Westminster Hall Sitting of 10 September 2003

Preamble
[MR. PETER ATKINSON in the Chair]

Accident and Emergency Provision
Motion made, and Question proposed, That the sitting be now adjourned.—[Charlotte Atkins.]
9.30 am
Dr. John Pugh: Mr. Deputy Speaker—
Mr. Peter Atkinson (in the Chair): Order. Before the hon. Gentleman begins his remarks, may I say that I am not a Deputy Speaker. I am simply the Chairman or Mr. Atkinson.
Dr. Pugh: Thank you, Mr. Atkinson. I apologise. I now see the name on the Table.
I have two cases to plead before the Minister—a specific case and a general theme. I am sure that other Members will want to describe their own parallel experiences and add their analysis to the debate. My objectives are quite specific, but I hope that the debate will range more widely than my speech does.
We all accept that accident and emergency departments, which we used to call casualty departments, are probably the most unpredictable and varied sector of modern medicine. They must be ready to field almost anything. They must deal with all ages, all ailments and all sorts of complaint, physical and mental, from the extraordinarily severe and life-threatening to the trivial and, at times, irritating. The key element of any accident and emergency department is that the patients go to it mainly because they require immediate attention and assurance. That is why the Government have stressed the importance of gauging waiting times in different facilities, and have set targets for them in their assessment of accident and emergency provision.
Although our attention is focused on targets, success must be measured to some degree by waiting times and other factors, such as a low rate of re-admission. We must assess the effectiveness of accident and emergency departments in some way. However, the unpredictability of accident and emergency—the fact that anything can happen—has led to several calls in the health service for increased training of staff, and for centralisation and the closure of small units that may be less competent at dealing with the full range of cases thrown at them.
Smaller units lack the full complement of specialists waiting in the wings, should something go amiss or happen out of the ordinary. However, centralisation comes with a price. Patients may have a longer journey, and may experience a delay in finding the reassurance that their problem is not out of control, or that it may not be as severe as they first thought. Centralisation increases social exclusion because more remote facilities mean longer transport journeys and more dependence on public transport, which may not be available. Not everyone has a fast and reliable car.
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Statistics show that 75 per cent. to 80 per cent. of the through-put of A and E is standard, unsurprising medicine that is usually fielded well in any A and E department. Only about 1 per cent. of cases daily are extreme and life-threatening. However, physicians know that things can always go wrong, and I am sure that they would sooner treat patients wherever possible in omnicompetent, large A and E departments and accept the minimum risk, should things go wrong. In this age of medical litigation, one can understand their perspective. However, the vast majority of A and E clients have no need of such an omnicompetent A and E department and generally would rather have a more local facility.
There is a tension that the Government well recognise. That was evident in their recent document "Keeping the NHS Local: A New Direction of Travel", which says several important and encouraging things, such as:
"The mindset that 'biggest is best' … needs to change."
It advocates a "closer to home" model, and discusses evidence that "small can work." It talks of helping local communities to "broaden their options," and it focuses on redesign rather than closure of facilities and relocation. Importantly, it speaks of implementing changes
"with people, not for them,"
and mentions "clinical networks" and "telemedicine links." It also discusses using imagination, thinking differently and involving the community.
I am sure that many people, particularly those with small local hospitals, found the document in many ways to be encouraging, thought-provoking and excellent. It gave comfort to many people who may have feared the total erosion of local services and the total domination of doctors' concerns.
I hate to use the words "producer interests". That is not my language for talking about public services, but I make the point that although doctors have the interests of patients in mind, they are also fully conversant with their own interests. For example, consultants would probably generally prefer that their patients travelled rather than they did because, by and large, they are busy people.
Other factors work against that document and the spirit of it. The agreement on junior doctors' hours constrains what hospitals and accident and emergency departments can do. When the working time directive kicks in, it will affect different specialisms differently. I understand that paediatrics will be affected less because a large number of paediatric specialists are female and have families to attend to, so they are currently unlikely to be working over the hours limit. The training standards and concepts of the royal colleges, which are raised all the time and justifiably so, also work against the document.
There is mixed evidence of differential clinical outcomes between smaller and larger units. Another pressure, to which it may be unkind to allude, is that NHS executives and others running NHS hospitals may gain more prestige from running larger units than a plethora of smaller ones. There is a balance to be struck, which the Minister and the Department of Health recognise. When that balance is wrong, the consequences are quite dramatic. There are scores of case histories to demonstrate that.

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On 17 August, 3,000 of my constituents marched to the local hospital to present a local petition against changes in accident and emergency provision and other changes, which was signed by nearly 14,000 people. In my constituency, the community is at loggerheads with its major health provider. The local council's overview and scrutiny health committee is currently constructing a report in reaction to that, which I expect will soon be with the Minister. I do not think that it will be entirely comfortable reading for the hospital authorities, but it will provide a good deal of evidence, which the Minister might well like to consider.
In my constituency, there have been angry public meetings and scores of stories in the local papers, including poignant human stories about real people who have suffered real trauma precisely because of the confusion surrounding the way in which accident and emergency cases have been dealt with.
I will expand on the problem. We are now implementing the 1999 Shields report on reconfiguring local hospitals. In effect, it recommended a division of spoils between two hospitals, Southport hospital and Ormskirk hospital, which had been merged into one trust by the previous Government. The report concluded that maternity services, children's services and children's accident and emergency should be situated in the neighbouring town of Ormskirk, outside and away from my constituency, Southport. The traffic was not one-way. A number of facilities that were previously in Ormskirk were to come to Southport, including eventually, though not yet, accident and emergency services for adults. So the proposal was that adults go down one road to hospital, and children go in the reverse direction.
The one issue that has lit up public interest and incensed people most is children's A and E. In 1999, when the first proposal was made, I led the opposition to the changes. I am completely unrepentant about that. I said at the time that the myth of the ever-mobile patient and the static doctor was embodied in the proposals. I want to put on record that I am still opposed to the proposals, root and branch. In 1999, protest about the issue was mild, compared with the present situation. There are three reasons for that.
First, the original report recommended that Southport retain some in-patient paediatric provision. That was in the original report submitted by Professor Shields, but was removed by the then Minister of State, the right hon. Member for Southampton, Itchen (Mr. Denham). Secondly, the original report recommended that Southport A and E staff should have paediatric training. I am not sure that that has been implemented. Thirdly, there was a fatal ambiguity in the report as to what would happen to patients under the age of 16 who were self-referred, or referred by their parents, to Southport, as opposed to being taken by ambulance. There was much debate in 1999 about blue light ambulances rushing down the road from Southport to Ormskirk. That was contentious in itself, but there was an underlying supposition that if a parent turned up with their child at an accident and emergency department in Southport, the child would be treated.
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I think that everybody recognised at the time that there would be problems. Southport and Ormskirk, for those who do not know, are linked by a winding and largely agricultural road, which is often blocked and suffers influxes of traffic at certain times because Southport is a holiday resort. A prime example would be last weekend, when there was an air show on Saturday and Sunday and it was simply impossible to move at any speed along the road. The case that I am making is not my own; it was embodied in the original Shields report. Shields explicitly recognised that in any reconfiguration of services, the road was an issue. I see that the hon. Member for West Lancashire (Mr. Pickthall) is in his place. He and I have worked hard to advance progress on the road and I would welcome anything the Minister might do.
Last time I initiated a debate on the subject, in December 2001, the then Under-Secretary of State, Department of Health, the hon. Member for Salford (Ms Blears) said:
"The hon. Gentleman's constituency has two good local hospitals but pretty poor road links. I understand that the proposal to upgrade the A570 is in fact the number two priority on Lancashire county council's transport plan, and I hope that even if it is not the top priority, being second will mean some action fairly soon."—[Official Report, Westminster Hall, 4 December 2001; Vol. 376, c. 66WH.]
The action that the hon. Member for West Lancashire and I wish for is that, when the Lancashire transport plan is reviewed by another Department, there will be a wide acceptance that health should be a contributory issue in the progress of the development of that road.
I initiated a debate on the road link in 2001, and the Minister was reasonably bullish about what may be achieved to mitigate the problems. However, the problems have been compounded by insensitive implementation. That is the accusation that I am making—perhaps it should be called an allegation Perhaps the hospital authority would want to say something about it. I think that it would be widely agreed among informed people that the hospital has not done very well at implementing or defending the proposal on accident and emergency.
When the Minister receives the scrutiny and review report he will see evidence of very poor integration. By that I mean that there is little evidence that the ambulance service has been properly and thoroughly consulted and that the demands on it have been weighed, given that some people who previously would not have moved between hospitals will now be moved. There is some concern about the sudden increase in cases—particularly surgical cases—being received from Ormskirk at the neighbouring children's hospital, Alder Hey, often after being sent from Southport to Ormskirk. Many of my constituents have spoken of being turned away at Southport and sent to Ormskirk, and then being sent on to Alder Hey, because Ormskirk could not field the complaint. It is not only Southport residents who complain—rightly—about that. It would appear that Alder Hey is not delighted, either.
There has been no progress on the linkage between the hospitals, which was mentioned in response to my previous debate by the then Under-Secretary of State, Department of Health, the hon. Member for Salford. She talked about the development of telemedicine and the use of imagination. I have not seen a massive

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amount of telemedicine, and have found little in the way of imagination. We are dealing in this context, and perhaps in others, with a fundamentally confused set of protocols. In the present instance they relate to children's accident and emergency services, but I should not be surprised to find similar confusion in evidence elsewhere.
For the benefit of hon. Members who do not know about this, Southport district general hospital serves a community of well over 100,000 people. It is not a small cottage hospital. It is modern, highly equipped and purpose-built, and it has an A and E department, yet it offers nothing to parents and children. In fact, it has a sign repelling them. Worried, anxious parents with their children must, no matter what the complaint—unless it is so severe that the child must be stabilised in some way—leave their town, where there is a district general hospital and an accident and emergency department, and go to a currently unbuilt and partly understaffed facility in another town. I understand that elsewhere there are even longer journeys to get to A and E, but in some respects what I have outlined takes some beating.
I have asked the Minister whether he could think of parallel instances in other areas in which a fully-equipped A and E department includes no facility for children. I am not sure whether I asked the Minister who is present today, but I certainly asked the Department of Health to give me statistics about that, and I was told that they were not collected centrally, so I sent a researcher to spend a great deal of time phoning a range of hospitals. I found extremely few parallels—perhaps one or two. Many A and E departments had no paediatric unit, but none the less admitted children and dealt with children's complaints.
Chris Grayling: The hon. Gentleman is raising some interesting points. In my constituency it was proposed three years ago to close the paediatric facilities at Epsom hospital, which would have led to the absurd situation of a parent who had been in a car crash with their child arriving at the A and E department and being admitted and kept in overnight, while the child could not be admitted. That was defeated by the weight of medical and public opinion—medical opinion in particular—so I suggest that the hon. Gentleman should involve local doctors in his campaign. I suspect that they may think that the state of affairs is very unsafe.
Dr. Pugh: The hon. Gentleman's intervention was extraordinarily helpful, but I can cap that story. In my neck of the woods, if a parent and child are in an accident halfway between Southport and Ormskirk, the child, in distress, will be taken to the accident and emergency department in Ormskirk, and the parent, because there will be no A and E, ultimately, in Ormskirk, will be taken to the one in Southport. That is the kind of incident that was cited in the debate on the Shields report, and I thought that it was bad enough, but things have evolved. The situation is, if anything, worse.
To answer the hon. Gentleman's point about medical opinion, having canvassed the GPs in the area, I found them divided on the changes, with the balance against. While it has not always been easy to assess medical opinion inside the hospital, I have not necessarily found every medical expert, including the royal colleges,
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agreeing with my side of the argument as unequivocally as I would wish. I think that they are wrong, but as I am not a medical practitioner, it is difficult for me to say why they are wrong.
I want hon. Members to imagine how it feels for an ordinary person, with a traumatised child, experiencing a major problem, to drive—it might not have been necessary to summon an ambulance—past a purpose-built A and E unit and on to another town. I also ask hon. Members to empathise with the situation that could occur in west Lancashire, where adults might find themselves in similar circumstances. In that area, there is at least the redeeming possibility of a minor injuries department. In Southport, there is nothing.
The system is not what was originally consulted on, it is not humane and it is not intelligible. It has hardly a defender in the town. The Minister might consider that I have already rehearsed the arguments presented by the royal colleges. However, even the royal colleges cannot defend the unintelligible, and the protocols at Southport A and E are unintelligible.
The situation is as follows, and I defy hon. Members to explain it clearly. The hospital authorities say that no child will be turned away—they are not as cruel as that—but that children who turn up will be triaged and only critical cases will be taken in, treated and stabilised. However, when they are asked why ailments that are standard but worrying for parents cannot be treated, they state that that is not within the competence of ordinary A and E staff, as such staff cannot adequately differentiate between minor, serious and critical cases and those that have to be dealt with immediately. That is a slur on ordinary A and E staff. They are said to know and not to know the difference between critical and non-critical childhood cases.
Although there are doctors present, the Minister, like me, is not a medical doctor. However, I know from his background that he will have more than a passing regard for logic, and the position adopted by Southport and Ormskirk NHS trust is incapable of clear expression. I refuse to accept the unintelligible, and I ask the Minister, who knows about seaside towns as well as logic, to think about the circumstances of families in Southport and of visitors to the town who, reporting to the local A and E department with their children because, for example, they have cut themselves on the beach, are told: "Hop it. Get over to Ormskirk."
Having been through such things before, I do not expect the Minister to wave a magic wand today. Nor do I expect him to rush into any sudden commitment. What I want is for the Minister to listen—not to me, as he has done that for long enough, but to my constituents, who are sensible, ordinary, non-political people, and to other hon. Members, whose constituents' case histories might parallel those of mine—and to help us to get the balance right.
We in Southport cannot sustain a situation in which a progressive health agenda is hijacked by a guerrilla war between the community and its hospital. There are better things for people to do than to row with their local hospital, and better things that can exist than a dispute between hospital doctors and their patients. There are signs that the local PCT and the local strategic health authority recognise that, and there are also signs that

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imagination may be stirring. All I ask the Minister to do is look, take counsel, review and, where possible, reverse those changes.
Broaching a general theme—I did say that I would talk about general issues as well as the specific issue—I conclude by drawing on a matter that has dogged the debate over my constituency, which is the position of the royal colleges. The Royal College of Paediatrics and Child Health and the Royal College of Physicians will often go so far as to specify an ideal set of requirements from the medical point of view. I am sure if one were to ask about children's accident and emergency, the Royal College of Paediatrics and Child Health would say that it would sooner have a system where every accident and emergency facility had 24-hour paediatric consultants on site, rather than on call.
Those are all ideal standards and they are subject to an important clause—all things being equal. Things are rarely equal and guidance is rarely absolute. The point to be borne in mind is that the royal colleges are not representative of medical concern in total, but they do have an eye on issues that the public do not have in their frame, such as medical litigation and the regulation of their profession. Although they are important bodies to consult, they are not necessarily disinterested and they are not always comfortable with every forward change. I do not want to lapse into any unfortunate talk about producer interest, which my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) and I agree is a completely improper way to discuss public services. The ball falls in the Government's court when striking a balance, and not in the court of the medical authorities.
I applaud the Government's increase in the number of trained paediatric staff and paediatric nurses, their encouragement of flexibility with regard to nurse practitioners, their encouragement of enhanced status for accident and emergency staff, and their preaching of the doctrine of clinical networks. They can have that for free—it is a wholly good move in the right direction. If we are to get the balance of accident and emergency right, all views, including those of the public, must be weighed seriously in the balance. Doctor does know best when it comes to ailments, but the best doctors—I hope that this applies to the Minister—are the best listeners.
Several hon. Members rose—
Mr. Peter Atkinson (in the Chair): Order. Front Benchers' contributions start at half-past 10, and three hon. Members wish to speak before that. With a simple mathematical division, that means about 10 minutes each.
9.57 am
Mr. Colin Pickthall: I will try very hard to keep to that. I want to use the case that was raised by the hon. Member for Southport (Dr. Pugh) to illustrate the problems of running smaller hospitals and of reconfiguring, or rationalising—whatever the appropriate euphemism is for what goes on. I thank the hon. Gentleman for opening the debate and for the rational and sensible way in which he has presented his case.
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The hon. Gentleman and I share a hospital trust. The hospitals—they were formerly separate—are on two sites six miles apart, with one in Ormskirk in west Lancashire and one in Southport. The trust operates with two different strategic health authorities, two different primary care trusts and two different ambulance trusts, because its two halves are in Lancashire and Sefton. Putting west Lancashire and Southport together, we find that Ormskirk is around about the centre of that catchment area. Skelmersdale and Upholland are on the eastern edge of the area, next to Wigan. That is the most densely populated part of the whole area—about 50,000 people live there.
It is important for the Minister to bear in mind the fact that the main road, the A570, also links Skelmersdale to Southport, so anyone travelling from Skelmersdale to Southport for adult A and E must pass through the middle of Ormskirk, which is one of the worst traffic bottlenecks in the north-west. Debate about an Ormskirk bypass began in the 1930s, but it seems that we are still no closer to getting one.
The hon. Member for Southport and I inherited a long-standing problem that has created enormous public concern ever since the debate began about the amalgamation of the former Ormskirk, Formby and Southport hospitals. The debate began seriously in about 1993. I came into Parliament in 1992 and have spent part of my time during the whole of that period wrestling with the agonies of a hospital in difficulties. Public concern grew enormously at the time of the Shields review in 1998 and 1999, to which the hon. Gentleman referred.
For years, there were outraged discussions about hot and cold sites, and a tendency for the proponents of each site to attack those of the other one, which I am pleased that politicians tried to prevent most of the time, with some success. There were threats that patients would leak out of the district to other areas such as Liverpool or Greater Manchester if the amalgamation went ahead. In fact, many GPs in west Lancashire campaigned actively and said that they would send their patients not to the newly amalgamated hospital but eastwards to Greater Manchester.
After all that, Sir Robert Shields put together a report that was endorsed by the then Minister, my right hon. Friend the Member for Southampton, Itchen (Mr. Denham), and approved by the then Secretary of State, my right hon. Friend the Member for Darlington (Mr. Milburn). The report was endorsed—uneasily, perhaps—by the communities concerned and by their political representatives: the predecessor of the hon. Member for Southport, my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas), local councils, community health councils and me. In outline, the compromise placed all children's services in a brand new centre in Ormskirk hospital.
Dr. Pugh: The hon. Gentleman mentioned the councils. I believe that the record shows that Sefton council opposed the changes—collectively, on a range of issues but, specifically, on transport links. It asked to meet the then Minister but was not granted an audience. Sefton council was opposed to the proposed changes at the time.
Mr. Pickthall: I am sure that that is true, and it is true also of West Lancashire district council, which did not want the changes and fought vigorously against them for a long period. However, the Shields report put together what seemed to most people a compromise that gave something to each side by not benefiting one site entirely at the expense of the other and by trying to work with the grain. However, I understand the hon. Gentleman's comments.
The compromise, which placed all children's services in a brand new building on the Ormskirk site, recognised that the vast majority of children in the overall area were in the traditional catchment area of Ormskirk hospital, particularly Skelmersdale. The services include children's A and E. On the other hand, adult acute services—surgery and, coming shortly, acute medicine and adult A and E—were to go to Southport. Despite all the flaws that the hon. Gentleman has analysed, we could, with difficulty, accept the compromise. I speak for West Lancashire.
There were other reconfigurations in the amalgamation, but the A and E, the children's services and the adult's services going to different sites were the main ones, and those that have caused all the dismay in my constituency as well as in the hon. Gentleman's, especially among people in Skelmersdale and Upholland, who have to travel through the middle of Ormskirk to get to the hospital in Southport, unless they take an enormously circuitous route.
Thanks to huge efforts by the national health service in the area and local politicians to explain reasons and problems, public understanding has been largely secured, if not public support. That was helped at my end—the Ormskirk end—by the primary care trust and the trust agreeing, originally at my suggestion, to build a minor injuries unit in Skelmersdale, where the main concerns were. As I understand it, a parallel minor injuries unit project is mooted for Southport, to meet at least some of the concerns expressed. That is only in the discussion stage, but in my view is a likelihood. The driving force behind all the change was the concern of the Department of Health and the royal colleges that each hospital was too small to guarantee a satisfactory or even safe service. As has been explained, that was compounded by problems with junior doctors' hours and the working time directive.
Shields's brief was to take all those problems into account. In all the public debate that ensued, the Lancashire ambulance trust—I cannot speak for the Mersey Regional ambulance trust because I do not know about that—was reassuring. It attended all the meetings and reiterated that it could manage the new situation. As I understand it, there have as yet been no problems getting people to and from Southport and Ormskirk. The situation now is that blue lamp and acute medicine services are, as we speak, being concentrated in Southport and maternity and paediatrics in Ormskirk, where they will shortly be housed in a brand new state-of-the-art building; it is not far from completion. That has cost many millions of pounds, for which I thank the Government, and I hope that the Minister will find time to visit it when it opens.
Recently, a group has arisen in Southport that has woken up to the fact that those changes, which have been staring us in the face for four years and with which the hon. Member for Southport, I and many others have
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been grappling, have taken place. So politically astute is that group that it wrote to me and to many others in Ormskirk asking us to support the removal of children's services from the hospital in Ormskirk, a very unlikely request.
I can say something that the hon. Gentleman perhaps cannot easily say. The removal of children's services from Ormskirk, to be placed in Southport, which the group proposes, is daft and will not happen. Part of the group—I believe that it has a provisional wing—opposes the proposal to put a Southport minor injuries unit in place. If ever there were a place that would suit such a unit, although I suggest this humbly because it is not my patch, a seaside resort with millions of visitors would seem to be it.
In my remaining two minutes, I shall raise a couple of general issues that arise from the problem.
Dr. Pugh: I would hate the hon. Gentleman to blight the thousands of people who have campaigned against some of the changes in Southport. I am a member of the group that has written to him, but I was unaware that the letter had been sent to him.
Mr. Pickthall: Indeed it was, some time ago. I was very interested by it. My constituency is undergoing a rationalisation of its hospitals. At the same time, it is undergoing a review of its schools to remove surplus places, which will result in the closure of several primary schools. It is hard to judge which of those arouses most concern and, I must say, most local hysteria—there is some of that. There is a tendency to extrapolate. It is well known in Ormskirk that the Government intend to turn Ormskirk hospital into a BUPA hospital and flog it off. It is wonderful where these ideas come from. It is important that all involved in the process speak rationally, and explain and listen carefully, without jumping on some of the local bandwagons.
Hospitals and emergency provisions are changing. Specialisms are becoming more special and vastly more expensive. Many expertises are in short supply. Some reconfiguration is inevitable, therefore, and must be managed with enormous care and some give and take. Areas such as mine, which is bordered on three sides by major metropolitan areas with huge hospitals, some of which are only 20 minutes away, cannot easily sustain small, local general hospitals. Compared with many areas in the country, journeys of six to 10 miles amount to virtually instant access. People think nothing of travelling six miles across London to a particular hospital. People in your constituency, Mr. Atkinson, may well think that a hospital six miles away is fairly convenient.
To secure a comprehensive and modern maternity, paediatrics and children's accident and emergency department such as the one being built in Ormskirk is substantial compensation for additional journey time. Paramedics in ambulances play a pivotal role. They make the crucial initial stabilisation and decisions about where to go for the best possible treatment. One ambulance officer told us in a public meeting that people in an ambulance are far better off being taken to the right place than being taken to the wrong place and having to be bounced off to somewhere else.

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The development of telecommunication—in our case, there are already links with Alder Hey—and of NHS Direct provide new alternatives for children as well as adults, dealing with serious and light problems. The minor injuries units will offer further alternatives.
The matter is important and affects many other constituencies and areas in the country, but few have the complication of being in two different authorities for almost all purposes. It is a difficulty, but the compromise reached by Sir Robert Shields seemed the best that could be arrived at in community and social terms at that time.
10.12 am
Dr. Richard Taylor: I congratulate the hon. Member for Southport (Dr. Pugh) on securing this crucial debate, which is near to my heart. I will relieve the Minister of any worries: I will not speak too much about local affairs—I will say just a little.
I absolutely agree that the ball is in the Government's court. Like the hon. Member for Southport, I welcome the Government's commitment to real consultation. That is expressed time and again in "Keeping the NHS Local". The establishment of overview and scrutiny committees and the reconfiguration panel are welcome. It is interesting that the first time that the reconfiguration panel was used, in Kent, it came down on the side of patients and citizens. The hon. Members involved must be awfully careful not to be seen to be defending their own patches, because that is exactly the sort of divide-and-rule technique that has been used in our part of the world.
Conventional consultation, as the Government have spotted, completely misses the point. There was a useful article in the Health Service Journal just last week referring to the current consultation on Barnet and Chase Farm hospitals. The hospitals are only five miles apart, yet the pressure has been taken out of the process by guarantees that both accident and emergency departments will remain. There is a crucial sentence in the article—at long last, somebody is realising that access means entirely different things to patients and to health service managers:
"To a manager, 'access' means waiting times, but to an elderly person without a car, it means bus and train services to the hospital."
To the elderly, access is purely and simply about distance and time, and the ease of getting there.
It has been hinted that we are approaching a collision. We have the needs and desires of patients and citizens on one side, and the clinical professions saying what is safe and possible on the other—and the Government are right in the middle. The citizens' wish is to travel for elective surgery, for which they can plan; they do not mind going to the best place for the operation because they can plan for it. However, they want bread-and-butter emergency treatment to be available near to them.
I shall refer briefly to Kidderminster in order to demonstrate to the Minister something that I suspect he already knows—if one takes three virtually equal accident and emergency departments, each with between 43,000 and 45,000 patients per year, and shuts
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one, the other two will be overloaded. That is particularly so if the one that is shut is left with a minor injuries unit but without a doctor, because it will not be able to treat anyone who may need admission. It will lead to queues in A and E departments and to demoralised staff. That was clearly demonstrated by the ambulance service's mileage: one month before the hospital was downgraded, it was 8,000 miles, but 12 months later it was more than 24,000 miles—a step of three times. The medical assessment units put in to take the load off A and E departments do not altogether work if the remaining hospitals are stretched. Only this week—it is referred to in today's papers—local medical assessment units have had to close.
There is a big myth about telemedicine. If a patient who lives in the wilds of Manitoba cannot be moved, telemedicine can be set up to a major hospital, which can take a surgeon through an operation he has not done before. However, experience of telemedicine here is that the machinery is often down and that the people at the far end are often too busy to respond. In my constituency, telemedicine is used less and less.
Turning to the clinical profession, I agree with the hon. Member for Southport that, by and large, doctors like the slightly easier life of working in a big unit. However, although it is much easier to provide a safe service in such big units, there has to be some compromise. I believe that the Government are working hard on the problem. Indeed, I am sure that the Minister takes a copy of "Keeping the NHS Local" to bed every night, because it is so important. It shows that the Government are thinking really hard about the alternatives.
For instance, the European working time directive will make it difficult to maintain many A and E departments. The Government are trialling four solutions in different parts of the country, all of which will retain a certain amount of local emergency work. I am waiting to see the details of the local emergency centre planned for Canterbury and to discover exactly how effective that will be.
The European working time directive is a time bomb waiting to explode. I would like for a few moments to impress the extent of the problem upon hon. Members. Of hospitals that serve fewer than 150,000 people, several have A and E departments. They include those in Bassetlaw, Grantham, Banbury, Weston-super-Mare, Halton general hospital in Runcorn and, I am afraid to say, Mr. Atkinson, the hospital in Hexham. As for hospitals with fewer than 150 beds, according to my sources, 36 apparently have A and E departments, including the Montagu hospital in Yorkshire and hospitals in Llandudno, Bridlington, Newark, Clacton and Louth. I could continue. There is a threat not only to services at those hospitals, but to services at some large units that are close together, which face problems because of the European working time directive. Shrewsbury and Telford are close together, as the hon. Member for Shrewsbury and Atcham (Mr. Marsden) knows, and we have heard about Ormskirk and Southport, but Falkirk and Stirling, Wakefield and Pontefract, Cheltenham and Gloucester, and Watford and Hemel Hempstead are also threatened. There is a time bomb waiting to explode.

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The Government's job is to provide what patients need and desire and to make it possible for clinical staff to deliver a safe service in those circumstances. Compromises are necessary, but local people need bread-and-butter, local emergency services.
10.20 am
Mr. Peter Luff: I congratulate the hon. Member for Southport (Dr. Pugh) on securing this debate and on his substantial contribution to it. I am grateful to the hon. Member for Wyre Forest (Dr. Taylor) whose comments enable me to curtail my comments because, inevitably, he and I have a similar perception of the issues he raised. I am sorry that he had to curtail his comments to enable me to speak, because his expertise provided a useful contribution. I echo what he said about consultation and keeping the NHS local.
We recently had an unsatisfactory consultation exercise in south Worcestershire, which led to the downgrading of the minor injuries unit at Evesham community hospital. Thanks to a corrected parliamentary answer, something I had not received before, I understand that that consultation was probably illegal, having been conducted during a local government election. I am grateful to the Department for correcting its earlier answer.
I want to make two basic points. Accident and emergency departments are often misused by us, the patients, and over-centralised, as the hon. Members for West Lancashire (Mr. Pickthall) and for Southport said, but they are often put under excess pressure for other reasons. I am making no criticism of local accident and emergency staff. My son was treated at the Worcestershire Royal hospital only a few months ago for a suspected broken back, and the quality of treatment he received was remarkable. That was a genuine emergency to which the hospital and the accident and emergency service responded magnificently. I am glad to say that he sustained only severe bruising, but he had to walk many hundreds of yards with a severely bruised back to the car park, because there is totally inadequate car parking provision at the hospital—but that is another matter.
I broke my finger some weeks ago when boarding a fishing vessel as part of the armed forces parliamentary scheme. On reflection, I should have gone to the accident and emergency department of Worcestershire Royal hospital, but I did not. The fracture set badly and I cannot get my wedding ring off, which I am sure my wife is pleased about. The psychology is interesting. I was not prepared to go and wait six or eight hours, which is common in accident and emergency departments for routine injuries such as a broken finger. I should have practised what I preach and gone to the minor injuries unit at Evesham community hospital, but I did not think to do so. I regret that mistake, because of the problem I now have with my finger—particularly as I am left-handed—which has lost some of its strength and, more significantly, because minor injuries units have a huge role to play is removing an unnecessary work load from accident and emergency departments.
The tragedy is that the minor injuries unit at Evesham community hospital, as a result of the botched consultation by the primary care trust, has been downgraded and has lost a staff member. That has
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serious consequences. The former matron wrote to the primary care trust to object to the proposal, but it has been implemented. The primary care trust argued that not enough people used it—I freely admit that it is not used enough—and that it could not justify two permanent members of staff. I suggest that the correct solution was to promote the unit more effectively to take pressure off the accident and emergency department at Worcestershire Royal hospital and probably even the Alexandra hospital at Redditch. However, that was not done and the unit was downgraded, which I fear is the first stage of its total abolition. Minor injuries units have a huge role to play in supporting accident and emergency departments. It is a tragedy that that is happening in Worcestershire, and I suspect that the pattern is being repeated elsewhere in the country.
The hon. Member for Wyre Forest also referred to medical assessment units and their important role. The unit at the Worcestershire Royal hospital is a great success and we all welcome it, but sadly it has closed twice during the summer—once in August and once on Monday this week. South Worcestershire primary care trust sent out a fax on Monday 8 September, which was sent to me by a local GP, stating that the hospital was
"requesting four hours of respite for their Medical Assessment Unit."
It is respite care for the health service. The fax concluded:
"Patients requiring urgent medical attention should continue to be sent to the accident and emergency department where they will be tended to as normal."
I have, of course, talked to local GPs, who say that their response was to send more people to the accident and emergency department. The problem was not solved; it was transferred. I do not know whether that has been repeated elsewhere in the country, but the pressures on the medical assessment unit are clearly unacceptable because it has had to close twice during the summer and early autumn, when there are no epidemics, emergencies or crashes on the motorway. There have been no systemic problems, but it has had to close down twice—once for two hours and once for four hours. What will be the impact on the accident and emergency department if we get a flu epidemic in a bad winter?
To his great credit, the former Secretary of State for Health acknowledged that the Worcestershire health economy lacks capacity—a point made by the hon. Member for Wyre Forest. Problems are inevitably created when an accident and emergency department is closed. The capacity problem is made worse by Government targets, which distort local decision making. For example, we would not have downgraded the minor injuries unit at Evesham; we would have upgraded it and promoted it better. However, the primary care trust must meet specific targets laid down by the Government, so it had no choice—I feel sorry for it.
It is a question not only of Government policy and capacity but of ensuring that the accident and emergency departments are used properly. Many of our constituents are confused by titles such as minor injuries unit, accident and emergency and casualty—a word that they still know very well. What are those titles all about? We must work towards a better definition of the use of accident and emergency departments.

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When I made a similar speech commenting on the lack of capacity in the local health economy, the hon. Member for Worcester (Mr. Foster) said that it was outrageous, because I would deter parents from taking children with temperatures to their local accident and emergency department. I replied that children with temperatures should not be taken first to accident and emergency. Yes, they might have meningitis, of which their temperature might be a worrying symptom, but they should start elsewhere in the system.
Parents should probably start with their pharmacist—a much under-used resource. Pharmacists could take pressure off accident and emergency departments. They should talk to their GP. They should talk to NHS Direct, which the hon. Member for West Lancashire referred to. I have my reservations about that organisation, but it is there. It would be better to discuss the case of a child with a temperature over the phone rather than rushing to an accident and emergency department, which denies other people with more threatening conditions access to treatment. GPs have out-of-hours centres, which are better places than accident and emergency to take that kind of ailment. There are also minor injuries units and medical assessment units.
Accident and emergency departments are often confronted with problems that are not medical. Such problems are the concern of the local education authority, the social services department or even the police. We must educate people to use accident and emergency departments better.
We are suffering in our county from a genuine double whammy. There is a systemic problem of people misunderstanding how to access the health service appropriately, which clogs up accident and emergency departments in Redditch and Worcester. Worryingly, ambulances have been queueing outside our accident and emergency department, where six to eight-hour waits are not infrequent. The fine staff in the health service generally, and certainly in our county, deserve better from both the Government and patients.
Worcestershire Acute Hospitals NHS trust has a fine new chief executive, who has a strong team of clinicians beneath him—some might say above him. Both the state and the citizen have a role to play in ensuring that all accident and emergency departments are used properly and serve the people effectively, and that is certainly the case in our county. I hope that the Minister will find ways to address the serious capacity problem in our county. As we approach the winter, I am fearful of what I will see in our local accident and emergency departments.
10.29 am
Dr. Evan Harris: I thank my hon. Friend the Member for Southport (Dr. Pugh) for allowing us an opportunity to debate accident and emergency provision. I applaud the expert way in which he has led the campaign locally, and the rational and effective way in which he has put his case today. He raised some serious questions for the Minister to answer, not least about the logic of the proposed arrangements. Since it was a Minister who altered the
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Shields report, the Government must take responsibility under current arrangements for the decisions that have been made, and be accountable for those decisions to local people and to the numbers of visitors to A and E departments in tourist destinations such as Southport.
We had a helpful contribution along the same lines from the hon. Member for West Lancashire (Mr, Pickthall), and a characteristic contribution, in its expertise and research, from the hon. Member for Wyre Forest (Dr. Taylor), who drew attention to the implications of some matters that I shall turn to later, including the working time directive. The hon. Member for Mid-Worcestershire (Mr. Luff) made some important points about the appropriate use of A and E services, which I shall also touch on.
The Government have raised expectations of having accessible A and E departments. They have focused on A and E services under the term "modernisation", which is sometimes a euphemism for interference, although not always. They have also raised expectations by calling a document "Keeping the NHS Local". Many hon. Members have already referred to the sentiments expressed in that reconfiguration document. It leads people to believe that they will be able to access their NHS locally, without some of the problems that we have heard reported in this debate. Again, it will be up to Ministers to defend the standard of service about which they seek to raise expectations when they title documents in such a way. The Government have an alternative: they could call a document "Look, we have a problem here", with regard to the number of doctors per head of population, the European working time directive and the pressure from the Royal Colleges, rightly or wrongly, over critical mass and training. However, they have chosen to stick with the language, "Keeping the NHS Local", and they will need to defend that.
The biggest threat to patient care and to the lives of patients in emergency situations is not the particular configuration of A and E departments, although that is postulated as a factor, but the capacity of our hospitals and, for the sickest patients, the continuing shortage, relative to need, of intensive treatment unit beds. When we heard of the tragic case of the child being ferried around in an ambulance between various hospitals in the north of England a few years ago, the key point was the shortage of ITU beds, not the configuration of A and E departments. Far too much can be made of whether there is adequate back-up of consultant staffing. For the sickest patients, we need to ensure that we have adequate numbers of ITU beds and adequate escorted transfer arrangements.
My hon. Friend the Member for Southport quite rightly said that there were general issues to consider. Those include the impact of the European working time directive and the need to ensure adequate training for junior doctors in all hospitals, not just smaller units. Sometimes their training is worse in larger units because they are there simply for service purposes. Another issue is the changing gender ratios in the medical profession, which will mean that, overall, doctors who have been considered full-time will be spending some time working less than full-time. There are questions over whether there could be too much status attached to working in large units and not enough research opportunities in partnership for those in smaller units.

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I shall spend most of my time today questioning the Government on their approach on targets. The Minister will have heard before my concerns, which I have been raising for six years now, over the way in which they have imposed targets on the health service that work against the best interests of patients and of the service. It would appear that only when the targets are going in the right direction is it in the interests of Ministers.
The Government have imposed targets on A and E departments. The 12-hour maximum wait, which is curiously defined as being on a trolley, and the four-hour target for processing people through the department both use the wrong measures. Even if those measures are not applied as brutally as the Government suggest, with their, "You are a failing hospital; you are a failing manager; you are failing your staff if you do not meet those targets", there is no doubt that they are applied and measured wrongly. That concentration has damaged patient care and distorted clinical priorities. The 12-hour target is not a target from presentation at A and E to finding a bed but between a decision to admit and being denoted to be in a bed; and a decision to admit can be taken many hours after patients arrive at the department, even if they obviously require admission.
When is a bed a bed? That depends on whether the target is about to be breached. The morphological changes that one sees at the 11-hour stage is either the stuff of science fiction or the manipulation of the measures in such a way as to make them practically worthless. The Government declared in advance that they were going to measure the performance of A and E departments during the last week of March, and they gave hospitals ample time to clear the decks so that they could be seen to be meeting the targets.
I raised the matter with the previous Minister, now a Constitutional Affairs Minister, the hon. Member for Tottenham (Mr. Lammy). I asked him at oral questions on 3 June 2003 whether he was embarrassed about the number of trusts that were forced to meet the target. At columns 2 and 3, I quoted a BMA survey showing that a majority of respondents in A and E departments felt that the measures taken
"had distorted clinical priorities … and many said that waiting times for patients with the most serious conditions had increased."
I pointed out that the survey also showed that
"patients were being rushed through A & E, inappropriately admitted, or transferred to the wrong department."
Believe it or not, the Minister's response was that the BMA had surveyed only 30 per cent. of its members. In fact, the survey was of 30 per cent. of A and E departments. For the first time in polling history, it seems that sampling 30 per cent. of a large and appropriate population is not felt to be satisfactory. That will be news for the Labour party's polling operation, which probably manages to poll about 0.003 per cent. of the population before saying, "This is what people want." It is astonishing that the Minister should say that the wrong 30 per cent. had been sampled and that everything was hunky-dory for the other 70 per cent.
Next we see the operation of spin, because the Government recognise that the targets are now associated with negative publicity. What did the Minister say? He said that it is not a target but a "milestone". The target has been rebadged as a
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milestone. I think that hospital staff see it more as a millstone, as it shows that the Government's policy of being "tough on trolleys, tough on the causes of trolleys" is detrimental to the work of accident and emergency departments.
There is now increasing evidence—it was mentioned in the newspapers only this week—that some patients need to stay in A and E, in a lit area with expert staff and resuscitation facilities, while they are being stabilised, especially if they are unconscious. I put it to the Minister that they are not going to protest about the relative discomfort of being in A and E, but instead we see the dangerous practice of transferring critically ill patients to beds on side wards in the ophthalmology department instead of being allowed to be stabilised by A and E departments. That makes A and E departments more like processing units than a speciality of medicine. No wonder morale is so poor.
Certain cases really need to be dealt with in A and E departments, such as people who have overdosed on alcohol and who need to sleep it off in A and E so that any underlying illness or condition can be assessed. If they are put on the wards, not only will they disturb other patients, as can be imagined, but they will not receive the neurological observation that they need. The Government need to drop this whole target culture, and in particular the targets that they have imposed on A and E departments.
There has also been talk of A and E units being run as private ventures. I do not think that the Government can be held responsible for what entrepreneurs do, but it is wrong to assume that they will not create problems for the NHS. They will cherry-pick patients who are not so sick that they require ambulances and will take staff from the NHS—and they will take a higher proportion of staff than they will take patients.
Mr. Paul Marsden: I am all in favour of diversity in health care provision. However, the NHS should be free at the point of delivery. Does my hon. Friend agree that there is a danger that patients could be turned away from private A and E clinics or forced to pay money that they cannot afford for services to which they should have a right?
Dr. Harris: Private A and E departments will find it difficult, because although they are offering a £29 initial service, the price will rise steeply if other investigations are required. I do not know what they will do with people whom they find to be ill but who cannot afford or do not wish to pay the additional amount; they will have a difficult job.
The European working time directive creates huge pressures on the Government, and they need to be clear about how they will tackle the problem. They have said that they will not seek an extension, but they have to recognise that there are implications for either the viability of departments or the quality of care delivered in those departments. It could pose a big threat to local services, and we want to hear answers from the Minister.
10.40 am
Chris Grayling: Given the problems that we have heard about, it is ironic that we are having this debate at a time when record amounts of money are going into the NHS. One is forced to ask what is going on and why.

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I congratulate the hon. Member for Southport (Dr. Pugh) on having secured the debate, which provided an opportunity to raise important local and national issues with the Minister. There have been two themes. The first was local hospitals, smaller units and the future of the A and E departments in such units. We heard about a number of constituency issues, and I crave the indulgence of the Chamber in putting some of my own to the Minister. They illustrate problems that affect many Members of Parliament, and reflect the unease within communities about the future of the health services on which they have depended for many years.
The second theme, highlighted by the hon. Member for Oxford, West and Abingdon (Dr. Harris), was the way in which staff in our A and E departments are let down by the Government's determined target, or milestone, culture. In accident and emergency departments, we see the NHS at its best, saving people who are seriously ill and putting them back on the road to recovery. Those are the first steps towards turning round situations that may be critical. The staff in A and E departments are fine professionals and do not deserve to have their work distorted, as is happening now, by a Government obsessed with numbers.
Nowhere is that obsession more evident than in A and E. In the past 12 months, the four-hour target has been at the heart of the target culture in the NHS. That is not wrong as an aspiration. None of us wants to see patients waiting for a long time in A and E departments. However, in conversation with health care professionals, we Members of Parliament hear how the target is distorting clinical decisions. A few weeks ago, I spoke to a consultant in a diabetic clinic, who holds an out-patient clinic every week. Sometimes, seriously ill patients need to be admitted quickly to hospital, but it is necessary to phone the A and E department first to ensure that nobody has been waiting for close to the four-hour limit, as they must take priority. That has nothing to do with health or with urgency of care needs. The need is to meet the target.
This time last year, we experienced the absurd situation of ambulances queuing outside A and E departments so that the four-hour wait figures for those departments were not damaged. The departments accepted patients only when they were ready to do so, and people had to wait outside in ambulances until they were taken in. That was ludicrous. Then, as the hon. Member for Oxford, West and Abingdon pointed out, there was the absurdity of the last week in March. With one week to meet the target, not surprisingly, hospitals threw in the kitchen sink in order to keep their stars and their reputations. Those that did not, suffered. I think of the example of a hospital on the south coast that lost star ratings because it behaved properly and followed conventional norms, and did not try to distort what it was doing that week.
In the words of the president of the British Association for Accident and Emergency Medicine,
"There is a feeling of panic out there at the moment. All sorts of quick-term fixes are being tried. Money appears to be no object, with staff being recruited and paid whatever necessary for the measuring period."
That is nowhere near a proper and appropriate way to run a health service. Unsurprisingly, most hospitals met, or were close to meeting, the target. The figures
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however, were highly dubious. There is plenty of anecdotal evidence to suggest that figures have sunk back to previous levels.
I was fascinated by the figures given to me by the strategic health authority in my area, which showed that throughout most of the first part of this year, the average achievement throughout its hospitals was that some 80 per cent. of people attending A and E got away in under four hours. In week 13, however, the figure went up to 88.4 per cent. We know that it has come down again since then.
The British Medical Association and the medical profession have been outraged by this absurd and disgraceful situation, which Ministers defend in the House of Commons. I do not blame the Minister, who is new to the job of Minister and was not in position when that was happening at the start of March, but I say, as did the hon. Member for Oxford, West and Abingdon, that it must not be allowed to happen again.
The BMA's response to the 30 per cent. of its members who took part in the survey is clear cut. An A and E consultant said:
"I am appalled to see how A&E departments have been forced into taking extraordinary measures for a week-long period just to meet political targets. It is completely immoral of the Government to claim that it is raising the standard of performance in the NHS when this is how they measure it. It is quite wrong for patients' expectations to be raised in this way."
He went on to say that
"the Government's obsession with waiting times is nothing more than bean-counting."
That culture must change. Will Ministers undertake to change the obsession with targets? Can we release our professionals from the burden that they must carry? Let us allow them to take clinical decisions in their own hospitals without having to worry about whether they are meeting the numbers target for that month.
The second and equally important issue, which the debate has already touched on, relates to the European working time directive, its potential impact on smaller hospitals and the changes taking place in them. The hon. Member for Wyre Forest (Dr. Taylor) was right to highlight the time bomb, as he called it, represented by the working time directive. There are smaller accident and emergency units throughout the country. We heard from two Members from Worcestershire and two Members from west Lancashire whose constituencies have accident and emergency units that face reconfiguration or closure because of the working time directive. It is costing hospitals millions. They need to employ doctors that the market cannot provide.
I was grateful, in an ironic way, to the chief executive of my local NHS trust, Epsom and St. Helier, who is about to leave his post. In what I can only describe as a stunningly ill-judged decision, he made a public statement, on behalf of the clinical service partnership representing all the local NHS bodies, that he aims to reconfigure services in my area. He chose to issue the statement without telling anyone, and attacked everyone who is challenging the plans. That was very foolish, and it will cause significant problems for the process after he has gone. He did, however, let the cat out of the bag, for which I am grateful, because the process is being advertised as an enhancement to local services.

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The chief executive's statement is headed, "Don't be bullied into second best!" The revealing element, however, is the fourth paragraph, which states:
"As the Working Time Directive comes into force there will not be enough doctors to go round. In future, we will require eight to ten doctors to cover the same shifts where we currently have four or five. So it makes sense not to spread them too thinly by duplicating some services unnecessarily."
That means that throughout the country, including west Lancashire and Worcestershire, as we heard from the hon. Member for Wyre Forest and my hon. Friend the Member for Mid-Worcestershire (Mr. Luff), and in Epsom and Ewell and Hertfordshire, where great debates are taking place, smaller hospitals will lose their accident and emergency departments, either full-time or part-time. I say to my constituents that it is likely that in the next few months Epsom hospital will lose its 24-hour cover for proper surgery and accident and emergency, as a consequence of the changes that the directive will bring about.
The directive is costing the NHS millions of pounds. The medical profession describes it as a disaster. It is reported that even the Prime Minister thinks that it is one of the worst pieces of legislation to come from Brussels, yet the Government appear to be doing nothing to stop it. If, in the next few months, the Government cannot find a way to mitigate the directive's impact on the NHS, the consequences for local A and E departments, as well as other services, will be disastrous.
10.50 am
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I, too, congratulate the hon. Member for Southport (Dr. Pugh) on obtaining the debate, which will, I know, be of great interest to his constituents. It is also of great interest to me. I declare a small interest: I am one of the products of the Ormskirk hospital maternity unit. Whatever other criticisms the hon. Gentleman may level at that institution, it produces damn good sturdy stock.
I shall, if hon. Members do not mind, deal largely with the specific issues that the hon. Gentleman raised about Southport A and E. It is fair to use the limited time that I have to do that. If I have time afterwards, I shall deal with the more general issues, which there will, I do not doubt, be other opportunities to debate.
The reality of modern medicine—the way in which we must meet its demands—will increasingly mean that we have to consider the reconfiguration of hospitals. That will be a continuing process, not something that we do once, after which everything will be right. We shall have to find the best ways we can of carrying out consultation and making decisions on the basis of that consultation, covering all the aspects of the matter that have been raised, such as clinical safety and locality, to meet the demand for a high-quality clinical service.
We heard in the debate, particularly from the hon. Member for Southport and my hon. Friend the Member for West Lancashire (Mr. Pickthall), the range of opinions that are encountered. My hon. Friend showed us a picture of how a community engaged over a considerable period in consultation, led by an expert report by Professor Shields, and clawed towards a compromise solution with which, perhaps, many people
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were not 100 per cent. satisfied, but which met the need for a safe, high-quality service; met, broadly, the local community's needs; and answered many of the concerns of the different people in the community. Reaching such a compromise is an incredibly difficult process, and I congratulate my hon. Friend and those who, when the compromise was reached, were prepared to say, "Well, maybe it isn't exactly what I would have come up with, but it is a compromise. It meets all the demands and has come about as a result of a lot of local discussion and consultation."
On the other hand, the constituents of the hon. Member for Southport obviously feel very upset about part of what has been decided, and are not able to accept that final position. However, sooner or later, the Government and the local health authority must say, "This is what we are going to do. We shall try to make it work." We have reached that stage in Southport and Ormskirk, and we believe that the solution meets the demands of the local population.
I have always said in debates in this Chamber and in the House that I am accessible; I hope that I am a listening Minister. I make the hon. Member for Southport the one promise that he asked me to make—to ensure that everything that he and my hon. Friend spoke about will be reviewed. We shall take a fresh look at the matter, and make sure that the local health trust does too, in the light of his comments. We shall proceed from there. However, I cannot promise that, having listened to him today, I shall unwind all the decisions and take a completely different, fresh view.
The hon. Member for Wyre Forest (Dr. Taylor) touched on some of the difficulties that we must consider in making decisions. They include locality, clinical safety, the working time directive and the need to maintain high standards of training, which we are told can really be offered only in large centres. He said that someone has to find a compromise, and he is right, and we must set our priorities on the basis of clinical safety.
I offer this suggestion to Private Eye, which runs a cartoon called, "Sights you seldom see". When someone appears on television to say that service in the local A and E department has failed their relative, one will never see an Opposition MP leap up and say, "Yes, but that's all right. We had to make a compromise when we were reconfiguring the local hospitals, and we compromised clinical safety, but that's okay, we won't blame this Government for it." We must ensure that clinical safety is a clear priority in making decisions. Often, that will mean that smaller services have to move, and that will always be unpopular with local communities. That is a hard choice that we in government find ourselves having to make, whether we like it or not.
Having said that, I undertake to listen very carefully to all the concerns about the Southport situation and ensure that they are all thoroughly reviewed. I also highlight the fact that the reconfiguration is not taking place without resources, as my hon. Friend the Member for West Lancashire pointed out. It will include a major investment in the local hospitals and require the provision of state-of-the-art facilities that will raise the standards for all adults and children in the area. It will produce a sound, clinically safe and very high-quality service, to which people in both constituencies are entitled. If we can do that as well as meeting the points

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raised by the constituents of the hon. Member for Southport, we will. However, at this time, we have not found a solution that meets the needs of both parties and reaches the compromise that the hon. Member for Wyre Forest seeks.
Among the more general comments that have been made, the hon. Member for Mid-Worcestershire (Mr. Luff) raised an excellent and constructive point, with which I agree. We must find a way of helping people better to determine whether they should go to accident and emergency facilities, a minor injuries unit, a doctor's out-of-hours service, their own GP, NHS Direct, or, as the hon. Gentleman said, a pharmacy. People need to consider which of those perfectly valid options is appropriate at the time.
The hon. Gentleman is right: too many people turn up at A and E units when, clearly, their problem is not the sort of emergency that needs to be dealt with there. We must look for a way to guide people in the right direction. The Government are aware of and trying to deal with that.
The hon. Members for Oxford, West and Abingdon (Dr. Harris) and for Epsom and Ewell (Chris Grayling) mentioned targets. I shall spend just a few seconds talking about targets. What are they? They are a management tool by which we distil the wishes of the general population. We do not pluck targets out of the air and decide to impose them on the national health service. Instead, we ask ourselves what people want from our NHS. What direction do they want it to take? What important factors do they want addressed? Waiting times is an obvious one.
Dr. Harris: Have the general public been asked whether they want a maximum waiting time of four hours, even if it means that the health of more ill patients will be threatened by doctors pursuing the maximum waiting time for the most stable cases?
Dr. Ladyman: If the hon. Gentleman had waited for me to finish, I would have dealt with that point. The public tell us that they want to be seen quickly in accident and emergency departments. We find a management target that we can give to local trusts to encourage them to put sufficient resources into their accident and emergency departments to deliver on the wishes of the public. That is what the targets are for. There would be a world of difference, if the hon. Member for Oxford, West and Abingdon and I were to turn up tomorrow in an accident and emergency unit, and the doctor were to say to him, "You need to stay in this unit for longer than four hours—
Mr. Peter Atkinson (in the Chair): Order. Time is up. We must move on to the next debate.

Energy Efficiency
11 am
Sir Sydney Chapman: I am grateful for this opportunity to raise the important issue of the need for energy efficiency in the commercial sector. It is a great pleasure to be speaking under your chairmanship for the first time, Mr. Atkinson. I am particularly grateful that the Minister of State will be replying to this short debate, because that shows the importance that the Government attach to the issue.
The issue was last raised as long ago as January 2001 by the hon. Member for Eltham (Clive Efford) in an extended Adjournment debate. I hope that I am not quoting him out of context. He said that energy consumption in offices had been generally neglected and that the rate of growth in energy consumption was
"three times greater in the commercial sector than in the domestic sector."—[Official Report, Westminster Hall, 23 January 2001; Vol. 361, c. 215WH.]
Replying to that debate, the former Minister for the Environment, the right hon. Member for Oldham, West and Royton (Mr. Meacher), recognised that
"We need a major shift in the way that energy is used in commercial buildings".—[Official Report, Westminster Hall, 23 January 2001; Vol. 361, c. 229WH.]
Little progress has been made in the intervening 32 months. Energy efficiency policies and programmes have focused on the domestic and industrial sectors and have tended to overlook the important commercial and service sectors, which represent about 17 per cent. of total energy consumption. By way of comparison, it is interesting to note that, whereas energy consumption has halved in the past 30 years in the industrial sector, and is down by almost 10 per cent. in the public sector, in the commercial sector it has grown by more than two thirds—the figure is something like 68 per cent.—and Department of Trade and Industry projections suggest that there will be a further rise. That is an urgent situation that must be dealt with quickly. There is real cause for concern if we are to meet our targets for carbon dioxide emissions.
In the commercial sector, offices are a significant contributor to energy use, but I think that the Minister will agree that they also offer the greatest potential for savings. Offices tend to be the same, unlike industrial processes, so if we can identify a significant cost potential, it will be much easier to put that into a policy, which will be more effective. There is cost-effective potential for savings in the commercial sector that can be readily identified. If we can get the large companies and businesses, which have more office space, on side and active in promoting energy conservation in the commercial sector, that will have a great impact.
The rapid growth in energy use in offices is due to a number of factors. Office space has doubled in the past 30 years. There has also been greater use of air conditioning as well as heating in the past three decades. Another obvious point is that there has been a tremendous increase in information technology equipment. That is why there has been a huge explosion of energy consumption in the commercial sector.

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The Association for the Conservation of Energy—an organisation that I salute, and that prompted me to raise these matters—under its director, Mr. Andrew Warren, published a report in March that estimated:
"Using readily available and cost effective technologies, up to 2.5 megatons of carbon could be saved."
As the Minister will confirm, the Government anticipated in their November 2000 climate change programme, and repeated in the February 2003 energy White Paper, that six megatons of carbon savings annually must be achieved by the business and public sectors by 2010. If we can successfully tackle the problems in the commercial sector, that sector alone could deliver almost half the savings required. The other half—the public sector—involves hospitals and schools, but not exclusively.
The European Parliament and the European Council approved the EU directive on energy performance of buildings in January. That comprehensive directive in part concerns where omissions can be made from the energy performance policy. I have three anxieties about the directive and I would like three assurances from the Minister. The first concerns listed buildings. We should remember that, while many of the 500,000 such buildings are of architectural or historic interest, they include quite a few buildings in the commercial sector. My first job as an architect was based in a listed building—a very fine early Georgian building.
The directive gives allowances to listed buildings that do not meet energy efficiency requirements where, in meeting the requirements of the directive by installing energy efficiency equipment, the character or appearance of the listed building would be unacceptably changed. It would be helpful if the Government sent the right signal to the owners of the 500,000 listed buildings by saying, "You have to show us that it would be damaging to your listed building if you were to put in energy saving equipment," rather than, "You don't have to do anything because you own a listed building." Have the Government estimated the proportion of those listed buildings that will be outwith the requirements of the directive?
The directive gives a dispensation to temporary buildings. It has also been over-generous with its definition of a temporary building as a building with a planned time of two years or less. That is far too long. Our landscapes and urbanscapes are littered with portakabins, and the qualifying period ought to be reduced from two years to, say, six months.
My third specific comment on the directive concerns industrial processes. It refers to "industrial buildings and offices", which is unclear. Will the Minister please ensure that offices in the industrial sector cannot be included in the dispensation?
I have a query about energy performance certificates under article 7 of the directive. As the Minister knows, certificates must be displayed in any office of more than 1,000 sq m, which, in my imperial-preference language, is about 1,000 sq yd. Buildings of more than that size which are visited regularly by the public—that is an indistinct phrase—must display the certificate. I welcome that because it should lead to significant improvement in energy performance in larger buildings. However, the directive also states that
"other relevant climatic factors may also be included."
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I hope that the Minister will look at that to see whether, in the United Kingdom, other climatic factors will be included.
This subject is necessarily complicated and I want to finish by posing a series of queries to the Minister. If he cannot deal with them all in detail now, which is understandable, I will be pleased to hear from him after the sitting.
I can see how, under section 2 of the Building Act 1984, it would be possible to incorporate requirements under the building regulations not just for new build but for refurbishment of owner-occupied properties. It is more difficult to see what legislation exists to facilitate certification for rented properties. I do not want to go too deeply into the rented office sector, but clearly there is a problem when someone owns an office or commercial property and rents it out. There is no incentive for the tenant to put in the energy-saving equipment—why should he? I am not attacking landlords, because there are very good landlords, as well as tenants, but a landlord may say, "Well, I'm receiving my rent, so what incentive is there for me to spend a lot of money to create energy savings?" The rented sector needs careful examination.
Similarly, article 8, which deals with the inspection of boilers, and article 9, on the inspection of air conditioning systems, are relevant. Is the Minister convinced that the Government have the right under existing legislation to require the inspection of boilers and air conditioning systems in rented properties?
My final point is that, despite the directive, building regulations, the Building Act and much other legislation, energy conservation is so important that we need primary legislation to fulfil the requirements of the EU directive on energy performance of buildings and other directives.
I know that space in the Queen's Speech is at a premium, and many Ministers will be disappointed because they cannot get their pet legislative proposals into the Government's programme. I want to be constructive, so I would like to make a suggestion. I hope that the Minister will say—of course he cannot confirm that today—that he will make the most rigorous representations to the Cabinet and his ministerial colleagues to include space for primary legislation dealing with energy conservation. If, by chance, they cannot find room for a Bill, will he look favourably on the possibility of legislation being made available to a Member who is lucky in the ballot for private Member's Bills?
Brian White: The other alternative is to use the regulatory report process, which can help Departments to achieve changes in primary legislation using a different route.
Sir Sydney Chapman: As ever, the hon. Member for Milton Keynes, North-East (Mr. White) makes a valid point. There are other ways of doing this. I have only once been lucky in the ballot for private Member's Bills, in my very first Session in 1970. I had a Rural and Urban Environment Bill, which bit the dust because of a lack of time. It was to do with listed buildings, trees and other such things. The Guardian reported it biting the dust by saying "Trees bill axed". I am going to put in for a

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private Members' Bill in the next Session. Perhaps, as it will be one of my last Sessions in this place, I might be lucky—or luckier.
There is a need for primary legislation. I hope that that might include a requirement for larger property owners not just to provide energy certificates, but to carry out improvements for energy conservation when the properties are sold, let, re-let or subject to a rent review. I had the great privilege of attending the World summit on sustainable development in Johannesburg, just over a year ago, in my own right as chairman of the Environment committee of the Council of Europe. I had a little competition to find out whether we were sure that we were getting over to our constituents—we all have the best and most far-sighted constituents, which is why we are here—what sustainable development is, and to find out how many of them know what it is. The competition was for somebody to give the best definition of sustainable development in as few words as possible. I came up with a seven-word definition, which I am still waiting to hear bettered. It is "Conserving Earth's finite resources for future generations". That is a major undertaking and we have realised almost too late that we are squandering many of the world's finite resources. We have to turn the tide, and one way of doing that is not just to talk globally but to act nationally and in our own homes and offices to ensure that we achieve sustainable development.
11.18 am
The Minister for the Environment (Mr. Elliot Morley): I, too, would like to say how nice it is to see you in the Chair for this debate, Mr. Atkinson.
I congratulate the hon. Member for Chipping Barnet (Sir Sydney Chapman) on his contribution. I thought that it was helpful and constructive and addressed a range of important issues. I can assure him that the Government share his concern in relation to commercial buildings. I share his admiration for the work of the Association for the Conservation of Energy, and he might be interested to know that the Carbon Trust has supported some of its recent reports. That is a good example of how money raised from the climate change levy supports energy conservation.
The hon. Gentleman is right to say that the office sector has continued to increase in importance. It is of course vital that we continue to address energy issues and, as he said, to ensure that energy is used as efficiently as possible. Energy efficiency is the most cost-effective way to cut our carbon emissions.
We all know that we have signed up to some very important targets in the Kyoto agreement and that we also have national targets. Those targets are demanding but important, given the need to reduce CO2 emissions. All sectors must play a part in that, including the commercial sector.
In the Energy White Paper, the Government committed themselves to publishing an energy efficiency implementation plan setting out in greater detail how to meet the challenge. DEFRA is in the lead on that, but we are working closely with other Departments, the devolved Administrations and bodies such as the Carbon Trust and the Energy Saving Trust through the
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sustainable energy policy network. I will set out what the Government are doing and respond to some of the points raised by the hon. Gentleman.
Commercial offices are responsible for only 2.5 per cent. of the UK's non-transport carbon emissions. We must view the matter in perspective, but of course we cannot ignore what is a big and expanding sector.
There are four main instruments designed to tackle CO2 emissions in the non-domestic sector. First, there are the building regulations, which are due to be revised in 2005. The hon. Gentleman touched on that subject, and I will look at some of the points that he quite rightly raised. The best builders could do better, which we have been encouraging them to do for some time. In the Energy White Paper, we announced that the better building summit and the sustainable construction working group will extend a challenge to all builders to raise their standards. We also declared our intention of raising standards on building regulations over the coming decade, having learned from the standards in comparable European countries and having looked at the best standards that we can apply in this country.
Secondly, there is the climate change levy, which has been in place for more than two years. Customs and Excise is currently conducting a study of its effectiveness in delivering environmental improvements. The Carbon Trust receives money from that levy. Several of the trust's programmes are designed to tackle energy use in the commercial sector, including offices. They include the provision of advice, information and loans through the action energy programme, the low carbon innovation programme, and enhanced capital allowances—the third instrument—which reduce the cost of buying carbon-reducing products from an approved list.
Finally, there is the European directive on the energy performance of buildings. The hon. Gentleman described those provisions and how they will allow member states to have discretion on the buildings that they may choose to exempt from the requirements to set energy performance standards. In response to his questions, I can reassure him about our intentions. Obviously, we want to see what comes from the detailed developments and consultation that are in prospect on that and on all the other articles. I understand that the Office of the Deputy Prime Minister takes the view that any exemptions should fall in line with the current building regulations.
The hon. Gentleman raised a number of detailed points that I will try to answer. First, there is the issue of historic listed buildings. The energy efficiency provisions in part L of the building regulations apply to all historic buildings, but reasonable provision depends on the circumstances of each case. For example, we would not expect Windsor castle to put UPVC double glazing in. Nevertheless, an awful lot can be done to improve energy efficiency, even in old and listed buildings, such as modifying central heating systems, draughtproofing and insulation. I live in a listed building and have upgraded the central heating and improved the loft insulation and the draughtproofing, which has had an effect. Old buildings with thick walls are often cool in summer and warm in winter, so they are good on energy efficiency.

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The hon. Gentleman also asked about the percentage that would be affected. It is not possible to calculate the exact percentage until there has been more careful consideration of which regulation should apply to which buildings. That is being considered and the figure will be available in due course.
The hon. Gentleman raised the subject of temporary buildings, which are in fact classed as those remaining in place for not more than 28 days. I can reassure him that the Government do not accept the two-year rule and that, as far as we are concerned, after 28 days the building regulations will apply.
Part L does not apply to industrial and commercial processes that consume energy, nor to that part of the building's environmental energy consumption needed to convey waste heat to the outside air. However, industrial and commercial buildings are not exempt from the building regulations unless they are controlled by other legislation. I agree with the hon. Gentleman that, even in industrial premises, there is no reason why the regulations should not apply to office accommodation. That makes absolute sense, but the wording is not clear and we are looking to clarify it.
The hon. Gentleman also described how article 7 requires building energy performance certificates whenever buildings are constructed, sold or rented out, and said that, in certain circumstances, it calls for building owners to display certificates prominently. The article also gives member states discretion to call for additional information to be displayed on the certificates about the building's internal climate. Interpreting the requirement to display information is proving difficult, and officials are in the process of seeking advice from the Commission and other member states. Again, we accept that that is a reasonable point. It will be interesting to see what officials discover in those discussions, but how we implement the directive is a matter for the UK, taking account of what it legally obliges us to do and the constraints placed on us by other policies for better regulation.
A separate issue is what information such certificates should convey. I understand what the hon. Gentleman said, but it may not be practical to convey the range of temperatures and other climatic parameters encountered and expected in larger buildings, which commonly accommodate many different types of activities. Nevertheless, we shall give consideration to those desirable points.
We intend to implement article 8 primarily through the provision of information. However, we shall also consider the energy and safety benefits of regular inspections for fuels with a higher potential for soot formation, the build-up of which could lead to incomplete combustion and the production of carbon monoxide.
The hon. Gentleman reasonably expressed concern about how quickly and by what means the Government intend to bring the directive into effect. Article 15
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requires us to transpose all the requirements into UK law by 4 January 2006. We announced in the Energy White Paper that the Office of the Deputy Prime Minister would take the lead in implementing it, for the good reason that the requirements fit well into the framework of the building regulations. We believe that many of the requirements can be implemented through changes to the existing building regulations without having to make changes in primary legislation.
Section 1 of the Building Act 1984 applies to construction work for new buildings and refurbishments on whatever scale, although, as the hon. Gentleman said, section 2 may need extending to oblige building owners to carry out regular inspections of boiler and air conditioning plant. The European Communities Act is likely to be the most appropriate way to implement those parts that cannot be implemented through existing legislation. However, I assure the hon. Gentleman that we will consider whether his suggestion of using a private Member's Bill could be a viable alternative. We shall certainly consider all ways of implementing the directive as quickly as possible. I know that the routes of private Members' Bills are often rocky, as those who have been involved in them over the years know well, but it is a sensible measure that would command widespread support.
Sir Sydney Chapman: I am very grateful to the Minister, and thank him for the way in which he is treating the matter. Let us hope that this debate is the beginning of a dialogue, because the issue transcends normal party politics.
One of the reasons why I was pleased to have been successful in gaining the debate today is that the week after next is energy efficiency week. The debate is a good curtain raiser for that most important event.
Mr. Morley: The hon. Gentleman is absolutely right, and his timing is most fortuitous.
I shall certainly look carefully at the hon. Gentleman's speech to ensure that all the points that he raised have been addressed; any that I have not had time to answer will receive a written reply. We in government must look to our own performance. We must also look at heating and cooling product standards. We recognise the importance of energy efficiency overall, which is why I welcome what the hon. Gentleman had to say. His suggestions were constructive, sensible and helpful, and I intend to ensure that the Government respond in kind. Such proposals will be an advantage, not only in terms of our commitment to sustainability but because efficiency savings make good sense for the commercial sector itself.
11.30 am
Sitting suspended until Two o'clock.

Seaside Town Regeneration
2pm
Chris Ruane: I welcome this opportunity to debate seaside town regeneration, and begin by recognising the good work that the Government have done in helping such towns to regenerate themselves. I shall ask my hon. Friend the Minister to consider three proposals. The first is the establishment of a resorts taskforce, perhaps followed up by a resorts trust similar to the trusts established for coalfield communities. The second is the establishment of a Minister with overall responsibility for seaside regeneration, and the third is parity of ring-fenced funding for seaside towns with that ring-fenced for coal, steel, rural and inner-city communities over the years. I shall draw on examples from my constituency to show the need for co-ordinated action.
The current Government have done much to help seaside towns. Most notably, in my area, they have achieved objective 1 status for Cornwall, west Wales and the valleys, Merseyside and South Yorkshire—although I do not think that there are any seaside resorts there. I pay particular tribute to the Secretary of State for Wales, my boss, who, when a junior Minister in the Wales Office, agreed to the redrawing of the objective 1 boundaries at the eleventh hour to include Denbighshire and Conwy. As a result, the towns of Prestatyn, Rhyl, Kinmel Bay, Towyn, Colwyn Bay, Conwy, Llandudno, Llanfairfechan and Penmaenmawr have been able to access objective 1 funding.
The Labour Government's attitude to securing structural funds for areas experiencing economic decline sharply contrasts with that of the Conservative Government, who refused to apply for EU structural funds, and took assisted area status away from many of our towns. I also congratulate the Labour Government on issuing new directions to the Heritage Lottery Fund.
Mr. Andrew Turner: I did not intend to make a political point, but as the hon. Gentleman has done so, I congratulate the Conservative Government on giving assisted area status to the Isle of Wight, and express my regret that it was taken away by the Government of whom he speaks so movingly.
Chris Ruane: It was probably redirected to the Isle of Wight from my constituency, which suffered a loss of £40 million.
On the Heritage Lottery Fund, under the previous Government, £12 million was given to the Churchill family for the Churchill diaries, and £5 million went to developing the playing fields of Eton. When the Labour Government came to power in 1997, they altered those rules and said that money from the Heritage Lottery Fund would be dedicated to places with architectural merit and areas of poverty and decline. As a result, Denbigh and Rhyl in my constituency will both receive approximately £6 million to regenerate their high streets and commercial centres.
The Government have also expanded the further and higher education sectors, and as a result, my home town of Rhyl has its first ever college; the second biggest town in north Wales had always been denied one. Unemployment in my constituency has dropped from
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4,500 under the previous Government to 900 people in 2003. The Government made west Rhyl a policing priority area 18 months ago. That was one of only five pilot projects in the UK, and Rhyl was specifically chosen because it was a seaside town. Through co-ordination and co-operation, crime levels in the west ward of Rhyl have dropped by almost a quarter—24 per cent.—in the past year.
However, despite those success stories, towns such as Rhyl and Prestatyn in my constituency, along with 43 other principal seaside towns around the UK, have specific structural problems that have not been addressed in a co-ordinated way.
Dr. Desmond Turner: I would like to pick up that point. Does my hon. Friend agree that, despite all that the Government have done so far, which is welcome, there is a continuing need to bang the drum for the special problems of seaside towns? They are exemplified in my Brighton constituency. Visitors get an impression of prosperity and economic activity when they see the seafront, which obscures all the problems that we face, including urban deprivation in large enough measure to have a new deal for communities; homelessness, which is some of the worst in the country, and the largest number of drug deaths; very poor housing in the private sector, and intense housing need. Yet, again and again we have to convince people, even those in our own Government, that seaside towns have problems.
David Taylor (in the Chair): Order. That was rather a long intervention. If hon. Members keep interventions short, there is a greater chance of everyone who wants to speak being called.
Chris Ruane: I agree with every word spoken by my hon. Friend the Member for Brighton, Kemptown (Dr. Turner). One of my recommendations, which I hope will have the support of seaside MPs from all parties, is that we need a dedicated Minister responsible for seaside regeneration. Many Departments are currently involved in seaside regeneration. Usually, the Minister with responsibility for tourism responds to these debates. With all due respect to him, I am particularly pleased that the Minister with responsibility for regeneration is responding today. Seaside issues usually form just a tiny part of the role of the Minister for Housing and Planning, a tiny part of the Home Office Minister's role and a tiny part of the role of the Minister responsible for licensing houses in multiple occupation. There is no co-ordination to deal with the issues that face seaside towns.
I do not necessarily believe that all the 43 principal seaside towns will regenerate themselves around tourism. Some will, with 100 per cent. regeneration centring around tourism. All 43 towns will probably have an element of tourism in their local economies in future, but that is not necessarily so. Coal communities have not regenerated themselves around coal. Steel communities have not necessarily regenerated themselves around steel. I am, however, pleased that a Minister with responsibility for regeneration is responding to today's debate. That is welcome.
Whatever happens in our seaside towns around the UK, the jobs that we create must suit our local population, bearing in mind that by 2010 50 per cent. of

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our young people will be graduates. We need jobs in our seaside towns that will attract and keep those graduates. We are looking for high-skilled, high-paid jobs, even if they are in the tourism sector.
Lawrie Quinn: Having described the relatively beneficial climate that the Government are delivering, not only in his constituency but in Scarborough and Whitby and right around the coast, does my hon. Friend agree that the key partnerships that will deliver new jobs, vitality and regeneration must be born out of community partnerships and a local feeling that there has to be a better way for communities that are on the fringe of the mainstream? I am pleased to support my hon. Friend's plea for the taskforce and the initiative from a Minister.
Chris Ruane: I thank my hon. Friend for that contribution. I shall expand on his points later.
All seaside towns will have a sizeable tourism sector, but it will not necessarily be as great as it was 20 or 30 years ago. The solutions for seaside towns will involve co-operation between many Departments. That is why a Minister with specific responsibility for seaside towns is needed to co-ordinate, monitor progress, commission cross-departmental research and spread best practice.
Mr. Geoffrey Clifton-Brown: I am very surprised to hear the hon. Gentleman say that he does not think that the regeneration of seaside towns will come mainly from tourism. Given the fact that the problems of seaside towns have come from the run-down of tourism, and that statistics show that on average 33 per cent. of a seaside town is devoted to tourism, hotels and restaurants, surely tourism will be the major leader in all seaside town regeneration.
Chris Ruane: That is an issue for the local community to decide in light of the local economy. In my home town of Rhyl, there used to be 900 hotels, guest houses, holiday flatlets and bed and breakfasts; now, there are 50 or 60, and we are not going to get back to having 900. The traditional two-week seaside holiday has by and large disappeared. We have to develop new markets and look to the future, not to the past.
Other Departments will play a key role in the regeneration of seaside towns. Previously I mentioned policing, which is a major issue in those towns. As I said before, the west ward of Rhyl was selected as one of five policing priority areas, and we have had great success through co-operation and co-ordination with a whole variety of agencies in the town. I would want the seaside Minister to have strong connections with the Home Office on such matters.
Rail services are likely to be a key issue for many seaside towns; I point specifically to Blackpool, Great Yarmouth, Cleethorpes and Llandudno. Many such towns grew up around the rail network in the 1840s and the 1850s. With the decrease in services in the 1960s under Beeching, and more recently, we must ensure that the rail connections are kept for those towns—not only the connections between the conurbations, but transport within and around those seaside towns. In my constituency, in which 65 per cent. of people do not own cars, people cannot access the 2,500 high quality jobs on
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the St. Asaph business park six miles away and they cannot readily access the 1,000 jobs in Glanclwyd hospital five miles away.
We need to work together and to come up with creative, innovative ideas to connect people who have by and large been cut off from where the quality jobs are. I am holding a conference in my constituency to tackle the issue in two weeks' time.
Mrs. Betty Williams: Does my hon. Friend agree that a good example of how partners can work together to succeed was the foot and mouth outbreak? At the beginning of the outbreak, the only people receiving the attention of the country and the world were the agricultural community. Some of us realised very early that the tourism industry was also going to suffer, because footpaths were being closed, and that attention had to be turned to the people in the tourism industry as well.
My hon. Friend asks for more partnership. As we are talking about ring-fenced money, will he join me in asking the Minister to ensure that if, God forbid, such a crisis happens again, the tourism industry receives attention early on rather than two or three weeks later?
Chris Ruane: I welcome that intervention from my hon. Friend. I will deal specifically with the grants made available in Wales after the foot and mouth crisis later.
A key role for any Minister responsible for seaside tourism will be in higher and further education because many seaside towns have traditionally had a low skills base; they do not have the skills base to attract new jobs, or to maintain existing jobs. That is why, as I mentioned, Rhyl college in my constituency is key to the regeneration of Rhyl and Prestatyn by expanding and supporting existing industries and the service sector, and by making sure that people working in the tourism sector are properly trained. We must look to the future, see what jobs are on the horizon and train for the future, not just for the here and now; in my area, that involves training for the optoelectronics industry based at St. Asaph business park.
A problem shared by almost all seaside towns is that of HMOs. As I mentioned, there used to be 900 hotels, guest houses and holiday flatlets in Rhyl; the vast majority no longer have a role in tourism. Many have been bought on spec by landlords living as far away as London and Birmingham, who have no interest in their tenants or in the town and its people. Their only interest is in maximising their profits or, to quote Cyril Roberts, a former housing chair of Rutland borough council, "making money out of misery." That has led to a concentration of poverty in particular wards in certain seaside towns, where landlords pack as many tenants as possible into substandard accommodation.
Such accommodation does not benefit the tenants, local public services—police, fire, education or health—or local people. The only beneficiaries are the landlords, who pick up their cheques courtesy of the British taxpayer. We need to tackle the issue of benefits. Careful thought has to be given to what the HMOs can be used for and what grant regimes can be put in place to support schemes. In the past 20 years, money has flooded in to Rhyl to improve the housing stock. However, the HMOs have remained as such and have gone back to their former condition, because no thought was given to diversification.

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What could the houses be used for? We would find a wide range of answers if we thought laterally and creatively. I urge a carrot-and-stick approach: grants should be made available for HMOs, but there should also be inspection, so that landlords understand the message: "Here's the grant. Convert or we'll come after you." The approach needs to be that bold. We should take the themed approach that I have suggested to my local county council. For example, all grants going to a certain district or street could be used to convert HMOs back into family accommodation and to create parks with swings and slides—a nice living environment—so that families return to the area. Alternatively, we could say that a certain street will be a "voluntary sector street", with shared communal facilities, or designate another "quality accommodation street." There should be grants and there should be inspection.
There is good practice around the country. In Conwy, representatives of the police, the fire service, social services, the education department, the Benefits Agency and the environmental health department meet regularly. They lay their cards on the table and discuss premises that are giving trouble and, invariably, the same two or three premises are mentioned. Then, they are able to go in mob-handed to sort those places out. However, even that approach is a bit hit and miss. We need a national licensing scheme for HMOs that leaves nowhere for slum landlords to hide. I urge the Minister to take back to her Cabinet colleagues the message that we should ensure that such a scheme is in the Queen's Speech this November.
My hon. Friend might also take back a message for the Lyons committee, which is considering the feasibility of relocating 20,000 civil service jobs out of London into the regions. I was informed yesterday that that committee will only consider towns with a population of 100,000 or more for the relocation of a Government Department. Of the 43 principal seaside towns, only nine will qualify. We have until Friday to make our submissions. I shall pursue the matter, and I ask the Minister to intervene to ensure that the seaside resorts that have been neglected for 35 years get their fair share of the cake.
We should consider not only public sector investment in towns but whether our seaside towns are getting their fair share of the public bodies that generate wealth by creating secure, steady, white-collar jobs. Again I use as an example Rhyl, where four public bodies are pulling out of the town centre and relocating to the St. Asaph business park. The central division headquarters of North Wales police should have been located in Rhyl, but sufficient land could not be found for it. Clwyd and Alyn housing association, which is supposed to be a social landlord, was located in the west ward of Rhyl, the poorest ward in Wales; that was great, but it has now left for the St. Asaph business park. The Denbighshire health board, which is supposed to look after primary care, is not located in the west ward of Rhyl, which has the poorest health record in the whole of Wales, but in the St. Asaph business park.
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That is the wrong message for public sector bodies to be sending out. What message does it send to the private sector if there is a public sector flight out of the town? I hope that the Minister will take up the point with the Home Office—I will be taking it up with the National Assembly. Instructions should be sent to public services that they should not relocate their headquarters or their personnel from any fragile community without a full assessment of the impact on it.
Lawrie Quinn: Does my hon. Friend agree that the migration or absence of high-skills jobs in seaside community economies compounds the spiral of decline, because the very best young people who go away to get degrees elsewhere in the country simply do not return to the coast? That compounds the stress that many people who work in the social services and health services find themselves under. Does he agree that our towns have ageing populations because of the economic decline that he describes?
Chris Ruane: I concur with everything that my hon. Friend says.
The trend that I describe is a double whammy for our community. It has not only taken high-quality jobs out of our seaside town, but those public bodies now take up valuable space in a business park that is now completely full. There is now no opportunity to create new jobs through inward or domestic investment. A Minister with responsibility for seaside towns, be it in the National Assembly for Wales or in Whitehall, could monitor these trends and, as I say, could intervene and modify or even stop them.
I have dealt with the public sector, but the private sector will create the bulk of new job opportunities in seaside towns. Far more could be done to increase the number of business start-ups in seaside towns. The small and medium-sized enterprise base is low. I refer again to my home town of Rhyl. Not many people know this, but Rhyl happens to be the birthplace of two of our best known high street shops—Iceland and Kwiksave—which were born of an entrepreneurial spirit that existed in that town 30 or 40 years ago. That entrepreneurial spirit is currently dormant. It needs to be brought to life once more. Rhyl, with a population of 27,000, had 24 new company start-ups in 2000, whereas Ruthin, with a population of 5,000, had 44 new company start-ups—a massive difference. Local authorities, regional development agencies and the HE and FE sectors working with the local population and private enterprise can have a huge impact on start-ups.
We should consider best practice for start-ups, especially those involving young people. The Prince's Trust usually deals with people whom the banks have knocked back and gives them £5,000 start-up funding. The key thing that it gives them, however, is a mentor who can help them to develop their business. The trust has an 80 per cent. success rate. In addition, a great deal more could be done to expand the intermediate labour market in seaside towns. There are excellent ways of attracting the economically inactive back into the work force. If the post of Minister for seaside regeneration is created, expanding the SME base in seaside towns will be a critical job for whoever holds it.
The long-term decline of the British seaside towns during the past 35 years has gone largely unnoticed by Governments. Unlike coal, steel and rural communities,

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seaside communities have not had on their side powerful unions that can commission research or exert political pressure. Seaside towns are literally on the periphery of the country. They are not consolidated in any one area, and their political voice has been diluted as a result. To counter that lack of political voice, my hon. Friend the Member for Blackpool, South (Mr. Marsden) set up the Labour group of seaside MPs six years ago. I congratulate him on his sterling work in the group, and especially on the document that we produced "Supporting Seaside Towns", which would form the perfect basis for a seaside regeneration trust or taskforce. The document promotes an holistic approach to seaside regeneration. I am sure that my hon. Friend will expand on that.
The third issue is the funding that will be required to help us to regenerate our seaside towns. Last year I asked my right hon. Friend the Chancellor of the Exchequer for a breakdown of the specific ring-fenced budgets for coal, steel, rural and inner-city communities. He gave me an impressive list—one of which, as a Labour MP, I am proud—totalling £4 billion. There was £380 million through English Partnerships, for coalfield regeneration; £90 million for the Coalfield Regeneration Trust; £60 million through the Countryside Agency for rural programmes; and £120 million from the regional development agencies for rural developments. For the new deal for communities partnership there was £2 billion, and for neighbourhood renewal there was £440 million.
Those are impressive sums, and we in Wales have gone beyond that. When 3,000 steel industry job losses were announced by Corus last year, £92 million was put on the table to help steel communities. Foot and mouth hit Wales particularly hard, and £65 million was allocated to rural communities. I mentioned Kwiksave earlier: in 1998 1,000 jobs were lost in the seaside town of Prestatyn, yet the help that was given to the Kwiksave workers amounted to £250,000. I do not say that coal and steel communities should not benefit: they should. However, I ask for a level playing field, parity, and political recognition of the problems that we have faced, which have gone unrecognised for the past 35 years.
If seaside towns are to be regenerated, ring-fenced funding comparable to that allocated to the other areas that I have mentioned needs to be set aside. More than 3 million people live in the 43 principal seaside towns. Those towns have experienced long-term decline over 35 years. Their plight has been largely ignored. I ask the Minister to do all that she can to rectify that and to look positively on my three requests: for the establishment of a seaside regeneration trust, for the appointment of a Minister for seaside regeneration, and for the allocation of sufficient funding to regenerate those towns.
Several hon. Members rose—
David Taylor (in the Chair): Order. Five hon. Members want to catch my eye in the 34 minutes remaining before I intend to call the three Front-Bench speakers in this important debate. If the hon. Members will confine their remarks to a suitable time, they will all be called.
2.26 pm
Mr. David Amess: In my relatively brief, eight-minute speech, I intend to talk about the present and the future. For the second day running I intend to praise the Government. I shall return to type next week, but credit must be given where it is due. When debates began in this Chamber some years ago, I obtained a debate to which the hon. Member for Rossendale and Darwen (Janet Anderson), who was then Minister for Tourism, Film and Broadcasting, replied. She was extremely helpful, and I know that the Under-Secretary of State, Office of the Deputy Prime Minister, the hon. Member for Pontefract and Castleford (Yvette Cooper), will be as helpful today as she was when she was a Minister at the Department of Health.
I congratulate the hon. Member for Vale of Clwyd (Chris Ruane). Except when he was knocking the Conservative Government, I agreed with much of what he said, especially about HMOs. Like him, I hope that the Queen's Speech will contain something to deal with the problem nationally.
We all know what the problem is with seaside resorts. It used to be expensive to travel abroad. The Brits have always moaned about the dodgy weather here, but it is now inexpensive to travel abroad. This year's experience may alter things—we have had unbelievably good weather and people may return to British seaside resorts for their summer holidays—but we must deal with the present situation.
Southend-on-Sea, as one of the 43 premier seaside resorts, suffers the same difficulties that all hon. Members present for this debate are concerned about. I thank the Government for the support that they are giving Southend. We have been delighted by the number of Ministers who have visited Southend. It is pretty convenient, at 40 miles from here, but we are grateful none the less. I shall end my brief speech with a request for just a little more help.
We in Southend have 4.4 per cent. unemployment, which is more or less double the rate for Essex as a whole. In addition, just as things were starting to look good, the cliffs began to slide. That has been a major difficulty for Southend. Where is the money to come from for restoration? We have a huge, very heavy bandstand where tea dances were traditionally held in the summer. It will be difficult to relocate that, but perhaps if I write to the Minister she will be able to come up with some ideas. Approximately 12.5 per cent. of Southend's work force is involved in tourism-related activities, so Southend is very heavily dependent on the tourism sector.
I am delighted that in August the Office of the Deputy Prime Minister announced a £29.6 million funding package. Southend, through public and private finance, was allocated, potentially at least, a decent share of what we were told would be £2 billion. We know that the Deputy Prime Minister intends to deliver 120,000 new homes, but we certainly cannot take them in Southend, because there is no land and areas that were empty have already been built on. We are commited to about 250 new houses. The Deputy Prime Minister also spoke about creating 18,000 jobs in the Thames gateway.
I am very grateful for Southend's £29.6 million. It will be spent on the regeneration of Pier hill, the 250 new houses, infrastructure development for improvements

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to the Rochford business park near Southend airport, and, most excitingly, development of the university campus. We are determined to make Southend a centre of learning. The various projects centre on South East Essex college. We are working with the university of Essex. We also have many tourism projects under way, and new hotels are to be built.
We can all argue about which is the best seaside resort in the United Kingdom, but I know it is Southend. We have the longest pier in the world at 1.3 million miles—
Mr. Andrew Turner: Million miles?
Mr. Amess: I am sorry, I meant 1.3 miles. That was a slight exaggeration, Pinocchio-style.
We have the finest ice cream in the United Kingdom—Rossi's. We have Adventure Island playground, which is a bit like what they have in America; we have the Sealife centre and the Kursaal, and the wonderful Cliffs pavilion. In addition, we have seven miles of shoreline. However, there are problems. The hon. Member for Vale of Clwyd talked about the money that his area had obtained from Europe. At the time when I secured a debate on the issue, one ward in my constituency, Westborough, was excluded from that funding. I hope that the Minister will help us to gain extra help for Westborough, which wants to become a village; I also hope for help for Westcliff community centre.
Mr. Andrew Turner: Does my hon. Friend accept that, although the hon. Member for Vale of Clwyd (Chris Ruane) was fortunate in that parts of his constituency abutted an objective 1 area, which was relatively easy to extend, the Isle of Wight does not abut an objective 1 area—indeed, it does not abut anything—and the Government found it impossible to extend objective 1 status to it? My constituents feel that that rule is very unfair.
Mr. Amess: I agree with my hon. Friend and I hope to visit the Isle of Wight in October, when I shall see the difficulties at first hand.
In the 90 seconds that remain to me I want to ask the Minister kindly to consider what help can be given for the Palace hotel, which we hope will be used by our new university. We would like a regional college for vocational skills and will need extra money for that. We very much need help with our fisheries project. My hon. Friend the Member for Castle Point (Bob Spink) and I gave evidence at the London gateway inquiry; I can foresee terrible difficulties in terms of the effect on the Thames estuary if that huge project goes ahead.
Finally, I am concerned about Sir Michael Lyons's public sector relocation project, which the hon. Member for Vale of Clwyd mentioned. Southend depends on Her Majesty's Customs and Excise being located there. If we were to lose that, it would have a devastating effect on the town. I thank the Government for what they have done so far, and look forward to the help that they will be able to give us in future.
2.34 pm
Mr. Gordon Marsden: I pay tribute to my hon. Friend the Member for Vale of Clwyd (Chris Ruane) for obtaining this debate and also for his indefatigable work since his election in raising the profile of seaside and coastal towns. That work has been shared by many members of the Back-Bench group of seaside and coastal Labour Members of Parliament that it is my privilege to convene.
On an all-party basis, I also pay tribute to the work of the British Resorts Association. I happen to have the title of president of that association, but all the real work is done, on a day-to-day basis, by a very small secretariat led by Peter Hampson. Indeed, I pay tribute to the work freely done by councillors of all parties and by officials across the country including this year's chairman, Mr. Les Byrom.
Reference has already been made this afternoon to the work of the seaside and coastal towns group in producing the document supporting seaside towns. I will refer to that, and to the specific proposal for a seaside regeneration trust and taskforce, later. However, much has already been done for seaside and coastal towns. Perhaps I could add to my hon. Friend's list. Many seaside and coastal towns, my own included, have benefited from the operations of the neighbourhood renewal fund. Increasingly, there is potential for business improvement districts. Blackpool has been cited as a pilot for business improvement districts. That is a real way of engaging the private sector in the improvement and regeneration of seaside towns.
Will the Minister take one point back to her colleagues? At the moment there is no mechanism in the proposed pilots for business improvement districts for the freeholders to contribute and participate. That, it seems to me, is a weakness. It has been raised by the Chairman of the Broadcasting Committee, my hon. Friend the Member for Brighton, Pavilion (Mr. Lepper) who is not here today but is chair of the all-party group for town centre management issues. It is an issue that should be looked at again.
Despite all the good things that the Government have done and, indeed, the funding by lottery organisations such as the Heritage Lottery Fund, to which my hon. Friend the Member for Vale of Clwyd referred, many problems remain. One of them is a statistical problem. Seaside towns are not only peripheral, but they are highly variable in the employment, accommodation, and everything else that they offer. That can mean that, taken on a constituency basis, pepper pots of extreme deprivation within seaside towns are not recognised by the Office for National Statistics or, indeed, by some of the other agencies involved.
The figures are stark. Many coastal towns are classified in the 100 most deprived areas in the UK in the index of local deprivation. In 1996, eight of the 20 worst deteriorating districts in the UK according to the index were in coastal towns. We need to bear that issue in mind when discussing regeneration. I am sure that the Minister, given her particular responsibilities with regard to social exclusion, will want to bear it in mind as well.
Recently there has been a major and significant report by Sheffield Hallam university on the seaside economy. One of the things that that report has shown is that,

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although seaside towns are bearing up better than was expected in terms of maintaining employment, particularly in the tourism sector, in-migration to seaside towns is outstripping local employment growth, leading to a continuing imbalance in seaside labour markets. There is extensive joblessness, or underemployment, in seaside towns. That is beyond recorded claimant unemployment. One has to think only of the seasonal nature of seaside towns and of the fact that many people often have to do two or three low-paid and low-skilled jobs to keep their family going. Any regeneration policy and activity needs to take that point on board; it needs also to take on board the fact that we need a targeted and focused approach to be successful.
Regeneration must benefit residents as well as visitors. Too often, the balance has not been right, and that has led to local divisions that have hampered regeneration. Blackpool, for example, got its first publicly built sports centre only after electing a Labour authority in the 1990s. If we do not get it right—this applies to resident-friendly design as well as to the detail of balancing project finances between the needs of residents and visitors—we shall regenerate on contentious foundations. As my hon. Friend the Member for Morecambe and Lunesdale (Geraldine Smith) said at a recent Treasury-led seminar, her town centre must be made good and fit for residents to live in before investment in new attractions or infrastructure will have a lasting chance of sustaining new markets and visitors. We should always bear that in mind.
Seaside towns put a strain on the services provided by local authorities and agencies, particularly because of their skewed demography; they have a higher than average number of elderly people and a higher than average number of younger people, often with low skills and low employment prospects. That is particularly true for hospitals, social services and education. For instance, Blackpool has between 12 million and 15 million visitors a year and, as I said to the Minister in one of her previous incarnations when I was pressing the case for a new scanner at Blackpool Victoria hospital in another Westminster Hall debate, those pressures affect services for local residents as well as for visitors.
Such pressures affect all doctors, from those in general practice to those in mental health. An interesting survey in Doctor magazine last year pointed out the pressures and strains placed on doctors in seaside towns. Some of those issues are only just beginning to be addressed by local government funding formulae. Some welcome changes have been made, but we need much more because the drain on local government funding affects the ability of local councils to introduce tourism and regeneration initiatives.
Regeneration needs to be underpinned by adequate planning and up-to-date powers and structures. My hon. Friend the Member for Vale of Clwyd referred to the control of HMOs, and I entirely endorse everything that he said. We need a draft housing Bill in the Queen's Speech to incorporate a national framework.
The Chamber may not be surprised to hear me refer also to the liberalisation of gaming and of casinos. Casinos, not least in Blackpool, have the potential to regenerate employment in the area because of an increase in the number of visitors. To be successful, however, proper planning powers and a strategic
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approach are necessary. That is why I welcomed the August announcement on restricting such liberalisation to casinos of a certain size.
Over and beyond that, regional development agencies and councils have to consider tourism and seaside needs as part of an overall strategy. Some are doing it far better than others. We should also be aware that, unlike Blackpool, not all seaside towns are unitary authorities and that they are therefore dependent on the views of other organisations.
We need action across government. That action should demonstrate the diversity of needs, and to do that we require the voice of a seaside regeneration trust. It does not have to have an enormous new pot of money. By examining existing government work and the adequacy of current regeneration projects, it could act as the champion for the development of seaside and coastal towns. However, it is crucial to monitor and assess the effectiveness of the various initiatives being undertaken by Departments. That is why the coalfields taskforce regeneration trust has been so successful; and that is why I believe a seaside regeneration trust would be successful.
Several hon. Members rose—
David Taylor (in the Chair): Order. Sixteen minutes remain for Members to catch my eye. I ask those who are called to speak to bear that in mind.
2.44 pm
Mr. Paul Tyler: I agree with so many of the contributions that have been made this afternoon that I do not propose to replicate or duplicate them. However, I must challenge the point made by the hon. Member for Southend, West (Mr. Amess). His ice cream may be the best in England, but Cornwall is another country.
I want to touch on another point. While congratulating the hon. Member for Vale of Clwyd (Chris Ruane) not only on the way in which he introduced the subject but on his long-standing interest in it and on securing this debate, I also want to congratulate the House of Commons Library. It is now producing an excellent debate pack for debates of this sort. I do not know whether all Members have had the benefit of reading it, but I am particularly struck by the wisdom of the first paper, which starts as follows:
"The debate on Cornwall's lack of affordable homes for local people reached boiling point this week when it was revealed that houses in some coastal areas have more than doubled in the past two years. The news, contained in the nationwide listing of property price increases in seaside towns complied by Halifax estate agents, brought a furious reaction from North Cornwall MP Paul Tyler."
Now, I am an equitable person, so I can tell the Chamber that it was not a furious reaction, except in this sense. The regeneration of our coastal towns, particularly in the south-west, is being completely hampered by the lack of affordable housing. There is no point even providing in Cornwall the full-time, full-year employment that I have been working for throughout my political life if we cannot also ensure that those who are going to work in those towns can find affordable housing. It is not sufficient, for example, simply to try to impose an additional council tax burden on those who

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have second homes. Only when we have planning control over the conversion of a full-time residence to a second home will we be able to give those communities the chance of retaining a reasonable number of homes for local people.
The right to buy was a disaster for these towns, but their ability to survive in future will depend on the continuing availability of a housing stock at a rent and price that people can afford. Unless the rent and purchase price are within the scope of local incomes, we have not a hope of regenerating the employment prospects of these towns. My Liberal Democrat colleagues, most notably my hon. Friend the Member for Torbay (Mr. Sanders), and I have been arguing this issue for so long with the Deputy Prime Minister that I hope that the Minister will recognise this afternoon that this is a particular and very serious problem.
There is some good news, however. I, too, will pay credit to the Government because, frankly, the previous Government did not seem to want to know what was going on in the coastal towns that I represent. The "Shifting Sands" report, which has not been referred to, was very useful and it was commissioned by English Heritage and the Commission for Architecture and the Built Environment. We have to provide a quality product. The hon. Member for Southend, West made that point very forcefully. We have to provide a quality product that can compete Europe-wide and worldwide. One way to do that is to make the places that we represent along the coastline of Britain more attractive. As everyone knows, North Cornwall has the most attractive coastline not only in the United Kingdom but in the world, so there is not a problem with the natural advantages of coming to North Cornwall. However, I worry about investment, private and public, in the built environment. This new report is extremely helpful from that point of view.
Again, I give credit to the Government for their response. As the hon. Member for Conwy (Mrs. Williams) said, the foot and mouth disaster hit coastline areas such as mine as hard as it hit inland, but help was not available so quickly. However, I give credit to the Government. The market and coastal towns initiative provides a mechanism to assist, and it has advantages over some of the traditional ways in which local communities have been helped because it is very much bottom-up. It is all about local initiative. If there is one point on which I disagree with the hon. Member for Vale of Clwyd, it is that I am not convinced that the man in Whitehall or, as I would say to the Minister, the woman in Whitehall knows best in such matters. The more we can give opportunity for local initiative and respond to that and match it with serious funding, the more successful we will be.
My only concern with the initiative is that it tends to concentrate on the larger centres of population. I have in my constituency the worldwide surfing centre of Newquay, but I also have some smaller coastal towns such as Bude, Tintagel, Port Isaac and Padstow, which are famous in different ways. They are not going to benefit in the same way as some of the big towns. Although Newquay, which is here in the list, has one of the worst unemployment rates for 2002—we are addressing that successfully with some effective
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initiatives locally—some of the smaller towns also suffer. My concern is that local initiatives must be given as much flexibility as possible and the opportunity to develop in their own way for their own circumstances and communities. Yes, let us have a dedicated Minister if that will help, but let us not have this top-down approach, but a bottom-up one.
I particularly want to take up the point made by the hon. Member for Blackpool, South (Mr. Marsden). The British Resorts Association, of which he is a notable ambassador and with which I am also involved, has been effective in galvanising local communities to do their own thing and not just to accept what Whitehall has said. The biggest single way in which we can assist those communities is to ensure that, when they can both meet the requirements of residence and extend their season, nothing should be put in the way to prevent that. Full-time, skilled jobs and a quality product must be the aim.
2.50 pm
Mr. Alan Campbell: I, too, congratulate my hon. Friend the Member for Vale of Clwyd (Chris Ruane) on securing this important debate, which provides an opportunity to reflect not just on the problems of seaside towns, but on the progress that is being made. It is almost unique to take part in a debate in which hon. Members on both sides of the Chamber acknowledge that.
My constituency includes Whitley bay, which, according to the Sheffield Hallam definition, is the principal seaside town between north Yorkshire and the Scottish border. It is a town of some 37,500 people and to a lesser or greater extent has similar problems to those outlined today. The explanation that is often given is the change in the annual week or two-week family holiday. That is a contributory factor, but on closer reflection there are other causes of the problems.
As well as those structural changes, important as they are, it is important to recognise that seaside towns suffered disproportionately from the big recessions of the 1980s and 1990s. Colleagues who do not represent seaside towns faced complaints, but those of us representing seaside towns in particular faced complaints about the number of for sale and to let signs and the number of charity shops in the high street. Seaside towns must attract people, and local residents were concerned that the wrong impression was being given.
The fact, not just the impression, of a stronger local and regional economy, helped by a particularly good summer, has created the feeling in places such as Whitley bay that perhaps we are turning the corner. We do not know whether that will be a long-term effect, because if one swallow does not make a summer, one summer does not make a strategy. However, although the structural problems remain, there are signs that seaside towns may be turning the corner.
It was announced yesterday that a long-awaited new shopping mall in Whitley bay has started. It was promised more than a decade ago but is being delivered only now. The local authority cabinet, which is a Conservative cabinet—I want to avoid accusations of political point-scoring—was due to make the decision yesterday on which developer will be given the task of

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developing the Spanish City site, and earlier in the summer it was announced that the Government would provide £7.5 million to improve the seafront and to put in some of the infrastructure for the private sector developer.
The Sheffield Hallam study shows that seaside towns have seen a rise in employment, which in many cases is at least the same as elsewhere in the country. More spending power in the high street, low interest rates and rising property values mean that Whitley bay is now a good place in which to invest, and I hope that people will do so. To that can be added the regeneration of the public sector infrastructure with two new first schools—controversially, they are being built close to the seafront—investment in the people who will teach in those schools, the increase in the number of nurses and local and central Government employees, a disproportionate number of whom choose to live in seaside towns because they are nice places in which to live. Public spending is an important factor in the regeneration and redevelopment of seaside towns and there are signs of that.
I want to focus on the balance between public and private regeneration. I welcome and encourage private sector developers, but local government and central Government should retain a role. I shall give a couple of illustrations. First, the Sheffield Hallam study showed that some seaside towns are changing what they offer and are finding a niche in the market. For Whitley bay, that means less emphasis on the annual family holiday and more on the evening economy. If one books into some hotels, one is more likely to find oneself among people on a stag or hen night than among people on a family holiday. That is not to be pushed away entirely, because it brings money into the town and people then develop hotels, bars and restaurants—that is welcome. However, the downside is the tension between residents and visitors over matters such as drink-related antisocial behaviour. A balance must be struck.
Secondly, private developers are too often trying to cash in on rising house prices. As such, development projects often mean a lot of houses, and they will change the architecture and nature of seaside towns if we are not careful. Local government and central Government have a role. I endorse entirely what my hon. Friend the Member for Vale of Clwyd said about ring-fenced funds. We need a resorts taskforce, and the idea of a Minister has much to commend it.
Another part of the jigsaw, the regional development agency, is underperforming in my region. We need a coastal strategy that includes coastal resorts, which are part of the regional economy. Fishing communities also need help, but I am sure that we can build on the progress that has been made.
2.56 pm
Shona McIsaac: Like others, I congratulate my hon. Friend the Member for Vale of Clwyd (Chris Ruane) on securing this important debate and on managing to raise the issue at Prime Minister's questions today. That was a marvellous trailer for a marvellous debate.
When I saw that the debate was scheduled for today, I cast my mind back to August 1996, which must have been the only time that Cleethorpes has appeared on the
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front cover of virtually every national daily newspaper. A one-man regeneration whirlwind in the form of my right hon. Friend the Member for Hull, East (Mr. Prescott), who is now the Deputy Prime Minister, descended on Cleethorpes and brought with him most of the national media. That certainly gave a mini-boost to the local economy that day. I do not think that as much fish and chips and ice cream has ever been sold. The story is there for everyone to see, and I am included as well.
To be fair, Ministers have visited: my hon. Friends the Members for Rossendale and Darwen (Janet Anderson) and for Pontypridd (Dr. Howells). However, such visits are few and far between. I believe that many Ministers do not really appreciate the serious nature of the problems in seaside resorts. When people visit on the weekend, they see the wonderful bustle of the seafront at Cleethorpes. Like others, we have a marvellous sandy beach. We also have a steam railway and the east coast's answer to Alton Towers in the form of Pleasure Island. Unlike the seafront in the constituency of the hon. Member for Southend, West (Mr. Amess), Cleethorpes has the shortest pier in Britain, but one can walk almost to the Netherlands when the tide goes out.
It is a marvellous place, but, as others have said today, behind the few hundred yards of seafront there exists phenomenal deprivation in seaside resorts. The statistics show that 10 of the 14 electoral wards in north-east Lincolnshire, of which Cleethorpes is part, are in the top 30 per cent. of the index of multiple deprivation. I live in the ward of Croft Baker, which is the heart of the resort. It is in the top 20 per cent. of the most deprived. Other wards in the local authority also come in very high. One comes in in the mid-200s in the list of more than 8,000 electoral wards in the UK. That deprivation exists. We have more people unemployed, more people permanently sick and more people with disabilities. Young people drift away to universities in other parts of the country and do not come back.
It was mentioned that house prices are rising in Cornwall. House prices are not high in north-east Lincolnshire. My neighbour, my hon. Friend the Member for Great Grimsby (Mr. Mitchell)—Grimsby and Cleethorpes go together like fish and chips—said in The House Magazine:
"house prices are so low you could afford to buy a house for your stay. It will be cheaper than a London hotel room and you'd end up with an investment property."
However, low house prices per se do not bring regeneration. The fact that our house price base is low means that landlords who have been milking the property markets in some of the towns in Yorkshire tend to want to sell those properties and move people into resorts such as Cleethorpes. Those people are being shifted, and that is leading to many problems in the housing markets in our areas.
As has been requested many times this afternoon, we need a coherent strategy pulling together the multiple problems that affect seaside resorts. If it were any other industry, the problems would have been addressed long ago, but because the resorts are dotted around the coast of Britain they have been overlooked. I hope that Ministers will do something. I issue a challenge to the Minister. Her Pontefract and Castleford constituency is probably just under an hour from Cleethorpes. She just needs to go down the M62, on to the M180 and stop

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when she sees the sea. She can bring her children and enjoy the day, but she can also take a look behind the seafront and see some of the severe problems that exist in our seaside resorts. Another Yorkshire MP said to me that he thought that there was deprivation in the mining communities in Yorkshire, but he had not seen anything like the deprivation he noticed when he visited Cleethorpes.
Vera Baird: My hon. Friend was verging on a subject that I want to mention, briefly, in connection with Redcar, which is the other seaside resort between north Yorkshire and the Scottish border. Does my hon. Friend agree that a problem that we have shows that the real difficulty is the lack of a conceptual grasp of seaside towns as a whole? We have a super new town centre and it is a great attraction. The trouble is that mobility patterns have altered, so that peripheral streets at the bottom end of the high street now have 19 empty shops—I counted last Saturday. Seaside towns are quite poor and peripheral. They do not have the money in the local economy to sustain themselves through change such as that. The situation is self-perpetuating and just gets worse.
David Taylor (in the Chair): Order. The intervention is rather long. Will the hon. Member for Cleethorpes (Shona McIsaac) respond and wind up as rapidly as possible?
Shona McIsaac: I totally agree with my hon. and learned Friend the Member for Redcar (Vera Baird). She has certainly added to the debate and illustrated the nature of deprivation in resorts.
I hope that the Minister will come to Cleethorpes—a nearby resort—to see the problems. I am sure that, if she does, she will appreciate the sheer strength of feeling among those who represent coastal areas, who know that something must be done to stop the decline.
3.3 pm
Mr. Adrian Sanders: I congratulate the hon. Member for Vale of Clwyd (Chris Ruane) on securing the debate. I entirely agree with him about ring-fencing and the need to create a level playing field. He gave the example of Corus, where 3,000 jobs were lost and £90 million paid. In my constituency, 4,300 jobs have gone—I am talking about Nortel high-tech industry—and not a penny was paid, although people were helped through the Employment Service into other work.
Most of our seaside resorts are Victorian in character. Their original infrastructure was created by the Victorians. They grew greatly at the time of the development of the railways as a way of enabling people from inland areas to visit the coastline. Things improved as the working man, and later the working woman as well, were allowed holidays. Statutory holidays helped to develop the British coastal seaside resort. Things changed in the '60s, almost at the height of that development, after people gained more employment and holiday rights. The jet engine came on stream, which guaranteed people decent holiday weather by taking them to the Mediterranean at a relatively
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reasonable price. That industry has got bigger and bigger, and families who used to have a two-week bucket-and-spade holiday in Bridlington, Torbay, or Blackpool, now enjoy the same holiday in the Mediterranean or even Florida.
The whole industry has therefore had to change and adjust. One way it has been able to survive is through people gaining more holiday rights—in many cases, people take a second holiday at a UK seaside resort. The transport infrastructure has improved, which has enabled people to reach holiday resorts more quickly, but it has also meant that they tend to stay for shorter breaks. They no longer depend on the coach or train service that took them down on a Saturday and did not allow them to escape for the next week or two. Today, they go down, and when it starts raining they leave the hotel and go home.
The whole industry has changed, and that has resulted in less money spent by tourists staying in local economies. That point should be emphasised. Today more tourists are needed to generate money that stays in the local economy than were needed in the '60s. Not only are tourist numbers down, but the value of that industry to the local economy is far less than it used to be. Holiday resorts have responded. They have tried to find new attractions, they have invested in their infrastructure, and they have looked for new products and improved existing ones.
The resorts constantly face trends that go against them. The 1960s holidaymaker who stayed in a guest house, which supported a family for 12 months a year, will today come down for a few days, go self-catering and possibly stock up in a Sainsbury's, a Morrison's or a Marks and Spencer's. Visitors do not spend their money in family-owned local businesses. When people went out in a town in the 1960s, they would go to a local restaurant or pub. Today, they spend their money in a branch of a national chain of restaurants or pubs. All the time, less money from tourism stays in the local economy, and that has a big impact on average incomes.
The Fothergill-Beatty report concentrated on unemployment and totally missed that vital point. We have been conditioned to think that unemployment is a dreadful thing—it is, but low incomes depress areas as well, and coastal communities face the problem of low incomes. There can be 100 per cent. employment, but if people are all in part-time jobs they are not earning the money that they used to. In many of our seaside communities, incomes are well below the national average, even if unemployment is only slightly above the national average. The Government have to recognise that and do something about it. It is the single biggest issue.
The Fothergill-Beatty report tended to concentrate on the right statistics but to draw the wrong conclusions. It seemed to take the fact that lots of people want to migrate to coastal towns as a good thing. We tend to accept that: people move to the south-east, the area is popular, house prices increase and therefore the area has a booming economy. However, the type of people who move to coastal areas—as the report identifies—tend to be those who are economically inactive or winding down economically. They are not thrusting entrepreneurs with high qualifications who want to create wealth. They migrate to enjoy the natural environment. There is nothing wrong with that, but the report turns it into a

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positive, when, in fact, it creates problems—it does not solve them. Migration is not, as the report suggests, a positive factor.
What do seaside resorts need? They need their problems to be recognised, which Ministers have begun to do. They also need support. Yes, some grants have been tweaked to help, and yes, word can go out to RDAs that some of the single regeneration budget funding should be skewed towards seaside resorts—I do not know whether that happens in every region. No specific grants are available for local authorities. The Government say, "Well, we have got some European funding." However, communities qualify for European funding irrespective of the fact that they are on the coastline. That is more spin than substance. Specific grant funding is required to help those communities to increase their incomes and economies.
Vera Baird: I intervene to emphasise the hon. Gentleman's point, which returns to the need to view seaside towns as a whole entity. Redcar, for instance, does not have a swimming pool, which is absurd for a seaside town of 40.000 people. No state agency will help us with that project because if one divides the population of the borough by the number of pools, on the face of it there are enough. State agencies do not see that such an amenity is absolutely imperative to a seaside resort. The want of a clear conceptual vision must be pursued.
Mr. Sanders: I cannot but endorse the hon. and learned Lady's comments, speaking as somebody who represents an area with a population of 126,000 that does not have an all-weather running track. We miss out with those grant regimes that do not consider applications holistically.
We are discussing what is behind the facade of palm trees and deck chairs. As my hon. Friend the Member for North Cornwall (Mr. Tyler) said, housing problems can be acute whether house prices are high or low. If house prices are high, local people cannot afford to purchase because they cannot compete with the people migrating in.
We have a problem with absentee landlords. Many social problems, such as antisocial behaviour and drug abuse, occur in areas of private sector rented accommodation where there are absentee landlords. We have an acute shortage of social housing. More money must be put into the Housing Corporation and housing trusts in order to put that right. We need investment in training, even better transport links and, above all, improved infrastructure to build on what the Victorians gave us and to make those communities vibrant, successful and prosperous in the future.
3.12 pm
Mr. Geoffrey Clifton-Brown: I am delighted to catch your eye, Mr. Taylor. Surprisingly enough, I have one thing in common with the Minister: she and I are the only two Members present for the debate who do not represent seaside towns. I do not have to be nice to the Government because I have nothing to lose if they fail to give my town any money.
I congratulate the hon. Member for Vale of Clwyd (Chris Ruane) on securing the debate, which has been extremely useful. Seaside towns have not been given
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enough attention by Conservative Governments or by the Labour Government, and there is a lot more to do. Seaside towns can learn a lot from each other's best practice. I do not agree with everything that the hon. Gentleman said, and I may return to that point if I have sufficient time.
I congratulate my hon. Friend the Member for Southend, West (Mr. Amess) and the hon. Members for Blackpool, South (Mr. Marsden), for Cleethorpes (Shona McIsaac) and for North Cornwall (Mr. Tyler) on their speeches. I have not forgotten the hon. Member for Tynemouth (Mr. Campbell), who is nodding his head.
I was delighted to hear my hon. Friend the Member for Southend, West praising the Government, although I hope that he will revert to type soon. I also hope that he manages to persuade the Government that his constituency should get the Palace hotel, that his fisheries project should be supported and that Her Majesty's Customs and Excise should relocate to Southend, West, in which case he will be delighted that he has attended the debate.
As many Members have said, many national problems affect seaside resorts. The hon. Member for North Cornwall briefly referred to the paper, "Shifting Sands", commissioned by English Heritage and the Commission for Architecture and the Built Environment. The opening paragraph admirably sums up the debate:
"As an island nation, our relationship to the border between land and sea is unique and deep rooted. Seaside towns share many similarities with their inland cousins, yet remain fundamentally different: climate, remoteness, ageing and transient populations, changing demands, balancing the needs of day-trippers with residents."
That sums up what many hon. Members have said regarding our 43 principal seaside towns. I have spent a good portion of my life in north Norfolk, near Sheringham and Cromer, which are not on the list of 43 principle towns, so it is clear that many other towns need to be considered, too.
Statistics show that seaside towns are often small and diverse. There are 1.3 million people in our 43 principal seaside towns, and such towns tend to be small; roughly half have a population of fewer than 50,000. The excellent statistics prepared by the Library for the debate show that 32 per cent.—almost a third—of the 1.3 million people in our seaside towns are, as one would expect, connected with distribution, hotels and restaurants.
I would have thought that in most, if not all, seaside towns, an increase in prosperity will be led by an increase in tourism. That is why they must be made into attractive places that people want to visit. That includes people in this country, many of whom take a holiday—and particularly, nowadays, a second holiday—to a seaside resort. Also, we need to encourage more inward tourism from abroad. The Government can play a greater role in that. Tourism is now the world's largest business. It employs many people, particularly at the lower-skills end of the spectrum, and so should be taken more seriously by the country.
I should like to plug my area at this point. I do not represent a seaside town, but my constituency, the Cotswolds, has a crucial interest in tourism. I invite all

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hon. Members to go there; we like lots of visitors and tourists. Indeed, I am sure that every other hon. Member here likes people to visit their seaside town.
I do not have many minutes left, but I could not conclude without mentioning some problems that seaside towns have in common with the rest of the nation. I agree with hon. Members who said that regenerating seaside towns is a cross-government, multi-agency problem, but I criticise the Government for having so many different regeneration schemes. The problem is that no one knows what they all are. Statistics show that many funds are underspent, because people do not know what they are. I ask the Government to consolidate those schemes and promote them further, so that everyone can benefit from them. That would be a major step forward.
I also agree with those who say that we need to increase education and skills, not only in seaside towns but for the rest of the country. That does not necessarily mean sending everyone to university—the 50 per cent. target is suspect—however, there are vocational and other courses that people in seaside towns should have the opportunity to take. Education, and persuading people with skills to stay in their home seaside town, is important.
Many have mentioned the lack of affordable housing, which particularly affects seaside towns. The hon. Member for North Cornwall, who is chuntering in the background, mentioned the problem. Unfortunately, the homelessness statistics that have come out today make pretty dismal reading. The number of homeless households with dependent children increased by a massive 8,000 between 1997 and the last quarter of 2003. The statistics show that the number of those in bed-and-breakfast accommodation almost trebled between 1997 and the second quarter of 2003; and, more worrying, that the number of unintentionally homeless in priority need has continued to rise from 102,430 in 1997 to a staggering 129,320 today. Indeed, the Select Committee report on affordable housing said that we now have the highest number of homeless households that this country has ever had.
We need to be building more affordable houses, and more houses throughout England and Wales full stop. We have the lowest number of housing starts at any time since before the second world war. We need to address those problems, and consider how we can build more affordable homes, because young people wanting to get on the housing ladder are simply priced out of the market in a lot of seaside resorts, especially those in the south.
I am surprised that the hon. Member for North Cornwall did not mention what he has said often in the past: that in the south-east and south-west the affordability gap—the gap between what people earn and what they have to pay for a house—is widening alarmingly. The problem is not so bad in some places in the north. That makes it very difficult for young people to buy a house in the area where they were born and where they want to live.
Finally, there is an issue of funding. As well as consolidating their regeneration schemes, the Government should consider other factors. In 1999,
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there was a problem because the partnership investment programme and gap funding was withdrawn by Europe. I want to hear from the Minister whether that funding has now been fully restored to the various projects to regenerate not only our seaside towns, but inner cities. Has the gap been plugged? We want to make sure that, where necessary, seaside towns get investment. It is clear from the statistics produced for today's debate that where there is a thriving seaside town, there is net inward migration—there is a relationship in that the more thriving the seaside town, the more inward migration, growth and employment there is. That is surely what we all want to see.
Seaside towns play a vital role in tourism in this country. We need to pay more attention to them and encourage people to think that a holiday by the seaside is the best possible thing they can do for their health—provided they do plenty of walking by the sea when they get there.
3.21 pm
The Parliamentary Under-Secretary of State, Office of the Deputy Prime Minister (Yvette Cooper): I congratulate my hon. Friend the Member for Vale of Clwyd (Chris Ruane) on securing this debate and on choosing a subject that is of such importance not only to his constituents but to many people across the country. I also thank other hon. Members for their excellent contributions this afternoon. I congratulate my hon. Friend the Member for Blackpool, South (Mr. Marsden) and many other hon. Members here on their work as part of the seaside and coastal towns group of MPs. They have undoubtedly done much to raise the profile of seaside towns and the complex issues that they face.
We know that many seaside areas face common problems and issues. First, peripheral location can be reflected in weaker transport links, which can lead to problems in attracting new businesses, especially manufacturing, and inward investment. Secondly, changing trends in tourism, as described in some detail by the hon. Member for Torbay (Mr. Sanders), have moved faster than local infrastructure. However, visitors still flock to the British seaside. In a summer such as the one we have just had, the British seaside comes into its own. Nevertheless, people seek different kinds of accommodation and breaks. Often, the accommodation provided has been historically developed and does not suit the expectations and demands of tourists today.
Thirdly, as many hon. Members have said, employment in seaside areas is often seasonal and low paid. That can lead to a low and variable skills base with problems in retaining and upskilling staff over time. That is one of the reasons why the Government are backing the establishment of the sector skills council for tourism. Fourthly, seaside towns attract a comparatively large number of people from the young and old age groups. That, combined with a high commuting population, can lead to high levels of non-employment and reliance on local authority services.
Those issues were explored in depth in the recent Sheffield Hallam report, which was conducted by many of the same people who were in the original coalfield taskforce. They examined 43 large and medium-sized

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seaside towns, and their report is a welcome analysis, which will help all of us to understand and tackle the problems of coastal areas. Two main things came out of the report. First, the traditional economic base of the seaside town is very much in place: significant numbers of visitors still go to the British seaside. In 2002, UK residents made 33.7 million trips, which were worth £4.6 billion. We have to recognise the changes in the nature of tourism, which remains a significant industry.
The hon. Members for Southend, West (Mr. Amess) and for North Cornwall (Mr. Tyler) both gave a strong account of the delights for tourists in their constituencies. I will refrain from discussing the merits of the different ice creams from the different areas, but if the hon. Gentlemen want me to sample the ice cream from their constituencies, I would be happy to do so. I would also be happy to visit the constituency of my hon. Friend the Member for Cleethorpes (Shona McIsaac).
The nature of tourism has changed, but we should nevertheless be optimistic about the prospects for tourism in our seaside towns. The second important point made by the Sheffield Hallam report was that, unlike coalfield and other traditional industrial areas, seaside resorts have experienced strong population growth, not an exodus of people. Between 1971 and 2001, net inward migration to seaside towns increased their population of working age by 360,000; people want an attractive and enjoyable living environment.
However, my hon. Friend the Member for Blackpool, South made an important point: although there has been job creation in many seaside towns, inward migration has often outstripped that job creation. That can lead to problems of non-employment and underemployment, although the Sheffield Hallam report makes it clear that seaside towns as a whole do not suffer from a spiral of decline. Nor should we write off seaside tourism; that is important.
My right hon. Friend the Chief Secretary to the Treasury held a seaside town seminar for MPs from all parties on 1 July, following a request from my hon. Friend the Member for Blackpool, South. On 18 September, an official seminar, in which many different Departments will be represented, will be held to discuss the Sheffield Hallam report; I believe that my hon. Friend will be chairing that seminar. The Chief Secretary will host a further seminar in December. Given that so many hon. Members have raised funding issues, and given the discussions in the run-up to the 2004 spending review, I can certainly say that the right host has been chosen for the seminar.
However, I would sound a note of caution on the issue, raised by many hon. Members, of ring-fenced funding. We get pulled both ways; every group or organisation wants ring-fenced funding for their area or concern, but equally everybody argues that we should
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get rid of ring-fenced funding and give local areas and organisations more flexibility to make local decisions about the way in which resources are spent. We are keen to promote greater local decision making, particularly by regional development agencies.
We recognise that there are significant issues that seaside towns have in common; we also have to recognise that there is a wide variety of issues. My hon. Friend the Member for Cleethorpes talked about the housing problem facing her constituency—low housing demand and its consequences. Meanwhile, the hon. Member for North Cornwall referred to high housing demand and high prices. So seaside towns also face very different issues; it is clear that there is not a one-size-fits-all solution. For that reason, we are not convinced that a seaside trust would be an appropriate vehicle to manage the difficulties faced by such towns. However, I am keen that we should continue to look at the issues and have further discussions with the seaside group of MPs.
We need to ensure that regional development agencies, which are well placed to take a local strategic look at the problems facing seaside towns, continue to work with regional tourist boards and with local councils. I agree with my hon. Friend the Member for Tynemouth (Mr. Campbell) that local authorities are a critical factor, and have an important role to play. We need to ensure that they look not only at tourism issues—which, as my hon. Friend the Member for Conwy (Mrs. Williams) says, are extremely important—but at other areas of employment and job growth as well.
The social exclusion unit is conducting a project that is looking at the barriers to jobs and enterprise in deprived areas and at some of the huge variations that exist between areas. One of the area studies that it is doing is at a seaside town; I will ask the unit to look particularly at whether there are seaside factors involved in the wide variation in employment and non-employment levels.
Hon. Members have made a series of important points about housing, particularly about the HMOs, which I do not have time to address, but I agree with my hon. Friend the Member for Vale of Clwyd that we need licensing of HMOs. We want mandatory licensing for HMOs that are of three stories or more and occupied by five or more people, and we want to give powers to local authorities to take further action. There is obviously a wide range of issues in seaside towns that need to be addressed. The broad programme of regeneration and neighbourhood renewal programmes that we have in place across the country forms an important building block, but clearly we have further to go. I look forward to working with seaside MPs to determine what further steps we can take.

Keynsham and Paulton Hospitals
3.30 pm
Dan Norris: May I say how nice it is to be here under your chairmanship, Mr. Taylor? I was not expecting to see you today. It is an unusual situation for us to be meeting here in September. It would not previously have been possible for me to air my constituents' concerns at this time of year. I am very grateful for the changes in the hours and sitting dates, not least because this matter would otherwise have gone unnoticed in this place.
This issue is about fairness, not favours. I want to stress that. It is a justice issue. To allow the Chamber to make sense of it, I shall explain something of the local situation in and around my constituency. The Bath and North East Somerset primary care trust, which is responsible for the decisions about Paulton and Keynsham hospitals that are the subject of today's debate, covers north-east Somerset, which is largely made up of about 80 per cent. of my constituency, as well as Bath. Although that forms one area, there is a distinct difference between how Bath operates and how Bath people see the world, and how north-east Somerset operates and views the world.
One of the most notable factors is that the north-east Somerset part of my constituency covers a very large area—as large as the neighbouring Bristol constituencies and Bath put together. There is a great difference in geography and in how people see the world and relate to it. It has an older population than average, and some of the proposals relate to older people. They have a resonance that might not be understood if one did not know how the population of my constituency was made up.
My constituency has, by and large, an affluent population. Unemployment is incredibly low, and was the lowest in the country six months ago. I think that I am right in saying that that is the first time that a Labour constituency has had the lowest unemployment in the whole country. It still remains very low, but there are areas of significant poverty. It is to people in those areas that Keynsham and Paulton Memorial hospitals are most valuable. If there are great distances to cover and one cannot easily afford to travel, they are all the more important.
I want to stress something that people will not understand without a local knowledge. The hospitals have great emotional resonance and importance for local people. Keynsham hospital is well known to many of my older constituents, not least because they remember it as being on the site of the old workhouse. In some respects, it strikes fear among the very oldest. Paulton Memorial hospital was established to recognise the needs of the mining community. It is centred in the heart of the former north Somerset coalfield area. Although the last pit closed 30 years ago this month, the miners whom I saw at a reunion on Monday were full of their concerns about the hospital. They know how important it is to that community, and what great service it has given over many years, not only in my lifetime but in previous generations.
This is not in any sense a criticism of the Government, because there is a perfect understanding in my constituency that the decision, on which I shall
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elaborate in a moment, to make changes that are in effect cuts to the local service has been made by the local primary care trust, Bath and North East Somerset, which is made up of local appointments and people who should well know the area and the reaction that there will be to the proposals—although I fear that they do not. For example, there is a complete understanding that the Government are investing hugely in the health service in my local area. Bath and North East Somerset primary care trust is to receive £40.7 million over and above what it had been allocated—some £12 million this year, £14 million next year and £14.7 million the year after.
Because such huge and welcome Government expenditure has resulted in extra staff and other improvements, there is consternation and disbelief that there could be any talk of cuts in local hospitals. That seems incongruous with what is seen as the good work of the Government, for which people voted in two successive general elections, and it causes puzzlement and concern. There has also been a welcome for the many millions of pounds of investment in local education.
On top of all that, there has been a particular welcome for the investment that has recognised the toil of and pain suffered by many former miners in my constituency and the surrounding areas. Wansdyke has just received £1.3 million in compensation for emphysema and related issues. That is something that people welcome and understand: they recognise that such huge investment is important, and there is no question but that they appreciate the local NHS staff. What is difficult to understand is my area's unique honour: two hospitals, Bath royal united hospital and Bristol royal infirmary, with its associated trust hospitals, both got zero ratings in the Government's listings. Local people do not perceive that as meaning that they are not doing good things; they recognise that they are clinically excellent and do some wonderful work. By and large, they welcome the scrutiny that went into the compilation of the figures and statistics—they long suspected that things were not of the standard that they should have been—and they recognise the importance of transparency. Unless a problem is identified, it cannot be dealt with.
Having said that, they also appreciate the work of local NHS staff, and that of the extra doctors and nurses who have been available since 1997. They understand that cancer treatment has improved significantly in the locality. Both in-patient and out-patient waiting lists have reduced a great deal, which is very welcome, as they were not satisfactory for a long time, and they also know that since last summer nobody has had to wait beyond the prescribed period of 12 hours on a trolley in Bath. That was not the case in past years, so there is great admiration for the work of NHS staff, not least those in Paulton and Keynsham, who have a good reputation and whose high standards are valued.
However, there is great anger and intense and passionate feeling about the proposals to cut services at hospitals in my constituency, which would involve Paulton's losing six beds and Keynsham 10, and the relocation of Keynsham clinic. People are concerned

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because they recognise the good work that is done there, but most of the anger relates to the bed cuts rather than to the relocation; they understand the need for change, provided that it means better services in the future.
There is also a worry that services to older people are under threat. Most of the population in Wansdyke and north-east Somerset is older than average. People also feel that there is an attack on mental health services and respite care services. Many carers are totally dependent on the respite care provided by the hospitals in one form or another. There is distress about the proposals because people had understood that when the new primary care trust came into being it would address mental health issues, issues for older people and respite care. Despite the opening up of communications, and the understanding that there would be proposals to make cuts if that were deemed necessary to balance the books, they did not expect soft targets to be hit. We are talking about the most helpless people in our communities and, along with the bed cuts, people are mystified as to why they should be targeted in that way. Having attended all four public consultation meetings, I know that they are not persuaded by the plans allegedly to maintain the standard and quality of service by new methods, not least care in the community.
You probably remember as well as I do, Mr. Taylor, that a Government of a different political persuasion set out on the care in the community road many years ago, thinking that it would bring cost savings, but it turned out to be a more expensive way of doing things. I think that, by and large, it was a better way of doing things, but it was not a mechanism for saving money. People are not convinced by the arguments put by the primary care trusts that the moneys that they want to save by making bed closures and other changes will fill the shortfall, although some of the money will be redirected to care in the community; people want to ensure that standards remain the same or, better still, that they improve.
I started by saying that there should be fairness and not favours for my constituents. They are aware of the overspend of £15 million, and they recognise that one has to balance the books. They do not want extra money, over and above their fair share, and they recognise that they are getting a lot more now, in line with many other parts of the country, which is right and just. However, if the books have to be balanced, they believe that the overspend should be corrected where it occurred. That was not in Paulton or Keynsham. Indeed, two thirds of that £15 million overspend took place in or around Bath royal united hospital. My constituents are rightly asking why the remedy is not being targeted at the place where the overspend occurred. The books must balance, but why should good hospitals that did not run up a deficit pay? That is to overlook the main culprit.
There is a history of poor management in relation to the Bath NHS trust under its various names over the years, not least the fact that it was so poorly managed at one time that three chief executives were salaried. Indeed, one of them was successful in obtaining £200,000 for unfair dismissal for being sacked while ill. An awareness of such figures when compared with saving beds does not go down terribly well with those whom I represent.
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Consultation meetings are a great forum for people to express their feelings—they are an important part of the process—but it is fair to say that some of the meetings have been quite stormy. I think that people have not been personally angry at the members of the trust, and although it might sometimes have felt like that to the chief executive, I assure her that that is not the case. However, it is a measure of the intense passion and feeling that has arisen. As a result, the chief executive sometimes thinks that it is being suggested that she does not care and that she is being cold and calculating. I do not believe that to be the case. I have found her to be accessible and prepared to talk at length about her plans. I am not convinced by the plans, although they have some merit because the books have to be balanced; but a range of other cost-cutting options that would be fairer and more just would not have created such a strong public reaction among my constituents.
In one matter, however, I am critical of the Government. I do not expect the Minister to share my view, but when the Government appoint primary care trust chairmen, they should be as partisan as necessary. One of the reasons for the current difficulty in the Bath and North East Somerset primary care trust is that the chairman is not of the same political persuasion as me or you, Mr. Taylor, and the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) is his leader. This Government are clearly committed to extra expenditure, to reform and to a set of values. After all, the Labour party, my party, created the NHS and wants to ensure that it becomes even stronger and better. It is therefore very difficult for many local people to comprehend how someone of a different political persuasion can, in all integrity, properly accept the thrust of Government thinking and want Government policies to be implemented. Clearly there is disagreement, although I respect their right to hold their own views.
We should reconsider how we appoint people to become chairmen of PCTs. There is nothing wrong with appointing people of the same political persuasion as the Government and being straight and open about it. People would understand that completely. They would not like it, however, if someone's political persuasion were somehow hidden or disregarded when it was an important factor. We should know that everyone is pulling together and working together in the same way. That issue has caused consternation among local people.
It did not help that the chairman of the trust missed the first three of the four consultation meetings. Of course, he may have gone on a well-deserved holiday. Who would not want someone to have a holiday in the summer? However, PCT chairmen presumably want to support their staff in the difficult proposals that they are presenting to the public, so when they know that a consultation meeting is coming up and have a choice about the times and dates of consultation meetings, surely they would want to be there to defend them and to explain, even to enthuse, if they felt so minded. I can say, in all charity, that not being present at the first three meetings was not the best way to win friends and influence people. I hope that he will be present at the final meeting in my constituency, so that he will have been present at two out of five meetings at least.

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The strength of feeling is best illustrated by petitions that have been collected in my constituency. At the risk of boring hon. Members, I will read them out, but promise that I will do so quickly. I penned the first petition myself, on behalf of the Wansdyke Labour party. It states:
"We, the undersigned, are deeply concerned by local plans to reduce the number of beds at Paulton and Keynsham Hospitals at a time when the Government is providing £40 million extra funding over the next three years to improve the NHS in our area.
We urgently call upon the Bath and North East Somerset Primary Care Trust to reconsider its ill thought out plans to cut hospital beds, at a time when extra Government funding means there should be improved NHS services."
That petition was also taken up by the friends and users of Paulton hospital, who have done great work in collecting signatures.
The second petition was undertaken by a local newspaper, the Somerset Guardian. I thank Joanna Roughton, its editor, for running it. It says:
"We, the undersigned, strongly believe that there should be no cuts in the number of beds or staff at Paulton hospital."
Another petition, undertaken by another local publication, The Journal, says:
"We oppose the closure of beds at Paulton and Keynsham hospitals, and other proposed economy measures, at a time when there is increasing NHS funding."
I thank George Donkin, its editor, for running that petition.
I want briefly to thank others, such as the friends and users group and everyone involved with it, especially Tony Clements, Mavis Ditte and Sue Padfield. They spent much time on their petition over the summer. I am very glad that it was a good summer, as they were outside for a great deal of time collecting signatures. I mentioned the local editors of the relevant media in and around Paulton. I also thank the local councillors, who have been part of an action group to fight the proposed cuts, especially Keynsham councillors Adrian Inker and Hilary Fraser and Paulton councillors Hattie Ajderian and Brian Barrett. They, too, did tremendous work over the summer with the ward constituents. They have been a source of advice and help to me, for which I am grateful.
I also thank members of Wansdyke Labour party, and all the other people unknown to me, many of whom have worked so hard to collect what is now approaching 10,000 signatures. That is roughly one in six of all my constituents. I am sure that it could be much higher with enough bodies to collect the signatures. It is certainly the biggest petition that I have received since becoming a Member of Parliament in 1997. It is fair to say—I am bound to be subjective—that the issue has created the most intense feeling in my time representing the people of Wansdyke.
The issue is about fairness, not favours. Local people do not want to be let off any financial impediment that would otherwise come their way. They recognise that if there has been an overspend the books must be balanced, but they want the balancing to occur where the overspend took place, which predominantly means the Bath royal united hospital. The Bath and North East Somerset primary care trust has not weighed that up in its proposals to make cuts.
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I believe in devolved decision making. Bearing in mind my proviso about the appointment of chairs, primary care trusts are a good way of making important local decisions in the NHS, but many people—in my view they are wrong—feel that the consultation is a sham. It is not a sham, and I am quietly confident that there will be a compromise because of the strength of local opinion, which is expressed through petitions, public meetings, letters and phone-ins to radio stations and various other media. There will be a compromise, but I ask the primary care trust to be careful not to jump out of the fire and into the frying pan. There may be a strong public reaction if it keeps beds open but changes their purpose.
3.51 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I congratulate my hon. Friend the Member for Wansdyke (Dan Norris) on securing the debate. I have listened to and appreciated his comments, which he has expressed with concern and passion, about an issue that matters to people in his constituency and thereabouts. I should also like to take this opportunity to join him in paying tribute to all the staff he mentioned in the local health economy. They are obviously committed to the improvement of the local NHS and also to the provision of services to patients.
I shall discuss the local issues in a moment, but it is important that we acknowledge the pressures on the NHS not only in my hon. Friend's constituency but throughout the country. We want not only to increase capacity but to raise clinical standards. We do not want more of the same; we want a radical re-examination of the best ways of providing services for patients both now and in the future.
The NHS plan sets out a challenging 10-year programme for the reform of the NHS. In that context, it is worth saying that far-reaching changes are often necessary to provide the best possible services for patients. We must ensure that services are accessible and flexible and we therefore want to design services around the needs of patients. As part of that modernisation programme, many economies and organisations in the NHS are considering changes in how they organise their services with stakeholders.
Hospital services must change if we are to continue to fulfil patients' needs and to improve access. Services cannot and should not remain static for ever. They should be responsive to local needs and to the changing opportunities for developing services. Local providers of health services have a responsibility to live within their means. My hon. Friend sketched out the balance between those two issues at play in this situation.
As my hon. Friend knows—I will not go into this in great detail—it is obviously for the primary care trusts in partnership with strategic health authorities and other local stakeholders to determine how best to use their funds to meet national and local priorities for improving health, tackling health inequalities and modernising services. They are in the best position to know, because they are closest to the local community.
In my hon. Friend's constituency, the local PCT, Bath and North East Somerset, is recovering from a £15 million deficit, and I appreciate the concerns that he has expressed on behalf of his constituents. The local

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strategic health authority, the Avon, Gloucestershire and Wiltshire strategic health authority, has worked closely with the whole health community to make the necessary savings. Savings are required not only from community and primary care but from the acute sector. My hon. Friend emphasised fairness, not favours. The whole health community needs to tackle the problems that it faces together. That is why the local PCT has published the consultation document, "Living within our Means", which identifies how it proposes to make the savings.
The consultation ends at the end of September. I assure my hon. Friend that local stakeholders have been involved in the process, and he knows that full well from his own close experience. Since the document was published, the PCT has engaged in wide consultation and there have been 30 to 35 meetings with specific interest groups. He has been active in attending many meetings on the subject himself.
My hon. Friend is right to say that the proposals in the consultation document include a reduction of 23 beds across three community hospitals. I recognise the interest in and love for those community hospitals that he expanded on. The plans also include expanding the PCT's hospital at home scheme, and working with social services and other partners to reduce the length of patients' stay in community hospitals to speed up discharge and get people back to their own homes, which is where most of us would rather be at the end of the day.
The PCT has been running the hospital at home scheme since 2000. It provides 24-hour cover, seven days a week and has been extremely successful. External evaluation of the service, which focused on the patient experience, has also been positive. The Commission for Health Improvement considered the scheme on a recent visit to the PCT in March and commented favourably on the extended service.
By extending the hospital at home service, the PCT is confident that it will be able to meet at least some of the needs that are currently being met in community hospital beds. Obviously, under the consultation arrangements, all those hospitals will still exist. It is simply the number of beds that is at issue.
The model of care proposed should provide a much more personalised and local service, tailored to the individual patient. That is in line with our policy on intermediate care, particularly for elderly people. Intermediate care is not an optional extra. It is central to the modernisation agenda. There could be slight confusion concerning both the modernisation agenda
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and the budget deficit. There may be attractions to making the changes in any event. I recognise that people must be more sceptical when there is a deficit, and that is probably part of the difficulty with considering the case and its issues objectively. That is not surprising.
Returning to the local health economy, it is only fair to say that I acknowledge that Avon, Gloucestershire and Wiltshire strategic health authority has inherited serious financial and performance issues. I was pleased to hear the account of the performance of many parts of the NHS. However, Avon, Gloucestershire and Wiltshire is one of the most challenged strategic health authorities in the whole of England. I am pleased to say that in order to assist the strategic health authority to manage the considerable financial pressures that it faces, an additional package of financial support has been agreed.
I recognise the pressures that the strategic health authority is under, but I repeat that our policy is that PCTs, in partnership with the local NHS trust and the strategic health authority, decide the priorities for the NHS locally. That is where local knowledge and expertise lie, and it is not appropriate for Ministers to decide on that direction of travel and how services should be configured. We have made that clear, and I know that my hon. Friend accepts it. It is right that the local NHS should deal with that. I hope that, having secured and driven forward the debate, he will continue to work with the local NHS, as I know he will, to build a better future for the residents in his area.
Whatever decisions are reached locally will involve full and public consultation, and the passion and expression of views that are a part of that. They will be made after much consideration and healthy, open debate.
I hope that hon. Members will understand that it is not appropriate for me to comment further on the issue, in case, following the local process, that pre-empts any future ministerial decision that may be necessary. However, I assure my hon. Friend that the Department and Ministers will continue to work with the local NHS to review the progress of the local economy, to ensure that the difficulties faced continue to he manageable and that changes to the service are in the interests of patients.
David Taylor (in the Chair): The current debate has finished slightly early and a Division is expected in the House, but as the opener of the next debate and the Minister are present, I am obliged to ask the hon. Member for Lewes (Norman Baker) to commence his remarks.

Flood Defences (Lewes)
4 pm
Norman Baker: I am sorry to be here again, as I am sure the Minister is, to speak on a matter that I had hoped we had, if not quite put to bed, at least sorted out in a way that would provide good progress for our local community.
The Minister will be only too aware of the terrible floods that hit Lewes in 2000, which we believe were the worst in the country. They were certainly among the worst, and—there is the Division Bell.
Sitting suspended for Divisions in the House.
4.25 pm
On resuming—
Norman Baker: I was musing on the fact that the stop-go arrangements that have characterised the beginning of this debate are not too different from the stop-go arrangements that have characterised the provision of flood defences in Lewes. I said during the half-minute or so that I had at 4 o'clock that the Minister knows only too well that the Lewes floods in 2000 were, if not the worst, certainly among the worst in the country. He visited Lewes, and I am grateful for the interest that he has continually shown in the matter.
The Minister may remember not just houses but upstairs bedrooms that had been flooded—the sight was unbelievable. Obviously, the floods caused huge distress and inconvenience to people living in Lewes. In some instances, they were out of their houses for almost two years. The feeling in Lewes is very much that such floods must never happen again. At the time, the Deputy Prime Minister spoke about a wake-up call. I am here to ensure that the Government have not gone back to sleep but are continuing to try to provide flood defences for Lewes.
People are particularly concerned, given that after the 1960s floods there was, apparently, a similar determination to do something about flood defences, but it ebbed away. In 2000, people recognised that the opportunity after the 1960s floods to improve the defences had been lost, and they are keen that the same mistake is not made again.
As a matter of fact, people in Lewes do not want to talk about floods and would rather put them behind them. They want to come together and move on with their lives after the unfortunate, unpleasant and stressful incidents that happened to them, but they cannot move on as they want to because the situation remains fragile. Yes, they are back in their homes. Yes, they are getting insurance cover now, and I thank the Minister and his colleagues for all the work that they did with the Association of British Insurers to help bring that about. Yes, the Environment Agency and the flood defence committees have produced plans that, by and large, the people in Lewes are happy with, but there is now a real concern that flood defences will not be provided.
The Minister may think that that is over-egging it, but that is what is circulating in my constituency. The local paper, Lewes Life, ran the headline "Anger as Government scraps flood schemes" a couple of weeks
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ago. I hasten to stress that that is not coming from me but is what is being said in local papers. Naturally, the people of Lewes are getting very edgy.
They are made even more edgy by the suggestion that has come from meetings with the Lewes Flood Action Group and Department for Environment, Food and Rural Affairs officials and in comments from the Environment Agency, that a solution may be found for part of Lewes but not for all of it. It would be very unfortunate if that were to be the case. When the town of Lewes was flooded, it pulled together very well as a community. People say to me that the community response and the way in which people helped others were similar to that in the second world war. People expect a townwide solution to a townwide problem, but instead they are offered cells.
The Environment Agency has done its best and has produced plans that will, if enacted, deal with nearly all the town. As the Minister knows, it has not been able to justify action in some areas: the Landport area, which is mostly council housing—there is a possibility that the district council could do something there—and Malling Deanery and New Malling, where there are a few houses. There are a few odd patches that are outside the main Environment Agency scheme, but the scheme, for which I am thankful, should deliver flood defences in Lewes. However, it now appears that it may not happen.
There will almost certainly be flood defences in Malling and probably in the Cliffe cell, but from the information that I have been given it seems unlikely, or at least highly debatable, that flood defence schemes will be produced for the other cells: town centre, west, the Talbot terrace area, North street, and so on. That is very serious. People would once again have the spectre of flooding hanging over them, with no relief in sight. People deserve better than that, after the horrors they went through and the promises that they thought the Government had given.
Insurance companies have, with the Government's help, been quite supportive. The insurance problem has, by and large, gone away because of the schemes; people are being asked to pay a lot more, but can mostly get insurance. However, that problem will recur, because if the insurance companies think that the schemes are off the agenda, they will simply pull the plug. We must not let that happen.
I could spend some time listing constituents who are worried about the matter, but I refer to Minister to just one group, in Lewes new school, a private, progressive school that has had coverage in the national papers for the education style it provides. It is in the Talbot terrace area. The school was badly flooded shortly after it opened. It has scrambled to get itself back together again, with a great deal of parent and community effort. It was flooded by up to 4 ft of water for three days during the 2000 floods. In a letter to me, dated 9 September, its representatives gave their view:
"If the Environment Agency does not flood-proof the Pelts"—
that is in the Talbot terrace area—
"we will be caused distress because:
It is unlikely that we will be able to renew our, or get any, insurance as the current coverage is contingent on the Environment Agency installing flood measures for our area.
The ongoing stress of the threat of winter flooding will be intolerable on our small school, especially as predictions are that more flooding is likely to occur as a result of global warming"—

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the Minister will recognise that as a genuine concern—
"and we understand that flooding of the Pells area is more likely if other areas like Cliffe High St. are protected."
The idea of dealing with flood defences in cells is divisive and nonsensical. I hope that the Minister will say that we will move away from the cell culture to a common community defence standard for the town. Why is there such a cell culture, and is the Environment Agency in favour of it? Has it made representations to say that it should be replaced? My indication, from national conversations, is that the agency does not like the cell culture. I am not convinced that the Minister does, either, although perhaps he will say he does. So who does like it? The Treasury, which wants to control funds? If so, why not say so in the open, so that we can deal with the problem?
It is invidious and inappropriate to have a cell culture, particularly if, by providing defences in one part of Lewes, the risk in other parts is increased, because the floodwater has to have somewhere to go. Will the Minister say directly whether the provision of flood defences in one part of Lewes will worsen the flood risk for parts that are not protected? If the answer is yes, it would suggest that the cell approach is completely wrong, and that in itself is justification for a common community defence standard in Lewes—and indeed in similar towns throughout the country. What is the DEFRA view on cells, and will the Minister answer my question about the relative risk to other areas?
There is genuine concern about how the present arrangements work. Tom Crossett, the flood defences co-ordinator for Lewes Flood Action, drew attention to some of the inconsistencies caused by the present arrangements in a letter to me, dated 5 September. He estimates that the defences for Malling will cost £800,000, and those for Cliffe £2.2 million. He says:
"the current points system, with its emphasis on economics rather than people, sets greater value on the assets protected. (£18.4 million as opposed to £4.5 million in Cliffe.)"
He continues:
"The tragedy of human suffering that flooding brings and you know so well among your constituents is much better represented by the rate of flooding. You will see from the attached tables that every time"
a flood occurs
"in the Brooks…the average Cliffe resident will have had to mop up between 2 and 3 times…In other words the rate of flooding in the Brooks is 1.9 houses per year, whereas in Cliffe the rate is 4/".
The risk to individual people, which is what matters, changes, but the economic calculation that is applied does not take that fully into account. That is a problem.
I recognise that the Minister is sympathetic—I am not buttering him up; he knows me well enough to know that I say what I think. He has tried his best to resolve this matter, and I have confidence that he will continue to do so. However, I need to know what obstacles are slowing things down in providing proper flood defences for Lewes. Is the flood defence review interfering? Is there simply insufficient funding for flood defence? There has been some increase in funding from the Government in recent years, which has been welcome, but if that is not enough I hope that DEFRA Ministers are saying clearly to the Chancellor that more money is needed. It is intolerable if towns such as Lewes—I am
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sure that there are others—continue to suffer major risks of flooding because the Government will not provide the necessary funds.
One of the problems in Lewes is that the cost of dealing with the walls is greater than was originally thought. Perhaps cost will make things more difficult, but Lewes's walls are more than 200 years old in places and they have not had money spent on them for the past 40 years. Is the Government's policy to replace or repair them, or shall we give Lewes back to the river and marshland? Lewes is an historic and special town, and it is recognised by the Government as one of the top 50 towns in the country for urban environment. We must have a townwide solution because we cannot have continued risk hanging over our head.
Downstream storage is not the whole answer, and I do not pretend that it is. However, three years after the floods occurred it seems that no progress has been made on identifying how we can use fields south of Lewes and north of Newhaven as excess storage capacity in the event of floods.
The Environment Agency acknowledges that using downstream storage would, at the very least, take the edge off some of the flooding that would happen in Lewes in the event of a major flood. Why has no progress been made? It seems a relatively simple matter of making environmental assessments, of having discussions with about 12 landowners and farmers and of ensuring that compensation plans are in place. That does not seem terribly difficult to organise. How could it be easier to get planning permission for dealing with major town walls in the middle of an historic town than to sort out downstream storage in a lot of fields? However, every time I raise the question with the Environment Agency I fail to get a straight answer. Will the Minister find out why no further progress has been made on the use of downstream storage to ameliorate the situation and take the edge off any future flood—God help us if that occurs?
I know that the Government would like to use contributions from developers or riparian owners to meet some of the costs of flood defence—who would not? If a Government of any persuasion can find someone else to pay for something that will be of public and private benefit, they will take that opportunity. My concern is that the rules are not clear. When do the Government expect riparian owners to contribute? Is it simply a question of when the Environment Agency is able to lean on people and persuade them to cough up, and if they do not the Government will make up the difference? What rules apply to contributions from riparian owners?
Can the Minister also assure me that we are not seeing a two-tier flood defence system emerging, whereby those areas with rich riparian owners who can contribute have their flood defences mended because they provide match funding, and those areas with no such owners do not have defences provided? It would be intolerable if there were one rule for rich areas and another for poor areas. I hope that he can confirm that that is not the Government's position. He needs to set out the position on riparian ownership. Finally, can he assure me that if riparian owners do contribute, their money is not counted as a windfall by the Government and will not be deducted from the money that DEFRA would otherwise provide?

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I hope that the days of my securing debates on flood defences in Lewes are numbered. I am really sorry to have to return to the matter today, but the uncertainty of the present situation makes that inevitable. I know that the Minister means well and I have every confidence in him. I hope that he can give some answers to reassure my constituents.
4.39 pm
The Minister for the Environment (Mr. Elliot Morley): I congratulate the hon. Member for Lewes (Norman Baker) on securing this debate. I understand his concerns and those of the people of Lewes who were badly affected by a severe flood. He was right in what he said. It is not unreasonable to have an opportunity to explain some of the complications of and reasoning behind flood risk assessment and the analysis of the general principle of flood defences.
I understand that people become frustrated, but it is not fair to go to the papers and say that flood schemes in Lewes will be scrapped. That is not so, and the Department for Environment, Food and Rural Affairs has given the go-ahead for Malling Brooks, which meets the criteria. It might be delayed by last-minute technical issues that the Environment Agency must resolve, but the scheme has our approval because it meets all the criteria and is not a problem in that sense.
I have been at great pains to ensure that I have been honest when I talk to the local media in the hon. Gentleman's constituency about the problems facing Lewes. Installing a flood defence scheme there is not simple. If it were, it would have been done a long time ago. There are complex technical and engineering issues, with the complication of riparian owners, walls being in private ownership and private contributions. There are all sorts of problems, and many of them can be resolved, but not overnight. I have always made it clear that there must be a proper assessment. A strategy must be put in place and worked up, and that is being done.
The hon. Gentleman asked me about the walls, which are a complication in Lewes. As he knows, for many years, houses have encroached on the river because people like to live next to rivers. That means that the walls are part of the foundations of the houses and of the river defences. The Environment Agency is trying to find an equitable split between the contribution that the Government, the agency and the regional flood defence committee are prepared to make towards strengthening those walls for flood defence purposes and the benefits that will accrue from strengthening the structural foundations of the houses. Under the strategy, some of the walls will have flood defences on top, and there is concern that because of their age and condition they will not take the weight and might collapse. There is also concern that when poking about in structures that may be many hundreds of years old an awful lot of problems may be found. That may increase the cost and we must have some idea of the cost implications, because the cost may be a great deal more than has been projected. That is not to say that the scheme will not go ahead. We are not saying that if the costs rise there will be no scheme—I want to make that clear—but we need to know exactly what is involved.
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We expect the Environment Agency to seek contributions from riparian owners for flood defence benefits, as well as the structural benefits from flood defence walls. That is of direct benefit to property owners because of the impact on property prices. If a lot of money is spent strengthening and defending a property, that will be reflected in its value and it is not unreasonable to have a contribution from the owner. That creates all sorts of problems, and the agency is currently trying to find a way through.
I concede that the way in which cells are approached is not ideal. For engineering purposes, it is normal to look at a flood defence scheme in terms of self-contained cells. That is part of the engineering assessment. I will be quite honest and say that it is also the case that an assessment must be made of the cost-benefit ratio. It would not make sense to spend millions of pounds on a cell if that is far greater than the value of the property within it. We have 1.7 millions properties at flood risk, and we face demand for schemes all over the country, including in the Uck catchment. We have to use resources in the most effective way.
To illustrate that point, I can give the hon. Gentleman an indication of the calculations that are made. He is quite right about the Malling Brooks and Cliffe areas. If we take a one in 100-year flood event, which is the kind of protection level that I want to see, there are about 218 residential properties at risk in Malling Brooks and 166 in Cliffe. There are also commercial properties. Town centre, west has a score, but one that is low priority. We have two residential properties at risk there in a one in 100-year event. In North street there are no residential properties at risk in a one in 100-year event. In Talbot terrace there are six. Some schemes may cost millions to defend a tiny number of properties.
I know that that is not much consolation to the people who live in those areas, or to the school in Talbot terrace that the hon. Gentleman mentioned, and I sympathise with their situation, but they cannot expect millions of pounds of taxpayers' money for a very poor return on those cells, when that money could go to other schemes, including in Lewes and other parts of the Uck area, where many more people can be defended. My intention is quite simple: I want to reduce flood risk for as many people as I possibly can. We sometimes have to accept that kind of cost-benefit analysis to get the maximum benefits from the available resources. That is why it is done in that way.
Having said that, with the development of new technologies that we are funding and experimenting with, although those communities do not qualify for defence now it may well be that they will in the future. It does not mean that there may not be some form of temporary or portable defences, which are being developed around the country, that could be applied to defending such areas. It does not necessarily mean that they face a future with no possible defence whatever. I do not know all the circumstances, and I do not know at present whether it is possible to use those means there; what I can assure the hon. Gentleman is that we are actively looking at ways of doing so. We are looking at ways all the time of maximising protection for people either through permanent engineered defences, soft defences or new technologies, such as portable, demountable or temporary defences. We are considering all those things, which may have potential

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benefits for people who live in areas that currently do not qualify for a scheme. It is not necessarily the end of the story.
The hon. Gentleman also asked about downstream storage.
Norman Baker: Before the Minister leaves cells, will he say whether the provision of flood defences in some parts of Lewes can worsen the flood risk in others?
Mr. Morley: Yes, I will deal with that point, because I think that I have some stats that I can give the hon. Gentleman. In examining the schemes, we have to take into account the impact on other areas of putting defences in one area. That is a normal part of the assessment. Looking at the defence that is likely to go to Malling Brooks, because the case has been accepted, up to a flood event of one in 50 years there is no change and no impact at all on other parts of the town. If we take a flood event of one in 100 years, there may be a difference in the water level as a result of the schemes of between 30 mm and 70 mm, which is not a very large amount. To put it in perspective, we would get a much bigger wave from people driving through flood waters as, sadly, they are rather inclined to do, not knowing that it creates a bow wave that raises the water level and can cause a lot of problems for people in flood-hit areas. The amount is minuscule. It is not really going to impact on other parts of the town. I can give the hon. Gentleman that assurance.
I am pleased to say that our discussions with the Association of British Insurers have been very constructive. The insurance companies are taking a perfectly reasonable and pragmatic position. In the case of the school mentioned by the hon. Gentleman, the ABI says that even properties without the short or medium-term prospect of a defence will not be automatically disbarred from insurance. The insurance companies are prepared to examine cases on their individual merits and talk to the people concerned.
Apart from the new technologies, we also give advice on floodproofing and flood mitigation through the Environment Agency. That can help to ensure that insurance is maintained and that people deal with potential risks even when there are no flood defences.
Do not think for a moment, however, that that is our preferred solution. Our preferred solution is, of course, to provide people with proper flood defences, but we must face the reality that we must prioritise. When I was the Minister responsible, I was very keen on the scoring system that we introduced. I want people to see how things are calculated, so that residents are aware of where they are in a calculation. A priority score is a way of ensuring that the maximum number of people most at risk get the priority. That is entirely justifiable. I know
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that it disappoints those who do not qualify. Although they may not qualify now, that does not mean that they will not qualify in the future, nor does it mean that no other measures can be taken to deal with the problem.
The hon. Gentleman asked about downstream storage. He knows that I am very keen on the upstream flood plain reinstatement and downstream soft defence approaches—they both have a role. The Environment Agency is actively modelling the benefits of removing some of the banks downstream from Lewes. As he said, when it models it must consider the impact on other areas, which it must ensure is not detrimental. It also has to model the removal of banks to understand what reduction there would be. One would not want to see the expenditure of large sums, which could be spent elsewhere on flood defences, to obtain only a small reduction. That would not work. The agency has to convince itself that the expenditure would be beneficial, and that work is under way.
I understand people's frustrations—with particular reference to the lady in the newspaper article that the hon. Gentleman mentioned—and I am always keen on getting things done tomorrow, if possible, but sadly, it does not always work like that: one has to go through the correct process. It is worth pointing out, however, that through the agency we have spent about £600,000 so far in the Uck-Ouse river valleys. That includes reinstating the existing defences to their pre-flood standard, and a lot of that money has gone into Lewes. The expenditure also includes improved telemetry and warning systems throughout the river network, and the upgrading of pumps in Malling Brooks. That £600,000 is money on account and is not to be sniffed at. It demonstrates the commitment of the Environment Agency and ourselves. We are committed to reducing risk.
We recognise the case that the hon. Gentleman makes, and he has every right to make it. I hope that he understands that I will not mislead people about the technical and practical problems that we face in areas such as Lewes. It is not the easiest place in the world to install flood defences, but I can assure him that we will install them. We have approved the first cell and I am confident that the second cell will also be approved. We will not stop there. We will continue the research into whole catchment management and continue to support new technology and defence innovation. We will also continue to provide advice for local residents, and to work with local councils and agencies to reduce risk.
I am sorry that progress sometimes seems slow, but I hope that the hon. Gentleman understands that our commitment is unwavering, and that we will find every way that we can to ensure that we improve the defences for the people of Lewes.
Question put and agreed to.
Adjourned accordingly at five minutes to Five o'clock.