providing him support to live on his own in the community would not be wholly dissimilar from the current cost of providing him with residential care. Consequent upon that exchange, I made one or two inquiries and discovered that the young man had moved out of residential care and had shared a home in the community with two others. However, because he did not want to live with the others and because of his limitations and disabilities—I attach no blame—he had assaulted both his co-residents and their carers. That is why he had had to be moved back into residential care.
When I followed the matter up with the local authority and inquired, in view of his choice to live on his own, what provision could be made to support him in the community, I was told that the constraint was not mainly financial—though it could be in certain circumstances. The reality was that providing care for the young man would require the full-time support of two people 24 hours a day, which has implications for the employment of rather more than two people. Ultimately, the state is limited in what it can do: it cannot satisfy every demand and every need. We can, however, go a long way and certainly do better than under the present system.
2.57 pm
The Parliamentary Under-Secretary of State, Office of the Deputy Prime Minister (Mr. Tony McNulty): It has been a worthwhile and timely debate—perhaps rather déjàvu in view of yesterday's debate when again we heard two eloquent, comprehensive and well-informed contributions, and then the Conservative stood up.

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My hon. Friend the Member for Stroud (Mr. Drew) has done the House and the wider community a service in initiating the debate. I fully appreciate his experience with home improvement agencies such as Care and Repair. He expressed understandable worries about the programme's complexity. I welcome his introductory comment that the scheme is overwhelmingly in the right direction and the underlying principles sound. I was slightly worried when my hon. Friend said that the Government had lots of guts for introducing the scheme: I rank that as similar to when Sir Humphrey says that a Minister is being brave and dire consequences follow.
It used to be said, in the days before some Ministers, my hon. Friend the Member for Stroud and the hon. Member for Ludlow (Matthew Green) got their heads round the issue, that only three people knew anything about how supporting people worked—it is rather like the Schleswig-Holstein question, one is dead, one is mad and the other is Bert Provan! I am happy to say that he still exists and is very much in charge of the programme.
I shall try to respond to my hon. Friends' questions and others, if relevant. The programme is a matter of real importance. I am not attempting to impugn Mr. Deputy Speaker's judgment as to whether certain subjects are in order—everything clearly has been, because he has not suggested otherwise—but I will not be responding to the comments that have been made about the partisan nature of the allocation because they are nonsense. Also, I will not respond to comments about the abolition of local authority social housing grant, which is not relevant to the debate, or about park homes, even though I am the Minister with responsibility for them.
The hon. Member for New Forest, West (Mr. Swayne) raised some serious issues, but with the best will in the world I cannot deal with them because I will have enough to do answering questions about the supporting people programme. I congratulate him, however, on at least seeking to hide the fact that he knows little about the programme, although he was not terribly subtle about it. However, that is by the by. If he wants to write to me subsequently with inquiries on those other issues, I will be more than happy to respond. That is particularly true of park homes, for which I have responsibility, as I said.
As my hon. Friend the Member for Stroud said, the timing of the debate is fortuitous because the programme goes live on 1 April. However, all will not be resolved then despite the welcome that the principles underlying the programme have been given in the main by the professions and local government. Given the programme's complexities, the serious concerns about it and the issues that will arise as it beds in, the system that we introduce on 1 April may not be 100 per cent. the same by the time that we sort out the allocations in 2006. We are talking about an organic process—that is the nature of the beast.
Let me try, however, to answer some of my hon. Friend's specific inquiries. He asked whether there would be an attempt to claw back resources after the transitional period. He will know from the allocations that there has been a large increase in transitional
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housing benefit in recent months and it is right that we ensure that the money is spent on high-quality, value for-money services that meet the needs of those who are, as he said, very vulnerable. We expect local authorities to study those issues with service receivers.
My hon. Friend also asked about sacrosanct local pots. Again, he will know from the allocations that there are major disparities between the amounts of supporting people grant available in different areas. We must consider how we deal with that to ensure that authorities can meet the needs of local people. As has been mentioned, we have consulted on an allocation formula and in the coming months we shall consider responses to the issues raised.
My hon. Friend also spoke about monitoring the process. We want to unpick much that is opaque and complex, which by definition is a complex exercise. We shall monitor all aspects of the provision of housing-related support, including the supporting people programme. Supporting people strategies must contain details of how commissioning bodies plan to spend grant money and we shall monitor the process carefully.
Mr. Drew: I share the concerns of the hon. Member for Ludlow (Matthew Green) about a possible problem with two-tier authorities. Can we ensure that housing benefit departments share their knowledge with the supporting people team? Concern has been expressed in some of the literature about the degree to which district authority departments will tell the team what information they have.
Mr. McNulty: That is a fair point. As my hon. Friend suggested towards the end of his contribution, there must be an almost root-and-branch cultural change in the way that all the assorted bodies share information among and within themselves so that they can work in the best interests of the most vulnerable people, on whom the programme will impact. There may need to be greater exhortation and guidance so that there can be discussion within and between local authority departments. The same is true of the various Government Departments and agencies in the field. I do not want the programme to flounder because people do not talk to each other about vulnerable people in their areas when they should be doing so. We are also aware that simplifying the complexity is a major task. Local authorities and providers have been working hard on preparations.
I was asked whether we are sure that everyone is ready for 1 April. We have trailed and monitored the process carefully and, in the main, most local authorities have climbed mountains and made enormous steps to be ready. There is an overwhelming desire that there should not be any mistakes or an absence of provision for those extremely vulnerable people. Without wishing to tempt fate, I would give local government a huge slap on the back for how advanced they have been. I may subsequently be giving local authorities a slap on the back of a different kind—things may be rather less amiable post-April and we will have to see how it goes, but people have generally taken the preparation very seriously.
We have issued guidance on monitoring and review that is designed to make the process as unbureaucratic as possible. We are piloting procedures in seven local

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authorities to find out how the review and monitoring on the ground works out. We will consider the outcome and review procedures if necessary. We all know what outcomes we want to achieve in service provision for the most vulnerable people in local authorities but, by its nature, unpicking complex schemes, myriad programmes and revenue streams and putting them into simplistic form for the most vulnerable people will take time. We will have to keep a close watch and monitor the process.
In one sense, my hon. Friend was not entirely right when he suggested that there is a £6million gap in terms of home improvement agencies. HIAs are already exempted from the rule regarding charges for short-term services during the first year of supporting people and will retain the ability to charge fees until April 2004. The statutory guidance is being amended to make it clear that HIAs are not to be considered as short-term services when it comes to their ability to charge fees. We will ensure that that situation is confirmed as a long-term arrangement when we revisit the grant conditions after the first six months of the programme.
My hon. Friend appreciates that much of what goes on in single assessment is not directly in my area, but housing is an important aspect. As supporting people unfolds, we will explore how teams are communicating with one another to ensure as seamless an experience as possible for service users, as my hon. Friend pointed out.
I agree that supporting people has a vital role to play in enabling access to housing support and reducing bed blocking, delayed discharge or whatever we want to call it, and in co-ordinating and looking specifically at how local health services and primary care trusts in particular are engaged with the process. Again, it is not simply a cultural rethink and change for many of the agencies and professions involved; it is also about rethinking their engagement with the most vulnerable people and engaging with other agencies in a productive, fruitful and cross-agency fashion.
As my hon. Friend pointed out, supporting people will make the real cost of support more transparent, which was part of the aim. Anyone who receives housing benefit will not have to pay under supporting people. Councils can provide protection to new tenants who are not eligible for housing benefit during the interim period until the first service review.
Statutory guidance emphasises that local authorities should not put in place eligibility criteria for sheltered housing that would dilute its preventative role or does not allow a balance of people with different levels of needs in the same scheme. Local authorities need to know the cost of support to ensure that services are being delivered in the most sensible, cost-effective way.
My hon. friend's arguments about learning disabilities and mental health were well made. As he said in the early part of his contribution, supporting people is not simply about the approximately 530,000 household units for older people, mostly in sheltered services; it is also about a range of other users defined as vulnerable. For example, there will be provision for 45,000 household units for people with learning difficulties and mental health problems, which he mentioned, 4,000 household units to support the rehabilitation of ex-offenders, 3,000 household units for women fleeing
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domestic violence and 75,000 units for people who have been homeless or belong to other vulnerable client groups. It is more than simply a reconfiguration of what we do with sheltered housing. Supporting people will help vulnerable groups to maintain secure houses. It will remain the responsibility of social services to provide care, and local commissioning bodies will ensure that partnerships between supporting people and social services develop appropriate solutions. Service reviews will ensure that supporting people grants are spent on support services.
As my hon. Friend pointed out, the income arrangements for people with mental health problems who are entitled to housing benefit are the responsibility of the Department for Work and Pensions. That was what I meant to say about four paragraphs ago. I reassure him that we will be monitoring the provision of services for all client groups as programmes get under way. We are keenly aware that we must capture developments in provision and support in each group and not just in a vague general sense. The vulnerable groups that I mentioned have specific needs and concerns. We will continue to work closely with the Department to ensure that supporting people links into other strategies to give a good service to vulnerable people.
I welcome my hon. Friend's endorsement of pipeline schemes and assure him that we welcome creativity and innovation in such schemes. We will shortly conduct an exercise to assess the amount of supported housing management grant pipeline required for 2003–04. Most pipeline schemes will not need full-year funding in the first year of operation and many will not be ready in 2004–05. If he wants to write to me on the matter, I will look into it for him in more detail.
As we approach 2003–04, authorities will be able to keep better estimates of the supported housing management grant required. The Office of the Deputy Prime Minister has made provisional allocation for pipeline schemes, and schemes with a confirmed capital commitment will be funded. Authorities have been advised on how to deal with specific schemes when there is a query about the provisional funding. Until those queries have been resolved, we cannot give more detailed funding figures.
The hon. Member for Ludlow asked about the allocation formula and whether 2006 is a realistic date. Throughout the process we heard many comments on the consultation on the formula. We will consider them carefully when deciding how to make progress. We must also consider timing, although we remain wedded to 2006. The intention is that the allocation formula will provide a guideline for allocation. However, the Government are in tent on avoiding sudden, dramatic changes in allocations to areas during the transition period when supporting people is being introduced. That is because, as both my hon. Friend and the hon. Member for Ludlow suggested, we must bear in mind the needs of these very vulnerable groups.
The hon. Member for Ludlow spoke about the commissioning bodies. It is for member organisations to decide the delegated authority that they give officers. He read from a letter that said that elected members may sit on the commissioning body if they want. The voting rules are one vote for the chief authority that administers the supporting people grant, one vote for

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each district council in the area, one vote for local probation services, and at least one vote for local primary care trusts, or more by agreement. All decisions must be unanimous; that is to ensure that all parties sign up to the arrangements. Exactly who attends the meetings is for the commissioning body to decide.
Despite the confusion in the letter, let me assure the hon. Gentleman that the arrangements are rooted in section 93, "Grants for welfare services", of the Local Government Act 2000. That is slightly different from the areas discussed in the letter that he quoted. They seem to be more about substantive points of committee membership and joint commissioning between two levels of authority that have more to do with the political and constitutional dimensions of local government, rather than being specific to the grant conditions of section 93. I am sure that that is the case, but if it is any different I shall write to the hon. Gentleman.
I invite any hon. Member who feels that I have not dealt with a relevant matter to write to me and I shall try to provide appropriate answers, given that we have a lead-in time of less than four weeks. First and foremost, the supporting people initiative aims to make things as clear as possible for the most vulnerable people who need housing. It requires a degree of cultural change among all who have at heart the housing needs of such people—how to work together in their interests is one of the most important matters to be addressed by the programme.
I know from the tone of the debate that other hon. Members will agree that the programme offers local authorities and their partners an exciting new opportunity to develop local partnerships that effectively meet local needs. It is far better than the existing systems that we are unscrambling, using innovative new models of preventative services. We look forward to developing and sharing positive practices that enable vulnerable groups to achieve social inclusion in their local communities.
I leave the hon. Gentleman with one thought: please do not pack up your tent, fold it away and go home on 1 April, but keep in touch as things unfold and bed in. No doubt there will be teething problems, but we should work collectively, cross party, with no obtuse partisan dimensions to minimise any dislocation or disruption to the services we provide. The system will be vastly improved and vastly more transparent. Its success is in our collective interest as public representatives, and certainly in the interests of the vulnerable people whom we choose to serve.
3.16 pm
Sitting suspended

National Minimum Wage
3.30 pm
Mr. John Lyons: I begin by declaring an interest. As a member of Unison and, previously, of the National Union of Public Employees, I have a background of campaigning for low-paid workers and of fighting for the establishment of the national minimum wage.
I, and millions of workers throughout the United Kingdom, think that the national minimum wage is a huge success story. Its introduction is a tribute to the work of Rodney Bickerstaffe, Lord Sawyer and many other trade union and political leaders who campaigned for so long to establish it.
I will highlight a number of concerns, including the fact that there is no rate of pay in the national minimum wage for 16 to 18-year-olds, and the issue of the development rate for 18 to 21-year-olds. I will also address the question of home working in the UK and its relationship to the national minimum wage, and deal with the rate of the national minimum wage.
The National Minimum Wage Act 1998 came into force on 1 April 1999 and there is no evidence to suggest that the national minimum wage has had a negative impact on employment, but there is evidence to show that it has delivered gains for the lowest paid in society. There are now 1 million more jobs in the economy than in 1999, so it is safe to say that we have all-party support for the national minimum wage, which never previously existed. That is a testament to its success.
The legislation does not include a rate of pay for 16 to 18-year-olds, however, and I believe that to be a mistake—a deficiency—that creates major exploitation in our towns and cities, and in some rural areas. Many youngsters leave school at 16. Some will not go on to higher or further education, but will go straight into the labour market to look for employment. Those young people must be protected against unscrupulous employers, and the way to do that is to establish a payment for the 660,000 young people aged between 16 and 18 who have no such protection at all. It is a simple balance: if there are youngsters in the work force, they must be protected. They should not feel isolated and unsupported.
Good employers are unhappy with the situation, and no guidance is given to them on what they should do when employing 16 to 18-year-olds, if an employer agrees a rate of pay for that age group, no matter what it is, someone will criticise it. If the rate is considered to be too low, the employer could quite properly say, "I am doing nothing wrong or illegal. I am paying the rate that I think is appropriate for the job." That is where the disparity creeps in throughout the UK, because different employers have different estimates of what appropriate pay should be.
As well as school leavers in the employment market, young people who are still at school often seek employment at particular times of year—in school holidays, for example. Employers in places with tourist attractions that are busy in summer, at Easter or at Christmas time need additional labour in those periods. Whether we like it or not, those employers often recruit those who are still at school, who will work for a few weeks and then return to school. That highlights the crux of the problem.

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Last summer, a man and wife came to my surgery to complain on behalf of their 17-year-old daughter, who was working in a store. The employer had decided to pay her £2 an hour. I had to say, "The employer is doing nothing wrong. There is nothing in the legislation to protect your daughter. I may disagree with the rate of pay, but the employer will say that he is doing nothing wrong."
When I visited the employer, that is, of course, exactly what he said. He told me, "If the Government will give me some guidance, I shall be happy to follow it." In the end, he paid the young woman the national minimum wage. He said, "If that is what you want me to do, Mr. Lyons, I am happy to do it." The major problem is not only employees' need to fight for their rights, but employers' need for guidance and support.
We need to review the situation—it is as simple as that. There is an argument for post-legislative scrutiny, which is ideal, as it would enable us to discover what is happening without relying on horror stories or anecdotes. We could simply consider the evidence provided by Citizens Advice and other organisations. It is unfair to treat young people as we do. Often we criticise them for not taking enough interest in society or politics, but the truth is that we do not take enough interest in them. What I have described is proof of that.
We need also to tackle the question of the development rate for the pay of people aged 18 to 21, which has existed since 1999. In evidence to the Low Pay Commission, the TUC said:
"The TUC believes the full adult rate of the national minimum wage should be payable at age 18. We have consistently argued that the lower rate is discriminatory, contrary to the principle of establishing a fair rate for the job and counterproductive for those who choose to use it. The fact is that most people believe adulthood starts at 18 and pay should reflect this norm. In most cases young people are taking on the same responsibilities and delivering the same productivity and performance as their older colleagues."
It is offensive that employers can legally pay lower wages to workers just because they are younger. I should be offended if that practice were applied to older people. The youth, or development, rate can often undermine a company's recruitment and retention strategy, and in today's economy that is often an important issue. We need to consider more fully the Low Pay Commission's views on 21-year-olds and the national minimum wage.
When the legislation was introduced, many people felt that the development rate would lead to a massive expansion of training, but there is no evidence of that. Many employers are abusing the availability of the development rate.
David Hamilton: I agree with my hon. Friend's sentiments and those of the TUC. Given that people can vote at 18 and, indeed, in this time of turmoil, could go to war and die for their country at 18, surely they should be entitled at that age to the minimum wage—which, of course, some employers treat as the maximum wage.
Mr. Lyons: My hon. Friend makes a valid point. He has a long record, based on what he has done in Midlothian and elsewhere, of fighting for young people and for proper pay for them.
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Home working is a major anomaly, and it is expanding massively in the UK. The figures speak for themselves. The National Group on Homeworking estimates that 1 million people are engaged in home working, while the Office for National Statistics thinks that the figure is about 650,000 for 2001–02. A range of organisations report not only the expansion of home working, but the abuse of home workers by some employers. I refer to citizens advice bureaux all over the country, the Scottish Low Pay Unit and the National Group on Homeworking. Recently, the Scottish Affairs Committee heard evidence from a range of home working organisations about what it is like to work in that situation—how, employees are paid and dealt with. It did not make nice reading.
In 1981, only about 345,000 people were engaged in home working. Since then, there has been growth in electronics, and teleworking, telecanvassing and the general assembly of gifts are increasing. That has led to the expansion of home working. If it is developing in that way, we need to tackle it and resolve the problem. In 1996, the International Labour Organisation set out clear guidance on home working and the importance of treating home workers as fairly as those employed in an office or a factory. The National Group on Homeworking estimated that, in 2001, the average wage for home workers was just £2.66 per hour. It also produced a report, "Getting what's rightfully theirs?" which examined the impact of the national minimum wage on home workers and identified worrying trends and examples.
I compliment the Department of Trade and Industry, as everyone involved in the home working survey said that their main sources of information on the national minimum wage were based on Government initiatives, especially television and radio adverts and the helpline. That was a great help to them, but there is one worrying aspect. Some 83 per cent. of those earning below the national minimum wage have not made a formal complaint, but for good reason: of those who made a formal complaint to the Inland Revenue, none managed to secure rates at or above the national minimum wage while keeping their work.
The minute that someone complains as an individual, the employer has the right to transfer that person's work to any other person or home worker. They have no support and are left completed isolated. There are lessons for us all in the National Group on Homeworking report and the evidence from, among others, Citizens Advice.
I turn finally to the question of pay. Everyone rightly has their own views on the rate of the national minimum wage and when it should be paid. Unison, the TUC and all other trade unions have their arguments about what it should be, but they all say much the same: we need to move from a national minimum wage to a living wage on which a family can live without a problem. That is what we need to aim at.
Jim Sheridan: I congratulate my hon. Friend on securing this crucial debate. Like him, through the Transport and General Workers Union, I was proud to campaign for the national minimum wage and even prouder when my Government introduced it. I remember organisations such as the Confederation of

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British Industry arguing against the minimum wage because it would cause job losses. As he noted, that was not the case.
Does my hon. Friend agree that the fundamental principle of the minimum wage should be that the taxpayer should not fund unscrupulous employers who choose not to pay people a decent wage? We have a working families tax credit that works out at £5 per hour, so surely it is right that the minimum wage should be no less than £5 per hour.
Mr. Lyons: I agree. My hon. Friend has long experience in the TGWU of examining the issues and coming to proper conclusions to support low-paid workers.
In recent evidence to the Low Pay Commission, the TUC suggested that we examine a new national minimum wage of between £4.60 and £4.75 by October 2003 and between £5 and £5.30 by 2004. It is important to develop a strategy for the minimum wage that includes an annual upgrade and review, rather than the current drifting system. The Low Pay Commission properly reported on the beneficiaries of the minimum wage—70 per cent. of them are women. It also said that the minimum wage is making an important contribution to narrowing the gender pay gap and addressing equality in the workplace. I welcome that.
The Government are on the right track. The National Minimum Wage (Enforcement Notices) Bill tackles some anomalies and problems, including when someone is a former rather than a current employee. The compliance teams throughout the country are doing an outstanding job, as are the citizens advice bureaux, which have to give the initial advice when someone comes through the door. In East Dunbartonshire, Catherine Bradley and her team are doing excellent work in advising people with problems with the minimum wage.
There can be no question but that the national minimum wage is a success story. The legislation is a credit to the Government, but to maintain its popularity with working people up and down the country, it must have relevance and importance. To achieve that, we must continually review it, examine its problems and rectify them. That will ensure that people keep their great faith in the minimum wage. They enjoy the legislation, but they want it improved, as it helps millions of people throughout the country. Long may it continue to do so.
3.44 pm
The Minister for E-Commerce and Competitiveness (Mr. Stephen Timms): I congratulate my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Lyons) on securing the debate, and I very much agree with him about the success that we have enjoyed from the introduction of the national minimum wage. More than 1 million people have benefited since its introduction in 1999. We have tackled the appalling situation that existed before the minimum wage was introduced whereby quite a lot of people were receiving wages of £2 an hour or less. As my hon. Friend rightly said, there has been no significant adverse impact on businesses.
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Indeed, as he also said, there has been a big increase in overall employment since the minimum wage was introduced.
The vast majority of employers are complying with the requirements of the legislation. For bad employers who are not complying, we have a network of 16 enforcement teams across the UK. My hon. Friend is right to draw attention to the excellent work of those teams, and I am grateful to him for making that point. Between them, the teams have completed more than 24,000 case investigations since April 1999, and they have identified more than £12 million of wage arrears on behalf of low-paid workers.
However, my hon. Friend is also right to say that we should not just leave things as they were when the legislation was introduced. I think that he used the term "post-legislative scrutiny", and I agree that we need to go through that process to ensure that the legislation is kept up to date, and that we must learn from our experience. My hon. Friend made proposals about the future rate of the minimum wage, drawing on the evidence that the TUC submitted to the Low Pay Commission. As he knows, the LPC's recommendations will be published shortly.
My hon. Friend picked on two aspects of the legislation that I want to deal with. He mentioned the position of 16 and 17-year-olds, who are currently exempt from the minimum wage. It is often claimed that the fact that the minimum wage does not apply to people of that age puts them at risk of being economically exploited, a point that my hon. Friend the Member for Midlothian (David Hamilton) made. It is also claimed that it is a form of discrimination against vulnerable workers.
The Government's priority for young people is that they acquire the education and skills that they need to progress in their working lives. There are fewer 17-year-olds in education in Britain than in any other country in the Organisation for Economic Co-operation and Development except for Turkey, Mexico and Greece. We need to do much better in keeping young people in education. The Department for Education and Skills recently published proposals for reform of 14-to-19 education. We want increased continuity in the lives of young people between the ages of 14 and 19, when education should be the priority. The minimum wage therefore needs to be structured in a way that is consistent with that aim. Employment and unemployment rates are less favourable for young workers aged 18 to 21 than for adults. Again, the structure of the minimum wage needs to reflect the reality of the labour market.
Annabelle Ewing: I thank the Minister for giving way. I hear what the Minister is saying about 16 and 17-year-olds, but surely that is not a reason to exclude young people who are already in work from the protection of the minimum wage?
Mr. Timms: The point that I am making is that the present structure of the minimum wage, which is based on a recommendation from the LPC, has been framed in light of those considerations, with a lower rate for 18 to 21-yearolds and no rate for 16 to 17-year-olds. However, my hon. Friend the Member for Strathkelvin and Bearsden made an important point about that, and I want to make it clear that we are not irrevocably opposed to a minimum wage for 16

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and 17-year-olds. We would be prepared to reconsider the matter, provided that the rate was set carefully and that the possible impact on education policy was taken fully into account. We can perhaps now be more confident about the matter given that, as my hon. Friend rightly pointed out, the legislation has so far certainly not had the adverse impact on overall employment that some expected.
Anne Picking: Does the Minister agree that, laudable though it is to want to introduce a national minimum wage for 16 to 17-year-olds, it is a bit rich for someone from the Scottish National party to come and lecture us about it when none of its Members turned up to vote for the measure in the first place?
Mr. Timms: My hon. Friend makes a telling point.
The question of home workers has also been raised. Successive publicity campaigns have ensured that there is almost universal awareness of the minimum wage. Research carried out in 2001 by the National Group on Homeworking found that 95 per cent. of home workers knew that they were entitled to the minimum wage. The majority of employers are complying with the minimum wage but some bad employers are not. I accept that, in some cases, although home workers vaguely know about the minimum wage, they are not clear exactly how it applies to them. We also know that few home workers are prepared to complain about underpayment and that they fear, sometimes with justification, that they may lose their job if they complain.
There are two key problems affecting home workers. We need to make it clearer to them how they are affected by the minimum wage, and we need to see what can be done to address the problem about complaints. We are taking several steps. We are issuing a consultation paper on the case for amending fair estimate agreements in the regulations so that employers would be required to pay all home workers either the minimum wage for all the hours that they work or a fair piece rate linked to the minimum wage. Those proposals should help to make the rules simpler and more easily understood. In turn, that should help home workers to understand and claim the minimum wage to which they are entitled. Both employers and home workers have said that they support the proposals.
David Hamilton: May I suggest to my hon. Friend the Minister that one way of getting that information out to home workers, which is a real problem, is to use local authorities that regularly put out newsletters? Perhaps the Department could include in such newsletters information for people who are really quite isolated.
Mr. Timms: My hon. Friend is correct. We need to be imaginative about sending out information. We are working with Citizens Advice Scotland and the Scottish Low Pay Unit to establish a Scottish minimum wage helpline, which was launched last month by the Under-Secretary of State for Scotland, my hon. Friend the Member for Stirling (Mrs. McGuire). In the first week, the helpline received almost 30 calls and passed four complaints to compliance teams in Scotland. I am sure that we can deliver the information by working with a variety of agencies.
We are funding an enforcement pilot project, which aims to improve awareness and compliance among home workers in Bradford. We are establishing a team
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of experts in home working cases to disseminate best practice throughout the Inland Revenue. We are working with ACAS on a fact sheet for all workers who want to bring a claim. The Inland Revenue will, in future, be trying to make it clearer to employers that home workers are not self-employed. We have also put substantial extra funds into enforcement and increased the number of enforcement teams to 16, as I mentioned.
The Department has also been looking at other ways of helping home workers. In particular, it is investigating home working scams. In 1998, the Department launched a publicity campaign to address that problem. There was evidence of people posing as home work providers and asking potential home workers to send them money. My Department also provides a leaflet, "Homeworking: Don't be taken in by bogus job offers."
To put all that into context, we collect figures through the labour force survey, for which the Office for National Statistics interviews about 60,000 households every quarter about aspects of their employment, including earnings. The results suggest that there are about 1 million home workers in the UK and that perhaps as many as 70,000 of them receive less than the minimum wage, so this is a significant issue. We must continue to be imaginative and, as my hon. Friend the Member for Strath kelvin and Bearsden said, to work with a variety of agencies to address the problems.
As my hon. Friend was winding up his remarks, he spoke about the enforcement arrangements. I want to say a little about how those are working, because some very effective work is being done. The minimum wage helpline takes calls that are assessed and referred to one of the 16 compliance teams. Compliance officers then investigate the employer's business to which the complaint relates. That investigation will usually include a review of the pay records, an interview with the employer and interviews with workers. The length of the investigation will depend on several factors, including the number of workers and whether there are technical questions about interpretation of the legislation.
On conclusion of an investigation, the officer will issue a calculation of arrears to the employer and to the worker, and an enforcement notice will be served if payment is not made. Our experience is that persuasion works best in the great majority of cases. Out of some 6,000 cases each year, it has been necessary to issue only about 100 notices.
If an employer fails to comply with an enforcement notice, the compliance officer may serve a penalty notice. That levy is a financial penalty payable to the Secretary of State, which is twice the hourly amount of the minimum wage for each day that the notice has not been complied with in respect of each worker named on the notice. So far, about 40 penalty notices have had to be issued every year. Further penalty notices can be issued where the employer's failure continues. That is not an automatic procedure, and an officer will consider the facts of the case before issuing a notice.
If there is continued non-compliance, the legislation gives compliance officers one of two options. First, officers can take a case to the courts. In that case, an officer can seek to recover arrears only for a period of up to six years from the date of the last underpayment, or five years in the case of Scotland, as my hon. Friend will

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be aware. Most of the cases that the Revenue has brought so far have taken that route. They are therefore subject to the restriction that has been introduced.
Secondly, officers can take a case to employment tribunals. In that case, they must put their case before the tribunal within three months of the underpayment or the last in a series of underpayments. In theory, at least, however, officers could pursue underpayments exceeding the six-year threshold. The three-month time limit for bringing a claim is very tight. In practice, therefore, the Revenue does not often use that route, but uses the first route of going to the courts.
It is possible for employers to appeal against enforcement notices, and in those cases, the appeals would then be heard by employment tribunals that can confirm, rescind, or amend the notices. Once an employment tribunal decides that the employer owes a worker moneys, that decision is legally binding. If an employer refuses to pay the amounts awarded, further action would need to be taken to enforce the payment.
The National Minimum Wage (Enforcement Notices) Bill will soon receive its Third Reading in the House, as my hon. Friend will know because he has taken part in the debates on it. If it is passed, it will limit to six years the period that enforcement notices can go back in time on behalf of workers, whether cases go through courts or tribunals. The Bill will not affect the rights of individuals who are pursuing cases on their own behalf; the restrictions do not apply to them.
Finally, I want to say a few words about avoidance of the minimum wage. It is generally acknowledged that its implementation has been a success and that the enforcement operations have been effective in tracking down employers who are not paying the minimum wage. Non-compliance has been identified in only around a third of the 6,000 cases that the Revenue investigates each year, and enforcement notices will be necessary only in 1 or 2 per cent. of cases. Complaints from workers and former workers are therefore very important in tracking down businesses that are not complying.
Compliance officers try to ensure that there is anonymity for complainants, because some people will be afraid of losing their job if their employer finds out that they have made a complaint. It will not always be possible to ensure anonymity. If formal enforcement action through a tribunal or court is necessary, for example, the minimum wage team at the Revenue also gather and analyse information from internal and external sources to help to identify employers who are most at risk of non-compliance. The work of the compliance officers is therefore not solely dependent on worker complaints.
There are areas where compliance could be improved, and in response to recommendations in the LPC's second report we funded a number of pilot projects around the UK. We are working to, identify the areas where we are doing less well and where employers may be avoiding paying workers the amounts that they are due.
This has been a useful debate, and I am grateful to my hon. Friend and to the other hon. Members who contributed.

Health Services (Cornwall)
4 pm
Matthew Taylor: Mr. Chairman, I welcome—
Mr. Deputy Speaker (Mr. Frank Cook): Order. I would be failing in my duties were I not to remind hon. Members that when the House took the decision to hold these sittings it stipulated that occupants of the Chair in Westminster Hall debates should be addressed as Mr. Deputy Speaker.
Matthew Taylor: Thank you, Mr. Deputy Speaker.
I welcome this opportunity to debate health services in Cornwall. I gave the Minister notice of some of the issues that I want to raise because I hope to get her support for some important developments. Some positive things are happening in the health service in Cornwall because of the investment that the Government are making as a result of the relatively small tax increases that allow significant extra funding to take place, which the Liberal Democrats support even if the Conservatives do not. We argued for it for many years; it is the sort of investment that we said was necessary, and it makes a real difference.
First, I shall mention some of the excellent things that are happening in the county as the public want to know what difference the investment is making and whether the health community in Cornwall is responding to the existing opportunities. I reassure the Minister that the health community in Cornwall is working positively as a team; it is a good example to other parts of the country that the three primary care trusts and the two hospital trusts have been working together and building social services in the wider community into their plans.
The Royal Cornwall NHS hospital trust recently went from two-star to one-star status, but there is a lot of good news and the staff do a great deal of hard work. The trust is actively working to meet the key targets. The basis of the star rating assessment is somewhat crude because a small change can make the difference between pass and fail. One hospital trust went from no stars to two stars in nine months as it had been just under its target and then managed just to get over them. Cornwall is not far off most of its targets, with one exception, which I will mention later.
The trust will be reducing the number of in-patients waiting more than 12 months from 238 in April 2002 to none at the end of March 2003. It is on course to meet the target. It is reducing the number of out-patients waiting more than 21 weeks from 385 in April 2002 to none by the end of March 2003. Again, it is on course to meet the key target. It opened a new clinical decision unit at the beginning of March for medical emergency admissions crucially to free up a significant amount of time for the accident and emergency department. Accident and emergency is making big improvements in meeting the target of 90 per cent. of all A and E patients being seen and discharged within four hours. That has been done despite a 9 per cent. increase in the number of people attending A and E in the first quarter of 2002–03 when compared with the equivalent period in 2001–02. Emergency admissions have been running substantially above funded levels. The trust has also had to contend

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with a 20 per cent. increase in out-of-area treatments over the past five years in accident and emergency for which it is paid in arrears. It is part of the explanation for the financial deficit, which is the one key issue that it has had to grapple with over a longer period of time. I will return to that.
I should add that the trust also met the target for two-week urgent cancer referrals for all patients since September. That is good news. It is working successfully to meet the Government's key targets. In addition, we have the welcome investments of the Well Cornwall project and the Knowledge Spa, a £14 million development in the Royal Cornwall hospital to create a new centre of excellence for education and training and research. It will be a centre of excellence that will benefit patients directly with more high quality staff at the Royal Cornwall hospital trust with the incorporation of the Peninsula medical school as well as the Institute of Health Studies, which will be used for nurse training. That will be a headquarters for research and development and national vocational qualification training. It will be an integrated training centre for all staff.
Additional wards are also coming in. The hospital does very well on some ratings. The latest Department of Health patient environment action team inspection was a great success. The trust was awarded "green light" status, which has only been given to one in six hospitals in England. It is the gold standard, which reflects on the high quality of some of the lowest paid staff within the hospital system. It is not only at RCHT. Cornwall Partnership NHS trust, for example, has been working hard to integrate health and social care services for people with mental health problems. It recognises that as many as one in four households will need those support services, and its work to provide them is very welcome.
I do not want the Minister to get the impression that we do not acknowledge that things are going well. We acknowledge that staff in Cornwall are working extremely hard, still with limited resources and under a great deal of pressure from rising numbers to deliver the goods. One of the greatest pressures on hospitals, and one of the reasons why they struggle—not only in Cornwall, although our figures are particularly high—is the increase in accident and emergency admissions and referrals to hospitals. These have consistently run above the projections, even though they were considered in great detail by experts in line with Department of Health guidelines.
I have one suggestion for the Minister. Will she consider helping to fund some specific research on this issue, linked with the development of the research and education base in Cornwall? Cornwall is particularly appropriate for such a study: first, the problem is quite high and secondly, because it is surrounded on three sides by sea, patients do not come in from surrounding areas. This may be a patient-choice issue as people choose one hospital rather than another. As the Government themselves are trying to work out what is going on, and this is clearly key to the ability to improve treatment times and outcomes and deliver the quality of care that we all want to see with the investment, there is a good case for considering Cornwall for a funded study.
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Rather more fundamentally on funding, I should like to raise the strategic outline case that Cornwall has put together involving all the health providers, including consultation with social services as well as the main players within the NHS delivery system. They have all worked hard with the strategic health authority and have had the support of all the county's Members of Parliament. I am glad to say that we received a very supportive response from the Minister in November 2001 when we met her and presented the case for expanding capacity and delivering patient care innovatively in a rural, dispersed county, moving away from all services being centred around Treliske. I am talking not about the community and community hospital services, but the great majority of other services that are centred around Treliske and the Royal Cornwall hospital trust. We are talking about using instead what I used to call intermediate hospitals. I am advised that that is the wrong term: they are diagnostic and treatment centres. That would enable patients to receive better care, delivered nearer to where they live, in a county where no town has more than 25,000 inhabitants.
At present, people have to travel very long distances to receive out-patient care and treatment at the Royal Cornwall hospital trust. The aim is to devolve acute care closer to patients' homes and, in the process, free up beds at Treliske for the more acute care that can be delivered only in a larger district general hospital.
The strategic health authority has before it the first two key bids in that process. One is for further new wards, theatre facilities and diagnosis and treatment equipment, which is very expensive, at Treliske. It is a £9 million proposal. Perhaps even more fundamental, as that is on the existing Treliske site, is the proposal for the first diagnostic and treatment centre at Bodmin. That would include outpatient clinics, diagnostic support, therapy services, day surgery, endoscopy and other primary, community and local care services.
That is preliminary to proposals for later developments on a similar basis at west Cornwall and, in the longer term although not quite on the same scale, proposals for St. Austell, Camborne and Redruth, Newquay and Helston. The proposals would create very good local services for people to receive treatments that currently are available by and large only at the Royal Cornwall hospital trust. They would allow the delivery of increased capacity and therefore the care that is so desperately needed.
I understand that there is as yet no decision on the proposals. There is concern that the decision may be held up because of the process of testing whether the private sector might be able to offer a provider. I am not here to get into a debate about who provides. In fact, Liberal Democrats believe that, providing that new systems of delivery are within the NHS and delivered free, they may be a good idea. It is hard to believe that the private sector is likely to want to cater for the sort of package of services that DTCs would deliver, but if it does, let us not allow that to delay a process that is key to tackling capacity problems in Cornwall and providing better patient care. I hope that the Minister can offer some reassurance about the speed with which the proposals can be decided on, so that we can meet the original timetable for rapid investment and rapid improvement.

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The use of DTCs is highly innovative. It has existed in some urban areas, for rather different reasons, but not, I understand, previously in England for the delivery of rural services to meet the needs that we are discussing. I note that Cornwall is doing this with no great support for the extra costs of rural areas, which are perhaps reflected in the proposal. There is now a rural adjustment, which I welcome, bur even the biggest eneficiary—Herefordshire—receives only a 0.6 per cent. increase in the budget above the level that it would otherwise have. Cornwall has rather less.
The next issue that I want to raise briefly relates to the fact that, despite all the progress that I have talked about and the fact that the hospital trust now looks set to meet almost all the key targets, there are real concerns about star status for the hospital, on two grounds. First, perhaps the Minister could help by clarifying how progress to meet these targets will be treated in future assessments, because the Royal Cornwall hospital trust is now delivering 100 per cent. on a series of key targets on which it was previously short, and it therefore cannot go any further in delivering on them. There is obviously a backlog in terms of the history of the figures, which will show that the hospital has moved from not meeting the targets to meeting them. The question is how long it has to live with the backlog in the assessment. Is the fact that it is now meeting the targets sufficient for it to get a tick in the box in future assessments?
Secondly, there is the financial issue. The Minister will be aware that there is a substantial deficit, which is shared across the health community and is not a specific issue for the Royal Cornwall hospital trust. There is agreement in the health community on how to tackle the deficit. The RCHT has an excellent record on deficits: until last year, it had had no deficits in its nine-year history. The Minister will be aware that the deficit relates to the working through of the changes caused by the abolition of the old Cornwall health authority and the financial knock-on consequences for not only the RCHT but the primary care trusts. Nevertheless, the trust knows that it must tackle the deficit.
The trust has agreed a three-year plan, which would entail breaking even next year and paying back the accumulated historic deficit over the following two years. It thought that it would obtain a pass once the strategic health authority had agreed the plan because a plan was in place to tackle the problem. More recently, it has been told that under the resource accounting rules—I do not understand why this should be the case—it has to turn the deficit round in two years, not three. It is therefore set to continue to fail. That has had a significant effect on morale because the trust is doing everything that it has been asked to, is working to a plan—I hope that the plan will be agreed shortly, and should like reassurance on that from the Minister—and is meeting all its targets. It cannot hope to get three stars because of historic problems rather than because of what it is doing now.
That has a crucial impact on foundation hospital status. My concern with that status does not concern freedom for hospitals, which they should be given, or innovative new forms of finance—I am with the Secretary of State for Health on that point, if not the
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Chancellor. My concern is the potential for a two-tier service if some hospitals get foundation hospital status and some do not.
For this debate, I shall forget about the rest of the country. I am concerned about Cornwall not being eligible to get the benefits that may shortly go to Exeter. That will suck out staff because Exeter may have the discretion to increase pay and to improve terms and conditions. It will also be a visible symbol for people in Cornwall that patients in Exeter will get improvements, which are not available in Cornwall, because of bureaucratic rules rather than because of anything that the hospital, which meets the key objectives, is doing. The matter certainly has nothing to do with anything over which patients or the community in Cornwall have had control. I hope that the Minister can offer some reassurance on that serious issue.
Although I have gone slightly over time, I shall raise a final point. The financial problems relate not only to historic national funding issues in the health service but to the distribution formulae. I will not start a debate about why the formulae are not fair to Cornwall, but I will make one observation: all the other objective 1 areas are deemed to be areas of high social need and have received extra resources as a result. Cornwall is an objective 1 area, which contains the lowest incomes in the UK, high levels of older people and pockets of high deprivation.
We would not have objective 1 status if the community were not deprived, but Cornwall has not been defined in the health budget as such a priority social need area. That relates to the old-fashioned assessments of rural deprivation. Other Departments used to use such assessments, which they have now accepted were not right. The Administration in Scotland has put particular emphasis on extra funding for rural areas. If Cornwall received the same treatment as other objective 1 areas, it would get an extra £18 million. I appreciate that the issue is technical and that I was unable to raise it with the Minister in advance, and I should be happy if she addresses it in writing or in her reply.
4.19 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): I genuinely congratulate the hon. Member for Truro and St. Austell (Matthew Taylor) on securing today's debate on important issues. I welcome his support for the new investment that is going into the national health service and the real and tangible benefits, some of which he outlined, that the people of Cornwall are seeing as a result of that investment.
The hon. Gentleman raised important matters relating to the unique nature of Cornwall, which have implications for the health system as a whole. I shall try to deal with each issue that he raised, particularly those concerning funding, the strategic outline case, constraints on capacity, the plans of the local health community as a whole to meet those challenges over the next few years and what the impact will be on the community.
I am delighted to confirm that, as the hon. Gentleman highlighted, all the primary care trusts and local authorities in the area are working tremendously well in

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partnership with the acute sector. All our ideas for shifting the balance of power, putting the money into PCTs and getting front-line clinicians involved have been illustrated in Cornwall with a real sense of people working together and looking to the future. I am delighted to place on record my congratulations to everyone in the NHS and social services in that area who is working to ensure that the community has joined-up and seamless services.
I shall deal first with the funding issues raised by the hon. Gentleman. He hears us say time and again that investment is crucial and that with reform we can achieve real results. He highlighted some improvements in the area, including a 6.2 per cent. real-terms increase for his local PCT—central Cornwall—this year and a 7 per cent. real-terms increase for next year.
I want to highlight a couple of matters to which the hon. Gentleman did not refer, including a new £5 million clinical oncology centre at Royal Cornwall hospital. I know that services in relation to cancer are still under pressure in the area, but the new oncology centre, which was opened last year, will be incredibly welcome. There has also been an £11 million development at Bodmin to provide a 15-bed centre for continuing mental health care. That area is not often highlighted when dealing with acute hospital sector provision, although mental health provision is equally important to local people. There has also been a £5 million development in Camborne to provide 67 beds for in-patient mental health care. We are not just aiming at targets and getting waiting lists down, but providing community-based facilities in important areas.
The hon. Gentleman referred to the formula and its impact on rural areas. We have tried to make it more sensitive to various measures of deprivation in this year's allocations. We are now using the indices of multiple deprivation of the Office of the Deputy Prime Minister, updated in our formula, which is a more sensitive measure. Such formulas are never perfect because of their complexity and we can all find cases in which they do not meet 100 per cent. of needs, but we are trying to ensure that rural issues are considered. For example, low car ownership is usually an indication of deprivation, but in rural areas where car ownership is more of a necessity because of lack of public transport, there is not necessarily the same direct correlation as in an urban area.
The same applies to the retention of senior staff in rural areas. Staff tend to work more on their own and to have more autonomy and skills, so usually they are better paid and more senior. They also tend to stay in post for longer, so they are entitled to increments, which is an extra pressure on the service. In a number of areas, formulas, no matter how sensitive, will not always meet the criteria, but we are trying to recognise in all our policies that sometimes there are pockets of deprivation in areas of affluence where they would not be expected. Drilling down to ensure that our resources go to the right places is important.
I am aware of the deficit facing the hon. Gentleman's health community over the next few years. It is significant, so I am delighted that everyone has come together to work out a financial recovery plan. I understand that there will be calls to wipe the slate clean
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and to start from scratch, but that is not realistic and I believe that people locally recognise that. I have asked officials in the regional office to work very closely with all the managers in the area to try to find the best way to tackle the challenging financial position that the community is facing.
A financial recovery plan is being drawn up, and I will be keeping a close watch on its implementation to ensure that we strike a balance on getting the organisations back into a good financial position, but not at the expense of plans to improve services for people in the area. This is about getting the balance right, and I give the hon. Gentleman an undertaking that I will continue to take a personal interest.
The strategic outline case has been built up to expand capacity, and the plans are extremely exciting and innovative. The strategic outline case is with the PCTs for approval. Obviously, as the PCTs have the budget, they must decide whether those plans are affordable in the context of the revenue streams that they will be able to provide to support them over the next few years. Once the PCTs are happy with it, they will have to take the case to the strategic health authority for approval. The hon. Gentleman will be anxious that there are no delays in the system, but he knows how important it is for every one of those players to buy in if the capacity expansion is going to work and be sustained for years to come.
The plans are exciting, and not just in respect of the diagnostic and treatment centre at Bodmin. I understand that it is part of a whole systems approach to have a series of DTCs in Penzance, Helston, Camborne, Redruth, Falmouth, Truro, Newquay and St. Austell, and Bodmin designing services very differently. Under our guidance, "Keeping it Local—A New Direction for the NHS", we are working with West Cornwall hospital on a pilot project. We have just commissioned an intensive evaluation programme through NHS research and development facilities, because we want to learn the lessons from that pilot. It will offer national lessons on new technology, telemedicine and joint assessment before transfer in respect of emergency services. It will also give reassurance to many communities up and down the country on doing things differently. The health community in Cornwall has not only good partnership, but good ideas, creativity and imagination. That is very welcome indeed.
I emphasise that the strategic outline case is not just about the acute sector. There are further initiatives to enhance primary care, with the development of the community hospitals to include intermediate care and rehabilitation facilities. Importantly, there is also the co-location of health and social services and voluntary sector services to support the development of integrated networks for seamless care so that people do not fall through the gaps. That has often been a real problem, especially for older people.
The plan seems to be well thought through, and it will help to ease pressure on the hospital and provide much better services at community level. It is with the PCTs for approval. It will then go to the strategic health authority, and it must find its way through the process. I will try to ensure that there is no undue delay in consideration of whether it can proceed.

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I understand the hon. Gentleman's concerns about the position of the hospital and its star rating. Performance is looking extremely positive, and by the end of the month there will be no over-12-month wait for in-patient treatment and no over-21-month wait for out-patient treatment. Again, I congratulate everybody who has worked so hard to make that the case. Obviously, the next performance assessment and the star rating will depend on the exact date at which the figures are taken. I am not sure that that has been decided as yet, but I could write to the hon. Gentleman to set out the details of exactly what the process will be.
I do not want the performance rating to act as a disincentive to that health community, which is working so hard to ensure that it improves, but there will inevitably be a cut-off point and people will fall on one side of the line. I say that with feeling, as my local hospital lost one of its stars this year—it did not quite reach the 100 per cent. mark, although the staff worked incredibly hard locally to try to get back-up. I understand what that is like from a constituency Member's point of view, but the performance framework that we have established should act as an
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incentive for people to do well and improve their performance. It should not act as a disincentive when staff are trying to catch up with a backlog, as the hon. Gentleman outlined.
The hon. Gentleman briefly raised the situation in relation to foundation trusts. He does not want his hospital to be unable to apply. We are conscious of those concerns as many Members have raised them, which is why we have said that there will be no arbitrary cap on the number that can apply for foundation trust status. We envisage that, within four to five years, most, if not all, trusts could be up to that level.
We want to put more support into trusts—not trusts such as the hon. Gentleman's, but those with a zero or one-star rating, to ensure that we have a managed process to get them to the point where they can apply because we want as many people as possible to get the new freedoms and flexibilities to be able to do that. The transition phase is key for us. We want to ensure that a two-tier service does not develop, particularly in relation to pay and staff incentives. We are absolutely committed, in the way that the licence and the regulator will operate, to ensuring that that does not happen.
It being half-past Four o'clock, the motion for the Adjournment of the sitting lapsed, without Question put