Westminster Hall Sitting of 14 October 2003

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

Smoking (Public Places)
Motion made, and Question proposed, That the sitting be now adjourned.—[Miss Melanie Johnson.]
9.30 am
Linda Perham: I am delighted to have secured the debate on smoking in public places, a subject about which I and many Members in both Houses care passionately.
I pay tribute at the outset to the many parliamentary colleagues who over the years have campaigned, asked questions, introduced Bills and generally badgered the Government on the matter. In particular, the Under-Secretary of State for International Development, my hon. Friend the Member for Harrow, West (Mr. Thomas), introduced the Smoking (Restaurants) Bill on 14 April and my hon. Friend the Member for North-West Leicestershire (David Taylor), who chairs the all-party group on smoking and health, introduced the Protection from Smoking (Employees and Young Persons) Bill on 24 April 2001.
I thank Action on Smoking and Health, the British Heart Foundation, the British Medical Association, the Cancer Campaigning Group, the Consumers Association and Smoke Free London for their help and information on the subject and two taxi organisations, the Joint Radio Taxi Association and the Licensed Taxi Drivers Association, for campaigning to allow licensed taxi drivers to designate their cabs non-smoking. Many taxi drivers—sometimes it appears all of them—live in my constituency, and I am well aware of how strong their feelings are on the issue. Unfortunately, it was not addressed in the Greater London Authority Act 1999, despite the backing of a majority of London Members of Parliament. Since then, the Greater London Assembly has held an inquiry into the subject and recommended that the appropriate legislation is changed, so that London taxi drivers have the right to work without the threat of smoke fumes.
Will the Minister and, perhaps, colleagues from other Departments make a commitment to review the report led by my colleague Jennette Arnold in the Greater London Assembly to see whether taxis can be brought into line with other forms of public transport, on which smoking is banned?
I have personal reasons for feeling strongly about the issue. I was a victim of childhood asthma and grew up in the 1950s, when my parents and almost everyone else, including people who came to the house, smoked. My condition was made worse by the culture that started with 1930s films, which I believe is what made my parents take up the habit at the age of 14. My parents are now well into their 80s—having given up smoking some years ago, they are, I am glad to say, still going strong.
When I was a child, smoking was allowed on public transport, in workplaces, places of entertainment, restaurants and bars. Now, smoking is banned on most
2WH
public transport, except, as I said, in taxis, and in cinemas and theatres. We are making progress on having smoke-free areas in the workplace and other public places.
Mr. Barry Sheerman: My hon. Friend makes an important point. She, like me, is a campaigner on the issue. Does she find it frustrating that Great North Eastern Railway is introducing a new train design in the coming months that will keep the smoking facilities? That means that the whole train, which travels at 140 mph, is really a smoking train. Does not she find it odd that smoking can be banned on planes, trains and buses, but railway stations and airports are still full of smoke?
Linda Perham:My hon. Friend makes some good points. I pay tribute to his campaigning on this issue and I will mention a contribution that he has made later. There is a problem with trains. Buses, the underground and aircraft are smoke free. I remember the time before there were designated smoking areas when people could smoke on public transport. As he said, stations are also areas where people can smoke and we should deal with that problem. We are making progress, but not enough and not quickly enough to put an end to the thousands of preventable premature deaths and the contraction and exacerbation of thousands more serious illnesses affected by tobacco smoke.
"Smoking kills". That is what it says on cigarette packets. That is what smoking does to a staggering 120,000 people a year in the UK—one in five of all deaths. That costs the NHS £1.7 billion and is a personal cost not just to those who lose their lives, but to their families and friends. According to "Towards smoke-free public places", an excellent report published by the British Medical Association last November, tobacco smoke is a potent cock tail of more than 4,000 chemicals, more than 50 of which cause cancer. Second-hand smoke is now the only proven human carcinogen that is unregulated in the workplace. About 85 per cent. of second-hand smoke is invisible and odourless and is not filtered by conventional ventilation systems.
Second-hand smoke causes at least 1,000 deaths each year and presents particular difficulties to the 8 million people with lung disease, the 2.1 million with angina, the 1.3 million who have had a heart attack, the 300,000 who have had a stroke, the 750,000 pregnant women and the 5.1 million asthmatics, 1.4 million of whom are children. Returning to my own experiences, I remember a photograph taken when I was about 12. It shows me with my shoulders practically level with my ears as I fought for breath. That is partly why I feel so strongly about this issue.
Second-hand smoke puts children at increased risk not only of asthma but of lower respiratory tract illnesses, middle ear infections, sudden infant death syndrome and lower birth weight. It is also connected to reducing children's lung capacity and exercise tolerance at a time when we need to get children to exercise more because of increasing concerns about the health risks of obesity. Indeed, describing children's vulnerability to second-hand smoke, the chief medical officer's annual report 2002 states:

3WH
"Children's lungs are smaller and their immune systems less developed…Children are smaller and breathe faster than adults and so take in more harmful chemicals per kg of weight than adults. Small children often have less choice than adults to leave a smoke-filled room."
As for young people taking up smoking, Action on Addiction estimates that around 450 children a day—more than ever before—are embarking on the slippery slope to smoking slavery.
I come now to smoking in the workplace.
Mr. Sheerman:Before my hon. Friend moves on from children, could I pick up on one point? As Chairman of the Education and Skills Committee I have become aware of the psychological damage done to children. They are constantly told at school and on the news media about the dangers of smoking and how it will kill them and give them cancer. They go home to a smoke-filled environment and see their parents smoking. They worry that their parents will die as a result. That is a serious trauma for children.
Linda Perham:I thank my hon. Friend for making that point, which he brings from his experience of chairing the Select Committee.
In the UK, 3 million workers are regularly exposed to second-hand smoke in the workplace. Less than half of workers are employed in smoke-free workplaces. I pay tribute to my hon. Friend the Member for Huddersfield (Mr. Sheerman) for securing a debate on employee health on 11 March—the eve of national no-smoking day. I had hoped to secure the debate on national no-smoking day itself, but he was fortunate to secure it on its eve. He was supported by interventions from my right hon. Friend the Member for Rother Valley (Mr. Barron)—another tireless campaigner on the matter—and my hon. Friend the Member for North-West Leicestershire, and he made a powerful case for more action to protect workers.
The all-party group on smoking and health met in April, on the eve of a conference on passive smoking in the workplace called, "Don't Choke on the Smoke". That conference was supported by ASH, the Trades Union Congress and the Chartered Institute of Environmental Health. We were told that it could be calculated that, in the UK, passive smoking causes the annual deaths of more than 900 office workers, 165 bar workers and 145 manufacturing workers. In the last category, three times as many people are estimated to die from passive smoking than all other work-related deaths. Seventeen per cent. of bar workers are estimated to die from passive smoking at current exposure levels. Deaths caused by second-hand smoke among office workers add an estimated 9 per cent. to the total occupational mortality rate.
A paper published in the British Medical Journal in July 2002 entitled, "Effect of smoke-free workplaces on smoking behaviour: systematic review", found:
"Totally smoke-free workplaces are associated with reductions in prevalence of smoking of 3.8 per cent.",
and
"3.1…fewer cigarettes smoked per day".
4WH
It continued:
"If all workplaces became smoke-free, consumption per capita in the entire population would drop by…7.6 per cent. in the United Kingdom".
It concluded:
"Smoke-free workplaces not only protect non-smokers from the dangers of passive smoking, they also encourage smokers to quit or to reduce consumption."
Employers bear the costs of workers' smoking, including higher maintenance and cleaning costs, increased risk of fire damage and increased fire insurance premiums. The economic and health costs of passive smoking at work include increased absenteeism due to illness and decreased productivity, and 86 per cent. of the public are in favour of smoking restrictions in the workplace, banks and other public places.
Although the hospitality industry fears that smoking-free workplaces would be expensive, evidence shows that smoking bans do not result in decreased profits. A detailed summary of studies assessing the impact of smoking restrictions on the hospitality industry is regularly updated by the VicHealth Centre for Tobacco Control in Australia. It finds no negative effects on business.
I concede that efforts have been made recently to curb smoking in the workplace, including designating whole buildings or areas as non-smoking. The Department of Health became smoke free only on 1 April 2003 and, unfortunately, the opportunity was lost to introduce a total non-smoking policy in our new building, Portcullis House. I was one of three Labour Members on the Accommodation and Works Committee to vote for that in 2000. Unfortunately we were defeated by the narrowest of margins. That was a great pity. A message could have been sent to the country at large that the new parliamentary building would be smoke free, but we did not take that chance.
Mr. Sheerman:Will my hon. Friend confirm that those of us with offices in Portcullis House were never consulted on that decision? As I understand it—I would like us to nail this one if we can—there was a meeting at which a no-smoking policy was approved, but the meeting was then reorganised, new people attended and the decision was reversed.
Linda Perham:I can speak only from experience on the Committee of which I was a member. It was argued that hon. Members could not be prevented from smoking in their own offices and therefore we could not enforce a total ban. However, there are total bans in other places and I think that, with a brand-new showpiece building, the chance should have been taken to make people aware that we are serious about the message that smoking should not be acceptable in public places.
Mr. Sheerman:We were not consulted.
Linda Perham:I think that that was probably the case. I do not remember my Committee going to every hon. Member on this issue. I can really remember only the discussions that we had in Committee, but the situation is extremely disappointing.

5WH
Some restaurants and pubs are introducing smoke-free areas or banning smoking completely. Pizza Hut did so recently. I shall mention some restaurants and pubs in my local area that are taking a lead. An Italian restaurant in Gants Hill called Don Pietro's has a completely separate non-smoking area, which is extremely popular. I spoke to the owner and manager last week to congratulate them on their initiative and to say that I would mention them in the debate. The JD Wetherspoon chain operates a public house in Barkingside called the Fairlop Oak. I do not agree with the views of its chairman, Tim Martin, on the euro, but I applaud his initiative to provide non-smoking areas in his pubs.
Our local health services have done a great deal towards attacking the problem of smoking. There is a smoking cessation service, with which my parliamentary assistant has been involved, with some success. A scheme was set up in May 2002 to help pregnant women to give up smoking. Each year in my London borough of Redbridge, 960 babies are born to women smokers. There are 40 community advisers across the boroughs of Redbridge and Waltham Forest. In April this year, the "Together" initiative was the first of its kind designed to support smokers at key stages in the giving up process.
Two years ago, Smoke Free London's British Market Research Bureau social research led a spokesperson from the then health authority in my area to say:
"Cancer is the 2nd biggest killer in this area. Banning smoking in public buildings would help reduce this figure".
Research shows that three quarters of residents in Redbridge and Waltham Forest want mainly smoke-free pubs. More than 96 per cent. want smoking restrictions in restaurants and cafés. Another figure from this local survey is that 90 per cent. would agree with a move towards a complete ban in hospitals. The figures are 76 per cent. for sports and leisure centres and 68 per cent. for shopping centres. Furthermore, 95 per cent. agreed that taxi and minicab drivers should have the right to a smoke-free environment.
Voluntary measures are not enough. An increasing number of other countries are forging ahead of the UK in their determination to protect the public from the dangers of environmental tobacco smoke. Closest to home, Ireland will ban smoking in all workplaces from 1 January 2004. Legislation for smoke-free places has been successfully introduced, or is about to be introduced, in Australia, Canada, Italy, the Netherlands, Finland, Norway, South Africa, Hong Kong, Romania and Kashmir, and in more than 100 cities in the United States.
Last year, my daughter was in San Francisco as part of her American studies degree, and my husband and I went out to visit her. It was a delight to know that we could go out for the evening in San Francisco and find a restaurant in which no one would be blowing smoke over us during the meal. It made me think how nice it would be if that were the case in the UK.
In July, the European Union Health Commissioner, David Byrne, proposed a ban on workplace smoking, referring to the fact that more than 500,000 EU citizens die of tobacco-related diseases each year. The Welsh Assembly passed a motion on 22 January in favour of the principle of legal restrictions to control exposure to tobacco smoke in indoor public places.
6WH
What should the Government do? In one of its calls for action in 2003, the Cancer Campaigning Group, which consists of 20 national cancer charities, calls on the Government to introduce effective legislation to create smoke-free public places. In the UK, no single piece of legislation pi-Meets against passive smoking in public places or the workplace. Governments have sought to control exposure to second-hand smoke through a series of voluntary measures. However, current UK health and safety law offers no explicit protection from the health effects of second-hand smoke.
Five long years ago, in the 1998 White Paper entitled "Smoking Kills", the Government recognised that hundreds of people die every year in the UK as a result of high levels of exposure to passive smoke. They also recognised that smoke-free areas offer the best protection and agreed that completely smoke-free places were the ideal.
However, the White Paper did not advocate an outright ban on smoking in public places, but focused on making progress through voluntary measures. Those measures included the tobacco education programme, which was launched in December 1999, and support for helping smokers to quit and to prevent children, in particular, from starting. More recently, funding has been provided for raising awareness of the dangers of second-hand smoke, working with Cancer Research UK and the British Heart Foundation. The British Medical Association proposes a new tax on all tobacco company profits to fund public awareness campaigns on the health risks of passive smoking.
The White Paper proposed two initiatives: the public places charter for clean air, aimed at the hospitality trade, and the introduction of an approved code of practice on smoking in the workplace. The public places charter was introduced in March 2000, and is a voluntary agreement between the Department of Health and the licensed hospitality industry. However, since its introduction, the proportion of smoke-free premises has increased only from 1 to 2 per cent.
The approved code of practice would provide legal guidance to employers on the steps that they should take to comply with their duties under the Health and Safety at Work, etc. Act 1974, which is the principal legislation that covers smoking in the workplace. The code would have a special status under the law—it would not be an offence not to comply with the code, but a code could be introduced as evidence in a prosecution. Compliance with the code would offer some legal protection to employers against claims that they had failed to protect employees from passive smoking.
Considerable effort was put into drafting the code. Yet, despite the Government consultation on it having been completed in 1999 and the Health and Safety Commission recommending its adoption after a further consultation in spring 2000, it has yet to receive final approval, in the face of continuing pressure from Members of both Houses. The code falls far short of legislation to ban smoking in public places, but it goes some way to protecting public health. I call on the Government to publish the approved code of practice

7WH
together with the regulatory impact assessment produced at the time, which I understand provides the economic background for implementing such a code.
Mr. Sheerman:Many of us are worried not only that the code has taken so long hut that international experience shows that voluntary agreements and codes do not work. From 1997, this Government have been timid, timid, timid on this issue—that has been their watchword. When does my hon. Friend think that they will take action to protect people in public places and workers in their workplace?
Linda Perham:That is why I mentioned the initiatives hat have been taken in other countries. I carefully read the report of my hon. Friend's debate from March in preparing for today, and, like now, he did not mince his words in calling for the Government to implement the code, as many Members of both Houses have done in the three and a half years that the process has taken. That is partly why I wanted today's debate—to move the agenda along.
We want to see the code in place. I was involved in campaigning on age discrimination, the result of which was the introduction of a code on age diversity. However, as we know, the problem with voluntary codes is that some people and organisations always say, "Well, it's only voluntary, so I don't have to do anything." The worst must be brought up to the level of the best. Once such a code is in place, if sufficient progress is not made I hope that the Government will consider legislation.
As well as record investment in our health services, the Government have achieved a great deal to promote public health issues, including banning tobacco advertising last year and establishing the first ever post of Minister responsible for public health—my hon. Friend the Minister has recently been appointed to that post. I urge her and her Government colleagues not to drag their feet in working towards enabling the people of this country to live, work and enjoy themselves without suffering the scourge of smoke in public places.
9.58 am
Mrs. Patsy Calton: I congratulate the hon. Member for Ilford, North (Linda Perham) on securing what both the Liberal Democrat party and I consider a very important Adjournment debate. I congratulate her on the quality, number and range of arguments, because the debate is worthy of wide dissemination. I hope that it will not be disregarded because it is the first Adjournment debate after the recess although so few Members have turned up for it. Far more would have turned up had they been aware well in advance that it was going to take place. Even yesterday, notice was given only on a separate sheet rather than on the advance warning blue papers. It is a pity that more Members are not present.
We are in a transition stage in dealing with smoking as a public health issue and people's perception of it. Smokers and the public at large are finding that their attitudes are changing, and slowly—perhaps much too slowly—subjecting others to smoke is becoming as
8WH
unacceptable as drinking and driving. Successive Governments have managed to produce a change in the attitudes, particularly of young people, towards drinking and driving. The same job needs to be done with smoking in public places and elsewhere. I hasten to add that I am not arguing that legislation is unnecessary, and I shall come to that in a minute.
There is now no doubt that smoking kills. Smoking is linked with a range of cancers besides lung cancer. There is no doubt too that passive smoking kills and worsens a range of illnesses and conditions such as asthma and heart disease. There is no doubt that giving up smoking is the single most important thing that any individual can do to improve not only their quality of life but their life chances after doing so. Furthermore, smoke makes people's eyes smart, offends the olfactory organ and destroys quality of life. Providing information about the likely disbenefits, such as low birth weight, is accepted practice with pregnant mothers, and was 20-odd years ago when I was pregnant for the first time. I gave up at the time, as I had smoked for 10 years. Giving up was so difficult that I determined that I would never smoke again; I have not and will not do so. That is why I have a view about why people fight so hard to maintain their ability to smoke whenever and wherever they wish: quite simply, they are addicted, as I was, and are under the influence of a drug that is very difficult to be rid of. That is not true of everybody—some people give up more easily than others—but large numbers of people find it very difficult. I suspect that some of our colleagues are among them.
It is now standard practice that pregnant mothers, and mothers and fathers of young children, are given information that makes it clear that their children may well suffer if they are exposed to cigarette smoke, either in the womb or by being in the presence of smoking. I do not think that we can accept that such information should be available yet not take steps to ensure that children are not exposed. If we know that children are at risk, we should ensure that that risk is lessened in every situation that we can. Low birth weight—one of the factors associated with pregnant women smoking—is also a risk factor for lower achievement at school. Children are being put at risk for the whole of their lives because their mothers smoke. Everything that can be done to encourage people to give up smoking and not to expose themselves to passive smoking should be done to improve both public health and children's individual life chances and quality of life from the word go.
Mr. Sheerman:The hon. Lady is making some extremely good points and speaks compassionately. Does she agree that those of us who hate smoking and campaign on smoking too often come over as do-gooders who know best, and who hector and lecture people? Those who are addicted to tobacco have a severe form of addiction and sometimes that is the wrong approach to the problem.
Mrs. Calton:I agree that reformed smokers are often regarded as public enemy No. 1. As the hon. Gentleman says, we are regarded as do-gooders. I prefer to think of smokers as victims and when I listen to people who, for whatever reason, began smoking and then found it extremely difficult to give up, I think in terms of the drug speaking rather than themselves. It is best to regard

9WH
people who put up such a fight for their right to pollute the atmosphere as victims of a very addictive substance that is extremely difficult for them to get away from.
Case law—Stockport had a famous case a few years ago—indicates that employers are liable if they fail to take action to reduce the risk of workers developing illnesses because of exposure to smoke. Those cases are rarely brought to court because they are expensive and extremely difficult to prove. The code of practice, as we heard from the hon. Member for Ilford, North, has taken a long time to implement, and it is time for it to be finally approved.
The code of practice should be approved for the workplace not only outside the House but inside it. Hon. Members should be consulted. Early-day motion 866 provided a form of consultation and won considerable support from Members, but it is important that they are given the opportunity to make their views clear. Hon. Members should be able to take a lead in designating smoke-free areas and environments.
Many workers are not adequately protected from smoking in enclosed spaces and—this has been mentioned—the public have little or no protection apart from smoke-free areas, which are often next to and influenced by smokers' areas.
I applaud Virgin trains, although few people will hear its users do so. Its timekeeping has improved quite a lot in the past few years and it insists on a smoke-free environment. Like several north-west MPs, I travel up and down on its trains most weeks, and now that smoking is not allowed anywhere on its trains the environment is much improved. I applaud it for banning smoking and for reminding people that they should not smoke on its trains. The issue affects not only those of us with chest infections; the journey is more pleasant and the carriages are not nearly as dirty as they were when smoking was allowed. That is another important issue.
The Liberal Democrats are developing policy in that area. I was interested to hear the hon. Member for Ilford, North tell us about taxi drivers. In fact, the Liberal Democrats used to have only one policy on smoking. At one party conference—I cannot remember which—we decided to ban smoking in taxis. I hasten to add—before anyone else says anything—that that may have been at the time when the whole parliamentary party could have fitted into one taxi, but we live in happier times and we certainly could not all fit into one now.
Liberal Democrats have a health policy paper out for consultation. Smoking is in the prevention of poor health section and we are looking for comments on it. When the paper goes before the party at its conference next spring, we will have extensive, possibly heated, debate about whether it is liberal to ban smoking in enclosed public spaces. No doubt some organisations would support a heated debate given that they believe that they would lose business. As the hon. Lady said, however, the evidence does not support that argument; it supports the argument that making an environment smoke free does not reduce business.
Clearly, in these circumstances I cannot say what our party will do when it makes its decision at conference. I have made my position absolutely clear. I would welcome a ban in enclosed public spaces. That is my
10WH
position, until we have party policy on the matter. I will try to influence the outcomes, but one can never tell about such things.
A number of countries, and states and cities in the United States, have already introduced legislation to ban smoking in restaurants, cafés and bars without, as I understand it, any particular ill effects. Such bans probably contribute to smokers being put in an environment in which it is less and less acceptable to smoke, and must make it easier for them to give up.
Personally, I would ban smoking from all enclosed public spaces, but, as has regularly been pointed out to me, there is no one as sanctimonious as a reformed smoker. I do not believe that people who are addicted to a drug with lethal side effects should be allowed to determine the quality of the environment
10.10 am
Chris Grayling: I, too, congratulate the hon. Member for Ilford, North (Linda Perham) on having secured the debate and kicked off our return this autumn. I am sure that this debate should be thought about in terms of quality, not quantity. This is a valuable opportunity to discuss what I have no doubt will be one of the most important areas of public health debate in the months and years ahead, whatever one's perspective may be.
We have also heard from the hon. Member for Huddersfield (Mr. Sheerman), who has carried out extensive work on the matter through his Select Committee role, and from the hon. Member for Cheadle (Mrs. Calton). I do not doubt that she speaks with great sincerity, although I am not entirely certain how the Liberal Democrat spokesman can avoid speaking for her party in a debate such as this. I await the results of her conclusions with interest.
Mrs. Calton:May I help the hon. Gentleman? It may seem strange, but, in our party, policy is made and confirmed by the party and not by spokespeople. In the absence of written policy, the party will make a decision. Perhaps that is not so in all parties.
Chris Grayling:We shall wait with interest to see what comes out of that exercise, but I want to be slightly more clear-cut this morning.
I shall start by setting out some principles that underlie my contribution. I have a lot of sympathy with the sentiments that have been set out this morning. Smoking is a fundamental health issue in our society. In an ideal world, no one would smoke. All those involved in public health education—in whatever capacity they serve and in all the different ways in which that takes place in our society—should see reducing the number of smokers as a core aim. That is unequivocal. I strongly believe that people who do not want to be exposed to cigarette smoke—I am one of them—should not be forced into a situation in which they are so exposed. I shall touch on that in particular in relation to the workplace.
There is a caveat, and those of us who hold strong views about smoking need to remember one crucial point. Smoking is a legally accepted practice in our society, whether we like it or not, and the provision of adequate protection for those who do not want to

11WH
smoke must be balanced, reasonably, against the interests of those who do. We cannot just forget smokers, even though those who do not like smoking would perhaps sometimes like to do so. Nowhere is that point brought into starker relief than in the debate about whether we should ban smoking in public places, and, particularly, in the debate oil the impact of passive smoking.
In recent weeks both the British Medical Association and the chief medical officer have made contributions and issued warnings about the threat to public health from passive smoking. Some places, such as New York, have decided to take action against passive smoking by banning smoking in public places altogether. Most recently, the Commissioner in Brussels indicated that he is reviewing the issue. I fundamentally disagree that this is a matter for the Commission and very much hope that the Minister and her colleagues will ensure that the interest taken by Brussels is stamped on quickly. This is a matter for national Governments—for her and her colleagues, and their counterparts in other countries—not a Europe-wide issue. The Minister and her colleagues may not be able to resist the pressure, but their counterparts in France very likely will.
The arguments tend to focus strongly on health, and clearly the debate about the health implications of passive smoking is important. However, it is not always easy for politicians to be protagonists in such a debate, because we are not experts or scientists. Like everyone else, we amass and analyse evidence from those who bring professional expertise to the debate. I do not want to take one side or the other in the argument about the specific health implications of passive smoking. It is not necessary to do so, because the matter is clear-cut beyond purely the health situation. The issue is about balancing the freedom of individuals not to suffer unwanted exposure to cigarette smoke against the interest of not turning those people who want to smoke into pariahs in our society.
I wish to be absolutely clear this morning, first and foremost, that I do not want people to smoke and to inconvenience others when they are out and about. However, I do not in any way support a blanket ban on smoking in public places. That may seem slightly odd, coming from someone who is not a smoker, who does not like smoking and who wishes it would disappear. Such a ban would be impossible to define in a legally sound and fair way, and it would create anomalies that my colleagues and I could not personally defend. I shall give some examples.
I intensely dislike smoke-filled pubs and restaurants. I have sat in restaurants wishing that the people smoking at the next table would leave. If one is not a smoker, it is not pleasant while eating a meal to be exposed to smoke from someone sitting at the next table who is.
Mrs. Calton:Surely, it is not just that that is not pleasant. The people in the next seat who are blowing smoke over are passing on something that could kill. It
12WH
is not just unpleasant; it is lethal. Usually, people are not allowed to do things next to others that are likely to cause ill health or, possibly, death at a later date.
Chris Grayling:Obviously, the hon. Lady was not listening to what I said a moment ago. Because politicians are not experts, we are not always best qualified to indulge in the fierce health debate that is taking place at present, and we do not need to. Even if passive smoking turned out not to be a health threat—I am not suggesting that it is not—the debate is more fundamental. Clearly, someone who suffers from asthma or lung problems has a right to sit in a restaurant and not have someone smoking at the next table.
Mr. Sheerman:What is worrying me is that it is taking a long time for the hon. Gentleman to find the courage to say where he and his party stand. People who work in restaurants, pubs and clubs are very vulnerable, and that is particularly true of those who really are at the edge, in rooms where there is constantly a great deal of smoke day after day, year after year. Why should that group of workers be subjected to poisonous fumes that will affect their health and do them great damage? Surely, this is not just about the inconvenience to the hon. Gentleman of going to a restaurant and having someone smoke at the next table.
Chris Grayling:If the hon. Gentleman will allow me to finish my remarks, I will come on to the workplace. Let me deal initially with whether there should be a blanket ban on smoking in public places.
Are we going to make it illegal for someone who owns a bar or restaurant to target their venue specifically at smokers? Will it be illegal for one pub in a high street in which most of the pubs and restaurants have banned smoking to be a smokers' pub? That would be the problem if we introduced a blanket ban. We would be saying, "It is illegal for you to have a pub specifically targeted at smokers." I do not believe that that is sustainable, nor is it justifiable in the context of human rights.
I hear what the hon. Gentleman is saying, but are we going to make it illegal for a rail company, private or public, to decide that it wants to make one sealed or unsealed compartment on its train an area designated for smokers? And in the natural correlation of that, are we going to make it illegal for an airport to provide a smoking room in a passenger terminal? I do not believe that that is sustainable.
How do we define a public place? If people smoke in a park, is that a public space? Are we talking about indoors or outdoors? Are we concerned with arenas where people are getting together for sporting events? What about a deck on a cross-channel ferry, a cliff-top walk on National Trust land or the platform of a railway station which is partly under a canopy and partly open? A law on the matter would be impractical to define and draft, unworkable and probably unenforceable. It is the wrong way of tackling a very important problem.
Mr. Sheerman:Does the hon. Gentleman accept that we have one of the most sophisticated and advanced democracies in the world? That is what we always tell ourselves. Other countries have grappled with the issue,

13WH
come to a balanced decision and banned smoking in public places. With common sense and good legislation, that works. Is he saying that this democracy cannot manage to do that?
Chris Grayling:I am saying that it is not possible to draft a law that is just, fair and practical. However, although I think that a blanket ban would be impractical and wrong in principle, that does not mean that I do not recognise the importance of the issue, or that I do not want action to be taken to protect people.
I would be much happier for the Government to focus their attention on employee protection in the workplace, which I regard as a fundamental issue of rights. With the one caveat that I shall come to in a moment—the entertainment industry—smoking in the workplace is a difficulty that we need to address. I do not see why employees should be forced to sit in a workplace exposed to cigarette smoke day in, day out, when they do not want to do so. They should not feel that to complain about such a position, or to take action, would be to jeopardise their position. That would be fundamentally wrong.
Of course, most responsible employers now operate perfectly reasonable policies that provide space for smokers away from main working areas. I do not like the concept of a large office building with a total ban, which means that anyone who wants to smoke ends up in the car park or the street. There is nothing more unedifying than walking past an office building and seeing a group of people outside on the doorstep smoking. There is nothing wrong with providing a smoking environment that is entirely separate from the main workplace where people can go during the day to have a cigarette if they choose to do so. Frankly, I wish that they would not use that space, but it is wrong for employers not to provide that opportunity.
Not all employers do provide such a space, and that is to be regretted. Sometimes that is through choice, and sometimes it is because of practical difficulties. In too many places, such as small minicab offices, firms of half a dozen people or behind the scenes in the local corner shop, the employee who does not smoke has little choice but to put up with the smoke of colleagues. In my view that is neither fair nor just. There are grey areas, such as the hospitality industry where public pleasure and the working environment go hand in hand, and they are much more difficult to deal with. I shall talk more about that in a moment.
I entirely agree with the hon. Member for Ilford, North. Employment protection seems to be an area on which the Government have put their head in the sand during the past four years. It is four years since the Health and Safety Commission published its draft approved code of practice, and interestingly it said then that there was already sufficient health and safety and welfare law that could be applied to the question of passive smoking. What is needed is for the law to be better understood and followed. It said that the case for more law is not yet convincing because the existing legal framework is sufficient to deal with the issue. We need greater clarification to help employees to understand their rights and employers to understand their responsibilities, and to create the right framework for managing smoking in and around the workplace.
14WH
It is extraordinary that the draft approved code of practice is still sitting on the shelf. I have read it, and it is not perfect. It is too bureaucratic and focuses too much on employers drafting policy documents rather than on doing things. It also fails to reflect the fact that the entertainment industry is a genuinely special case.
Do the Government think that there should be an approved code of practice? If they do, let us see a document based on what they believe to be the next step after the initial draft document. Do they believe, as the Health and Safety Commission put it, that the law should be better understood and followed? Why has the code of practice sat on the shelf for so long? There is no justification for that—I would be fascinated to hear the Minister's justification.
I want to make it clear that although I may have an issue with the practicality of a total blanket ban, we should not put employees in a position where they must be exposed to cigarette smoke. This is a question of fundamental rights. It is very easy to discuss smokers' rights; let us discuss the non-smokers' rights. Why should people be exposed to cigarette smoke in the workplace if they do riot want to be? Of course, nothing is ever that easy. The leisure and entertainment industry is a particular challenge. It has advanced a robust case that it is working to improve the particular difficulties that it faces in protecting employees from passive smoking. Some people say that those efforts have not gone far enough.
The public places charter, which I have read, is a desirable step forward, as the hon. Member for Ilford, North acknowledged. She highlighted the fact that JD Wetherspoon has introduced non-smoking policies in parts of its pubs in her constituency, which is entirely desirable. Step by step, public pressure will make it less commercially viable for organisations to run big, smoke-filled pubs, as they have done in the past.
Can we, however, really reach a situation in which a blanket ban is imposed? I would be mighty reluctant to see us impose an absolute ban on anyone deciding that either part or all of their premises—a private venue—should be designated a smoking area. That approach would be questionable.
Mr. Sheerman:Does the hon. Gentleman not recognise the deep flaw in his argument? He does not want a blanket ban—people who support a blanket ban always worry me because they use it as an excuse for not thinking the issue through clearly. If he does not want a blanket ban, however, what are the implications for protecting workers in public places? If one is serious about protecting workers in public places, that must include pubs, bars, restaurants, clubs, railway stations and trains. If the health of workers is to be protected, smoking cannot occur in any of those places. The hon. Gentleman cannot have his cake and eat it.
Chris Grayling:I fully accept that. As I said, nothing is ever that easy. However, it is not sustainable to say to somebody who owns a pub, "You may not position yourself in the high street as the smoking pub."
When I examined the detail of the public places charter, I realised that it does not contain solutions to all the problems or go far enough on all the issues. It is, however, a positive step forward. It is definitely a

15WH
foundation from which the industry and the Department of Health—it has been signed by both sides—can try to find solutions to a difficult and complicated problem. Although those on the anti side of the argument are wrong to dismiss it, it is not the only acceptable way forward. It is, however, a valuable next step in the debate. I accept the hon. Gentleman's point that the entertainment industry is a difficult issue in what is otherwise a broad-brush picture in which the issues are fairly clear.
Smoking in public places is often a nuisance, it has potential health implications and it should be reduced wherever possible. That is happening. Smoking has disappeared in airlines, on buses, on the London underground and in many public buildings around the country. It is in the hands of the whole public sector, which controls a significant number of public venues around the country, voluntarily to decide to make those areas smoke free in the same way that airlines and the London underground have. They have taken those decisions because that is what their passengers want.
There is already substantial proof that fewer and fewer organisations and people are willing to tolerate cigarette smoke in areas where smokers and non-smokers mix. However, I do not believe that a draconian Bill to ban by law any public venue from specifically targeting smokers would be workable or right. It would be hard to define in legal terms and almost impossible to enforce. Smoking is still a legal activity in this country. We should not go down that road.
By contrast, the Government's inactivity in the debate on employee protection in the workplace represents a real failing on their part. There is no rational reason for them to have taken four years to resolve whether there should be an approved code of practice. Does the Minister plan to bring forward a revised code for debate? Does she think that there is a stronger case for employee rights? What does she plan to do to address smoking in the workplace, an issue that the Government seem to have forgotten since 1999? That is where there is the most pressing need for immediate work to be done. Sadly, I see no evidence that the Government are doing that work.
I agree with many of the sentiments expressed by hon. Members this morning, but, as a society, we have to find a balance between proper and appropriate public health measures and draconian measures that ultimately remove the freedom to undertake activities even in isolation from others. That is what a draconian Bill could do. Let us see action to define employers' and employees' responsibilities and rights in the workplace. Let us encourage, by whatever means possible, those who provide public venues to continue to segregate and to provide spaces, protection and smoke-free environments wherever possible—but let us not, ultimately, be draconian in how we instruct our society to behave.
10.32 am
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson):I, too, congratulate my hon. Friend the Member for Alford, North (Linda Perham) on securing this Adjournment debate. It is
16WH
clear from the quality of the contributions that this is an important debate. I entirely accept that had it not been the first debate today it might have attracted a much greater attendance. I reassure my hon. Friend and other hon. Members that I am not concerned about the lack of people here. I know that this is an important debate that contributes to a wider public discussion on the dangers of tobacco smoke. It is a valuable reminder of the need to tackle those dangers.
In the hour that this debate has taken so far, more than 13 people in the United Kingdom have died from smoking. We must remember that all these discussions take place in that context. The vast majority of those people have died from smoking directly, but that is not to belittle the contribution that secondary smoking makes. It is also important to recognise that half all smokers will die of a smoking-related disease. This is an enormously important matter.
The debate gives the Government an opportunity to say what we have been doing to raise awareness of the health dangers of second-hand smoke and to reduce the risk to smokers and all those around them. Smoking kills more people than any other avoidable cause of ill health in the UK. There are 120,000 deaths, as has already been said, and the cost to the NHS of such diseases is £1.7 billion a year. Smoking causes more than 80 per cent. of deaths from lung cancer, and one in seven of all deaths from coronary heart disease is the result of smoking. Tobacco smoke is probably the biggest single cause of health inequalities because it affects not only those who smoke but those exposed to it.
There are many reasons why smoking has been, and continues to be, a top priority for the Government since we came to office in 1997. One of the first things we did was to launch the White Paper "Smoking Kills", which outlined a tobacco control strategy for the country as a whole. It has been echoed in subsequent documents such as the NHS plan, the cancer plan, the national service framework for coronary heart disease, the national service framework for children and others. The cancer plan recognised the major health inequalities that result from smoking and set specific targets to reduce its prevalence among manual workers to bring their smoking rates closer to those in the general population.
I want to say something about the nature of those who are addicted to smoking tobacco and the fact that 70 per cent. of them do not want to smoke. In respect of all the comments made about the evangelism of reformed smokers and about where people are coming from on the issue, we must remember that the vast majority of those who suffer from this serious addiction do not wish to smoke. We have therefore set targets to reduce smoking rates in the population, focusing particularly on young people and pregnant smokers. The targets take into account the impact of tobacco smoke, not only on the health of the smoker, but on those around them. Reducing smoking in the general population will reduce exposure to second-hand or passive smoking.
In June, the Government signed up to the World Health Organisation's framework convention on tobacco control. The framework convention is an international legal agreement agreed unanimously by the 192 member countries of the World Health Assembly. The convention covers all aspects of tobacco control and makes a specific recommendation that

17WH
action be taken to provide for protection from exposure to tobacco smoke. It is the Government's aim to increase provision of smoke-free or non-smoking areas.
On smoking in public places, the Government have always recognised that completely smoke-free places are the ideal. Seven out of 10 smokers do not want to smoke and many people do not want to breathe the smoke of others. Furthermore, many smokers do not want to breathe other people's tobacco smoke. At the time of "Smoking Kills", the Government took the view that a universal ban on smoking in public places was unjustified while we could make fast and substantial progress by other means.
Mr. Sheerman:We all recognise that this Labour Government have very good intentions on the matter, but it is 2003 and we have been in office since 1997. We have had a succession of Under-Secretaries of State for Health and my hon. Friend knows that I have the highest regard for her as a politician and as a Minister. This is an opportunity for her to make her name as the one public health minister anyone will remember for taking a really tough stand on the issue. I hope that she will not make excuses, but will tell us why there has not been much concrete action so far.
Miss Johnson:I am grateful for my hon. Friend's kind remarks and his desire that I should be remembered for achievement on this matter. I disagree with his recollection of the achievements of my predecessors, which are considerable. In the course of dealing with some specific matters, I hope to reply to his remarks.
On smoking in taxis, which was raised by my hon. Friend the Member for Ilford, North, the Department for Transport consulted nationally in 1999–2000 and in March 2001 announced that it recognised the merits of banning smoking in taxis, but that it did not consider the case to be strong enough to make a commitment to legislate. It was satisfied that the voluntary approach of drivers being able to ask passengers not to smoke—in other words, to make the decision per cab—was adequate.
Chris Grayling:I am on the side of Labour Members on this point. It is not always easy for a minicab driver picking up a group of drunken revellers on a Saturday night to persuade them not to smoke. Does the Minister accept that the voluntary code brings with it some serious shortcomings?
Miss Johnson:If I were a taxi driver picking up a group of drunken revellers late at night, I would probably be concerned about other things that could go wrong, but forgive me if I do not elucidate.
Linda Perham:The problem is that taxi drivers feel that they do not have the force of the law behind them. As hon. Members will have seen, many cabs carry a sign saying "Thank you for not smoking", but drivers do not feel that that can be enforced. Rather than a ban, they want the choice to designate their cabs as smoking or non-smoking. They cannot do that at the moment and they feel that an opportunity was missed during the passage of the Greater London Authority Act 1999 as such a provision could have been introduced. That is why they continue to campaign.
Miss Johnson:I understand my hon. Friend's arguments. They appear to be matters for the
18WH
Department for Transport, although I can report on the current state of play. I have travelled in many taxis in which smoking is banned by the choice of the taxi driver. As a non-smoker I can tell whether someone has smoked recently in the cabs by the smell, and most cabs have remained smoke free. There is scope, but I understand my hon. Friend's point about some cab drivers' anxiety.
Children and smoking was the starting point for my hon. Friend's interest in the subject. Teenage smoking is one of the greatest challenges that we face and 82 per cent. of smokers start the habit when they are teenagers. We have taken many measures to tackle teenage smoking, including banning tobacco advertising—something that the previous Government consistently refused to do—and introducing tough enforcement on underage sales. From 13 September 2000, the Government launched an enforcement protocol with local authorities to ensure that existing legislation on underage sales was properly enforced. That is monitored by trading standards officials from time to time. The Government also support proof-of-age card schemes that protect shopkeepers and children alike, and there are tougher new restrictions on the siting of cigarette vending machines, which must be located in a monitored and supervised area.
My hon. Friend also spoke about the effects of passive smoking in the home. In 2002, the International Agency for Research on Cancer conducted an extensive review of the evidence. It concluded:
"There is sufficient evidence that involuntary smoking (exposure to second-hand or environmental tobacco smoke) causes lung cancer in humans."
The overall conclusion was that involuntary smoking is carcinogenic to humans, and the agency is the accepted world authority on carcinogenic risks.
Second-hand smoke exposure causes lung cancer and ischemic heart disease. It also causes serious respiratory illness and asthmatic attacks in children, as my hon. Friend said, and second-hand smoke exposure triples the risk of sudden infant death syndrome. Middle ear disease in children is often associated with exposure to smoke, which also causes pregnant women to give birth to lower birth weight children.
Mr. Sheerman:Although my hon. Friend is expounding a brilliant set of facts, we still have a Government who refuse to ban smacking and smoking in pre-school nursery settings. We have the information, and if we believe it we should surely deliver on it. Campaigners within the Chamber and outside are waiting for her to explain what will be done to protect children and workers in particular, since they are at the forefront of the battle.
Miss Johnson:I will deal with some of my hon. Friend's points shortly. I have the luxury of a little time and I am trying to use it as constructively as possible. I am sure that I will not satisfy him on all those points, but I will come to them.
I will deal with the workplace as that has particularly concerned my hon. Friend, as shown in his recent remarks. The point was made that public opinion is in a transitional state on smoking in confined public spaces—not open spaces but all others—and that is correct. There is a shift in public opinion to banning smoking, but also a division of view among both smokers and non-smokers.

19WH
When the subject arose in a recent discussion, I was struck by the fact that some trade unions, such as Amicus, whose job it is to protect workers, circulated material arguing against a ban on smoking in workplaces, particularly in the entertainment industry, due to a concern about jobs. That is no reason for the Government not to introduce a ban, but some people who might be expected to argue strongly for it are not doing so.
Mr. Sheerman Mr. Sheerman indicated dissem.
Miss Johnson:My hon. Friend is shaking his head but I do not know why.
Mr. Sheerman:I am a member of the union that the Minister just mentioned and I spoke at a recent conference held by the TUC on the matter. The trade union movement has dealt slowly and poorly with that aspect of workers' rights. However, as we both know, in the TUC and across the trade union movement, change is coming fast. If she is not aware of that, she should be. I have not seen the material that she mentioned, but will take it up with the general secretary at Amicus as soon as I leave this Chamber.
Miss Johnson:I am grateful for my hon. Friend's remarks. I suggested that there is a transition in all public opinion and that includes the trade unions.
Existing legal requirements on employers in the workplace come under the scope of the Health and Safety at Work, etc. Act 1974, which states:
"It shall be the duty of every employer to ensure, so far as is reasonably practicable, the health, safely and welfare at work of all of his employees."
If we are to ensure protection against second-hand smoke in public places, there must be action nationally and locally both to raise awareness of the risks associated with passive smoking and to increase the prevalence of smoke-free environments. The Department of Health will continue to encourage the development of smoke-free policies, working with both employers and communities.
Locally, the Department funds tobacco control alliances across England to work in communities to raise awareness and increase the number of smoke-free environments. Findings from those projects will inform the development of the Department's work. The Department of Health will, in addition to existing action, develop educational and information resources to raise awareness and understanding of the risks associated with passive smoking.
In that context, the Government are still considering the code of practice and I understand hon. Members' frustration. However, the Health and Safety Executive has been asked to examine the costs further, as they affect the small business and hospitality sector.
Chris Grayling:The Government have taken a long time to consider the issue—when will they stop?
Miss Johnson:That is not entirely under my control, but I assure the hon. Gentleman that I acknowledge that
20WH
the process has gone on for some time. It would be good to conclude the discussions, but the time scale is not under my control—it involves parts of the Government over which I have no say.
Linda Perham:I think that my hon. Friend's argument about small business was also advanced in a colleague's reply to a debate secured by my hon. Friend the Member for Huddersfield (Mr. Sheerman) in March. I mentioned the problems that employers have with insurance premiums—the risk of fire and so forth—because of people smoking. I hope that not only small businesses but all businesses will regard attacking the problem of smoking as an opportunity as far as health and safety is concerned, not as yet another bit of red tape.
Miss Johnson:I share my hon. Friend's enthusiasm for the approach that might be taken and I agree with her remarks.
The public places charter—a hospitality industry-led initiative—declared an intention to improve facilities for non-smoking customers and for pubs and restaurants to highlight their smoking policy through universal signage. That was mentioned by several hon. Members, not least my hon. Friend the Member for Ilford, North in her opening remarks. The charter set the target that, by January 2003, 50 per cent. of pubs should have a formal smoking policy in place and available to customers. However, an independent validation showed that by January only 43 per cent. of pubs had the appropriate signage in place, which could mean that smoking is allowed throughout, and a formal written policy available to customers. That obviously fell short of our target. Most pubs still have smoking throughout and only a handful are entirely smoke-free. That is not satisfactory progress.
Later this month, officials from the Department will meet the charter group, which is responsible for the charter, and will consider any positive suggestions for improving health. As more companies recognise the health benefits for their staff and customers of becoming smoke free they will follow suit, but it is true that more motivation and enthusiasm need to be engendered in some to make the progress that is right and proper.
The Government acknowledge that much needs to be done in tackling smoking, but we have an excellent record of doing so—a record that is recognised worldwide. We have put in place a number of measures that have an impact on smoking. We have set up a comprehensive support service for smokers to help the 70 per cent. who want to quit. Cessation aids such as nicotine replacement therapy are available on the national health service. There are dedicated helplines for all smokers, for pregnant smokers and for south Asian tobacco users. The NHS stop smoking service is designed to help smokers to give up with expert professional support.
Among the measures having an impact is the Tobacco Advertising and Promotion Act 2002, which brought to an end billboard, newspaper and magazine advertising of tobacco products. From the end of July this year, virtually all sponsorship featuring tobacco products had gone.
In July, we launched the UK's first television campaign to raise public awareness of the health risks from second-hand smoke. It is estimated that 42 per

21WH
cent. of children live in a house where at least one person smokes and that approximately one third of smokers—more than 4 million people—continue to smoke near children. Smoking near children is linked to cot death, serious respiratory illnesses, asthma attacks and serious breathing problems. As the advert says, every year thousands of children have to go to hospital because of breathing other people's cigarette smoke.
The advert is the first step in a campaign to increase awareness of the risks of second-hand smoke not only to children, but to everyone. We have followed it with more information, newspaper advertisements and billboards highlighting the risks. In addition, the new, larger health warnings on cigarette packets, which became compulsory at the end of September, include the messages: "Smoking harms you and those around you", "Protect children: don't make them breathe your smoke" and "Smoke contains benzene, nitrosamines, formaldehyde and hydrogen cyanide."
We aim to raise awareness of the health risks from second-hand smoke to enable the public to take steps to avoid them. The chief medical officer, in his annual report published earlier this year, drew particular attention to the seriousness of second-hand smoke.
Mr. Sheerman:Will my hon. Friend the Minister talk to the Health Minister in the Irish Republic about the planned introduction of a ban in public places, and will she listen to and learn from him? Will she remind my right hon. Friend the Prime Minister that he said that we are at our best when we are at our boldest? Although there were many good things in her speech, it did not sound bold or like a Government at their best.
Miss Johnson:I shall ensure that we are in touch with developments on the smoking ban in Ireland. In any case, we take a wide interest in what is happening on the issue around the globe, not only across Europe. I shall ensure that we see whether any lessons can be learned from it.
As a result of the tobacco control alliances a number of cities and towns have declared their intention, on a voluntary basis, to create more smoke-free environments and thereby be able to declare themselves smoke free. From 1 April this year, the Department of Health has become entirely smoke free. We offer support and help to staff who want to give up smoking, and encourage others to follow that example.
This autumn we sponsored conferences in each of the English regions so that local organisations could meet to share examples of good practice. The conferences have been chaired by regional public health directors—there is a high-level commitment on the public health side—who have an important role in any event in increasing
22WH
local awareness. Various businesses are getting involved in that initiative. There are speakers at the regional conferences from organisations as varied as the Cambridge Blue pub, Mars in Slough, the Land Registry in Plymouth and Aston Villa football club. It is a fairly disparate collection of interested parties, but that gives the feel of the range of businesses and employers—in the public and the private sectors—that recognise the importance of tackling smoking and responding to the wishes and needs of workers and their customers.
Chris Grayling:Will the Minister give way?
Miss Johnson:I should like to finish if I may. Public attitudes towards smoking and smoking in public places have been gradually changing in the past two decades. The days when cinemas, theatres, underground stations and trains were filled with smoke are in the past, notwithstanding the earlier remarks about GNER. It is in response to such changes in public attitudes that many businesses have moved to provide smoke-free premises. It is particularly noteworthy, as my hon. Friend the Member for Ilford, North commented, that the popular chain of restaurants, Pizza Hut, chose to go smoke free in response to both customers' and workers' wishes. When a restaurant business that is a name recognised throughout the country takes such a step, others should take note and act accordingly.
There has been a measurable shift in the number of smoke-free workplaces since "Smoking Kills" in 1998. Figures from the Office for National Statistics show that in 2002, for the first time, more than 50 per cent. of workplaces were free from smoke—that is up from 40 per cent. in 1996. Perhaps that is not enough, but it is progress. The same publication shows that the number of people wanting to eat in a smoke-free restaurant has been well above 80 per cent. for several years in a row. That statistic should be used to encourage operators of restaurants to respond appropriately to public demand.
Of course, old habits die hard—we know that that is particularly so with smoking—but things are changing, and we are more aware than ever of the risks of smoking and the effect of passive smoking. I recognise that we have some way to go and I encourage those employers and businesses that can make a real difference to show leadership in responding to public and customer demand for more smoke-free places. I am committed to real progress in all aspects of reducing smoking and assure my hon. Friend the Member for Huddersfield, who has urged on me the opportunity to make a name for myself in this regard, that I shall do all that I can to ensure that all partners who can help to achieve this result make more steady progress than they may have made to date towards achieving what we all want to see in the due fullness of time.

Mental Health Services
10.59 am
Mr. Stephen O'Brien: I am grateful to Mr. Speaker for making the time available for this debate on mental health services in the United Kingdom. It is clear to those of us who take an interest in the subject that the debate will be extremely important. The way in which a society treats those least able to play a full role is a measure of how civilised it is.
Mental illness is society's unspoken epidemic. It is rarely discussed. All too often, people regard mental illness as a weakness and stigmatise the individuals who suffer from it. The draft Mental Health Bill, which was published by the Government in 2002, has not helped to alleviate that. The debate surrounding the Bill concentrated on the potential dangers posed by psychiatric patients rather than or the more important issue of the appropriate treatment for all patients. We need to shift the debate away from those rare incidents of violence—important as they are when considered individually—that stigmatise anyone with a mental health problem. Health policies can and must be shaped to support those who suffer from a mental health condition in what can, at times, be an atomised and alienating society.
More than one in five people are afflicted by mental illness during their lifetime. It is therefore fair to say that everyone in society—whether in the context of the family, or in a caring capacity—is affected by mental illness. However, those suffering from such an illness often have the smallest voice in terms of representation and in getting society, and the Government in particular, to wake up to their needs.
This debate is therefore a good opportunity to give the mental health sector, and the people affected by it, a true and loud voice. I therefore welcome the Minister, and hope that she will be able to give answers today that will provide hope to all those following the debate. If she does, that will be in contrast to the lamentable performance—and that is not intended to be a pun on his name—of her predecessor at the virtual Dispatch Box in Westminster Hall, now the Under-Secretary of State for Constitutional Affairs, the hon. Member for Tottenham (Mr. Lammy). In his response to the debate on this subject on 7 May 2003, he did not treat the subject with the seriousness, respect, dignity or importance that it warranted.
I therefore hope that the Minister will be able to put right the deep deficit on the Government's balance sheet in the way that debates in Westminster Hall have been handled. I also hope that—because her predecessor has been moved on—she will be able to make amends for the woeful Government response on that occasion.
It is fair to say that all Governments have moved on since the dark days when we used to talk about mental health patients and the asylum. It is important and necessary to pay tribute to the enormous number of highly professional workers in the mental health sector, and to those who are committed in a voluntary capacity to our mental health services. In our constituencies, we are aware of the enormous debt that we owe to all those who, with deep commitment and long-term dedication, care for many people who are afflicted by mental illness. To those of us who are lucky enough, at this stage in our
24WH
lives, not to believe that we suffer from mental illness, devising the optimum treatment for such sufferers appears baffling.
We must also be careful, however, not to be cowed by the wish for what is increasingly becoming the norm in today's politics—and described by that ghastly word "consensus". Consensus is soggy and invariably ineffective. It is a sort of middle way or third way, which is anathema to getting action. We need action rather than words or comfort blankets in this area, and we have been waiting for that action from the Government. I do not differ from other Opposition parties in saying that we are looking for action, not simply rhetoric and fine words.
Before I move on to more detailed and substantive issues, I should like to talk about a phrase that society generally should stop using. The Government have been wont to use it completely erroneously when talking about the official Opposition and saying, "The lunatics have taken over the asylum". It is disgraceful of them to use such a phrase. I do not use it; I have never used it because it shows such deep disrespect. Yet Ministers and even some Cabinet Ministers have used it. The media have occasionally used it too. Normally I am absolutely against political correctness, but this has nothing to do with political correctness. It is to do with the deep sensitivity and the concern that society should show for people who have a mental illness. I hope that from hereon that wrong, nasty and thoughtless phrase will not be used by any Minister or by anyone in a position of authority.
I say that with some passion because I well remember as a young boy my mother driving me past what was then known as the asylum near Warrington. She was a nurse and she used to say, "Now, Stephen, just remember that those are really poor, afflicted people in there. There are fantastic nurses who look after them. The one thing I hope you will never grow up to do is to call this place an asylum. It is a hospital and a place of care." I have always held that thought with me. She said the same about Fazakerley hospital near Liverpool and Lancaster Moor hospital. It is time that we moved away from some of the language that was relevant a hundred years ago. In view of the compassion and expertise that we have in today's society, mental health sufferers deserve better than some of the loose language that we continue to use. This point matters.
The mental illness spectrum is vast. We must take care to recognise that some mental illness is defined in terms of the potential risk to self, as opposed to a risk or even danger to the public at large. That is a key feature of mental illness, once it is diagnosed correctly and the right medication prescribed. I know from my personal family experience that medication is the key to maintaining a regime of control and dignity in these matters, yet medication is often the one thing that the sufferer does not want to take, which makes the illness even more difficult to treat.
In addition to the range of risk, there is the age spectrum. We have increasing longevity; shortly some 2 million in our society will be over 85. Many of them will, of course, develop Alzheimer's and dementia. Such increasing longevity certainly presents problems and challenges for our society.

25WH
At the other end of the spectrum are young people. Most hon. Members present will be familiar with the organisation YoungMinds. Incidentally, it is disappointing that only three Conservatives, two Liberal Democrats and only the Minister and her Parliamentary Private Secretary are present. It is a shame that this is such an ill-attended debate, particularly on the Government side. YoungMinds describes the unrelenting rise in mental illness among the young. We have all become aware in our constituencies of the marked increase in the number of young male suicides. It is a significant issue revealing both stress and an inability to cope in what I referred to earlier as an increasingly alienating and atomised society. We need to observe that issue carefully and take the right steps.
Other points on the mental illness spectrum are what might be described as stress and forms of depression moving through, say, schizophrenia to what are also called personality disorders. I do not want to get into a debate on this today, which would be straying a bit far from the main topic on the Order Paper, but we need to take a much more clinical and dispassionate view of the difference between mental illness and certain personality disorders. I do not want to go down the rather legalistic route of examining whether, for example, paedophilia—abhorrent as it is in all ways—is a mental illness, a personality disorder or some other form of condition. What matters, and what was so patently missing in the draft Mental Health Bill that we saw a year ago, is a focus on what is treatable rather than simply on what is a danger.
If we look at mental health from the point of view of what is treatable, we can, as part of our responsibility as a civilised society, examine what can make the life and participation in society of certain individuals better, rather than examining the danger to, and protection of, those of us lucky enough not to be afflicted. Our mental approach, our mindset, to mental illness—I hope that I am not being too tautological—should be that we are on the side of the person suffering, helping to give them better prospects in life, rather than being on the other side. Without wanting to apportion blame, I think that being on that person's side has not generally been the mindset to date.
What is the scale of the problem? The number of people off work sick with mental illness has increased by a quarter in a long period of relatively static figures for missing work through sickness. Since 1997—this is not a political point; it just happens to be the date that I have—the number of those claiming disability living allowance because of mental illness has increased by three quarters. The toll of personal distress, and distress for families and carers, is something that we do not cost, but can all appreciate, and we should not be shy of discussing the economic cost to the nation, because it is real.
Another very real factor is not often discussed. When we speak from the very privileged surroundings of a debating forum in which we all expect to have our full mental faculties and when we discuss people who suffer from temporary or long-term mental illness, we should see it as part of our sense of self—our sense of pride and confidence in our country and ourselves as part of a civilised and compassionate society—to address the matter with the priority and care that it deserves.
26WH
More needs to be done on the interactive side, and on how those with mental illness can participate most in day-to-day society. I look to the Minister to give at least an indication about and, I hope, answers on the pathways to work strategy. We must look very carefully at whether people on benefits are capable of being at work. A three-pronged strategy is needed. First, we need to increase doctors' sensitivity and understanding. I am not making any criticism of current practice, but we must increase their diagnostic and other abilities in mental illness, so that they match those in the field of physical illness. Secondly, there must be more flexibility over part-time working. It is quite obvious that many people who have gone through stress and who may be the most capable of being treated so that they can get back to work more easily and earlier may not initially be able to face a full week's work. An environment of flexible part-time working would help.
Finally, we need to do much more—whether we call this joined-up government or joined-up benefits—to link rules. If someone is capable of going back to work part-time, they are therefore no longer incapable. However, if they are no longer incapable, there is a real risk that they will lose their disability living allowance. We need to look carefully at how the rules link. There are often perverse incentives for the professionals, and there is the possibility of adding to the stress and confusion of those trying to overcome problems.
Another point to bear in mind, although I shall not stray too far down this path today, is the need to consider learning disabilities. Although such disabilities are not in themselves mental illness, it is interesting to note that Mencap has said that learning disability leads to an intense, long-term unrelenting frustration, even agony in the sufferer, that can lead to forms of mental illness. Without reservation, I praise Mencap for all that it does; I am sure that I am joined in that by everyone here today. It is an outstanding organisation, which is very well led and has a most remarkable, committed field force with the deepest expertise. I hope that that is not regarded as something that is too easily said. Mencap deserves praise, and it will certainly get it from us today.
We must look carefully at linking learning disability provision with mental illness. The Hebden Green school for learning and physical disabilities in my constituency deals with the families and provides residential opportunities—an issue to which we may have to return. I recommend that the Minister visit that place one day as it is an example of the best practice that makes links in the community.
Before I touch on a couple of other issues, I would like to mention another underlying principle. We have heard from the Government on the matter before, and I would appreciate hearing from the Minister today a genuine update on where the valuing people strategy has got to following the White Paper. My point relates particularly to child and adolescent mental health services. In relation to the valuing people strategy, one of the critical issues that the Minister will have been briefed on may well concern whether we will get the mental health legislation. When will we see the Bill that has been so long under consideration?
As we know, the Government published a draft Mental Health Bill in the autumn of last year, and it was met with near universal condemnation. I do not think

27WH
anyone would seek to correct me on that. The proposals in the Bill that provoked the most concern included measures to introduce compulsory treatment in the community, and proposals for the indefinite detention of people with severe personality disorders. It was a coercive measure and, ultimately, a shockingly dehumanising piece of proposed legislation from the Government.
The Mental Health Alliance, representing a group of more than 50 mental health organisations, said that the proposals would backfire because more compulsory detentions and forced treatment in the community would drive people away from seeking services. Marjorie Wallace, the chief executive of the mental health charity SANE, claimed that the Bill would not address the fundamental problems of mental health provision. The Law Society and the Royal College of Psychiatrists issued a joint statement unequivocally rejecting the Government's proposals for reform of the Mental Health Act 1983. They said that
"in our opinion, the proposals are fundamentally flawed."
Having promised mental health legislation for the 2002–03 parliamentary Session, the Government have failed to publish a final Bill or to give any indication of when legislation will be forthcoming. However, the Department of Health has promised to publish the consultation responses before publishing the new Bill. I hope that we can learn today, as a result of the debate, what the Government's intentions are. That would be helpful for all and not just those in the House. An awful lot of people—notwithstanding the fact that the Chamber is not overflowing today—will be following today's deliberations, and will be looking to see what answers are given.
The Conservative party has made it clear—I rely on the latest position from the shadow Minister who is here today—that if the Government were to introduce the Mental Health Bill as previously drafted, it would oppose it. That is well understood and accepted. We have had a year's consultation with, I hope, all the specialties, and shown a great deal of sensitivity to the various spectrums that I have outlined. We also recognise that the removal of liberty is the last, not the primary resort, so we have to put it on the record that there is a desperate need for a mental health Bill, but it must be the right Bill. It must contain the right provisions.
I call for such a Bill today, and I know that my party has consistently called for it. I ask the Minister to say whether it will be a priority for us in the forthcoming legislative year. All those who take a genuine interest in the subject need to feel that the time and care that they spent in consultation and in trying to influence Government policy was worth while because it will result in a genuine step forward. There should be a legislative move rather than simply the massive, protracted talking shop that is getting us nowhere.
On medical services for mental health, the interface with social services is critical. It is critical not only in emergencies, but in day-to-day life, particularly in relation to housing in residential areas, and the more common aspects of the ways in which people with
28WH
mental illnesses find that they have to live their lives. I refer to people with a relapsing or remitting form of mental illness that is not consistent over time.
There is now a new challenge. When the three district authorities in my parliamentary constituency were under Labour and Liberal administrations—I am glad to say that the situation has changed somewhat dramatically over recent years and we have Conservative administrations—there was a rush to privatise the social housing stock. I am sorry. I said that we must be careful about the use of language so I must be politically correct and use the Government's message. The word is "transfer", not "privatize".
There is now an increasing problem because people with mental illness are no longer able to go to a connection of various agencies and authorities, and there is also the matter of considering what is the appropriate placing, within housing stock, of people with relapsing or remitting types of mental illness. We need to consider that issue carefully. I hope that the Government will have something to say about that.
The perfectly laudable aim of the national service framework for mental health, which sets seven national standards for mental health services, is to drive up quality and reduce variations in services to patients and service users. It is intended to include round-the-clock crisis teams for emergencies, more mental health beds and improved training for general practitioners. As I understand it, there is a genuine attempt to ring-fence mental health money and the various mental health trusts are intended to reflect that.
It is, however, October 2003 and—although I condemn in all other respects the Government's completely ineffective and distorting ghastly target regime—we have had more than three years under their target regime for an assessment of what they believe they have achieved in comparison with the targets that they have set themselves. I refer to the impressive speech made in this Chamber by my hon. Friend the Member for Daventry (Mr. Boswell):
"I turn now to the NHS plan targets. I hope that the Minister will comment on the Department's claims in meeting them. I note that the mental health mapping atlas, which was published in June last year, pointed out that there were particular problems in providing a 24-hour service for mental health crisis resolution teams. Fewer than half the teams then established-52, from memory—were meeting that requirement. We all know that mental illness does not operate on a nine-to-five basis—even if the office does. A problem may become acute in the small hours of the night. It is simply no good fulfilling targets nominally, but not meeting them in substance."—[Official Report, Westminster Hall, 7 May 2003; Vol. 404, c. 221WH.]
The complete lack of any assurance or answer to that point is partly why I was so openly critical of the former Minister and why his performance on that occasion was so disappointing and lamentable. I hope that there will be an answer today.
I hope that there will be a genuine recognition that staff vacancies continue to be a problem. My wife is a nurse and we met when she was doing her psychiatric training at Highgate. It was part of the critical training for all nurses to understand how to nurse psychiatric patients and that led my wife to decide to continue nursing in the oncology and terminal cancer care area, working particularly with old people. Having an understanding of how to nurse psychiatric patients

29WH
becomes a must in terms of the full-scale professionalism that must be devoted to people of that age in those conditions.
There are a huge number of staff vacancies in the nursing, psychiatric and medical areas. I hope that the Minister will tell us what progress has been made since the problem was highlighted in the earlier debate, and before that, by the shadow health team. I hope that we will hear that there has been genuine progress, because there is no point in having fine words and strategies without having enough of the professionals who choose to do a particularly tough type of professional care and work. I am worried that only one third of primary care trusts have completed evidence-based guidelines.
I thank the British Association for Counselling and Psychotherapy for briefing me today, although there is not enough time to go into all its arguments. There is a real concern that, partly because of targets, there is too little flexibility to recognise the huge value that counselling and psychotherapy can add to the provision of mental health services. The Government should be tested by the measures that they set themselves, even if we do not agree that those measures are likely to be effective. The targets have been in place for more than three years. By any test, a target can be assessed as met, not met or, at least after three years or more, whether it is on target, missed or fudged.
We must consider whether the targets focus only on severe mental illness rather than on primary care for mental health. We should also examine the assessment of the effectiveness and desirability of early intervention. In so many walks of life, early intervention is key. I cannot find—I will be grateful to the Minister if she can prove me wrong—where early intervention was measured in the target regime. I come from the world of business, so I know that what one measures is what one gets. If early intervention is not measured, we will not get a real focus on it.
I have two further points and then I will have taken up my full share of time. First, there has recently been a huge campaign about community pharmacies. Thousands upon thousands of my constituents have signed petitions, and, as a result of the enormous pressure brought to bear on the Government and various quangos to recognise the real danger of community pharmacies being lost, there has been movement in the right direction.
I have received the briefing from the Pharmaceutical Services Negotiating Committee, and I am happy to copy it to other Members who are interested, although I would be surprised if it has not been made available to them. It sets out very clearly why, in addition to all the advice that they are able to provide, community pharmacies are so important in recognising early symptoms of mental health problems, identifying signs of relapse, helping with concordance, encouraging good mental health practice and helping to change attitudes towards mental health patients and the perceptions of their problems.
We should not forget the enormous difference made by the footfall of communities through those shops. People can be seen regularly without losing face, and other members of the community can help them. I hope that the Government will not relent and will recognise that, in addition to all the other arguments, those with
30WH
mental health problems benefit enormously from the advice, knowledge and discretion available in community pharmacies.
Finally, a story from my constituency may help. Several of my constituents have used the wonderful Gainsborough road respite unit in Crewe for many years. Crewe is not in my constituency; it is in that of the wonderful hon. Member for Crewe and Nantwich (Mrs. Dunwoody). Sadly, the unit was recently closed despite a prolonged and determined campaign conducted by a number of us. It is so easy to forget how important the respite or drop-in opportunity is for mental health patients. It provides medication and a support group of people whom the patients know and trust. It is as much a part of their treatment and their ability to cope as anything else. If we know anything about mental illness in addition to the professional medication and treatment programmes, we know that people need coping mechanisms and trust so as to surround themselves with confidence, the lack of which is often the deepest undermining aspect of their mental make-up.
The Gainsborough road unit was a marvellous place for people quietly to recharge their batteries. I have received a letter from a constituent, Sheila McKeowen, who is a state registered nurse. She is deeply involved with the unit:
"Last year the Respite Unit for the mentally ill in Gainsborough road Crewe was closed despite all our efforts to keep it open. You intervened on our behalf but unfortunately to no avail. Prior to its closure in May 02 four of us had a meeting with management and were promised in its place a Rapid Response Team and a unit to be run by trained staff and social services. None of this came to fruition.
Since then numerous clients have been admitted to hospital, who would have benefited from a short stay at Gainsborough road. Not only was it residential for 8 people. It was manned by trained staff 24 hours a day. This meant people in distress and alone could phone arty time day or night for advice and reassurance. The problem is psychiatric staff and social services finish work at 5 pm and are unavailable weekends and bank holidays. The only alternative is to phone Leighton and speak to a stranger.
I have been fortunate in having good community support from a psychiatric nurse and an outreach worker for whose services I pay the County Council. In your final letter to me last year you asked me to keep in touch if there were problems. Winsford has a small MIND group."
Mind is another laudable charity, but she points out:
"Other than that there are no facilities for the mentally ill."
She asks us to do all that we can to reverse that desperately distressing situation, which has exacerbated the already tough time endured by those who benefited from the services provided by Gainsborough road.
The Minister should ask mental health trusts and other NHS organisations whose work relates to the provision of mental health services about their strategies to recognise the importance of front-end respite care, because opportunities to use respite units seem to be diminishing.
Finally, I am not calling for the micro-management of that area—we must trust and boost the professionals. It is, of course, up to the Government to find the necessary resources to ensure that the right things to treat all those afflicted by mental illness can be done. There is a responsibility to examine where there are dangers to members of the public, but we should not make that the

31WH
focus of our attention and activity. For the sake of patients, carers and professionals, we should compassionately and professionally examine the full range of treatment available to anybody who is afflicted by mental illness at any time in their life. In a civilised society, people should be able to live participative, dignified, respected and full lives. That is a minimum requirement for us to be proud to live in our country.
11.32 am
Mrs. Patsy Calton:I congratulate the hon. Member for Eddisbury (Mr. O'Brien) on securing this important debate. I was pleased to hear him refer to child and adolescent mental health services because I want to highlight an issue that affects children and their families in my constituency and, indeed, the whole of the metropolitan borough of Stockport.
I know that the Minister is not responsible for child and adolescent mental health services and, given the title of the debate, it will obviously be difficult to get answers today. I have corresponded with other Ministers about the issue in Stockport, where there is currently no specialist child and adolescent mental health service. There are no consultants in what used to be Stockport health authority, which has been subsumed into Greater Manchester health authority.
The correspondence to which I referred involved trying to find out how, despite the lack of child and adolescent mental health specialists, interim services can be provided in Stockport while child and adolescent mental health services are sorted out. Although there are 13 or 14 specialists in the Greater Manchester area, they unfortunately cannot take on work from Stockport. My latest correspondence from a Minister indicates that general paediatric consultants, excellent as they are, have the benefit of a telephone helpline. That might be appropriate for the outback of Australia but not for Greater Manchester, where the distances are not as great.
Unfortunately, child and adolescent mental health services has become an umbrella term not just for mental health conditions but for a range of others that may have associations with mental health but that are not directly mental health-related. For example, I have become particularly interested in autistic spectrum disorders, given the number of my constituents who are affected.
The Government have produced the document "Every Child Matters" for consultation. It includes much that is good and commendable, but I am very concerned that it suggests that all areas are expected to put in place a comprehensive child and adolescent mental health service by 2006. That is more than two years away at the minimum, but children and their families in my area need specialist advice now. They need to know where to go. Unfortunately, they are in the position, not just with medical health advice but with related agency advice, of having to go from one appointment to another—if they can get appointments, which is not always the case. Sometimes they have to wait two or even 18 months, when virtually everyone is aware that early intervention is needed for child and adolescent mental health problems.
32WH
I am not in any way decrying the excellent services that Stockport metropolitan borough council and the local health service provide. I recognise the benefits of the portage service, the social care that is available, the work that is done in education and by community services, the Connexions service and the disability database. The problem is that Connexions and other services are not connected. At present, there is no lead person or professional who points parents and carers and their children to the right place. I am very worried that there may be a two-year period in which little or no improvement is made.
There are bits of excellent service available all over the place, but parents and carers must find it for themselves. It is not clearly laid out for them, and it is almost as though they stumble by accident on to some of the services that they receive. That simply is not right. They should not have to go to their Member of Parliament to find out about such services. If a child is identified as needing multi-agency work, that work should be available from the beginning.
My plea today is that the named person—the lead professional—and full, comprehensive child and adolescent mental health services must be in place well before 2006. Children and their families are suffering and having to cope now. They must get the help and support that they need before another two years have passed. It is in the interest not just of the families and the children but of the whole society that early intervention, which makes such a huge difference, and the wrap-around service that people need should be available to my constituents and others.
11.39 am
Mr. Robert Key: Mental health services in Salisbury and south Wiltshire are very dear to the heart of my constituents. Therefore, I am pleased to be able to take part in this debate, thanks to the foresight of my hon. Friend the Member for Eddisbury (Mr. O'Brien). We are all very grateful to him for securing this debate for our first day back.
I wish to address the broad issue of the provision of mental services, mentioned by my hon. Friend, and the matter of locking up people who have not committed a crime just in case they commit one. That is the most contentious part of the Government's proposals for the reform of mental health services.
I give an example from my experience. A convicted man, who was in prison for some years for manslaughter, was released into Salisbury precisely because he had no connection with the town. There was an enormous police and health service operation to provide surveillance of him from the moment he was let out of the bus. We were briefed in advance that he would be watched and were told that the moment that he broke his bail conditions he would be put straight back inside, so everything would be all right. We thought, "Is this right?" Of course, he broke his bail conditions. He hopped out of the bus, walked up the road, went straight into an off-licence and was immediately rearrested and put back inside. Everyone breathed a sigh of relief. The alternative was to say that, because this man had a diagnosed mental condition and because there was a significant chance that he might reoffend, he should not be let out in the first place. As I understand it, that is what the Government are proposing.

33WH
In a mature democracy, it must always be unacceptable to deprive a citizen of his liberty just in case he reoffends. That is the position that we have to take. The reform of the Mental Health Act 1983 must be consensual because there will always be professional differences of opinion between different branches of psychiatry. If they cannot agree, it is right that such moral and ethical issues should be decided in the House of Commons. We will have to take those decisions on behalf of our constituents, the professionals and those to whom future laws will apply. Indefinite detention is the problem, not the solution, when it comes to mental health services, and I hope that my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) will have something more to say about that matter.
In my constituency, in common with most others, the provision of mental health services over many years has been complex. There is a complicated pattern of delivery in general medical services and, in particular, in mental health services. There was a splendid Nightingale hospital, the Salisbury general infirmary, in the heart of town, and it was an excellent place.
In 1945, the former American field hospital at Odstock, a hutted hospital that had been built in preparation for the liberation of Europe, was handed over to the new national health service. It provided the backbone of local acute services for my constituents for many years; I had my tonsils out there in about 1952 in an American hut. It did not do me any harm; indeed, it did me a lot of good. We were grateful for those facilities and for the generosity of the American people in providing them just after the war when we needed them more than they did. A hospital is still there on the same site, although I am glad to say that hardly any huts—either American-style or Nissen—remain; there is a fine Salisbury district hospital.
A contentious strategic decision was taken not to relocate the old asylum to the new hospital site. The acute provision was to be at Odstock in the new district hospital and the mental health services were given a lower priority. There is nothing new in that; it is the experience up and down the country. Mental health services always get the Cinderella treatment. However, I am delighted that a substantial building programme, which has been planned for more than a decade, is at last coming to fruition and new buildings are opening, although the strain on the mental health team has been enormous. I pay tribute to the magnificent consultant and the team who run the local site. They have been pushed around from pillar to post. They moved to a new office block to administer the service at Century house in Endless street, which is aptly named, and were then told that the premises were too expensive and that the building would be sold to pay their wages for another year. I jest not. That is what happened.
The position of the people providing mental health services has been uncertain. The team has been overstretched and undermanned and the reforms that were introduced in recent years have caused the loss of quite a lot of income from, for example, the county of Hampshire because the service went over the county boundary and provided services for part of Hampshire. That has now stopped so staff have been withdrawn.
34WH
There has been no guidance yet on, for example, how the service can be run to conform to the new European directive on working hours. The staff have no clue as to how that will be met. That matters enormously and even more to the acute provision of mental health services than to general acute provision. The staff do not know how they can possibly afford the new mental health services in the face of such bureaucratic decisions.
The team battles on and there is no doubt that it will settle down on the new site because its dedication is clear to everyone. However, a particular problem remains—the lack of an overall strategy for the provision of mental health services, including health services for young people. The county council has an excellent children's service, which it reorganised. It provides a wonderful service for my constituents and their children, but how does its attitude to mental health provision interface with the primary care trusts and the district hospital? There are elements of the mental health service for young people and the rest of the community at the district hospital when they should perhaps be based with GPs or in a special unit run perhaps by a children's trust. Some people suggest that the way forward is for the various partners to come together in care provision. There is also the overriding problem of respite care and how that interfaces with the different agencies whose mission seems to be very unclear indeed.
I needed to put those matters on the record because this is a great opportunity for the Minister to deal with our points. She is a sensitive Minister and I know that she will do her best. However, I hope that the Government are aware that joined-up government must take account of the provision of children's services not only by her Department, but by county councils and ensure that there is a proper read-across from the acute services provided by district hospitals and GP services supervised by the primary care trusts.
In Salisbury and south Wilshire, we are holding our breath. I shall continue to speak from the heart for those constituents who need our help and I shall continue to champion the cause of the remarkable professionals who run our mental health services. In the dying years of this Parliament, we shall expect the Government to address some of the issues with more vigour than they have shown since 1947.
11.48 am
Mr. Paul Marsden: I add my congratulations to the hon. Member for Eddisbury (Mr. O'Brien) on securing this important debate. He did well to introduce the wide-ranging issues and I associate Liberal Back-Benchers with his kind tributes to many of the mental health organisations, charities and health care professionals. I also echo his concern that not a single Labour Back-Bencher seems to want to contribute to the debate, which is regrettable as the issue is so important.
I congratulate the hon. Member for Salisbury (Mr. Key) on raising constituency issues and the eloquence with which he spoke. I hope that the Minister will deal with those issues. The matters raised by my hon. Friend the Member for Cheadle (Mrs. Calton) may not fall directly within the Minister's remit, but I sincerely hope that she will pass them on to her hon. Friend because the problem is clearly serious.

35WH
I shall direct my comments to the draft Bill, which we have seen some 16 months after the Government promised that they would introduce it. It is long overdue and will replace the Mental Health Act 1983. It is highly regrettable that the Bill seems to have been introduced in a vacuum, as it does not relate to other parts of the health services, such as primary care or housing or social services. It is a mixture of a much-needed updating of mental health legislation and repressive legislation that will lock up people who have personality disorders. I agree with the hon. Member for Eddisbury, as we will add to the stigma that is regrettably attached to those with mental health problems if we allow the Bill to proceed unamended.
The Bill seems to focus primarily on compulsory treatment in the community, and its definition of mental disorder is far too widely drawn and regressive compared with the original 1983 Act. The Bill mentions care plans but does not guarantee that they will be implemented. It also removes the treatability test in the original Act, which is that an order for compulsory treatment can be made only when treatment is likely to alleviate or prevent a deterioration of the medical condition. I cannot understand why that is removed.
The Bill may lead to excessive and inappropriate use of compulsory treatment in community settings, and real damage may be done to the relationship between the health care professionals and their patients, who will have the fear of compulsion hanging over them. There may also be pressure on the professionals to recommend compulsory treatment in the community as a form of defensive medicine. We already have the ongoing problem of disproportionate use of compulsory treatment for patients from ethnic minorities—that will continue and might be made worse by the Bill.
Other vulnerable groups, particularly the homeless, will also be targeted by the Bill. In 1998, the Government published their report on rough sleepers, which found that between a third and a half of the homeless suffer from mental health problems. We should be trying to help those people more rather than locking them up, which will be the practical effect of the Bill. That will also be a distraction to and diversion of existing mental health resources, taking them away from where they are needed—front-line patient care—into more bureaucracy and red tape. We will find more procedures to cover compulsory treatment, which may ultimately be a waste of public money.
The worrying point is that the Government, after being opposed by more than 50 mental health groups led by the Mental Health Alliance, want to go even further. In June this year, The Guardian reported that following a meeting between the Home Office and the Royal College of Psychiatrists, the Government want to give courts the power to detain in hospital people who are deemed to be dangerously mentally ill, even if they are not charged with an offence that is punishable by prison. For example, if someone was stopped for speeding and deemed to meet the criteria, they would be locked up.
That is not my suggestion, but that of Tony Zigmond, the Royal College of Psychiatrists' lead member on mental health reform. He has also said:
36WH
"This new plan is a disgrace and shameful. The government should be hanging its head in shame in how it is treating the mentally ill. If this action was taken against any other group in society it would be called prejudice."
This is not a personal attack on the Minister, because she is new to the issue and I know that she is a fair-minded individual who has a good track record of listening to people. I hope that she will listen now, as there is a danger that this will come across simply as a quick-fix solution to try to grab an easy headline for the writers of certain right-wing newspapers to satisfy their prejudices.
The professionals are overwhelmingly against the current form of the Bill. What was reported in The Lancet belies the Government's approach. It said that at a conservative estimate, six people with dangerous and severe personality disorders would have to be locked up to prevent one of them from possibly acting violently. Five out of six people, who are not violent and are no danger to society or themselves, could be locked up to try to find that one other who might be. That is no way to act in a decent, democratic society.
I shall put that figure in context and get it into proportion. Each year there are approximately 700 tragic homicides. Every life is precious and we want to act where we can to reduce that number. Out of that average of 700, however, only about 39 a year can be attributed to people who have been referred to mental health services in the year preceding the offence. Those 39 may have had mental health problems that led to the violence, but we do not know that for certain. Let us weigh that up against the fact that, as reported in the last health profile in June, in my county Shropshire alone there are on average 31 suicides. Almost as many people commit suicide in one small county in Britain as arguably have mental health problems and commit homicide in the whole country. Yet, to try to satisfy those headline writers, all the attention seems to be focused on the draconian action that the Government should take against those individuals.
Likewise, as has been said, the number of prison suicides has risen under this Government from 41 in 1997 to 94 at last year's count. This year, the number will be more than 100. A person is 13 times more likely to commit suicide in prison than in the wider community. Does that not tell us that something is fundamentally wrong, which the Government should address rather than focusing their attention as they have?
The Liberal Democrats would like to ensure that the treatability test is put back into the legislation. We want to ensure that there is a reciprocal principle so that where compulsion is required—sometimes it is—entitlement to appropriate care and access to that care is also guaranteed. There should be the necessary resources for all the additional administration that will no doubt be created and there should be a guarantee and a right for all patients to nominate a person to act on their behalf, including access to trained advocates. In short, we want treatment and care of the mentally ill to be based on optimising patient advocacy and providing the highest quality care for those who need it. The vision should be about people, not about perceived problems. We want more support for families, carers and mental health professionals, who are overworked and under enormous pressure. The Royal College of Psychiatrists has said that another 600 professionals will be needed to cope with the new legislation.

37WH
My questions on the Bill for the Minister are as follows. When will the final Bill be published? Have the Government listened to the thousands of voices steadfastly opposed to the current drafting? Will they focus the new mental health Bill on the individual patient rather than on the Home Office's perceived problems? Otherwise, the Liberal Democrats, like the Conservatives, will oppose that legislation.
One final thought: we talk about our concerns at a high level and we are concerned about possible effects, but the Government are not tackling the fundamental problems. A gentleman came into my office three or four weeks ago. He was homeless. He readily accepted that he had mental health problems. He had been released from hospital in Yorkshire and was wandering around the country. He had arrived in Shrewsbury and was trying to find a place for the night. There was a complete lack of understanding; there is no joined-up thinking between services. My office spent two hours on the phone trying to secure a roof over the gentleman's head. There was a lack of understanding—the housing office wanted him to walk a mile and a half to fill in forms so that they could put a roof over his head for that night. They then expected him to walk another half mile or so in order, possibly, to secure some travel money. As he was mentally ill, he refused to travel by train. He would take only buses or coaches, so we had to ensure that we could get him back from my office to the Yorkshire hospital the following day. We did that, but we did not do it by filling out forms. We did not do it by saying, as the services seemed to do, "We expect you to walk all the way across town even though you have broken ribs because you slept rough on the streets. I'm afraid we do not take any great interest in your personal well-being." It was easier for me to pay for a bed and breakfast to take him in for the night than to force the services to work together and to appreciate what it is like to be mentally ill. Such problems can be overcome; nevertheless, a helping hand is required. That is what it is all about.
The Government will say, rightly, that there are more resources and I congratulate them on that and on making it a priority. However, they must ensure that the resources get to the front-line services. They must ensure that they start to deliver for the most vulnerable people in society. At present, they are failing those people.
12.1 pm
Tim Loughton: What the debate has lacked in numbers, it has certainly made up for in quality. I reiterate the congratulations to my hon. Friend the Member for Eddisbury (Mr. O'Brien) on returning to this important subject. He was right to say that the former Minister responded woefully to the debate on 7 May, which made it all the more necessary that we keep the subject at the top of the agenda. My hon. Friend struck exactly the right note with his wide-ranging comments—perhaps not surprisingly, as I noticed during his speech that his comments were written on the back of a music score. The way in which society values and looks after people with mental illness is a touchstone of the strengths of that society.
I agree with the hon. Member for Cheadle (Mrs. Calton) about the big problems around the country with child and adolescent mental health services. There are
38WH
big divergences in the level of services provided and early intervention for young people is crucial, because it is a false economy not to get to the root of the problem while an increasing number of young people develop mental illness in those early years.
My hon. Friend the Member for Salisbury (Mr. Key) is absolutely right about coercion. There is a libertarian issue in the proposed legislation. We all agree with his comments about a Cinderella service, although we did not know that he had made such a large personal sacrifice of his internal organs to cement Anglo-American relations in the post-war environment. The details he gave suggest a tonsils-for-tanks approach.
The debate is timely because the Queen's Speech is in a few weeks, and Opposition Members hope that it will include a mental health Bill that reflects all the horror at, and the objections to, the Government's original attempt in draft form 16 months ago. It is also timely to have the debate a few days after world mental health day last Friday, in which I am sure many hon. Members participated.
Part of the Conservatives' intention is to keep mental health high up the agenda, and to raise the profile of a subject that has been far too much hidden away and feared as a taboo. We have held two mental health summits in Westminster and we should be holding a third at the end of the month ahead of the debate on the Queen's Speech. We have been working with the Mental Health Alliance and all its partners to maintain the pressure for the right mental health legislation.
The debate is also timely because, as hon. Members will remember, the extraordinary headline "Bonkers Bruno locked up" appeared in The Sun just three weeks ago. Many of us who saw that headline recoiled in horror at the language used by our most popular tabloid newspaper. Frank Bruno would not have attracted that sort of headline if he had been diagnosed with cancer or had suffered a stroke. Why, therefore, should he be castigated in such disgraceful terms simply because he fell foul of a mental health problem? We must reach the day when people with mental health problems are treated no differently from those who have suffered a stroke or have a condition such as diabetes. Mental illness is just another health problem; it does not make people any less human or less deserving of the help and treatment that is required than if they had a physical ailment.
As my hon. Friend the Member for Eddisbury rightly said, the way we treat people with mental health problems is a test for society. That headline pandered to the "lock 'em up" mentality of certain tabloids, and I fear that the Secretary of State for the Home Department shares that mentality. That is not the answer. We must give the mental health services greater access to funding within the NHS, and further dispel the stigmas that affect one in four people in the UK.
However, that headline did a lot of good, because the readers of The Sun forced the paper to reverse its approach. The following day, it contained an article by Marjorie Wallace, the chief executive of SANE, and the paper has been forced to set up a fund to help people with mental health problems. I welcome that big turnaround in its approach. It could prove to be a

39WH
significant turning point in the way in which people regard mental illness. I wish The Sun well in its conversion, if it now promotes a manifesto for greater understanding of mental health by ordinary people in the UK. In targeting Frank Bruno, The Sun picked the wrong target, and I am glad to see that he is fighting back. I am sure that all hon. Members here today wish him well.
It is important to discuss mental health services because, as the hon. Member for Shrewsbury and Atcham (Mr. Marsden) said, we are not merely updating the 1983 Act. Mental health legislation is still based on the legislation of 1958 and 1959, and it is therefore about 45 years since it was fundamentally reviewed. That is why we must get the new legislation right.
The evidence, however, does not give great cause for optimism. YoungMinds, which was mentioned earlier, launched its new website on mental health day. I congratulate that organisation on the great job that it does in providing information to people affected by mental health problems. One million children have some sort of mental health disorder, yet only 27 per cent. of them will receive assistance from specialist health services. Some 45 per cent. of looked-after children between the ages of 15 and 17 have some sort of mental disorder, and that problem needs to be given greater priority.
I also refer to the campaign by the The Independent on Sunday. A recent article by Sophie Goodchild, which was based on research done by the newspaper and by the Conservative health team, focused on the treatment of people from ethnic minorities with mental health problems. The article revealed some starkly worrying figures. For example, Afro-Caribbean men are seven times more likely than white men to be sent to a medium-secure unit, 51 per cent. of patients in the London psychiatric hospitals surveyed were black, compared with their 17 per cent. representation in the population as a whole, and 28 in every 100,000 black men end up in a secure unit compared with four in every 100,000 white males. Women born in India and west Africa have a 40 per cent. higher suicide rate than those born in England, and Caribbean men are 10 times more likely to be diagnosed as schizophrenic.
I therefore ask the Minister how the Government are addressing the problem with real action. Is it true that the Government suppressed a report by Professor Sashi Sashidharan? She is a member of the Government's mental health task force and produced the report "Inside Out", which concluded that mental health services were institutionally racist, that the issue of ethnicity in mental health services has been marginalised or even ignored and that the problems were getting worse. Perhaps the Minister would like to comment on that.
I have mentioned the campaign by Maca concerning people suffering from mental health problems in the workplace and my hon. Friend the Member for Eddisbury has covered that ground. I would also like to mention the survey by the Royal C allege of Psychiatrists concerning funding, which found that on average among mental health trusts there had been a real-terms reduction in budgets of 0.8 per cent. Out of 45 trusts
40WH
surveyed, three had experienced a reduction of more than 5 per cent. in their budgets, another three had experienced a reduction of between 2 and 4.9 per cent., and 10 a reduction of just under 1 per cent. Those are alarming figures.
We hear about all this new money but it is not ending up at the sharp end treating people with mental health problems where it is required. We carried out an extensive survey of all mental health trusts throughout the country and found—surprise, surprise—that the new money is being used far too much to pay off inherited debts. We found that 73 per cent. of trusts have not yet employed primary care workers, only 22 per cent. have multi-disciplinary assertive outreach teams, only 17 per cent. have early intervention teams, only about half the trusts with crisis resolution teams have 24-hour cover, 85 per cent. of the trusts that we spoke to said that the provision for child and adolescent mental health services is inadequate and that 70 per cent. do not offer women-only day-care facilities. Those provisions are all required by the Government's mental health strategy. Boxes have been ticked, but at the sharp end the services are not there, the coverage is far too patchy and people are not benefiting from the things that we all agree they need.
I come finally to the draft Mental Health Bill. It is a vital opportunity to update 45-year-old legislation. The draft Bill was published 16 months ago, but more than 2,000 consultation responses have still not been published by the Government. Will the Minister tell us when those consultations will be published, and will she confirm that they will be published in full rather than in some abbreviated form? Will she give us a progress report on whether we are going to see the Bill in the Queen's Speech? Will it be the same as the draft Bill, or will it be a properly amended Bill that takes account of the consultations? Will the Bill be examined by a pre-legislative scrutiny committee? A precedent has perhaps been set by the draft Mental Incapacity Bill, and many of us would welcome such consideration given the legal expertise one would be able to call upon from both Houses to inject some sense into the Bill. Perhaps the Minister will show us that the Government really are listening in relation to this important legislation.
We have serious problems with many aspects of the draft Bill and, most of all, with the elements that involve coercion. There is also the duty to provide general assessment that is not a requirement. The treatability test has already been mentioned, and we want to see process and safeguard measures involving advocates, nominated people and the role of carers. There is the issue of continuity of care such as the right to free treatment for mental health, which was in the 1983 Act and is not mentioned in the draft Bill. Some people require special protection: what are the rights for 16 and 17-year-olds who fall down the gap between child and adult services? How will the legislation relate to the Children Act 1989?
There is also the matter of some of the more severe treatments, such as ECT, psychosurgery and high drug dosages. Prescribing standards are not mentioned in the Bill for those and other intrusive treatments, but will it take account of them? Many questions arise from that draft legislation, and we need to get it absolutely right. It is vital legislation that we have the opportunity to produce only once in a generation. I urge the

41WH
Government to introduce a proper Bill. Let us take the coercion out of it. We need a Bill that is all about treating people and helping people with mental health problems—a health Bill—rather than a Bill that is all about locking them up, which would be a law and order Bill. I hope that Minister and her colleagues are listening. If they are not and the Government go ahead with the draft Bill as it was, we will be part of the enormous alliance that wants to kill the Bill and get back on track with real mental health legislation that is about helping people with mental health problems, not just about locking them up and stigmatising them.
12.14 pm
The Minister of State, Department of Health (Ms Rosie Winterton):It is a pleasure to serve under your chairmanship, Mr. Deputy Speaker. The debate has been very interesting, and I congratulate the hon. Member for Eddisbury (Mr. O'Brien) on securing it. It has highlighted the importance of developing modern mental health services for the one in six people at any one time who suffer from a mental health problem.
I shall try to address as many of the points raised in the debate as possible, as well as some aspects of the draft Mental Health Bill. I hope that hon. Members will understand that I cannot go into too much detail about the Bill at this stage, but I shall certainly try to return to it.
I begin by highlighting the fact that the priority that the Government have given to mental health, putting it up there with cancer and coronary heart disease, has been welcomed by all sections, many of whom felt that mental health had been considered a Cinderella service. There has been under-investment in it for many years. Many hon. Members have talked about targets, planning and priorities. The feedback that I get from those who are working on the front line and in the voluntary sector is that we should continue to give mental health the priority that it has at present, because what has happened has made a real difference.
Before there is too much condemnation of targets and priorities, I urge hon. Members to bear in mind the people who are involved. I join the hon. Member for Eddisbury and others who praised the work that is done in this very important sector, not only by many thousands of NHS staff but by those who work in the voluntary sector and by the many thousands of carers who give our society so much support in very difficult circumstances.
One in six people at any one time suffer from a mental health problem and, as the hon. Member for Eddisbury said, suicide is the most common cause of death among young men. We have tried to address that in the strategy that we published recently in an effort to consider the issue and to see what more can be done. Each year, more than 600,000 people with serious mental ill-health problems receive care from specialist mental health services, and many more look after themselves or rely solely upon their GP.
Let me give some background to the national service framework. It was designed with the input of stakeholders and service users. It identified the need for early intervention and crisis resolution, so that people were not put into a hospital situation but, as far as possible, were treated in the community. To fast
42WH
forward delivery of the NSF, £300 million has been made available. It is new investment, over and above the 2001–02 baseline.
There are criticisms about how the funds have been feeding through to front-line services, and the hon. Member for East Worthing and Shoreham (Tim Loughton) talked about that. Hon. Members must bear it in mind that the first year was a planning year that allowed people to get a proper idea of where the money would go and which services needed to be provided at local level. We have absolutely firm evidence that, last year, some £262 million extra was spent. That has resulted in more than 100 crisis resolution teams and more than 200 assertive outreach teams being in place, and in targets for early intervention teams. At the same time, we want to consider whether there are new ways of working in those teams, to break down some of the traditional barriers that have prevented the working together that we need across the professions. The money is getting out there.
We recognise that there are recruitment problems in some areas, but 25 per cent. more psychiatrists and 7 per cent. more nurses are in place. We are considering other issues, including graduate workers, so that we can ensure that the teams operate appropriately.
Tim Loughton Tim Loughton rose—
Ms Winterton:Let me say this, because it may deal with what the hon. Gentleman wants to say. When we feel that the plans are not adequate, we are working with strategic health authorities to ensure that the money is directed towards the targets and priorities that we have set. Although it is important that local people set up ways of working that suit their areas, we are concerned to ensure that, through the SHAs, there is the right service delivery. We will work with the SHAs on an ongoing basis to ensure that that is the case.
Tim Loughton:Will the Minister confirm that, on matters such as crisis outreach teams, the figures that she gave related to a snapshot date, which I believe was 31 March? There are many cases of someone's date of leaving the service being stretched to 1 April and the date for the new person coming into the service being brought forward to 31 March, so that both could be counted in the figures for 31 March, although in reality there was only one person. That is the sort of bogus nonsense on which many of the Minister's figures are based.
Ms Winterton:I reject the assumptions behind the hon. Gentleman's remark. The figure for the money being spent is based on the autumn survey. I need to correct myself in one respect, because in fact the number of consultant psychiatrists has increased by more than 20 per cent. since 1997, the number of nurses has increased by more than 25 per cent. and the number of psychologists has increased by more than 50 per cent. However, we are not complacent. It is important that we continue to ensure that the 24-hour service to which the hon. Member for Eddisbury referred is available. I assure him that, when there are areas of concern, we want to ensure that an efficient, effective and high-quality service continues to be available to people.

43WH
I shall deal briefly with the draft Mental Health Bill before addressing some of the points that were raised. I cannot today give some of the detail on the Bill for which hon. Members asked, but I can say that I worked throughout the summer with the stakeholder groups to ensure that we have the right Bill and I will continue to do so. I know that there are concerns, but in this area we must have a balance. I think that we all agree that there is an overall need to update the 1983 legislation. We need extra safeguards for the people who are detained. We need to ensure that the legislation is updated to make it compliant with the European convention on human rights. At the same time, with regard to stigma and discrimination, we must recognise that we need a system that reassures people that there are safeguards for the wider public. In my discussions with organisations from the Mental Health Alliance, we are reaching a consensus over some of the principles and we are discussing some of the practicalities of how the legislation will work.
I can give a firm reassurance that it is certainly not our intention to increase the number of people subject to compulsion. The definition of mental disorder coupled with the strict conditions that must be met before compulsory powers can be used will ensure that only people for whom compulsory treatment is necessary receive it. The Bill will not oblige doctors to treat patients nor make people use facilities. The conditions for compulsion include the requirement that appropriate medical treatment must be available for the individual patient concerned. That should reassure hon. Members who have raised that point. I hope that, in discussions with the groups involved, hon. Members will receive feedback that suggests that we are making progress in addressing concerns that have been raised through our examination of how the Bill can be put into practice.
I take on board the comments that have been made on children's and adolescent mental health services. We recently announced an extra £240 million for that. I realise that there is slow progress at the moment but we are looking to improve those services as quickly as we can because of the very real problems presented there.
44WH
On stigma, the hon. Member for Eddisbury mentioned pathways to work. He is absolutely right. I am working with the Department for Work and Pensions to see how we can ensure that we give support to people who have been on incapacity benefit for a long time but wish to return to work. We must make sure that we do not write them off as being incapable of doing any more work for the rest of their lives. In many senses, that means, as he said, changing the perceptions of health care workers. Returning to work should be seen as part of getting better and returning to normal life, rather than it being said that being on incapacity benefit is how life is going to be led in the future. It is important to take a cross-Government approach, which is why the social exclusion unit brings together different Departments to examine discrimination against people with mental health problems.
In addition, it is important to get the message over to employers that they need to provide support to people who are in work and suffering from stress problems. Recently I, along with some high-profile people in the private sector such as Lord Stevenson, launched more guidance to employers to ensure that such support can be available. Employers should no longer be frightened of how to cope with someone who says that they are suffering from stress. We need people to come forward and be upfront about their problems, but we also need to ensure that employers have proper strategies in place to deal with them.
The hon. Member for Eddisbury also mentioned losing benefits. There is quite a lot of flexibility in the benefit system at the moment. We are running pilots through pathways to work to look at how we can improve that.
I absolutely agree that there is much more that we can do on the role of community pharmacists, especially in medicines management and respite care, which are very important and must be delivered at local level.
Today's debate has been constructive and has raised many issues, but I hope that I have provided reassurance that we are making progress in the national service framework. Issues still need to be addressed and we are well aware of them, but we are moving to ensure that there is a high-quality service for people with mental health problems and that a mental health Bill will provide greater safeguards to this important group of people while at the same time providing the public with proper security.

Offshore Oil and Gas
12.30 pm
Mr. Bob Blizzard: I am pleased to have secured this debate, particularly at a time when the United Kingdom oil and gas industry is at a crossroads. Oil and gas is not a sunset industry, either in this country or the rest of the world. In energy debates in Westminster Hall and in the main Chamber, hon. Members often argue that we are running out of oil and gas. That is not true in the world. Vast reserves remain and many remain to be discovered. I am sure much more oil and gas will be discovered following advances in technology and innovation.
We are not running out of oil and gas in the UK either. Production reached an all-time high only last year or the year before. We will be a net importer of gas in about five years, but we should also remember that this country is the fourth largest gas producer in the world and the 10th largest oil producer in the world, making us a substantial player on the world stage. We will continue to be so for a good while to come.
There may be as much oil and gas left yet to be extracted as has already been produced to date, which means that we are probably half way through. In the early 1960s when gas and oil were discovered, it was said that reserves would last 20 years. We are still saying that they will last 20 years. What has changed in the meantime is the huge technological advance, which exposes another false perception about the oil and gas industry. It is not a dirty, dinosaur industry but a high-tech industry involving leading-edge engineering solutions. That image needs the well-paid, high calibre jobs that are on offer.
My final introductory point concerns the sheer scale of the industry and the magnitude of its impact on our economy. We all know the huge amount of money that was involved in building the channel tunnel. The oil and gas industry is equivalent to a channel tunnel each year in terms of spend. It supports approximately 265,000 jobs and has generated £190 billion in revenue for the Treasury through taxation since the 1960s.
Why do I say that the industry is at a crossroads? For the past few years there has been little new exploration. Few wells have been drilled. Only about 16 were drilled in the United Kingdom continental shelf last year and some of those were not particularly exploratory. That has to be a concern because if we do not explore we will not find; if we do not find we cannot produce; if we do not produce we will not maximise the extraction of the oil and gas that we need for our own energy needs and for Treasury income through taxation. It has been said time and again that undiscovered fields pay no tax at all.
We also need to maximise extraction for jobs and the economy, especially in oil and gas areas like my own constituency. A recent study of the East Anglia oil and gas area concluded that there were about 6.2 jobs in the local economy for every operating job in an oil company through contractors and the supply chain. That is a telling statistic. Many of the issues relating to low levels of exploration have been focused on by Pilot. Pilot is a model of industry-Government co-operation. More than one incoming American chief
46WH
executive officer to whom I have spoken has complimented us on how accessible our Government are and how they are listened to much more than their Government.
In spite of all Pilot's good work, we still have low levels of exploration. The Chancellor was wise when, earlier this year in the Budget, he announced a review to examine the issues and identify measures to stimulate and encourage more exploration.
It is not the case that nobody is interested any more in exploration in UK waters. It is true that our oil and gas province is in its mature stage and that most—although certainly not all—of the big discoveries have been made. We have a healthy number of new companies—they are often smaller, but are still big companies in themselves—which have been entering the United Kingdom continental shelf with exploration ambitions. Some are showing a keen interest in wild-cat exploration and some are interested in doing more exploratory drilling around the margins of existing fields. It is noteworthy that there are 53 companies involved in the latest licensing round under the new promote rules, which encourage the kind of risk taking that we want to see. I congratulate the Department on coming forward with that promote round.
We could be on the verge of a new era in the North sea. However, a number of obstacles need to be tackled as part of the review. For a start, there is access to infrastructure—the existing platforms and pipelines needed to get new reserves and finds ashore. I have heard of numerous complaints from companies both large and small about unreasonable charges demanded by some of the majors who own the infrastructure. Those charges, based purely on avoidance costs, block developments or delay them while long-winded negotiations take place. That kind of problem discourages the new culture of exploration and risk taking that we want to foster in the United Kingdom continental shelf.
The Department of Trade and Industry has powers to intervene if it receives a complaint but, of course, no one has ever made a formal complaint because people in business—often small players—do not complain to the Government about people with whom they want to continue to have some kind of business relationship. The DTI must not wait for complaints. It must establish an interventionist regime and an independent watchdog to determine fair rates. I urge the Minister to be strong when formulating the proposals under the review. We cannot allow our country's natural assets not to be exploited because of individual companies' positions in the marketplace of infrastructure use. We have tried voluntary codes of practice, but I do not think that they have worked sufficiently, and they certainly have not worked fast enough.
Time and pace are the key issues. If the stacked-up drilling rigs around this country are not commissioned soon, they are likely to move to other parts of the world and it would be prohibitively expensive to try to get them back again. Also, some necessary infrastructure—the hubs and platforms—is getting older. The longer it is left, the more expensive its maintenance becomes, adding to cost in marginal fields. If it is decommissioned, we will lose

47WH
opportunities completely. That is why access to infrastructure must be taken seriously and why the Government must be strong about it.
There are similar problems with access to seismic data. Again, complaints have been made that it is difficult and sometimes costly for smaller companies to obtain such data. In the interests of the whole country, we need a national archive of that information that is open to all. We need a shift away from a culture of confidentiality to a culture of openness and co-operation and we need to recognise that there is a shift going on in the North sea from a small number of dominant players to a diversity of many more smaller companies.
Another, even more basic, obstacle to the exploration that we want to see is that some licences are retained by operators who are, not doing anything with them. I understand that about half the North sea licences were awarded in the first four licensing rounds and, with oil company mergers, about two thirds of those licences are operated by just three companies. We need a robust process whereby operators agree to relinquish licenses for areas where they are not active. That should apply to blocks with no discoveries as well as those where a discovery may not have been developed. Good work has been done on that in Pilot, but such work and discussions must come to a crunch. We must apply a new, tougher regime to all such licences in the national interest to maximise the recovery of oil and gas. Companies that are willing explorers must have early access to blocks; time is of the essence.
Another problem is the alignment of partners. Many potential developments involve several companies, some of which may want to make progress while others do not, because that does not fit their global investment plan. I do not know what the Government can do about that; it is a difficult situation but we need discussions. Some companies are frustrated at not being able to proceed with what they view as an excellent opportunity because another company has different priorities. Time is running out.
Another obstacle is the fiscal regime. The Treasury has set a regime for existing production, much of which is derived from bigger and easier past discoveries. We must have a different regime for future fields and finds, which will be riskier, harder to find and smaller. We can learn lessons from other regimes around the world, where the mature phase has been reached. No tax is payable on undiscovered fields, so the Treasury has an interest in stimulating developments. I emphasise that we must not look at the issue solely in the context of a narrow equation on offshore taxation. We must consider the wider economic benefits that can flow to communities around the country, both locally and nationally, from the employment and supply-chain activity, and the tax that the Treasury can levy on that.
We must concentrate on measures applicable to drilling that would otherwise not take place, possibly including appraisal wells, which occasionally have to be drilled. We are considering not only outer margin wildcat drilling, but sometimes satellite drilling of existing fields, which may require an incentive to make it viable. A fiscal incentive is needed if we are to realise
48WH
the potential and enter a new era with new entrant companies. We must listen to the experiences of those companies and their ideas. We do not have to accept everything that they say, but if we do not listen there is a danger that we adopt a mentality of managed decline.
The other side of the deal must come from the companies, whether new or old, large or small. The gain to the UK from the measures I have described will be jobs and economic activity flowing from discoveries. That will be realised properly only if the work goes to competitive contractors in the UK. It was sad that most of the fabrication of the last big development—the Clair development—went to Norway. Sadly, we now recognise that we no longer have the capacity to fabricate large jackets. However, UK companies are competitive for other parts of the platforms, and I hope that there is no repeat of the Clair scenario for any other big developments. I am sure that my hon. Friend the Minister shares my concern.
The process of the ongoing review is impressive. The DTI, the Treasury and the Inland Revenue have worked closely together and engaged widely and thoroughly with the industry. I cannot believe that the Government can undertake that kind of task every other year. This is the final opportunity to get the taxes and regulations on the industry right for the future to ensure that the new era occurs. Time is of the essence and the window of opportunity will close if we do not act decisively.
The key to maximising oil and gas extraction, which has always been the first aim of all policy through Pilot, is the pace of activity in the North sea. We need a positive announcement in the pre-Budget report. The problem is not that oil and gas are running out. The critical issue is the time left in which to exploit those resources. Time need not run out, and I hope that this timely review will deliver results.
12.45 pm
The Minister for Energy, E-Commerce and Postal Services (Mr. Stephen Timms):I start by congratulating my hon. Friend the Member for Waveney (Mr. Blizzard) on securing this debate. People working in the industry have told me how much they appreciate his support and constructive lobbying.
The Government and the UK oil and gas sector have two main objectives. First, we must ensure that oil and gas resources within the UK continental shelf are fully and effectively exploited. Secondly, we must maintain the UK's pre-eminent position as a centre of expertise for the oil and gas sector.
I agree with my hon. Friend that to maintain that world-class reputation, the Government and the industry must work together. I also agree that Pilot—the oil and gas industry task force—has been an extremely valuable collaboration. In particular, a lot of work has taken place to ensure that the North sea remains vibrant and continues to attract investment from around the world.
My hon. Friend rightly made the point that the region is maturing, but he is also right to point out that there are still a lot of opportunities. The recent success of the Buzzard discovery—the largest UK offshore oil find in the past 20 years—is evidence of that. The scale of the

49WH
find caused some surprise, but, as my hon. Friend said, huge quantities of oil and gas—potentially greater than the amounts that have already been extracted—can still be produced from under the North sea. We must ensure that those opportunities are fully taken up.
We are keen to attract new players to the North sea, and I am glad that a number of the companies that have come here have had some important successes. It was excellent news to hear last month that Venture, which is comparatively new to the North sea, has made a successful discovery at Annabel in the southern North sea. That well has been tested at rates exceeding 50 million cu ft of gas per day and could deliver its first gas in 2004–05. I look forward to receiving a development plan for that field in the near future.
We want to encourage new entrants into the UKCS and to make things easier for those companies that are already here. That is why we have introduced the new master deed through Pilot, which brought in a streamlined system for licence and assets transfers. I was pleased recently to announce consent to the first transaction under the new system, namely BP's sale of its Bacton area assets to Perenco. I hope that others will now take advantage of the new system's benefits.
In the long-term, some 15 other north American companies are undertaking strategic assessments of the UKCS. They include US companies such as Apache, ATP, Challenger Minerals, Palace Exploration, Newfield Exploration and EOG, and Canadian companies such as Talisman, EnCana and CNR. We welcome their interest, which we want to reach fruition.
Mr. Frank Doran: Does my hon. Friend the Minister accept that all those new entrants, which we welcome to the North sea, face the fundamental difficulty—spelled out by my hon. Friend the Member for Waveney (Mr. Blizzard) in his important contribution to today's debate—of the control that the existing operators have over infrastructure? My figures are slightly different from those of my hon. Friend, but I understand that about 60 per cent. of the acreage left for exploration in the North sea is owned by four individual companies. We have reached the stage in North sea development in which the interests of those companies that first developed the North sea are perhaps running counter to the national interest. Most of the new incomers see access to the infrastructure and the unexplored acreage as fundamental, but it is far too expensive.
Mr. Timms:My hon. Friend raises important issues. I know how much his support for industry, particularly that part of it that is based in Aberdeen, is welcomed by leading players in the industry. We need to make much more progress in addressing the problem of fallow fields that are not being exploited at present and I will say in a moment what we are doing in that respect. It is important to stress that we want the major North sea players to continue to take an active role and I am glad that they showed a continuing interest in the 21st offshore licensing round.
My hon. Friend the Member for Waveney talked about the promote licences, which have been very successful. On 18 and 19 November, the Department
50WH
of Trade and Industry and the Petroleum Exploration Society of Great Britain are jointly hosting UK Prospect Expo 2003, where there will be a good deal more information about what it is anticipated will come out of those plans.
My hon. Friends raised the issue of fallow assets. During the last 18 months, the fallow initiative, which has been taken forward through Pilot, has been aiming to stimulate more seismic activity and drilling on blocks and discoveries that have seen no activity for four or more years. We continue to push the industry hard to relinquish fallow acreage because, as my hon. Friends rightly said, we cannot afford to have assets sitting idle—in a number of cases, for a very long period.
There have been some successes. We have targeted more than 300 fallow blocks and discoveries for action and there has been significant renewed activity on more than 60 of them. More than 40 blocks have been relinquished and have been, or soon will be, offered for re-licensing. The next major release of fallow blocks will occur early next year and will contain many blocks from the first to the fourth round of licensing. As a result, I hope that there will be progress in opening some fields that have not been active for some time.
We must continue to work hard to increase exploration levels. Like my hon. Friend the Member for Waveney, I welcome the work being done by the Treasury. We have been looking closely at the two issues highlighted by my hon. Friend—access to existing infrastructure and access to seismic data. I agree with my hon. Friend that the offshore infrastructure on the UK continental shelf is one of our most valuable assets. It provides a basis for the continued exploitation of our offshore reserves, which might otherwise be uneconomic. We have looked closely at the issue through the Pilot working group, which has agreed to a new level of transparency on the deals being done in aspect of access to infrastructure and also on the potential of a new process of intervention by the Secretary of State, who is automatically brought in when negotiations are unsuccessful. The Secretary of State also has access to legislative regulatory powers and to the Competition Act 1998. We have reached agreement on those points through the Pilot working group, and that is an important step forward in addressing the issue that my hon. Friend raised.
My hon. Friend also spoke about access to data, and I agree with him. A great deal of data have been gathered in the United Kingdom during 30 years or more of oil and gas activity. During Offshore Europe in Aberdeen last month, I announced two significant initiatives to improve access to that collection of data. Those initiatives are the result of close collaboration between the Government and the industry through the Pilot forum. I am pleased that UK companies have helped in that process by agreeing to allow the Department of Trade and Industry to publish exploration data after four years, which is full year earlier than previously.
In addition to exploration, we should not forget brown fields. Those that are already in production have the potential to yield prizes in terms of activity, investment and jobs. New approaches and new technology often allow operators to increase recovery

51WH
from a field far beyond the levels originally predicted. I am delighted that in the past couple of weeks Tuscan Energy in Aberdeen has achieved the first oil production from its Ardmore field—formerly Argyll—bringing the UK's first field back into production 11 years after it was abandoned. That is an important illustration of the remaining potential on the UKCS.
Tuscan Energy has successfully redeveloped the field with the use of modern, long-reach drilling technology and production is expected to peak at 40,000 barrels per day in the first quarter of next year. Achieving further production from the field is an important achievement and a tremendous boost for the North sea. That shows just what is possible with new thinking and new technology and it is good news not only for the oil and gas industry, but for the economy as a whole.
Angus Robertson:On new thinking, will the Minister confirm that a number of initiatives are being considered to boost exploration., which is the main issue facing us in the oil and gas industry? When are the Government likely to make public the conclusions of those initiatives and how will they ensure that the initiatives have the desired effect of boosting exploration?
Mr. Timms:The industry is optimistic that the measures that we are discussing will achieve the objective. I have spoken a little about progress on the non-tax issues and in due course my right hon. Friend the Chancellor will make announcements about progress in the Treasury and Inland Revenue. I know from my discussions with the industry in private and when I was at
52WH
Offshore Europe at Aberdeen last month that there is a lot of optimism about what we can achieve with the industry and Government working together.
Another important area is co-operation across the meridian line in the North sea between the UK and Norway. The energy White Paper heralded the forthcoming UK treaty with Norway to facilitate continued supplies of gas and followed last year's Pilot and Kon-Kraft report—Kon-Kraft is the Norwegian counterpart to Pilot—on North sea co-operation, which recommended that a new treaty be put in place to clarify the regulatory framework for a range of commercial projects across the boundary. That includes pipeline projects transporting gas across the meridian line, field developments that straddle that line and the use of host facilities for developing reservoirs from one side of the line, using infrastructure on the other.
The week before last marked a key milestone in the future partnership between the UK and Norway when both Governments signed up to principles that will underpin future cross-boundary oil and gas co-operation between them. These are to be incorporated in a new framework treaty. The agreement of principles to go into that treaty constitutes the most comprehensive energy co-operation yet between Norway and the UK and will facilitate the delivery of 20 billion cu m a year of Norwegian gas to the UK, which is equivalent to 20 per cent. of UK gas demand from 2006 and around the same proportion of Norwegian gas production. That is key to unlocking the remaining reserves within the median corridor and it will set us on the road to realising the $2 billion co-operation prize identified in last year's report. Pilot and Kon-Kraft are holding a joint meeting in London next month where I hope that we can further explore the opportunities for co-operation.
We must work together to maintain the UK as a centre of excellence for the business.

Post Office Closures (Eastbourne)
1 pm
Mr. Nigel Waterson: I am delighted to have this very timely opportunity to raise the subject.
Although the title of the debate refers to Eastbourne, this is a national issue. Government policy has been a direct cause of anything up to half the post office network being rendered non-viable at a stroke. The introduction of direct payments—leaving aside all the other difficulties such as PIN pad design and the problems caused to elderly, disabled and housebound people—has dramatically reduced business and the footfall in many of our local post offices.
The Government accept that 3,000 branches will close. I suspect that that figure is the minimum rather than the maximum. That is set against the background of the Post Office losing upwards of £1 million a day despite still having close to a monopoly in its own business.
Record numbers of post offices have closed under this Government. More recently, the rate of closure has slowed. There are two reasons why, neither of which has much to do with Government benevolence. First, a lot of people who would like to sell their businesses as sub-post offices cannot give them away; they certainly cannot find any buyers because of the gloomy prospects for many sub-post offices. Secondly, a large number of people have been hanging on in the hope of receiving compensation for closing their businesses.
The Government and the Post Office have produced their so-called network reinvention policy, which involves a large bag filled with money to dole out to sub-postmasters and sub-postmistresses who are willing to close their businesses. Rumour has it—I do not know whether the Minister will confirm or deny this—that when there was an initial trawl through sub-post offices who might be interested in funding, the Post Office was appalled at how many of them put their hands up to ask for a share of the fund simply to go out of business. There must, therefore, have been a rethink.
The Post Office has now come up with the area plans system, which I raise on behalf of my constituents. I do not know why we were singled out for this particular honour, but we are the first place in the country to go through that process—we are the guinea pigs. Instead of a programme of piecemeal closures, the Post Office has now decided—I concede that there is some logic behind this—to consider each parliamentary constituency as a unit to try to determine logically whether there are too many post offices and whether they are too close together. At the end of the day, the system will produce closure proposals that have some internal logic.
Sadly, Eastbourne has been on the cusp of those new arrangements, which, until fairly recently, have verged on the shambolic. First, the Whitley road sub-post office was marked for closure, which has now closed. Secondly, out of the blue—I mean that, because it was announced in early August when many people were on holiday—the Post Office announced that it was proposing to close the Upperton road post office, which for most people is the main post office in Eastbourne. It is in the centre of the business district, and it is one that I often use. Incidentally, if it is to be closed because of a
54WH
lack of business, I should point out that I must queue for quite some time to get served every time I go in. The proposal was announced by the Post Office, because Upperton road post office is directly administered as a Crown post office.
Just as the hoo-hah was beginning to die down about that proposal, another Post Office department announced independently that it was going to close three more sub-post offices in my constituency—in Compton street, Church street and Avard crescent. Those closures involved different departments of the Post Office and different consultation exercises that ended on different dates and were conducted by different people.
I am pleased to see that, in part due to my representations, the Post Office has taken a grip of the situation and brought together all the consultations, extending them to the same closing date, which happens to be this Thursday, 16 October. It has also agreed to my request to send representatives to a public meeting in my constituency, which will take place in Eastbourne town hall at 7.30 pm on Thursday. If the Minister has nothing better to do, he is welcome to join us. I shall be at that meeting, as will representatives of the local council. I want to pay tribute to the efforts of Postwatch, the consumer watchdog, which has been proactive in helping the consultation, supporting my efforts to ensure a rational approach from the Post Office and organising and chairing the meeting.
All sorts of petitions have been flying around. Earlier this year, I presented a petition with 8,000 signatures to No. 10 Downing street, but many have signed others, too. I have also been inundated with letters, e-mails and phone calls, so I can assure the Minister that there is strong feeling locally on the subject.
I have already conceded that it makes sense for the Post Office to consider an area as one whole. To use current jargon, it should examine the area and its needs holistically rather than just with regard to individual post offices. However, leaving aside the massive concern of those who want to continue to use the post offices, there are several points to be considered. The first is the question whether the Post Office will take any notice of the strength of local feeling, which runs across the board, including all parties on the local council. The chamber of commerce and the Federation of Small Businesses have also both been involved in lobbying.
The proposed closures, especially that of the Upperton road post office, will directly affect not only elderly people who live nearby and regard the post offices as a convenient place to make purchases and so on, but local businesses. The post office is slap bang in the middle of the town and surrounded by businesses, many of which have written to me to describe how they use the office for bulk mail and other services. Indeed, one of the main reasons why the local borough council previously shut its cash office was that the main post office was available just down the road for at least some transactions.
Another major concern is whether anything can be reversed. The Upperton road office is dealt with differently as a Crown post office, and the Whitley Road post office has already shut, which is very sad. However, the Post Office has not only identified the three other post offices that should close, but has already struck a

55WH
deal with the sub-postmasters. That has not encouraged me to put my posters or petitions on their premises, as they are looking forward to being paid substantial compensation for closing down.
When I met representatives of the Post Office here in Westminster, I asked them whether in principle any of the decisions could be reversed. They assured me that they could, but from the point of view of commercial reality I wonder how right that is. I intend to test the theory to destruction, because one of my constituents is ready, willing and able to take over one of the post offices as a going concern. He has made an offer to the Post Office, but as far as I am aware he has not had any response as of today. I intend to pursue it on his behalf.
Another issue is the need to test the Post Office's business case for closure, especially in respect of Upperton road. It has made broad assertions about losing money. It has quoted and bandied around in the local paper figures that range from £65,000 to £100,000 in losses a year, but it will not give chapter and verse, as it regards the figures as commercially sensitive. However, my information from a mole in the Upperton road post office suggests that the staff are well ahead of their targets for reducing costs and increasing revenues, so much so that they are about to receive a bonus.
Presumably, the decisions have been made without taking any account of the recent announcement that was all over the press in the past week or so that the Post Office had struck a deal with, I believe, the Bank of Ireland, with £100 million being injected into the post office system to provide banking services. The Minister may tell us more about that. Is it really sensible for the Post Office to contemplate closure of so many retail outlets when it is doing its best to reinvent itself as a properly run commercial business?
I should also say in passing that the Post Office seems to believe that most of the business currently done by the Upperton road post office will easily migrate to the Terminus road post office, our other so-called main post office in Eastbourne. That is quite unlikely. In any event, Terminus road is already extremely busy. It has long queues and a great deal of its own business. Again, that issue will be gone into in even more detail at the meeting on Thursday.
There is another major concern. The Post Office said that the great advantage of the new approach—the area plan approach—is, as was put to me in my meeting with the Post Office, that it will not be coming back to Eastbourne. As far as it is concerned, that will be the end of the matter and all the pain will happen at once. The problem is that other local sub-postmasters and sub-postmistresses wanted to take the money but were not offered that particular deal. Their business may already be losing money, or they may be reaching retirement. The Post Office accepts that it cannot guarantee against what it terms force majeure closures. The closures have nothing to do with an act of God but are a direct result of the Government policies that I described earlier.
The situation is that already five of the 19 post offices in the town are set to close—more than one quarter—with no guarantee whatever that other post offices outside the area plan will not be forced to close in due
56WH
course or feel that they have no alternative. In fact, the situation could be much worse. Could one third or one half of all the post offices in the town close?
When the smoke clears and the dust settles, the Post Office's stated aim of providing a post office within one mile of 95 per cent. of the urban population in a place such as Eastbourne could be shot to pieces—partly due to decisions of the Post Office itself and partly due to the Government policy that lies behind all this, but also partly due to the decisions of individual postmasters and postmistresses. I cannot emphasise too strongly to the Minister the consequences, particularly for the very elderly population in parts of my constituency but also for the business community, of such vandalism to a post office system that has served the local community extremely well for a long period. I hope that the Minister will have some words of comfort that I can take to the public meeting in Eastbourne town hall on Thursday.
1.14 pm
The Minister for Energy, E-Commerce and Postal Services (Mr. Stephen Timms):I congratulate the hon. Member for Eastbourne (Mr. Waterson) on securing the debate and on the very close interest that he has taken in the lively discussion in Eastbourne in recent weeks.
I must say that I was sorry to hear the hon. Gentleman run down the post office network in the way that he did when he spoke about it becoming unviable. He is quite wrong about that. The post office network has a very promising commercial future. I want to reassure sub-postmasters in Eastbourne and elsewhere of the Government's commitment to a viable future for the post office network. Of course they recognise, as the National Federation of Sub-Postmasters has, that in urban areas where there have been large numbers of post offices in a small area there is simply no longer the business to sustain so dense a network. For example, more than 1,000 sub-post offices have more than 10 other branches within 1 mile of them. That density can no longer be supported, so we need a rational process to decide which branches should continue and which ought to close.
I am disappointed that the hon. Gentleman has talked about half the post offices or more closing. This process is about ensuring that there is a commercially strong and viable future for the branches that remain. That is why we have invested £500 million in technology to ensure that banking transactions can be carried out at every single post office branch in the country. I join the hon. Gentleman in welcoming the announcement of the joint venture with the Bank of Ireland to allow, within a few months, every post office branch in the country to sell financial services and new products further to develop commercial viability.
I was pleased to hear the hon. Gentleman's comments on the role of Postwatch. I am glad that what he has seen in Eastbourne confirms what Postwatch has told me of the effectiveness of its role in monitoring this process in urban areas. I am also glad that he gave a welcome, if a rather grudging one, for the area-based approach that the Post Office has now introduced. As he rightly said, we are seeing the first example of that in Eastbourne.
At the beginning of his remarks, the hon. Gentleman wondered why the number of post office closures had sharply reduced, especially in rural areas. That has been

57WH
case in the past couple of years, and is precisely ause the Government imposed a requirement on the ffice that there should be no avoidable rural post of closures. That has been very effective, and is a direct consequence of the Government's approach. At the same time, we recognised the need for a sensible rationalisation of the urban network, given the issues about density in urban areas that I mentioned earlier.
The policy goes back to the recommendations of the performance and innovation unit in 2000, which recommended that if the Post Office decided that fewer offices were needed in some urban areas, the Government should consider providing funding to ensure that the sub-postmasters affected could be adequately compensated for the loss of their business. That report was widely welcomed. We accepted all the recommendations made, and following parliamentary approval of the funding last November, Post Office Ltd. initiated the programme that we are debating today.
The network of post offices includes nearly 17,000 branches, which is more than all the banks and building societies in the country put together. The Post Office is ensuring that, in a properly managed way, the post office network will meet the needs of the communities that it serves and fit the business passing through it. There have been reductions in post office usage for all sorts of reasons, past under-investment being one of the most important, but some two thirds of the urban population live within half a mile of two or more post offices, many of which have been struggling to survive. Rationalisation of parts of the network will improve its viability and allow the development of better services, from brighter offices, for customers.
The great danger of not having such a process would be unmanaged decline in which individual sub-postmasters simply decided to shut down and leave. That is what the hon. Gentleman feared might happen in his constituency. I hope that, on reflection, he will agree that the process we have put in place is a much better alternative and that it will avoid the unmanaged decline that he feared. It is important that all of us express confidence in the future of the post office network because it is such a valued feature of our lives in every part of the country, in urban and rural areas.
Mr. Waterson:Of course I agree with the Minister's point about unmanaged decline, but would he like to deal with my central point? No matter how much the Post Office organises an area plan—I see that there is some logic to that approach—it cannot cauterise the situation. It could shut those five offices and still end up with more offices closing in the next year or two.
Mr. Timms:I hope that as a result of the process, which has been designed to achieve this goal, we will achieve a viable network in the future. I have talked about the investment in technology for banking. It is now the case that any customer of Lloyds TSB, Barclays or Alliance and Leicester can withdraw cash from any post office in the country with their cash card. That is a new service, and we have seen rapidly increasing numbers of people taking advantage of it. I use it myself at my local post office; it is an excellent service. We have talked about the new products that the Bank of Ireland joint venture will produce.
58WH
There are no cast-iron guarantees that one can give about the future of any commercial business, but we can look forward with some confidence to a viable network in urban areas as a result of the admittedly rather painful and difficult process we are going through at the moment. I think that the hon. Gentleman will agree that completing that rather difficult exercise now stands us in better stead for having a successful and viable network in the future. I take his point about there not being cast-iron guarantees but there is a high level of confidence in my mind, and among those who work in the Post Office network, that at the end of the process we will have a financially sound network that will continue to serve all our urban and rural areas.
The hon. Gentleman made some points about the rate of closure of offices and the sales of sub-post office branches. I can tell him that in 2002–03 there were nearly 1,500 sales of post offices. The previous year there were about 1.600 such sales. I do not think that there is as significant a depression in the market as he suggested. The hon. Gentleman has talked about the branch at Whitley road in Eastbourne, which has already closed under the terms of the programme. Although nobody is pleased about the closure of any post office, the way in which that was handled meant that the postmaster could inform customers of what was happening, and of alternative offices such as Terminus road, Marine parade and Seaside, all of which are less than a mile from the closing branch.
I am glad that the hon. Gentleman acknowledged that the Post Office has now pulled together the various proposals relating to its operations in Eastbourne. It has produced three proposals for compensated closures under the urban reinvention programme for Avard crescent, Church street, and Grand Hotel buildings. It is also proposing to close its directly operated Eastbourne Crown office and will consider that proposal in conjunction with its wider plan for the area. I should say that I am advised that all those changes, including the Whitley road closure, would amount to five closures out of 22 post offices in the hon. Gentleman's constituency. I think that he referred to a figure of 19.
Mr. Waterson:There is no reason why the Minister should know this off the top of his head, but he will find that there are 19 in the town of Eastbourne. My constituency extends to places such as Willingdon and East Dean where, I am delighted to say, the post offices will remain untouched as long as they remain viable. Out of 19 post offices in the town itself, five will have closed if the plan goes through.
Mr. Timms:I bow to the hon. Gentleman's knowledge of the boundaries of the town. I think that only one post office in his constituency was classified as rural; no doubt he will correct me if I am mistaken on that as well.
There has been a lot of debate and I am glad that the Post Office has extended the consultation period for the Eastbourne Crown post office following the meeting with the hon. Gentleman on 8 September. That is an example of the attention that the Post Office will pay to local opinion and need before reaching its decision. Postwatch and I are satisfied that good processes exist to express local community concerns through Postwatch, and that those concerns can be effective in influencing

59WH
the final decision of the Post Office on individual closures. Under the programme, several closures have been proposed, which, following representations from Postwatch, have been amended or withdrawn.
In Eastbourne there is the issue of the Crown post office as well as the sub-post offices. Crown offices are generally the largest post office outlets in an area and the Crown office network makes substantial losses of around £50 million a year. I think that Eastbourne is unusual in having two Crown offices operating. In the financial year 2002–03, losses for Post Office Ltd. increased to £194 million, before exceptional items. Eastbourne Crown office is making an operational loss of around £65,000 a year, and that figure would increase if all the overheads were added. That illustrates the need for urgent action to maintain the viability of the network.
Consultation on the proposals for the hon. Gentleman's constituency remains open until Thursday and he referred to the public meting being chaired by representatives of Postwatch on that day. He has been influential in securing that meeting and I hope that it will allow further, fruitful discussion of the proposals and give the company the opportunity to consider comments that are raised. Importantly, once decisions on the current proposals have been reached, Post Office Ltd. has no intention to return to Eastbourne with further proposals. The company's view is that, should the proposed changes go ahead, it will have fulfilled its objectives of ensuring that there is the right service in the area for the custom, and that the network can continue to serve Eastbourne on that sound basis.
60WH
An additional element of the programme is the £30 million that the Government have provided for modernising and adapting the offices that remain in the network. The key to improving standards in those offices will be the increased volume of expected business. The grants of up to £10,000—a figure to be matched by the proprietor—for each office expecting to take on a significant number of additional customers will also be an important boost. The Post Office will generally require the receiving offices to improve facilities and increase opening hours so that sub-post offices will maintain the same hours as the associated retail businesses alongside them and improve the service to customers in contrast with the hours being kept in the past.
The proposal is the first ever programme of Government investment in urban sub-post offices. It is a welcome, additional measure to those recommended in the performance and innovation unit report. The Post Office is assessing applications totalling more than £12,000 from branches in Eastbourne that would expect to receive additional custom should proposed closures go ahead. I am sure that the hon. Gentleman will welcome that and agree that it is important that sub-postmasters are given the encouragement to improve and develop their offices.
I am going to leave Westminster Hall immediately to attend the award for this year's best post office, a competition that has prompted enormous enthusiasm on the part of members of the public supporting their post offices. There is an immense commitment to the post office network and the changes that we are making provide a high-level assurance about the prospects of the business going forward.

Paediatric Allergy Services
1.30 pm
Jon Cruddas: I wish to raise a number of issues concerning allergy in the UK. I will talk specifically about paediatric allergy and the lack of allergy services within the national health service.
Allergy is a major public health problem in developed countries. In the UK over the past 20 years, the incidence of common allergic diseases has trebled, giving this country one of the highest rates of allergy in the world. In any one year, 12 million people in the UK—one fifth of the population—are likely to be seeking treatment for an allergy. Allergies range from debilitating conditions such as asthma and hay fever to life threatening conditions such as anaphylaxis.
There are solutions to the problems that face us. However, they require an understanding of the issues from within the NHS and a new strategic approach to the issues of allergy within the Department. A recent report from the Royal College of Physicians stated that
"despite the epidemic proportions of the disease, the health service is failing to meet the most minimal standards of care—far less clinical governance".
Today's short debate gives me the opportunity to raise some points regarding allergy—these are very real concerns to my constituents in Dagenham—as well as to probe the Department about why there are so few specialist allergists to meet the needs of the population in the UK. On a more positive note, however, the debate gives me the opportunity to propose a series of initiatives that might allow the Department to demonstrate an acknowledgement of the problem and a readiness to develop a training programme and infrastructure to improve the care available within the NHS.
At the outset I must declare an interest. My family has had first-hand experience of severe allergy and anaphylaxis. I am a member of the Anaphylaxis Campaign, which is the research and campaigning group raising awareness of issues centred around allergy and anaphylaxis. The campaign's food safety adviser Hazel Gowland is listening to the debate this afternoon.
I want to place on record my own personal debt of thanks first to the Anaphylaxis Campaign and its director David Reading for the support that they offer to thousands of families who have to confront issues of child anaphylaxis every year. From personal experience, I know that their work is critical for many families in terms of offering support and understanding to enable people to deal with the condition. Secondly, I thank the excellent paediatric allergy centre at St. Mary's hospital under Dr. Gideon Lack. As a family, we were fortunate to live close to that hospital. The problems that I will describe are centred around the postcode lottery of being referred, or not, to a specialist paediatric allergy centre.
Thirdly, I am thankful for all the hard work being carried out within the medical community on allergy, especially by all those involved in the Royal College of Physicians working party on the provision of allergy services in the UK. The working party has meant that this summer has seen greater awareness of allergy issues in the public press. The headlines were generated by the
62WH
report by the Royal College of Physicians, "Allergy: the unmet need. A blueprint for better patient care", which was launched in the House of Commons in June.
The Royal College of Physicians has sought to put allergy higher up the health care agenda of the Department of Health and of planners and managers. It has made proposals for an improved allergy service for the British people, which, if taken up, would result in more consultants, a network of accessible centres around the country and better training.
In terms of the nature of allergy in the UK, it is worth considering some of the statistics. One in three members of the UK population?about 19 million people—will develop an allergy at some point in their lives. Asthma, rhinitis and eczema have increased in incidence two to threefold over the past 20 years. Among 13 to 14-year-old children, 32 per cent. report symptoms of asthma, 9 per cent. have eczema and 40 per cent. have allergic rhinitis. The UK ranks highest in the world for asthma symptoms and is also near the top for allergic rhinitis and eczema.
High and increasing trends are also apparent in nut allergy, anaphylaxis and occupational allergy to latex, for example, and allergic reactions to drugs. Anaphylaxis occurs in one in 3,500 of the population each year. Hospital admissions have increased sevenfold over the last decade and doubled over the last four years. Peanut allergy, the most common food allergy to cause fatal or near-fatal reactions, has trebled in incidence over four years and now affects one in 70 children in the UK. Only 10 years ago this was deemed a rare disorder.
Allergic reaction currently accounts for 6 per cent. of general practice consultations, according to the Royal College of Physicians report, 0.6 per cent. of hospital admissions and 10 per cent. of the GP prescribing budget. It is estimated that the cost in primary care, excluding hospital services to the NHS, is around £900 million per annum. Even before the recent increases in allergy were registered, it was estimated that paediatric allergic disease in the USA constituted 28 per cent. of all chronic disorders requiring medical attention and resulting in school absence.
In a nationwide study of children's allergies in the UK, of the 27,507 children surveyed in 1999, 20.4 per cent. were reported to have had asthma in the previous year, and 16.4 per cent. eczema. One or more atopic symptoms were reported in 47 per cent. of all children. Those rates are reflected in acute paediatric care. In a recent survey of accident and emergency admissions at St. Mary's hospital in London, 7 per cent. of children seen as emergencies were diagnosed as having an allergy disorder. Those children required twice the rate of admission and twice the rate of specialist tertiary referral compared with other children attending as emergencies.
Is it any wonder that many experts in the field now talk of an allergy epidemic in this country specifically with reference to allergies in children? The allergy charities are inundated with telephone inquiries from a desperate public. The vast majority of GPs have no training in allergies and few are aware of any of the formal guidelines for allergy management. In many instances, the severity of the symptoms, with attendant high morbidity, has forced the public to look outside the NHS.

63WH
Urgent action is required. However, consider the deficits in current paediatric care. Across the whole country, there are only six centres staffed by consultant allergists who offer a full-time service with expertise in all types of allergy problems. Three are based in London; at Guy's, Royal Brompton and St. Mary's. The others are in Cambridge, Southampton and Leicester. Services are extremely poor in the rest of the country. There is no specialist provision north of Manchester or west of Bournemouth. All six specialist centres provide a high quality multi-disciplinary approach. Moreover, they have an international reputation for research. Five of the six—the exception is Leicester—were developed as academic units with university funding. That is an indication of the lack of tradition within the NHS of allergy support.
Demand is enormous and waiting lists are very high. In Cambridge, for example, the number of patients seen increased by 440 per cent. between 1993 and 2000. Referral rates rise continuously while waiting lists remain unacceptably high for serious disease. This pattern is the same in all six specialist centres. Overall there is only one consultant allergist for every 2 million people in the UK, compared with rates of around one per 100,000 for mainstream specialties such as heart disease.
Allergic diseases comprise a significant percentage of the workload of primary care and the majority of children with allergy problems will have their care provided exclusively by a GP. Yet according to a survey of GPs carried out by the British Society for Allergy and Clinical Immunology, the majority of GPs had received no training in the management of allergic disorders. Only 23 per cent. of respondents reported that they were familiar with any guidelines for the management of an allergic condition. More than 80 per cent. of respondents considered current allergy service provision throughout the NHS poor, with deficiencies being most marked in secondary care and in accessing appropriate specialists.
There are four NHS paediatric allergists in the UK. In Sweden, there are 96 trained paediatric allergy specialists; in Germany, there are 500. Compared with the UK, there are five times the number of paediatric allergists in Greece, and four and a half times the number in Switzerland. In Japan, the paediatric allergy society has 2,000 members. As a consequence, parents who are desperate for treatment for their children seek help from complementary and alternative medicine, which can sometimes lead to potentially dangerous recommendations.
Given the lack of specialist care, many children with different types of allergy such as eczema, rhinitis, asthma and food allergy may be seen consecutively in different settings—general paediatrics, ear, nose and throat, dermatology, chest medicine and the like. That remains a highly inefficient method of delivering health care. As such, the underlying causes of allergic disease are often left undiagnosed. Delivery of care by a paediatric allergist would provide a more rational, integrated and cost-effective service—in effect, a one-stop shop. All the above can lead to so-called steroid loading, owing to no single specialist taking charge of overall management.
64WH
The report by the Royal College of Physicians contains a series of excellent proposals for the way forward. It proposes that each new NHS region should have at least one specialist allergy centre staffed by a multi-disciplinary team covering a population of 5 million to 7 million people. Staffing levels in those centres should include two new additional consultants to cover diagnostic procedures and specialist treatment, a minimum of two full-time allergy nurse specialists, one half-time dietician and one half-time paediatric dietician with specialist training in food allergy and two consultants in paediatric allergy supported by paediatric nurse specialists and dieticians.
The development of services should be gradual, and long-term savings through better-educated GPs and more effective referrals would largely offset the increase in costs. That, in turn, would lead to a more efficient use of allergy services. There would be fewer hospital admissions, less accident and emergency attendance, reduced drug costs and lower levels of illness. Moreover, to create more new consultant posts, it is essential to increase the number of trainees in the specialty. There are only five trainees nationally. Despite the explosion in allergies, the Department of Health has allocated no new funded posts for 2004–05.
In conclusion, it is not melodramatic to talk about an allergy epidemic in this country, especially over the past 10 years. The issues will not go away. All evidence suggests that the number of people affected will continue to rise, especially given the profiles among children. In one sense, it is not surprising that the extraordinary growth over the past 10 years appears to have caught the NHS by surprise. What is lacking, however, is an adequate response from the Department of Health.
Evidence locally suggests that some primary care trusts are considering cuts in the minimal specialist provision that currently exists. The people who work in that area are extraordinarily committed and they know that the situation cannot be resolved overnight. They are, however, looking for a lead from the Department of Health that demonstrates a commitment to the work. They are looking for a commitment to fund new training posts in paediatric allergy over the next 10 years with a corresponding number of consultant posts, support to start investing in regional specialist centres and a commitment to further research, particularly into the early prevention of allergies in children. A willingness by the Minister to meet a representative group of campaigners and medical experts would also be very welcome. Paradoxically, given what I have said, there is a great opportunity for the Government to recognise those problems and to demonstrate that they are moving toward some solutions.
I hope that we will receive such a response from the Minister. It would be a welcome development as, too often in the past, the Department of Health and health managers have been in denial about what is really happening across the country.
1.44 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson):I congratulate my hon. Friend the Member for Dagenham (Jon Cruddas) on securing the debate. I am aware both from his remarks and earlier that he has a personal interest in the subject. I welcome the opportunity to outline the Government's policy on allergy services.

65WH
I should say that a friend of my son has a severe peanut allergy. As my son has grown up—he is now 17—I have seen his friend at close quarters, having taken them on holiday, and I am well aware of the issues surrounding allergies for parents and families.
Perhaps it would be helpful for hon. Members if I defined anaphylaxis, an acute, immune reaction requiring urgent medical attention that may occur in children or adults who suffer from severe allergies. The most common cause of anaphylactic attack is a severe allergy to food, although certain drugs such as penicillin, and the venom of stinging insects, such as bees and wasps, can result in an attack. In its most severe form the condition is life-threatening but it can be treated with medication, such as antihistamine, adrenaline inhaler or adrenaline injection, depending on the severity of the reaction. Most parents are normally prescribed a device for personally injecting adrenaline. It looks like a fountain pen and is pre-loaded with the correct dose. It is not possible to give too large a dose when using the device.
The Royal College of Physicians recently published a report called "Allergy: the unmet need. A blueprint for better patient care". The report notes that allergies, including asthma, rhinitis, eczema, food allergy and drug allergy, are becoming increasingly common, as my hon. Friend remarked. It called for improved NHS allergy services across the board and offered useful models of how that could be achieved.
We agree that NHS allergy services need improvement and our substantial extra investment in the NHS will help to deliver service improvements. My hon. Friend will be aware that up to 2002–03, expenditure on the NHS has increased by an average of 5.7 per cent. in real terms each year since the Government came to power. NHS expenditure is set to increase further by an average of 7.4 per cent. in real terms over each of the next five years. Such substantial investment in the NHS is not being wasted. It is producing real results, including significant increases in the number of health professionals, increases in capacity, prescribing of new and better drugs, shorter waiting times and greater choice for patients. There will be further improvements, including expanding capacity, increasing staff and training numbers, and reducing waiting times.
Although the waiting times figures do not relate specifically to allergy, it is worth mentioning that the vast majority of patients receive their first out-patient appointment within 21 weeks. In the quarter ending June 2003—the last for which we have data—82 per cent. were seen within 13 weeks and 99 per cent. within 26 weeks of referral by their GP. At the end of June, the number of patients waiting over 21 weeks for their first out-patient appointment with a consultant had fallen by more than 29,500 over the past year. That is real progress and it is making a difference to all patients, including those with allergies.
I should like to comment on the role of the Food Standards Agency. My hon. Friend mentioned the growing incidence of allergy and there is a question relating particularly to food. The FSA's approach to food allergy and intolerance has three main components. The first is to help those with food allergy by improving understanding of the issue among consumers, all sectors of the food industry, including
66WH
caterers, and local authority enforcement officers. The second is the funding of research to investigate the causes and mechanisms of food allergy, and the third is to encourage fully informative labelling of foods.
The board of the FSA recently agreed a detailed action plan to help food-allergic consumers. The work is concentrating particularly on teenagers and young adults and on the catering sector, as most food allergy deaths occur in that age group when eating away from the home environment. That could create a particular difficulty when selecting food and knowing what is in it.
The agency has put a detailed fact sheet about food allergy and food intolerance on its website to provide food-allergic consumers with information. It is also conducting research into other sources of information about food allergy for consumers, the food industry and enforcement officers, and into the knowledge and understanding of the issue in those sectors.
The agency will work with others to provide further information and training and education to address the gaps identified. It will also work with health professionals and dieticians to help to provide patients with food allergy such information as they need to make safe choices about the foods that they eat.
The FSA also funds research on food allergy and intolerance, with particular emphasis on severe allergies, how often they occur and what causes them. A large programme of research on food intolerance and allergy, costing about £1 million a year, is ongoing.
Part of that research programme is examining the impact of advice issued by the Government in 1998 that, where there is a family history of allergic disease, pregnant women and breast-feeding mothers should avoid consumption of peanuts during pregnancy and lactation. That advice arose from a report issued by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment in 1998, which addressed some of the issues behind the possible causation of peanut allergy. In July 2000, the committee issued a further report on adverse reactions to food and food ingredients.
The agency has been working with a wide range of interested parties in the UK and Europe to ensure that food labelling is informative to allow those with food allergy get the information that they need. A new EU directive on allergen labelling has just been agreed in Brussels. It will tighten up existing legislation and will help to ensure that consumers are provided with comprehensive ingredient information to allow those with food allergies to identify products that they must avoid.
The agency has also been addressing consumer concerns about the inappropriate use of "may contain nut" labelling—we have all seen it—which can severely restrict consumer choice. We will shortly seek comments on an alternative phrase for use in labelling.
My hon. Friend said that hon. Members often call for research into various conditions. It is worth saying that the research effort is not confined to the UK Government because there is also an international dimension. The main agency through which the Government support medical and clinical research is the Medical Research Council. The MRC is an independent body that receives its grant in aid from the Office of Science and Technology. The Department of Health

67WH
also funds research to support policy and the delivery of effective practice in the NHS. The MRC spent an estimated £11.9 million in 2001–02 on its respiratory disorders portfolio, which includes allergies.
A number of research studies into aspects of allergy are under way. The national research register, for instance, shows that there is a study under way on peanut allergy in children at Southampton general hospital; my hon. Friend mentioned Southampton. The study is called "The Prevalence of Peanut Allergy in British Children at School Entry Age" and it is funded by the Food Standards Agency. It is due to report in 2005.
"The International Study of Asthma and Allergies in Childhood" was established in 1991. Phase one measured the prevalence of childhood asthma, hay fever and atopic eczema for international comparisons. Phase two began in 1998 and involves more intensive studies in a smaller number of countries. The Department of Health funded the UK contribution to phase two.
We are currently working up a children's national service framework to set standards to improve health services for children. It would clearly be impractical for the NSF to cover every specific condition or problem in detail. However, in illustrating what the NSF standards will mean for children with asthma, the asthma exemplar, which will be published in tandem with the main NSF, is likely to make a general reference to allergy. Consideration will be given to the general issues relating to the problems encountered by allergic children in schools.
My hon. Friend raised the issue of the number of consultants. Consultant numbers in immunology, which includes allergy, have increased by 11 per cent. from 63 consultants in September 1997 to 70 in June 2003. There are, however, ongoing discussions between the British Society for Allergy and Clinical Immunology and the Department of Health, which are aimed at improving the provision of consultant allergists, and I recognise that that is a specific issue.
A small number of specific full-time or full-time equivalent posts are devoted to allergy. The British Society for Allergy and Clinical Immunology handbook
68WH
lists 86 NHS consultant-led clinics in the UK, and the British Allergy Foundation handbook lists an additional 15 clinics. However, only six of those 101 clinics offer services provided by a whole-time specialist allergist. I recognise the problem that my hon. Friend outlined and we are doing what we can to improve the situation. In June 2003, there were 10 consultants in allergy, an increase of four, or 66 per cent., on the September 2000 level. September 2000 was the earliest date at which specific numbers on allergy consultants were collected in the work force census, so I cannot give my hon. Friend a better figure than that.
From 2003–04, the trusts will have an opportunity to create up to five locally funded specialist registrar posts for training opportunities in allergy. Central funding will also be distributed to support the implementation of an additional registrar post in immunology. Trusts will have the opportunity to create up to five locally funded training opportunities. Work is going on to improve the spread and degree of specialism available, but I recognise that we have some way to go given the starting point and the level of need, which my hon. Friend rightly sketched out.
I am not the Minister in the Department who principally deals with allergy, although the Food Standards Agency obviously falls within my remit. I am sure that the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman) would be happy to meet members of the organisations which my hon. Friend the Member for Dagenham mentioned to discuss the provision of services.
In conclusion, I hope that my hon. Friend agrees that we must take the provision of allergy services and paediatric allergy services very seriously indeed. Our substantial extra investment in the NHS and the action on waiting times will lead to better allergy services for all NHS patients. The work of the Food Standards Agency will give us a greater understanding of the problems caused by food intolerance, and research is under way into the causes of allergy. We are starting from a low base and have some way to go, but the debate has been useful.
Question put and agreed to.
Adjourned accordingly at four minutes to Two o'clock.