Westminster Hall Sitting of 13 July 2004

Preamble
[MR. BILL O'BRIEN in the Chair]

NHS (Thames Valley)
Motion made, and Question proposed, That the sitting be now adjourned.—[Paul Clark.]
9.30 am
Mr. David Cameron: I am delighted to have the opportunity to open this debate on the national health service in the Thames valley. My remarks will focus mainly on my county of Oxfordshire, where the state of the national health service remains a huge concern to my constituents. I held a debate on the NHS in Oxfordshire more than two years ago in this Chamber, and rereading it today, the issues are depressingly familiar: the closure of cottage hospitals, problems at the John Radcliffe hospital, staff shortages and bed blocking. I am not going to make exactly the same speech again, but there will be similarities.
It would take a heart of stone not to repeat to the Minister the pledge that we heard so many times from Labour in 1997—"24 hours to save the NHS". In Oxfordshire and parts of the Thames valley, seven years on, it all sounds rather hollow. I shall put a genuine puzzle to the Minister this morning. There have been huge increases in spending on the national health service in Oxfordshire—no doubt the Minister will dazzle us with the statistics at the end of the debate—so the puzzle is why, with all the increased spending, the news flow about the NHS in Oxfordshire and the Thames valley is so bad.
Let us take a number of true stories from the past 18 months. They come from my postbag, my surgery, local newspapers and local doctors. The Witney minor injuries unit is to be shut in the evenings. Community beds are to be cut throughout the county, north and south. Ambulance stations are to close, including the two in my constituency, Witney and Chipping Norton. A new out-of-hours service is to be introduced, which will give less than the good service that we enjoy now. There are blocked beds, cancelled operations, financial problems and large deficits at the John Radcliffe, and substantial cuts are set to follow. As is the case across large swathes of the country, no NHS dentists take new patients except in emergencies.
If that sounds like a list of moans and groans, that is because it is. Those problems are all genuine and all inconvenient, and sometimes a lot worse, for my constituents. First I shall try to explain the three problems at the heart of the NHS economy and the health economy in Oxfordshire. I will then rewind and run through some of the individual problems that I have mentioned in more detail. I will finish with a few suggestions for the Minister on how to try to start to put the NHS economy in Oxfordshire back on track.
In the spirit of fairness, I should say that there is some good news—Thames Valley strategic health authority helpfully gave me a sheet entitled "Good News". Waiting times were 11 weeks on average at the end of
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2003–04, compared with 14 and a half weeks the previous year. Accident and emergency waiting times were dreadful in Oxfordshire; we no longer have people waiting more than 12 hours for admission—but no one should ever have to wait in accident and emergency for 12 hours. We no longer have many four-hour waits in A and E, but sometimes waits are still very long.
I have spent quite a lot of time in the John Radcliffe hospital over the past couple of years with my son, who is severely disabled. We have had some long waits in accident and emergency, but recently it has got better. The care that we have received at the John Radcliffe—normally on ward 4C, known as Smallpiece—has been superb. I pay tribute to the wonderful caring nurses who have looked after us, and the excellent doctors and consultants. We have had our problems trying to get discharged, particularly with the right set of drugs. When asked, I always say that the John Radcliffe is hard to get into and hard to get out of, but it is wonderful while one is there.
To return to the mystery: what is wrong with the health economy in Oxfordshire? As I have said, at its heart lie three problems. First, Thames Valley receives low funding per head of the population—according to the head of the Thames Valley strategic health authority, whom I met last week, it is the lowest in the country. Of course we are a wealthy and, as a result, quite a healthy area, but the money is asked to stretch very far compared with what happens in other parts of the country.
The second problem, which is at the heart of all this, is the state of the finances of the Oxford Radcliffe Hospitals NHS trust. Last year, the trust faced a deficit of more than £40 million, and broke even only with £25 million of external support and housekeeping savings of £20 million. This year, it looks as if the situation will be even tougher. The external support will fall and there are additional cost pressures, which include the consultants contract, the pressure on the drugs budget, and NHS inflation. The Thames Valley strategic health authority financial performance report put it like this:
"The Oxford Radcliffe position is now £10m worse than the original plan: a £7m shortfall on the savings originally planned, £2m further costs of the Consultant contract … and £1m of other pressures (mainly activity-related). Overall, there is a potential deficit of up to £45m, to be reduced by the further savings plans that are being worked on."
On the general situation in Thames Valley, the report says:
"The overall level of savings needed to give breakeven would be £154m, equal to an average 7.6% of PCT allocations. There is £14m of planned support available towards this, which still leaves a requirement for £140m"
of savings, which is
"almost 7% of allocations overall. This level of required savings creates significant financial risk, reflected in the deficits currently forecast."
There are also significant risks that there would have to be substantial cuts in NHS services in order to meet those deficits. That is what the Minister has to focus on. We can all look at the Thames Valley SHA report and see the reductions in services that will be needed in our own health areas.
For Oxford Radcliffe Hospitals NHS Trust, even the earlier figure mentioned as the amount needed for savings—£35 million—is 8.7 per cent. of its income.

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That would mean making substantial reductions. I meet the new team at the Oxford Radcliffe Hospitals NHS Trust regularly, as do colleagues, and it seems to me that Sir William Stubbs, Trevor Campbell Davis and their team are trying to get to grips with the real problems. However, the size of the deficits make it likely that there will have to be significant cuts, including redundancies. Given that we are endlessly being told that the health service is expanding rather than contracting, that seems extraordinary. I hope that the Minister will look into the matter carefully.
My hon. Friend the Member for Banbury (Tony Baldry) has been raising the issue consistently. As a former Minister, he does not cry wolf, and he has looked into the matter carefully. However, the problems continue, and he has written an endless number of letters to the Department of Health about them. I appeal to the Minister to take some time to consider the Radcliffe, try to understand what is wrong, and make sure that front-line services do not suffer.
The Oxford Radcliffe Hospitals NHS Trust towers over the rest of the health economy in Oxfordshire. Its problems and deficits have caused problems for all other trusts. The reductions in the rest of the budgets set out in the Thames Valley SHA plan may look small, but one has to remember that the primary care trusts are very small, and have little discretionary spend. Most of their money is already allocated to GP practices and to commissioning in the health service, so any cuts that they have to make will hit the extra services that they have been funding, such as community health services.
Part of the issue is funding, and part is the fact that the health system seems to have a problem with a hospital as complex as the John Radcliffe. It is a district general hospital, a specialist referral centre and a teaching hospital. That can give it something of an identity crisis. More to the point, the system does not seem to reward it adequately for all that it does. The John Radcliffe strategic review is now under way, and we hope that it will settle some of the issues. I hope that the Department of Health will engage in that process.
Both the strategic health authority and the John Radcliffe have mentioned to me the way in which research and development is funded under the trust. They believe that there is a shortfall of some £7 million to £10 million. I would like the Minister to look into that, and perhaps write to me after the debate.
Matters are made worse by the third problem at the heart of the health economy of Oxfordshire, and it is a problem that also applies to the rest of the Thames valley—the high cost of living for our constituents and ourselves. House prices in parts of Oxfordshire are well above those in parts of London, so the temptation for nurses and doctors—just as for teachers and police officers—is to train in Oxfordshire and then go to lower-cost areas of the country. That partly explains the high level of vacancies in Oxfordshire. There is a 10 per cent. vacancy rate at the Oxford Radcliffe Hospitals NHS Trust, and that helps to explain the truly frightening figures for the use of agency staff. We all know that use of such staff is a tremendous waste of money, when we should have permanent staff.
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The high local costs have been, and still are, a problem, but I believe that they are about to become even more of a difficulty. The Government are moving the NHS towards a tariff system for costing operations and a concept of payment by activity and payment by results. A cynic might say that that sounds a little like the internal market that they abolished with such a fanfare seven years ago, but we will let that pass.
The new problem for the tariff, as I understand it, is that the costs of some London hospitals will be adjusted by 30 per cent., but the cost of the John Radcliffe hospital and other Oxford hospitals will be adjusted by only 3 per cent., even though the costs in Oxfordshire, as I said, are very high. Indeed, this tariff derailed the one piece of good news that the Government hoped to announce about the Oxfordshire health economy—the fact that the Nuffield orthopaedic centre, or NOC, had applied for foundation status. The way in which the tariff system will work is one reason why NOC's application for foundation status had to be rejected, so the thousands of hours of work and the thousands of pages of paper that it produced for the application were all in vain.
I have set out the problems of the overall funding situation, the special position of the John Radcliffe hospital, and the costs in Oxfordshire and the Thames valley, so I shall go into a little more detail about some of the key health issues that now affect the county in general and my mainly rural constituency in west Oxfordshire in particular. First, there are the community hospitals—an issue that is close to the hearts of many of us here today. We in west Oxfordshire are scarred because of the experience with Burford hospital, a much loved hospital that was closed after 1997. We were told that money would be reinvested in the area, and that there would be new community hospitals in other parts of the county, but so far we have been very disappointed.
Cottage hospitals are in a very strange position in the modern NHS. Patients love them, and write to me and to other Members about the wonderful intimate care that they receive in them. Local GPs like them, and the fact that they can visit their patients as they get ready to go home. Local communities adore them, and work their socks off to raise money to equip and endow them. The only people who seem not to treasure the cottage hospitals are those in the local NHS.
The most recent threat comes in the shape of the southern locality plan and the northern locality plan, whose raison d'être appears to be to reduce the number of beds in community hospitals. Whenever one asks why it is necessary or desirable to reduce the number of beds, one is pointed towards a study on the shifting balance of care and the White Paper entitled "Shifting the Balance of Power", which is all about trying to ensure that people are treated in the right setting. As my hon. Friend the Member for Banbury said, it should be called not "Shifting the Balance", but "Shifting the Blame", because the local emphasis has been on trying to save money in the Oxfordshire health economy to cope with the deficits at the John Radcliffe hospital.
I have four points to make about that. First while 100 to 150 beds are still blocked at the John Radcliffe hospital, it seems perverse to be trying to close beds in

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community hospitals. I should add that representatives of the John Radcliffe hospital gave me those figures in my meetings with them; I did not make them up.
Secondly, representatives of the John Radcliffe hospital argue that Oxfordshire has too few beds, not too many, so we must ask why their view is different from that of the PCTs. Thirdly, if Oxfordshire health chiefs want people to believe that more care can be delivered at home rather than in a hospital, they must first prove it. Given our natural scepticism, it is not good to say, "We'll all be fine and there will be much more treatment in the home," when we know from our postbags that social services cannot currently deliver that care in the home. After everything that has happened, we are sceptical, which not surprising.
Fourthly, work needs to be done to determine whether the community hospitals operate at or near full capacity. There seems to be some disagreement about that, as the hon. Member for Oxford, West and Abingdon (Dr. Harris) said in his Adjournment debate some weeks ago. If they do operate at full capacity, and it is my understanding that some of them do so much of the time, it seems hard to believe that the number of beds should be reduced.
The next point in my list of woes on the Oxfordshire health scene is about the way in which the Witney minor injuries unit has been managed. There have been two announcements that the unit would have to shut in the evenings. The first was because the John Radcliffe hospital was withdrawing staff from the unit so that it could meet its own four-hour waiting limits at its accident and emergency department. That is targetitis gone mad: one set of targets is met by shutting provision elsewhere. No one needs to worry about missing targets at the unit because, hey presto, it has shut—and if it is not open, it cannot have a four-hour waiting time. That is madness. Then the minor injuries unit was threatened with evening closure because the emergency nurse practitioners were hired by the PCT responsible for the Witney hospital to run the out-of-hours doctors service at Abingdon hospital. I hope that that will not appear in the manual of how to practise joined-up government.
West Oxfordshire district council stopped the closure by bravely taking the PCT to the High Court for its failure to consult, and reason now seems to be prevailing. However, I repeat the message that patients, staff and their communities at large value their community hospitals, and we should consider ways of building on them. They, too, suffer from the difficulties of recruiting and retaining staff, and the problems with the minor injuries unit prove just how thin the cover can be: if one nurse is off sick, the whole service can be threatened.
Wanting community hospitals to succeed is part of the solution. West Oxfordshire district council would help with key worker housing if the staff kept some of the rural facilities open. That is only right and natural, and the council would be doing its job of looking after local services. The health authority should be talking to the council.
I cannot stress the rural factors enough. We are often told, "The ideal size for a hospital is 60 beds, so your small cottage hospital just won't work." However, if people in rural areas were offered a choice between the perfect hospital 50 miles away and their present
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hospital, they would choose to keep what they have. To put it bluntly, in rural areas, living a long way from a hospital can mean death. We would rather keep what we have in Witney and west Oxfordshire than have the ideal hospital—or courthouse, or care home—somewhere else.
I turn now to the proposed out-of-hours service to cover for doctors. I shall then deal with the ambulance service and the proposals for Chipping Norton hospital, before making suggestions for the future. We all understand that out-of-hours cover was proposed because of the new GP contract, but my constituents want a simple answer to one question: will the new service be at least as good as, or better than, the existing service? At the moment, it is hard to believe that the answer could be yes.
In the South West Oxfordshire PCT, which covers about half my constituency, doctors' practices run a co-operative system, under which a doctor is on call. That is to be replaced by a service run out of Witney hospital, under which a paramedic will be on call. Anyone needing a doctor will have to go to Abingdon, which will become the hub of the service, with Witney as a spoke. For those who live in the countryside—in Leafield or Charlbury, for example—getting to Abingdon can take about an hour. People will not go to Abingdon; they will get in their car, drive to the John Radcliffe hospital and further fill up an already overcrowded A and E department. If the money being put into services is intended to improve them, it would seem logical to make Witney a hub, like Abingdon, because that is what it is to our villages. The service should also provide cover by a doctor as well as a paramedic.
With ambulance stations, I accept, as I am sure my constituents do, that it is the level of service, not the bricks and mortar, that matters. We should not be too sentimental about bricks and mortar, but people are sceptical about the level of service that they will receive when the ambulance stations in west Oxfordshire close. They are used to seeing the stations in their communities.
There is, however, a simple answer to that problem; I hope that colleagues will join me in recommending it, and I press the Minister to take it up. At the moment, the ambulance service is required to meet the eight-minute response time 70 per cent. of the time. However, that is calculated on a county-wide basis, so if the service concentrates on meeting its targets most of the time in urban areas such as Oxford, it does not have to worry so much about the rural parts of the county. Why not have a new stipulation that the eight-minute response time must be met 70 per cent. of the time in every part of the county, including rural areas? One could ensure that that it was met in every postcode area. That would be a neat solution to the problem: it would give people in rural areas a real feeling that they were being listened to and that the level of service that they received mattered.
In a way, Chipping Norton hospital presents a microcosm of the problem that we face in Oxfordshire. Retired doctor Sheila Parker wrote to me, saying:
"This hospital which was started by public subscription is part of our town and belongs to the citizens of Chipping Norton. Not to the Primary Care Trust who have the task of administering it."
I am afraid that she is probably wrong: the hospital probably does now belong to the primary care trust. However, her letter shows that people really feel that the

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hospital is theirs. The preferred solution is for the primary care trust and Oxfordshire county council to build a new care home, and for the health service to have some rehabilitation beds in that home. Under that plan, however, there would be no X-ray unit, although there is one now, no minor injuries unit, although there is some form of unit now, and fewer beds. People are left asking, "If all this extra money is going into the health service, why are we going to get less?"
Graham Pike, a nurse in Chipping Norton, wrote to me saying:
"Closure of the minor injuries unit … will also affect waits in the EDs"—
the emergency departments—
"The PCT claims that it is not well-used enough to be economical. I have lived in Chipping Norton for three years, yet I did not even know we had a MIU until I worked a shift at Chipping Norton Hospital. If people don't know about it, it will not be used. Far better, surely, to advertise the service better—thus taking a load from the EDs".
The primary care trust does not advertise or promote those services enough.
I shall end on what I believe the Government need to do for the health economy in Oxfordshire and Thames Valley. First, we need a proper explanation of the overall funding pattern, and of why the funding per head in Thames Valley is so much lower than in other parts of the country. Secondly, we need a proper Government-inspired look at the John Radcliffe hospital's finances and funding. To judge from my experience of looking at the issue—I am sure that my hon. Friend the Member for Banbury would agree with this—that seems to be at the heart of the problem. The big deficits at the John Radcliffe hospital cause a lot of problems elsewhere.
Thirdly, we need to take another look at Oxfordshire social services. It is no good saying that we will be able to have fewer community beds, when Oxfordshire social services already spend way more than the standard spending assessment, and yet are under so much pressure. Fourthly, we need greater moves towards flexibility on local pay. I do not see how our hospitals will ever be able to recruit and retain the necessary level of staff unless they have more flexibility on pay.
In order to restore the confidence of my constituents and others, I would also ask that the plan to reduce the community beds be shelved. The northern locality plan and the southern locality plan have been met with a hail of bullets, as it were, from MPs and others in our community, who simply do not believe that the argument has been made. If we are thinking about freedoms for hospitals to manage themselves—the Government are, and my party certainly is—we should give them to all hospitals, not do as the Government have proposed. We need a pledge from the Government, and all those involved in the health service in Oxfordshire, that if the deficits must be dealt with within a year—I am not at all clear why that should be the case—the axe will fall on bureaucracy, not on front-line services. On that note, I look forward to hearing the rest of the debate and the Minister's reply.
9.52 am
Tony Baldry: The Chamber will be grateful to my hon. Friend the Member for Witney (Mr. Cameron) for having initiated this debate and for describing the issues so excellently. The Oxfordshire health economy is in serious difficulties. I understand that the Oxford Radcliffe Hospitals NHS trust is expected to be overdrawn by at least £40 million next year, and there is speculation that the figure could be even higher. This is not the first time that that has happened. It also happened last year, when disaster was staved off only by using the proceeds from the sale of the Radcliffe infirmary to pay off the trust's overdraft, instead of recycling them back into new capital build in the NHS. That was not a particularly sensible way of using resources.
In part, the problem reflects the unfair formula by which the Government allocate money to health authorities across the country. It has never been properly explained why funding per head in Oxfordshire is so much less than elsewhere in the country. In part, that reflects the fact that there is no local cost of living allowance in Oxfordshire, which means that the trust has to pay premium rates to recruit and retain such staff, but has no budgetary provision for that. For example, the National Institute for Clinical Excellence guidelines for post-operative radiotherapy treatment for women who have had operations for breast cancer specify four weeks. By comparison, the period in Oxfordshire is 24 weeks on average, even with the trust paying radiotherapists a 30 per cent. premium on their salaries.
In part, the problem arises because no one has ever really got to grips with the nature of the John Radcliffe hospital, what part of the budget should be allocated to it as a district general hospital, what part should be allocated to it as a teaching hospital and how it should be rewarded for the research done there. That is not a new problem; it is ongoing, and has been so for at least the 20 years for which I have been fortunate enough to be an MP for an Oxfordshire constituency.
May I suggest that the time has come for an independent review, perhaps by an organisation such as the King's Fund, of what actually happens at the John Radcliffe, to ensure that it is fairly rewarded for the work done there? It cannot be right for a district general hospital to be substantially overdrawn year on year. Over the past 20 years, John Radcliffe hospital has experienced a sort of cyclical crisis: either the chief executive or the chairman is sacked or removed, and then there is a new internal review or a suggestion that the hospital has an internal problem. What is needed is an external objective investigation into the complexities of the way in which a district general hospital, a research hospital and a centre of excellence are organised together in Oxford.
The overspend has implications across Oxfordshire. One of the consequences is that primary care trusts are asked to make savings on their budgets but are not allowed to pass on the cost of making those savings to the Oxford Radcliffe Hospitals NHS trust budget. That makes nonsense of the concept of commissioning. Cherwell Vale primary care trust, for example, will have to find a £2 million saving this year. That may not seem a significant sum, given the totality of the budget, but because most of the budget is ring-fenced for GPs and others, that saving has to come out of just £9 million,

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most of which is for community health—so it is likely that nurses will be withdrawn from schools, the number of health visitors will be reduced and there will be other cuts in important front-line services.
Disturbingly, those reductions in primary care trust community budgets come at a time when the strategic health authority is trying to reduce the number of beds in community hospitals on the grounds that patients can better be treated at home. That is being done as a consequence of a White Paper called "Shifting the Balance of Power". As my hon. Friend the Member for Witney said, it should be entitled "Shifting the Blame", because it seems to be a rather cack-handed exercise. The NHS is shifting the responsibility for community health from community hospitals and the NHS budget to social services and the county council budget.
My constituents will never see the new 30-bed hospital at Bicester of which the right hon. Member for Darlington (Mr. Milburn) spoke when he was Secretary of State for Health. That is just not going to happen, and people in Bicester feel betrayed. They were promised a community hospital, and they are not going to get one. There are many other instances of the downgrading of local services. For example, it is clear that we will end up with, at most, two mental health in-patient beds in Banbury. Once Orchard Lodge closes, that resource will be moved to Oxford and we will also, effectively, lose The Elms. Any hope of a new-build successor to The Elms is forever lost, and, increasingly, any medicine that is vaguely specialist will be centralised in Oxford as a cost-saving measure.
It is also disturbing that we have been told that, as a consolation for not getting a community hospital in Bicester, we will have a minor injuries unit there. Having heard my hon. Friend the Member for Witney describing what is happening to the minor injuries unit at Witney, I wonder what benefit a minor injuries unit at Bicester will bring, and whether it will function as promised. There is a substantial attempt to shift the blame, both by the NHS centrally and by the strategic health authority, which seeks to blame any problem on the primary care trusts. That is one of the reasons for my concern about a treatment centre in Banbury. Of course one wishes to see greater activity in the national health service, but my concern is whether there will be increased money to match the increased activity.
Whenever I question the strategic health authority about that, I am told by the chief executive that:
"decisions on the commission of services are taken within the PCT's current commissioning budgets",
and that
"PCTs are in control of how and where their commissioning funding is used."
In other words, the funding for a new treatment centre in Banbury will have to come largely from Cherwell Vale primary care trust's existing budget. The PCT is in danger of being put in the invidious position of feeling obliged to support the treatment centre initiative, even though it might have to do so at the expense of funding that would otherwise have gone to the Oxford Radcliffe Hospitals NHS trust. If that turns out to be the case, it will be a curious state of affairs. Local people—GPs and others—would rather see services delivered coherently at the local NHS hospital than have to worry about the fact that delivery of services at that hospital is being
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undermined to satisfy ministerial press releases saying that additional activity is being introduced into the NHS.
Our other challenge in the Thames valley is the EU working time directive. Obviously, the directive's impact will be felt throughout the NHS, but potentially it will be greatest on smaller general hospitals. The geography of England is not convenient; the population does not always divide neatly for the purposes of the large general hospitals, and Oxfordshire is a case in point.
Oxford is pretty much in the centre of what is now the county of Oxfordshire, and, conveniently, the John Radcliffe hospital is able to serve much of that county's population. Looking at a map, one sees that the north of Oxfordshire tapers into a triangle surrounded by Warwickshire and Northamptonshire. At the apex is Banbury, the second largest town in the county, which is at the centre of what historians have frequently referred to as "Banburyshire"—the traditional area of surrounding towns and villages, from Brackley in Northamptonshire to Chipping Norton, and across to the Cotswolds in Oxfordshire and Shipston-on-Stour in Warwickshire.
Such places have always looked to Banbury, which was historically a day's cart ride away, as the local market town. To many people, Banbury is still the local town. The Horton hospital in Banbury has a catchment area with some 140,000 people, with many more at the margins. For decades, it has been the chosen general hospital of a very large population in north Oxfordshire, south Warwickshire and south Northamptonshire. There is no way that the John Radcliffe hospital could cope with all the extra work from the Horton.
However, there is no doubt that the Horton is a smaller general hospital. A number of years ago it started to have difficulties with some of the royal colleges, which asked whether medical training for junior doctors at the Horton alone was sufficient for them to qualify. Horton General Hospital NHS trust merged with the John Radcliffe NHS trust to form the Oxford Radcliffe Hospitals NHS trust, largely for that reason. The main intention was that junior doctors should be recruited by the trust as a whole and required to work both in Oxford and Banbury. By suitable rotation, one could then ensure good junior doctor coverage at the Horton and the junior doctors would achieve the necessary specialist training to satisfy the royal colleges. That system has been working well for some time.
However, the threatened impact of the EU working time directive is about to cause considerable difficulties at the Horton hospital. The Oxford Radcliffe Hospitals NHS trust is already reviewing whether it can continue to deliver 24-hour-a-day in-patient paediatric care at the Horton. That is a good service, which has existed in Banbury for at least 30 years. If the in-patient paediatric care goes, there will be a potential knock-on effect for the 24-hour-a-day accident and emergency cover and for the maternity unit.
If the Government were willing to make money available to smaller general hospitals to enable them to recruit additional junior doctors, that would be one way through the problem caused by the EU directive. I

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would imagine that the number of general hospitals would not be huge; they would be mostly in rural areas such as Cornwall or Lincolnshire. However, there would be a number in semi-urban mixed rural areas such as Banbury.
Presumably, the Government do not want to see existing general hospitals such as the Horton getting into difficulties with what services they can provide. Indeed, that would be all the more ironic, given that the Government are intent on setting up a treatment centre in Banbury. Presentationally, it would look perverse for the Government to set up a new treatment centre there while the general hospital, which has been in existence for decades, ran down its services.
This coming Monday, a petition signed by 40,000 people local to Banbury will be presented at Downing street. That is probably north Oxfordshire's biggest ever local petition; 40,000 signatures mean that at least one person in every household in Banbury and the surrounding area will have signed, because they wish to see children's services at the Horton saved. We have taken our campaign to Ministers at the Department of Health, to the president of the Royal College of Paediatrics and Child Health, to the board of the NHS trust, and now to Downing street.
The Prime Minister is ultimately responsible for funding the NHS, and he—and, through the Department of Health, the taskforce—should listen to the deep local concern. If paediatric services are downgraded at the Horton, children's lives will quite possibly be put at risk, as was said at the public inquiry that set them up 30 years ago. We come back to the conundrum with which my hon. Friend opened this debate. Ministers will tell us that more and more money is being put into the NHS, but the practical effect on the ground in our general and community hospital services in Oxfordshire is cuts and reduced services, bringing short-term crisis and long-term uncertainty.
10.5 am
Dr. Evan Harris: We should all be grateful to the hon. Member for Witney (Mr. Cameron) for securing this debate, which has given us an opportunity to talk about the problems affecting health services in the Thames valley—and, as we can see from the MPs who are present, Oxfordshire. I am in no doubt about the hon. Gentleman's commitment to improving services in his area. The same applies to the hon. Member for Banbury (Tony Baldry), who has a long history of seeking to secure the maximum possible effectiveness of the services in his area, and has raised some of the issues in various Adjournment debates and in questions to the Prime Minister.
I shall deal with a number of points, but I shall try not to duplicate what has been said by the hon. Member for Witney, much of which I agreed with. I agree that the problem is one of the health economy. When we discuss the NHS in Oxfordshire, we need to ensure that we do not "silo off" parts of the NHS, and that we recognise that it is all interrelated: we are talking about acute trusts, primary care trusts, community services and social services. If one or more of those service providers
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is constrained, it will have significant implications for the rest of the system. If we sort out constraints at the cheaper end of the service, where care costs less per night stay, for example, we can deliver savings in the rest of the system, and avoid false economies.
As the hon. Member for Witney said, that has not happened in Oxfordshire, because of the ongoing problems facing social services both with its budget—the services that it provides already have very tight eligibility criteria, although it spends above standard spending assessment, and is under Government pressure to reduce that spend for fear of council tax capping—and because of the difficulty, in an area of housing shortage, in recruiting relatively low-paid staff into jobs that are difficult. challenging and not well rewarded.
If the concept of joined-up government and joined-up provision of services is going to mean anything, it is time the Government demonstrated how they can be provided at a local level. There are partnerships, and service providers are working together, but a lot of that working together simply shows that none of them has any spare funding.
At the acute end, where most of the targets apply, there is enormous pressure to invest in acute services—"Hospitals first," in the words of the Prime Minister—but that means that we often do not get the funding for the more community-based services that would reduce demand for and spend on acute services. I am in no doubt that the money available could be better spent on simply sorting out the order of treatment. The Cinderella services—community and social services—should get a fairer share of the funding. The Government are at fault, because they have invested so much political capital in meeting targets that predominantly relate to the secondary care sector, which is far more expensive.
I did not wholly agree with the comments of the hon. Member for Witney about the unfair allocation system. I have always supported a system of funding allocations weighted according to the York formula, and I supported from the Front Bench the amendments that the Government made in the early years to ensure that it responded to need even more accurately. I cannot say that it is wrong and unfair simply because an area such as Oxfordshire gets less per head of population than inner-city areas, or areas in the north of the country with greater health needs and more deprivation. I have always been clear about that. It is easy to claim that the system is wrong if one is not prepared to look for more money globally.
However, the Government can be criticised on two grounds. First, generally speaking—I believe that this has been confirmed by independent inspectors—although there have been significant real-terms increases in funding, which have given the opportunity for underfunded primary care trusts, and health authorities before them, to move more quickly to target, the Government have not moved quickly enough to tackle areas whose funding is significantly below target. However, that criticism does not apply to Oxfordshire and the Thames valley as a whole. The figures show that if anything, Oxford city, which covers part of my constituency, has benefited in a sense from the slowness of the movement towards target, and I recognise that.

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That is a general point, and we should look beyond our own areas. I hope that the Government take on board the fact that as there are significant real-terms increases—for which I voted on every occasion—if they set out a target allocation based on need, they have a duty to move those who are below target more quickly to it.
The point that the hon. Member for Witney made about Oxfordshire and other parts of the Thames valley receiving proper recognition of the cost of living—effectively, the cost of hiring staff—needs to be stressed. It is clear that the arrangement is inadequate when the comparison is made with the London living allowance. Something must be done, because the inability to attract staff because of the high cost of living, and particularly of housing, is the major constraint at all levels of health and social care provision in Oxfordshire.
The Government have chosen to try to tackle the housing issue by providing mortgage help for what they call key workers—although I do not think that their definition of key workers is wide enough. That is not a holistic approach to the problem. Merely increasing the demand side through mortgage subsidies does not solve the problem; if anything, it puts house prices up. I want the Minister to say which NHS land has been identified as useable for affordable housing for key workers.
As Members of this House, when we get lobbied against development, we must remember how acute that problem is in the public services. Oxfordshire needs housing, and I am acutely aware of that. My instinct is not to oppose every new development, even those on greenfield sites. I recognise that there is a balance between environmental and housing issues. The Government must play their part, alongside the local health services, and release land in health service sites for housing—and they must do so quickly. I would argue that we are already seven years too late.
The other problems in Oxfordshire are too numerous to mention in this debate, although I will touch on a few. The GP contract is running into problems. I met GPs in Abingdon the other day and they pointed out that they were promised money this year for enhanced services, but that it has not been made available; legally it did not have to be, but they were at a presentation where it was promised. Therefore, there has not, for example, been fair recompense for sexual health services, because the money has been used by the PCT to prop up the family planning clinics, which were threatened with closure, and saved by central diktat at the cost of a transfer of money from other services to which it had previously been allocated.
The John Radcliffe's financial problems mean that there will be job cuts. Rumours abound that the hospital has accepted that there will be such cuts, and it has not said that they will involve only civil servants or bureaucrats—the sort of jobs that, trendily, it seems that we do not have to worry about these days. Front-line jobs will be cut for some of those savings—otherwise known as cuts—to be made. I do not see how that fits with a growing service.
Social services are still having difficulty recruiting. That situation is not getting better quickly enough, judging by a meeting that I recently had with the director of social services. I fear that in the health economy, matters will get worse before they get better.
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I support the comments made by the hon. Member for Witney about recognising fairness in the new system of financial flows. I have had representations not only from the Nuffield orthopaedic centre but from other hospitals in Oxford to say that the tariffs still do not recognise the extra costs of delivering specialised care and ultra-specialised care. Research funding under the tariff—and, indeed, under the current system—is inadequate. It is clear that the London teaching hospitals and medical schools get the lion's share compared with everywhere else; there is clearly an imbalance. I hope that the Minister recognises that, and will explain how it will be dealt with.
There are other developments in Oxfordshire in relation to the provision of care that are effectively cuts. For example, South West Oxfordshire PCT has ruled that people who have previously received respite care in a community hospital cannot receive it any longer, unless they are being rehabilitated.
Mr. Cameron: I am glad that the hon. Gentleman said that. As I was preparing for this debate I opened a constituent's e-mail, which arrived at 5 o'clock this morning. It said:
"Up to last March my wife was given 7 days respite in Witney community hospital every 8 weeks and we were not charged for it. Now we have to pay the full cost of any respite. Can anyone tell me why we have to pay when Tony Blair tries to lead us into believing that the NHS is free for all?"
An important change has taken place. That e-mail is yet another example of people saying to me, "We've had all this extra money spent on the health service, yet I'm now having to pay. What's happened?"
Dr. Harris: I have several constituents with the same problem. I am glad that the hon. Gentleman took the opportunity to raise that case in his own debate. This is a stealth tax. People who were getting respite care in community hospitals are now being means-tested for it and are having to pay. South West Oxfordshire PCT said that the reason was not that patients did not require nursing care—although that might be a basis for saying, "Let's ensure that the respite care is provided elsewhere, as we don't need NHS nurses to provide it"; the question was whether the patient could be rehabilitated.
Most patients with chronic care needs could not benefit from rehabilitation, but their carers require the support that respite care gives. The decision to deny people ongoing respite care that was provided for only a few days a year, and which was probably inadequate already, has upset several people. I question whether there was adequate consultation on that decision, and therefore whether it was lawful. Will the Minister look into whether that decision, whatever its merits, was conducted in a lawful manner in terms of process, with adequate consultation? I hope that he will agree to do that; I do not expect him to have a reply ready now.
I recognise that we do not have an opportunity in this debate to discuss the likely cuts in the mental health sector, which are often overlooked. We hear that there are proposals to reduce health services in the mental health trusts in Oxfordshire so that they can break even.
Finally, I shall talk about the treatment centre, and the serious allegations of bullying in Oxfordshire. I know that the hon. Member for Witney is aware of this

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matter, as he has been working closely with the people who have raised concerns. There was a proposal to transfer a contract for cataract surgery from the Radcliffe infirmary to a new independent provider, Netcare. Expressions of interest were invited in 2003, and both Cherwell Vale primary care trust and South West Oxfordshire primary care trust expressed interest.
It later emerged that part of the Oxford Radcliffe infirmary—the eye hospital—was going to meet the three-month waiting time limit on schedule, without the need to resort to expensive Saturday morning lists paid at private practice rates, and was delivering those operations cheaply, significantly below the NHS average—the so-called tariff. Yet when the PCTs realised that they did not need that service, and that it would not be cost-effective to purchase it, they were not allowed to pull out.
In an interview in The Guardian, and on "File on 4", the South West Oxfordshire PCT claimed that it was given the full business case only one hour before the meeting at which it was due to decide. We also learn that prior to that, its members had been verbally threatened with being personally surcharged if it failed to vote the scheme through. However, the primary care trust had a legal responsibility for the scheme, and it was not a national scheme, so it is outrageous that someone should have threatened people with bankruptcy and surcharge if they failed to vote it through. That was never followed up. That is the worst kind of bullying, because the threat was unfounded. We have never heard that idea retracted, unless the Minister can say that the allegation was a falsehood—but I believe that it has been confirmed by more than one person.
After the primary care trust rejected the deal—which, under "Shifting the Balance of Power", it had the right to do—the then chairman of South West Oxfordshire PCT, Martin Avis, said that he contacted Jane Betts, the strategic health authority chair, to communicate the decision. She said, "The tumbrels are ready." If that is not a threatening expression, I do not know what is. Martin Avis said that he took it to mean that his job was on the line, and that she was aware that hers was, too. He went on to say that Jane Betts said:
"Our jobs were at risk if there was not a note on the secretary of state's desk by the beginning of the following week saying that the decision would be reversed."
We have never heard the Government explain the role of the Secretary of State in pressurising the primary care trust to reverse its decision. Indeed, a fortnight later that decision was reversed by a full turnout of executive members, who are effectively employees of the Secretary of State.
The chairman of the primary care trust, who was well regarded by people on all sides of the debate, was the only primary care trust chairman not automatically reappointed when his job fell due for reappointment. He was told that he would have to apply again for his own job solely because of the decision that had been made. He had taken a casting vote to side with all the non-executive members of the primary care trust, whose job it is to defend the interest of the patient and the community when such decisions are made. At best, it is a murky business. We have never received full clarification of the matter from the Government. I do
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not understand why the Minister does not request an independent inquiry. When Sir Nigel Crisp, the head of the NHS, was questioned on Radio 4 about what had happened, he ended the interview and walked out of the room. What sort of response was that? What sort of open government or accountability was that?
If the head of the NHS will not take responsibility for such matters, politicians must. Will the Minister ensure that the issue is examined independently so that we know what is happening? We will not find people to work as non-executive directors in Oxfordshire or Thames Valley because of the bullying, let alone the financial problems facing the NHS that we have heard about today.
10.23 am
Mrs. Patsy Calton: I offer my congratulations to the hon. Member for Witney (Mr. Cameron) on introducing the debate, and to the hon. Member for Banbury (Tony Baldry) and my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris), who have also made important points. The hon. Member for Witney made it clear that despite the huge increases in spending, the news on the ground is bad. The bad messages tend to overwhelm the good news that the hon. Gentleman acknowledged when he said that there were decreases in some waiting times, that no one was now waiting for more than 12 hours—although that still seems a long time—and that his son had received superb care. He also acknowledged that when one is inside the system, it is brilliant. It is getting in, and sometimes getting out, that can be difficult. In the light of my experience, I echo that.
The good news is being somewhat overwhelmed by the bad news. However, it would have been fair for the hon. Member for Witney to acknowledge that although the situation is bad, it would have been considerably worse if the decisions had been up to the Conservatives, who voted against the extra funds that have recently been put into the health service.
After listening to the problems that have been aired and reading the necessary information to familiarise myself with the issues involved, I believe that there is a real problem centring around the role and functions of the John Radcliffe hospital. We have had a national sickness service, focused on hospitals rather than on primary care and care outside hospitals. We must acknowledge that the model we have now, whereby gradually everything gets sucked closer to hospitals, needs to change. I suspect that no one in the Chamber would say that no change is necessary, but change can sometimes be painful and difficult, and the process of change could be a lot better managed.
The hon. Member for Witney is concerned about staff shortages, and about the fact that many of the potential closures do not allow for travel by public transport. Although the target-driven culture is undoubtedly producing some change for the areas that are covered, they are hospital-focused, which can mean that anything that is not a target gets neglected. My hon. friend the Member for Oxford, West and Abingdon made it clear that those targets are distorting clinical needs. The Government would do well to consider that.
The responsibility for local services, and the role of the PCT and its autonomy, is reflected throughout the country, not just in the Thames valley. Although the

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Minister of State, Department of Health, the hon. Member for Doncaster, Central (Rosie Winterton), has said in a written answer that the responsibility for local services now rests with PCTs, the truth is that, as we can see from South West Oxfordshire, local PCTs are autonomous only as long as they do as they are told. In my area, the Greater Manchester strategic health authority will allow plans to go forward only if it is satisfied with them. If it is not entirely satisfied, the PCT has to go back to the drawing board—and that will continue until it comes up with something that the Greater Manchester strategic health authority is happy with.
There is overt bullying. An article in The Guardian on 2 June 2004 said:
"the recently-retired chairman of the areas primary care trust … explained how his board was bullied by Thames Valley strategic health authority … to sign a contract with a South African company for a treatment centre that it did not need."
The chairwoman of the SHA, who has also retired, admitted that she had engaged in
"bullying tactics, but claimed her authority was merely 'the jam in the sandwich',
and she was simply carrying out what she had been asked to do:
"It behaved as it did, she said, because it was under heavy pressure from the Department of Health to deliver a deal that the Prime Minister had set his heart on."
The Government cannot have it both ways; they have to make their mind up. Do they want PCTs to take responsibility, or are they intent on ensuring that everything happens from the centre and there is total central control?
Both the Conservatives and the Liberal Democrats have made it clear that they would like control to be much closer to home, and that it should be in the hands of local people. The difference between the Conservatives and the Liberal Democrats is that they would give the control to local hospitals, whereas we would like to see proper democratic control, both locally and regionally.
The hon. Member for Banbury asked the Minister to give a proper explanation of funding, and particularly wanted him to consider the finance and funding of the John Radcliffe hospital and Oxfordshire social services. He wanted greater flexibility on pay, with which we agree, and freedoms for all hospitals to manage themselves. The Liberal Democrats also want to see a considerable advance on that front.
My experience of consultation in my area is that plans for future provision are often nebulous. With regard to provision for care outside hospital, people have been asked to agree to locations, but when they look at the map it says, "Location still to be determined." That is not real consultation. It is the type of consultation in which it is hoped that those being consulted have not read the document, and when they read it, they find that they cannot possibly agree with it because it does not give them enough information. Rather than people going through the motions of consultation, there should be true consultation. There should be true engagement with local people. That sort of consultation is not taking place, either with patients or with local people.
That must start to happen. I doubt whether anyone in Oxfordshire or the Thames valley thinks that there should be no changes to hospital services or other
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services in their area. However, if there is not proper consultation about what needs to happen, people will feel that things are being done to them, rather than that they are being properly involved in the future of the health service in the Thames valley.
10.31 am
Mr. John Baron: I, too, congratulate my hon. Friend the Member for Witney (Mr. Cameron) on powerfully raising his concerns about the state of the NHS in the Thames valley. I hope that the Minister will address those concerns, and some of my hon. Friend's suggestions. I also congratulate other Members on their contributions, including my hon. Friend the Member for Banbury (Tony Baldry), who has done a lot over many years to raise these issues; among the concerns that he has raised in this debate is the impact of the working time directive.
My hon. Friend the Member for Witney was right to say that the extra resources being pumped into the NHS are not achieving the results that we expect and hope for. Nowhere is that clearer than in the Thames valley. My hon. Friend touched on the financial health of the NHS in the Thames valley. That is a major concern. The 2003–04 report of the chief executive of the Thames Valley strategic health authority stated:
"Overall, the NHS in Thames Valley achieved financial balance but had to rely on one-off measures to achieve this."
The one-off measures needed to meet the Government's target of achieving financial balance last year included the sale of the Radcliffe infirmary. In addition, the Oxford Radcliffe Hospitals NHS Trust had to take out a £25 million loan. Across Thames Valley strategic health authority, the debts run up by the health service were so serious that PricewaterhouseCoopers was called in to help. Last Wednesday's financial performance report of the Thames Valley SHA board suggests that in order to meet the Government's target, and despite the increases in health service expenditure, funding of the NHS in Thames Valley may have to be reduced by 7 per cent. That is quite a cut, all things considered.
The effect on, for example, Milton Keynes, with its rapid population growth, is likely to be far worse even than that. On July 8 the chairman of the Milton Keynes primary care trust said that it had to provide for 235,000 patients but that funding was available for only 212,000.
The Government must shoulder some of the blame for the deterioration in the finances of the NHS in Thames Valley. The PCTs in the Thames Valley area will receive £170 per head less than the English average for next year. That has contributed to the appalling financial situation there. In addition, we have heard that there is no local cost of living allowance. I want the Minister to explain why Thames Valley is being discriminated against compared with other areas. The facts speak for themselves, and they suggest that there is a major issue here.
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): Will the hon. Gentleman share with us which areas of the country he thinks should get less so that Thames Valley can get more?
Mr. Baron: The Minister is missing the point. I am suggesting that no area should be discriminated against.

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It is clear from the funding formula that has been devised for Thames Valley that it receives far less than other areas, which is wrong. I simply ask the Minister to explain why that is the case.
The Government will doubtless point to increasing staff numbers, and to a long line of statistics that suggest that the NHS is improving. There is no doubt that it is improving in certain areas, but our central point—to return to the conundrum presented by my hon. Friend the Member for Witney—is that there has been a massive increase in money, but not as much improvement as we had all hoped. As I said, no doubt the Minister will point to an increase in the head-count number of people working in the various departments of the NHS, but the three-month vacancy rate for posts in the Thames Valley area is worse than the English average. For example, the average three-month vacancy rate for all qualified nursing and midwifery staff in the strategic health authority area is 4 per cent., and that rate rises to about 7.5 per cent. in Milton Keynes general hospital. The English average of about 2.9 per cent. is well under half that.
In addition, the lack of permanent staff surely exacerbates the already grave finances of the NHS in Thames Valley as the rising cost of the agency staff needed to fill temporary staffing posts kicks in. That does not help the situation at all. There is also a particular shortage of radiographers in Thames Valley, and breast cancer patients are forced to wait up to four times longer than specialists recommend they should have to wait for potentially life-saving radiotherapy.
There are also problems in dentistry. The Thames Valley area has the lowest percentage of people registered with an NHS dentist. For example, only about 32 per cent. of adults in Oxfordshire are registered. That is an appalling record of the Government's making. They have now been in power for seven years, but they have done very little to reverse the decline in the general dental service. As a result, only 11 of the 113 dental practices in Oxfordshire are taking on new NHS patients.
The Government will no doubt hail the new contract as a solution to those problems, but we are not so optimistic. They will know that the British Dental Association has warned that 60 per cent. of dentists will reduce their NHS commitments, or will opt out of them altogether, when the new contract comes into force. That, surely, does not bode well for the future. Little attempt seems to have been made to increase the dental work force above 1997 levels. In 1997 there were about 576 graduates of UK dental schools. Last year there were about 549—a clear drop.
People with Alzheimer's disease are also suffering needlessly in the Thames Valley area. Recent research has discovered that many people with the disease are being denied access to drugs that could slow the advance of their condition. The drugs in question were recommended in guidance issued by the National Institute for Clinical Excellence back in January 2001, but a recent report has shown that there is significant geographical variation in their uptake. West Yorkshire has a population of 312,000 over the age of 65, and about £880,000 was spent on the drugs last year. Thames Valley has the same size of population over the age of 65,
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but not much more than half that amount—about £485,000—was spent on the drugs. That postcode lottery in the prescription of drugs is all the more tragic, because, as we all realise, without medication to slow the onset of the disease, sufferers will be forced into residential care.
What is happening in Thames Valley illustrates what is happening throughout the NHS, and returns us to the conundrum presented by my hon. Friend. There is no disputing the Government's best intentions, given the extra money that has gone into the NHS, but improvements have not been what they should have been. In some cases things have got worse, as we have heard from Members' contributions today.
One of our key concerns is the demotivating effect of targets. Despite the best efforts of NHS staff, to whom we are all thankful for their hard work and achievements, the NHS suffers from too many Government targets and too much red tape, which clogs up the NHS, prevent; many people from reaching front-line services, distorts clinical priorities and demoralises staff. That is one of he main reasons why there are so many recruitment and retention problems in the NHS, and why, after such a massive increase in spending, there has been only a modest increase in activity, and patients are suffering because they have to wait longer than necessary to be treated. It is also one reason why staff turnover in the NHS runs at something like 22 per cent., whereas the national average is 16 per cent. In financial terms, the cost to the NHS of about 270,000 people leaving and having to be replaced is approximately £1.5 billion—the cost of something like 10 new hospitals.
There is no shortage of evidence that the Government's targets are distorting clinical priorities and demotivating staff. Last year, BMA News asked its readers whether then were too many specific targets set in the NHS. Nine out of 10 replied that there were, and more than 60 per cent. suggested that they had personal experience of clinical priorities being distorted to meet targets. What will the Government do to try to reduce the incidence of clinical priorities being distorted by their targets? Such targets can and do demotivate staff who are already working under tremendous pressure. As Dr. Ian Bogle, outgoing chairman of the British Medical Association, put it last year:
"The one memory that will linger long … is the creeping, morale-sapping erosion of doctors' clinical autonomy brought about by micro-management from Whitehall which has turned the NHS I hold so dear into the most centralised public service in the free world."
No wonder morale among medical professionals is so low and frustration so high. A recent Royal College of Nursing survey, "Stepping Stones", consulted 10,000 nurses. One third said that they would quit the profession if they could, and more than 11 per cent. said that they planned to quit in the very short term. No wonder the number of nurses leaving for the US doubled last year. Morale has not been helped by the delay in the roll-out of "Agenda for Change". What measures are the Government going to take to reduce staff turnover and raise staff morale? That is so important to the efficient running of the NHS.
It is no surprise that, with morale so low and staff turnover so high, the NHS has not made the progress that it should have, bearing in mind the extra money

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being spent. We know the figures: expenditure has increased by more than 40 per cent. in real terms since 1997, and yet hospitals treatments have increased by only 5 per cent. According to the Organisation for Economic Co-operation and Development, the NHS increase in output lags far behind increases in input. It points out that
"in the health sector there are few indicators showing unambiguous improvements in outcomes over and above trend improvements that were already apparent before the surge in spending".
We have seen a massive increase in bureaucracy: the number of managers has increased at approximately three times the rate for doctors and nurses. There has been a £2 billion increase in the amount spent on administrative and other non-clinical staff. Meanwhile, the Department's own figures suggest that average waiting times have increased—a fact admitted by Sir Nigel Crisp, the chief executive of the NHS. In addition to addressing the specific concerns with regard to Thames Valley, will the Minister address the central conundrum of why money is not reaching front-line services so that patients can benefit? something is clearly going wrong.
I hope that the Minister will address the specific concerns raised by me, and by other Members, about the state of the NHS in the Thames Valley. but I put it to him that what is happening there reflects the fact that, although it cannot be denied that there have been some improvements in the NHS, progress it not what it should be, bearing in mind the money invested. Why else does the NHS have such a high turnover? The situation is not the fault of the professionals who work in the NHS, but that of the Government, who still cannot see that they have got their approach fundamentally wrong. Politicians must stop interfering and the Government must stop bombarding staff with targets and micro-managing the NHS. The NHS has been a political football for far too long. Politicians must learn to trust medical professionals and allow them to get on with their job. Targets simply ensure that the NHS responds to the Government and not to patients' need for care.
I put it to the Minister that the time has now come to scrap targets and the star-rating system, and give all hospitals true freedom so that they are accountable to patients, not bureaucrats. Such an approach would usher in an environment in which doctors and nurses would choose to stay because they enjoyed the freedom to deliver to patients a standard of care of which they could be proud. In that environment, the NHS, for the first time in a long time, would realise its full potential and become a patient-centred health service. That would benefit the patients in Thames Valley, and throughout the country.
10.45 am
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I, too, congratulate the hon. Member for Witney (Mr. Cameron) on securing the debate and on the interest that he takes in the national health service in his area and in general, although in other Adjournment debates that I have shared with him, he took a slightly less political and more constructive view than he has today. Before I deal with the hon. Gentleman's substantive points, let me dispose of the two contributions from the Opposition Front Benches.
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The hon. Member for Billericay (Mr. Baron) asked what we could do to reduce staff turnover. One thing that we can do to reduce turnover and increase morale is to stop running down the NHS. Several times during his contribution, the hon. Gentleman said that things were getting worse. They are not. His comments contained numerous inaccuracies, one of which was the ludicrous productivity figure that the Conservatives continually trot out, which takes account only of operations done in hospitals. It ignores the huge increase in services now being provided in primary care, and does not look holistically at the total output of the NHS. That demoralises the people who are providing valuable services in primary care, which the Conservative party completely ignores.
If we want to increase staff morale, we can also stop talking about a huge growth in bureaucracy, red tape and the recruitment of managers. The fact is that when the hon. Gentleman cites statistics for the total management overhead of the NHS, he is including people such as cleaners, cooks and technicians—everyone who is not a doctor or a nurse—to arrive at his ridiculous figures. If we compare the management overhead of the national health service with that of any blue-chip company in the private sector, the NHS appears rather lean and mean. It would be nice if the Conservatives started to recognise the contribution that management makes to the improvements in the NHS.
Mr. Baron: Will the Minister give way?
Dr. Ladyman: No I will not, because the hon. Gentleman took too long, and I need to get on to the points made by the hon. Member for Witney.
I wonder whether the hon. Member for Cheadle (Mrs. Calton) recognises some of the contradictions in her comments. At one point she talked about the need to democratise the national health service, but she contradicted that when she voted against foundation hospitals, which are a small step in the direction of democratisation. However, I note that although she voted against them in the House of Commons, she then shot back to her constituency and issued press releases to say that she supported the creation of a foundation hospital there.
Mrs. Calton: Will the Minister give way?
Dr. Ladyman: I will not, because I have very little time.
Mrs. Calton: This is on a matter of fact, so I again ask the hon. Gentleman to give way.
Dr. Ladyman: Very well.
Mrs. Calton: The Minister will know that that hospital was seeking foundation hospital status before the Bill was published or debated, and that there were various flaws in the Bill that were not put right by the time it became an Act. It was therefore not difficult to vote against it.
Dr. Ladyman: So the hon. Lady is now telling me that she does not support her local hospital becoming a

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foundation trust, which I do not think is the case. It believes that she is supporting its bid to become a foundation trust under the existing Bill, which she voted against.
That was not the only contradiction in the debate. The hon. Lady referred to her local Greater Manchester strategic health authority and its strategic overview. That is why strategic health authorities exist—to take such an overview and to ensure that PCTs are working together. I do not accept the allegation that central influence has been used, which emerged several times in the debate in connection with the treatment centres in Thames Valley. The other allegation, which was put to us by the hon. Member for Banbury (Tony Baldry), was that we are not using central control on issues such as community hospitals. On the one hand, we have the cynical view that "Shifting the Balance of Power" is actually shifting the blame, and that we should be more dogmatic and centrally controlling from Whitehall in establishing community hospitals. On the other hand, we hear from the Front Bench that all targets should be swept away and all power given to the front line.
The Conservative party cannot have it both ways. Either we shift the balance of power to the front line, which is what we are trying to do, or we keep it at the centre and I decide from my office whether the hon. Gentleman gets a community hospital in his constituency. I suspect that he would not want me to make that decision, as I do not know his constituency as well as local people do. That is why we are shifting the balance of power—to allow such conflicts to be resolved locally. They are conflicts and challenges, and as the hon. Member for Cheadle said, for consultation to work, people have to understand the challenges that are being faced.
Several hon. Members mentioned the affection that local people have for community hospitals. That is true, but equally, when we speak to people about what they believe can happen in a small community hospital, we discover that they have completely unrealistic service expectations, which it would be clinically unsafe to try to fulfil through community hospitals. Clinical safety and patient outcomes must be put first, and part of any consultation process is ensuring that people start to face and address the challenges.
The hon. Member for Witney mentioned a number of issues, including—several times—delayed discharges. I do not know which political party controls Oxfordshire. I suspect that it is not the Labour party, but whoever it is, he might wish to talk to them about the social services that are being provided. It is largely the authority's responsibility to take a strategic view of facilities in the community to enable people to be discharged.
I also note that the hon. Gentleman voted against the reimbursement system. which is having a tremendous impact across the country. It has reduced delayed discharges by 1.5 million bed days since its introduction, which is the equivalent of eight district general hospitals. That was opposed by him, and both the Opposition parties represented here are committed to getting rid of the legislation if they form a Government. If the reimbursement system were removed, how would that alleviate bed blocking at the John Radcliffe?
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This is not the only time that I have debated the health economy of Thames Valley in this Chamber. Last time, the debate was largely focused on Buckinghamshire, and I remember one Conservative Member making the bizarre argument that because the wealthy middle classes are more assertive and articulate, they place greater demands on the national health service than poor people from inner-city communities who may have greater health needs. According to that Member, we needed to reflect that in the money given to the Thames valley health economy.
Mr. Cameron rose —
Dr. Ladyman: Let me just finish my point.
I am pleased to say that that bizarre argument was not deployed today, but the hon. Member for Witney did his best to give the impression that the health service in the Thames Valley is somehow fighting against insuperable odds, with falling budgets and crippling financial overheads, and that services are going backwards as a consequence. In reality, the average expenditure per weighted head of population in the area now covered by Thames Valley SHA was £594.29 in 1997. whereas in 2002–03, expenditure was £904.32—a 52 per cent. increase. In case the hon. Gentleman did not catch that, I will repeat it: £594.29 then and £904.32 now. Those figures do not even include dental or pharmaceutical services, and under this Government, plans are in place for that expenditure to continue to grow.
Mr. Cameron: The Minister said, rather unfairly, that I had introduced the debate very politically, but as his reply so far has been pure politics and knocking copy aimed at the two Opposition Front Benches, will he now address the question about the John Radcliffe hospital? He only has five minutes left. My hon. Friend the Member for Banbury (Mr. Baldry) and I have discussed the serious problem there many times, and it seems to us to be causing some of the problems in the Oxfordshire health economy. We came to debate that point seriously, and I wish that the Minister would respond in the same spirit.
Dr. Ladyman: If the hon. Gentleman wanted to debate the issue seriously, he should not have filled his contribution with political knockabout stuff or given the ridiculous impression that services in his area were declining. However, he is right to say that the financial balance at the John Radcliffe hospital is important, and is causing pressures in the local economy. The hospital has managed to achieve balance in the past two years as a result of land sales and funding from the NHS bank, but it has still not managed to address the overspend. In June the trust estimated it at £25 million, although it believes £17 million to be a more realistic figure. It will have to be put right.
Each local health economy must end up with a balanced budget. If it does not, the money must come from another area. Why should an area that has managed its budget properly finance an area that has failed to balance its budget? The hon. Member for Billericay seems not to understand that for every average, there are always some people above the average and others below it. As I told him, shifting money to Thames Valley from another area would mean that that area lost out.

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We can argue about whether the funding formula is a good one, but no one who has spoken in the debate has challenged the view that there should be variability in the funding formula to reflect the different costs in different areas. The present funding formula reflects the increased cost of provision in some areas, which is one reason why Thames Valley gets more money. As the hon. Member for Oxford, West and Abingdon very fairly noted, however, it is also important that funding distribution should reflect areas' health needs. Areas with the greatest health needs must have the most funding.
One could argue, as the hon. Members for Witney and for Billericay did, that all that variability has left Thames Valley too far behind and that it is being unfairly treated, but how do we measure whether it is too far behind? Surely, one way would be to look at the performance of the area's health economy to see whether it was moving forward. How has the Thames Valley health economy performed under the existing funding formula? No patients are now waiting more than nine months for planned treatment. Twelve-month waits fell from 1,657 in March 1997 to zero in March 2004, while nine-month waits fell from 3,712 to zero in the same period. The number of people waiting more than 13 weeks for out-patient treatment fell from 4,256 in March 1998 to 992 in March 2004.
Patients are being treated more quickly in the accident and emergency departments. Three acute trusts in the Thames Valley—Buckinghamshire Hospitals NHS trust, Heatherwood and Wexham Park Hospitals NHS trust and Milton Keynes General NHS trust—were among the first to receive financial rewards for overachieving on A and E targets. They saw more than 94 per cent. of patients within four hours in the quarter to December 2003. Overall, 89.5 per cent. of patients were admitted, transferred or discharged within four hours in the quarter to December 2003. Some 99.4 per cent. of people with suspected cancer are now seen by a specialist within two weeks of being referred by their GP. Some 96 per cent. of people can now see a GP within 48 hours, while 97.8 per cent. of people are offered an appointment to see a primary care professional within one working day. There are 1,970 more nurses and midwives than in 1997—
Mr. Bill O'Brien (in the Chair): Order. We must now move on.

Landfill Directive
11 am
Sue Doughty: I am grateful for the opportunity to raise this issue, which is extremely topical. In 2001, 5.2 million tonnes of hazardous waste were produced in England and Wales, of which 40 per cent. was landfilled. I know that the Minister will know an enormous amount about the changes to the regulation of hazardous waste, but for the record I should state that they will have a huge impact. This year, more waste will be classified as hazardous, and the co-disposal of hazardous and non-hazardous waste will rightly be banned. As a result, however, more businesses will need to dispose of increasing quantities of hazardous waste while the availability of waste disposal sites plummets. There will be dramatic cost increases to business. The new regime starts on Monday, and it means that small and medium-sized businesses face major changes for which they are ill prepared.
I want to explore the impact on small businesses—I should say at the outset that they are not against meeting their environmental commitments, and the purpose of this debate is not to have a barney with the Minister as to whether they should do so; I do not want the debate to become such a confrontation. There are opportunities for small businesses in finding novel ways to replace some of the more hazardous products that we use and to treat hazardous waste. They have a strong role to play. However, I am particularly interested in small businesses that produce substances, sometimes in very small quantities, that will now be classified as hazardous waste, and what they will need to do to conform to the requirements.
Yet again, there has been too little planning, information and publicity ahead of the implementation date of a major environmental directive. That leaves small businesses in particular with major problems. The difference between small businesses and medium-sized and large businesses is that larger businesses have people who make it their job to be aware of the environment and environmental measures. They have time to scour the relevant websites, and they have large industry groups. For small businesses, however, we are usually talking about the people doing the payroll in the evening, and new regulation can sometimes pass them by, no matter how hard they try to conform to it. Such businesses rely on waste contractors to tell them of changes coming down, and as the Minister knows, if contractors are not certain about what the requirements will be, problems will occur. There is, therefore, the risk of increasing costs and of non-compliance. Sadly, there is also the risk of cowboy contractors moving in on the market and fly-tipping, which none of us wants.
I have been told about a plant protection and pharmaceutical testing firm in south-west England, which disposes of approximately 10 litres of hazardous chemicals every six months at a cost of £80 plus transport costs. It relies entirely on the contractor to deal with the relevant paperwork. It files the paperwork and ensures that the waste is disposed of correctly within the law. However, last month, when I received this information, the firm had not been advised by its contractor of any future problems or increased costs associated with waste disposal. We are talking about a cost of £80. We should also bear it in mind that, in the

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south-east of England, the only site licensed for hazardous waste as of Monday would take only asbestos, so it will not be able to take any of the product to which I have referred.
The Federation of Small Businesses reviewed a business park in Surrey. There were 35 businesses in a broad range of sectors. It considered what the impact of the changes would be, talking with the facility manager and the waste contractor. The former did not know of the changes, and the latter was not able to help either. It was therefore not possible to do the costings, but when a small business is putting in a bid, it has to know what things will cost. There is a problem with lack of facilities in the south-east and in other places, such as Wales, but major problems will also arise from sheer lack of information.
Because contractors have not been able to tell businesses what changes there will be—they have not had the specifications—they have not been able to advise them, as they have traditionally done. Businesses need to be able to plan. If they are to meet these requirements, they need to know what they are. They have got to be able to work with contractors and trade organisations, and they must look at opportunities for co-operative working to drive down costs—and rightly so. Yet when back in April I asked the Secretary of State for Trade and Industry how many of the 100.000 special waste producers and the 750,000 future hazardous waste producers the Department had contacted to inform them of the hazardous waste requirements of the landfill directive, the Department of Trade and Industry said that the Department for Environment, Food and Rural Affairs leads on hazardous waste and the landfill directive. It said, however, that the DTI was investing in the development of a communications strategy to raise awareness of these issues among businesses through a variety of mechanisms and media.
By the week of 19 April, therefore, business still did not know sufficiently what was required of it. With respect, that is not good enough, because business must plan. Such directives have long lead-in times, and businesses cannot suddenly get together in co-operation to dispose of waste paint, litres of chemicals, fluorescent tubes and computer monitors; that takes time and planning. Small businesses may not have the capacity for storage that would be required if they were to bulk up materials for disposal somewhere in the north of England, for example.
What discussions has the Minister had with his colleagues in the Department of Trade Industry to understand the impact of the landfill directive on small business? Has he taken a view on the need to communicate the changes to business, and has he had any information from his DTI colleagues? Does he understand why small businesses are different from large businesses and need strong messages? Will he work with the DTI on a rapid roll-out of information and awareness-raising programmes specifically for small businesses? It is a question not only of whether we are going to tell them anything, but of what we are going to tell them.
The European waste catalogue defines hazardous substances, but new substances are being added all the time. Every time a new substance is added, people who
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use and dispose of the substance need to be told of their responsibilities. Does the Minister have any plans for a strong media programme to explain to businesses their responsibilities and how to conform? We are finding that they do not know enough about the directive. In a survey by the Federation of Small Businesses, 41 per cent. of businesses said that if they knew how to meet environmental objectives, they would try to do so. It is not the case that business does not want to know—it does.
Business wants to use a range of remedies. Businesses are not saying that they are going to continue using a product, and what the hell, if costs go up. The purpose of the directive is to encourage the use of safer substances. It encourages the phasing out of the most damaging products. It aims to avoid ticking time bombs with hazardous waste going into landfill, and some of the problems that developers are now facing because they have built on top of landfill. All sorts of damaging products and their associated risks are coming to the surface. It is quite right that we are implementing this directive, but business cannot plan for and phase out the use of the worst of these substances without clear information.
Anybody who regularly debates the environment knows that we often come back to the problem that businesses use a lot of batteries, for example. There are also salts and solutions, heavy metals and waste paint. The number of small painting and decorating businesses that use those products and that will have to find appropriate disposal facilities is enormous. There will be a huge problem of cost. If I get in the painters, they may say to me, "Next week we will cost more, because we have to pay more for the disposal of paint." However, if it is to cost them 100 per cent. more because of the increasing gate fees, which I shall come on to, and the excessive travel to dispose of paints, I as a consumer have a right to say, "Hang about, this is a bit sudden. That was not in the quote you gave me two months ago, before you were free to get on with my job." Certainty in business is important.
Hazardous waste producers will be required to register what they are doing, and 1.5 million businesses will come into the hazardous waste regime. At present, we do not know whether there will be a de minimis for registration. There is a question as to whether minimal and sporadic waste producers—a hypothetical case is those who dispose of monitors once every five years—need to conform to the requirements. If they do—I am not saying that they should or should not—what will we do to support such businesses through an incredibly difficult time?
Businesses want to comply, but the arrangements are vague and cripplingly expensive. My purpose is to express their concerns. I have no difficulty with the Government's supporting the environmental objectives of the directive, but we have the problem of too little, too late. There are risks, for example, that cowboy contractors will mix waste oils with sawdust and then just shove them into a landfill site somewhere. No one wants that to happen.
Yesterday, I attended the conference of the all-party group on sustainable waste. In fact, I was chairing the session just before the Minister kindly joined us. The representative of the Chartered Institution of Wastes Management, of which I am an honorary fellow,

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pointed out how much the costs will increase. The waste industry wants to be respectable, dispose of waste in the right way and drive out the cowboys. It does not want unsustainable discounts put into the costs of waste management, but it is concerned that the gate fees are bound to go up because of the limited number of sites. It is also a fact of life that there is extra cost in pretreatment.
As far as the waste management business is concerned, the directive may present good opportunities, and there is nothing wrong with their taking such opportunities. The problem is with people at the beginning of the spout, the businesses that produce the material. Their costs will escalate rapidly, and that is a considerable concern.
I would like to hear from the Minister not only his reaction to what may be an increasing problem for small businesses, which are very important, but how he will be much more proactive with the DTI on the issue and—I am sorry to return to this—how lessons learned from earlier failures will be applied. There have been problems in the past. It is considered below the belt to mention fridges, but let us not forget that tyres were also a big problem. We have had since 1999 to get our act together. The issue is not new or something that suddenly came along—whoops, we did not know. Everybody except small business has known about it, yet there will be problems.
The next time a directive comes around, will we start by engaging business, particularly small businesses, from the very beginning, and ensuring that we understand the cost implications and how the process will be managed? Without that, we cannot go forward. We may have to go through product by product, depending on the likely damage and the impact of any de minimis regulations that say that one product can be allowed but not another.
I look forward to the Minister's response. I hope that he has some good news for small businesses and at least recognises their innocence in this situation. They want to comply, but their compliance must be at a price that they can afford.
11.14 am
The Minister for the Environment and Agri-environment (Mr. Elliot Morley): This is a very important issue, and one that the Government take seriously. As the hon. Lady knows from the discussion yesterday in the all-party group on sustainable waste, the directive offers important benefits. I welcomed the opportunity to address that conference, and I thought it was useful in bringing together many of the key players in the waste sector. Indeed, that is part of raising awareness about the changes and what is happening.
There has been a great deal of debate on the issue since 1999, as the hon. Lady rightly states. All the regulations on landfill have now been published, and it is true that there will be a consultation on hazardous waste regulations over the summer Of course, the hazardous waste forum has been held, which involves representatives of all sectors, including the Federation of Small Businesses.
It is quite remarkable that the FSB today put out a press release that appears to say that it has no role in the situation that we are discussing. The FSB is actually
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involved in a forum discussing the details, and one reason for that involvement is precisely so that it and other such organisations can give information back to their members as part of the communication strategy. Yet the FSB seems to think that it has no role whatever in these issues. Although the FSB often goes on about too much government, it appears that, for the FSB, any kind of change involves hand-holding with the industry sectors that it represents.
Having said that, of course there is a role for central Government in terms of communication, and we take that seriously. I might just point out a mistake in the FSB press release. It claims that there are no waste sites in the south-east, but that is not true: there is availability there.
Sue Doughty: I hope that the Minister is right, because it is my understanding that the site in the south-east will take only asbestos. If he has good news about a wider range of hazardous wastes, I will be delighted to hear it.
Mr. Morley: I will certainly give the hon. Lady that information. There is more than one site in the south-east, as a matter of fact. It may well be that there is one that takes just asbestos, but there are others, too, and I will give her more information on that.
There has been enormous discussion of the issue. There has been a lot of press and TV coverage, and I did something on the subject on the BBC over the weekend. It is not as if the matter is not in the public domain. In fact, we know that businesses are taking note, because as the hon. Lady will have heard at the conference, there has been a 45 per cent. increase in disposal of hazardous waste. That is because companies know that the regulations are being introduced in July, so they have been advancing some of their arisings before the regulations come in. There is plenty of evidence that people are well aware of what is going on.
It is true that there are very small businesses that may produce very small quantities of materials that are regarded as hazardous waste—painters are certainly a case in point—but most small businesses get rid of their waste through commercial contractors or local authorities, both of which are well aware of what is going on. In relation to amenity sites, many local authorities have facilities for paint, batteries and asbestos, which they collect. They can collect small quantities until they have gathered a lorryload of material that it is economical to dispose of, and they provide that service for small companies. None of that will change. We do not want to overestimate the potential change. Incidentally, there will be no de minimis. We should be clear about that.
Sue Doughty: With local authorities taking trade waste and, as the Minister said, bulking it up before onward disposal, there will still surely be rising costs. Where is the cost likely to fall?
Mr. Morley: It is likely that there will be an increased cost, and it will vary according to circumstances. I repeat the point that the hon. Lady heard me make yesterday: the costs of disposal in this country for a range of waste, including hazardous waste, has been the lowest in Europe. The reason for that is that people have

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benefited for a long time from cheap, unsustainable landfill. The true costs of the environmental impact have not been borne by various sectors. That is going to change: there are no two ways about it. It is appropriate that the costs reflect the environmental impact and the costs of proper treatment and disposal by professional companies. People will have to accept that change, which is fair and equitable in terms of the environmental impact of waste handling. The increased cost is also an inducement for a range of companies to think about the waste that they produce and consider minimising, reusing and recycling it.
Yesterday, we heard from some companies that are gearing up and investing in many ways to provide reuse and recycling services. I talked to a few of their representatives afterwards. Perhaps in future various streams of waste, which are currently considered waste streams to get rid of, might have value because they can be reused and marketed. We want to encourage that, and we are putting money into bodies like the Waste and Resources Action Programme to support research and development, and into small and medium-sized enterprises to help develop the growing sector of environmental industries. That is good for the economy, the country and the environment. Part of the approach is for companies to bear the proper costs of the environmental disposal of waste, and we should not be too apologetic about that.
There is always a risk that when costs relate to disposal, there is a temptation for the cowboy element. We understand that, which is why we are talking to the Environment Agency about the work that it is doing to combat fly-tipping and crack down on illegal activity, which we take seriously. It has been doing a good job and has introduced specific campaigns in hot spots, which has been impressive. I should like to see more such action and I will be talking to it about what can be done.
Sue Doughty: In the Minister's discussions with the Environment Agency, what representations has he had from it about this problem and about an increase in the risk of fly-tipping as of next Monday, because of the current shortage of capacity in the regions where waste is being produced? Will it need more resources? Are the resources adequate to deal with fly-tipping? What publicity is available to make it clear that fly-tipping is a crime and must not happen?
Mr. Morley: I will come to that point in a moment, and I will go through all the actions that have been taken on publicity.
Of course, I talk with the Environment Agency about issues such as resources. However, although we are not complacent about fly-tipping, we do not assume that there will be a large increase in the fly-tipping of hazardous waste post-16 July. The bulk of hazardous waste has always been contaminated soil. We know that developers understand the regulations and know about that. A lot of hazardous waste has always travelled to specialist sites, and there is nothing new about that. There will probably be a reduction in the number of sites, which will mean that waste will have to go to fewer sites. In many cases, however, there will be no change.
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For example, a lot of hazardous waste in Scotland has always been transported over considerable distances, so there will be no change. I am keen to see as good a geographical spread of site facilities as possible. We are beginning to see that happening, and we will certainly see it over the next 12 months.
The changes on 16 July will not automatically lead to an increase in fly-tipping, but we must not be complacent. The current level of fly-tipping is not acceptable and we need to take action on it. The Environment Agency is taking action. It has been assisted by the new "Flycatcher" initiative, about which the hon. Lady may have heard yesterday, and targeted enforcement exercises, such as those I mentioned to her, which have been successful. Letters have been sent to all hazardous waste producers, waste managers and local authorities. All categories have received individual letters to alert them to their responsibilities and their duty of care. New powers, including stop and search, have been given to local authorities to help combat fly-tipping. There are permit arrangements for the transportation of hazardous waste. The responsibility is not only on the transporter: under the duty of care, it goes back to the people who have produced the waste. If they do not ensure that it is properly disposed of with transport and proper permits, they are liable.
Sue Doughty: Given that the new regulations will require more producers to register so that 1.5 million businesses will be drawn into the arrangement, does the Minister mean that letters have been sent to existing hazardous waste producers or to all the 1.5 million businesses?
Mr. Morley: Letters have certainly not been sent to 1.5 million businesses because, as the hon. Lady rightly says, some of the businesses are small. They have gone to the main producers of hazardous waste. However, there is information for everyone. I shall run through the type of work that is being done.
A communications manager has been appointed so that there is a full-time person working on getting over the message to stakeholders. A communications programme has been put in place. It co-ordinates the communications activities of the Department for Environment, Food and Rural Affairs, the Environment Agency and Envirowise. Activities include a new web portal, www.hazardouswaste.org.uk, specific leaflets aimed at all producers of hazardous waste, press releases, mailings to trade associations either as inserts or by email, articles in the trade and regional press, attendance at exhibitions and conferences with speakers and displays, and surveys. In addition, guidance has been issued by the Environment Agency to appropriate parties.
More work is being done in relation to dedicated communications mangers. To answer the hon. Lady's question, the co-ordinated communications strategy has been set up with the DTI, part of which is to set up a communications network throughout the country with active participation by industry and relevant trade associations. The website will reinforce that. The hazardous waste forum, which includes the Federation of Small Businesses, has been kept informed at every

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stage of development, which allows it to communicate such matters to its members, which I assume it has been doing.
Sue Doughty: The Federation of Small Businesses, which was actively involved in the waste forum, has made recommendations that dissemination should be made through small firms, waste contractors and local authorities. Although it could do so much, it believed that not only it should make such an outreach. Not every small business is a member of the FSB.
Mr. Morley: I absolutely accept that. I am not for a moment suggesting that the responsibility should fall entirely on the shoulders of the Federation of Small Businesses. All I am saying is that it is part of the network of information dissemination. To pretend that it is outside the loop and that it has not received the information would be misleading. I am not accusing the federation of doing that; I merely want to emphasise that it is part of a framework of communication that is sophisticated and comprehensive.
We shall do more in the future and ensure that the message gets across so that people understand their responsibilities and how new regulations will impact on them.
11.29 am
Sitting suspended until Two o'clock.

National Parks
2 pm
Lawrie Quinn: It is a great personal pleasure and privilege to be allowed to introduce this debate, which I hope will enable us to consider the present activities and future mission of national parks in the United Kingdom. The debate will allow us to consider the issues surrounding national park authorities and their role in national conservation, recreation, tourism and rural regeneration agendas.
First, I thank you, Mr. O'Brien, and all right hon. and hon. Members who, with me, have requested an allocation of time to consider this important matter. This Adjournment debate is timely and I congratulate everyone who has been able to find time to attend this afternoon. I hope that we shall have a good debate and that we shall be able to give wide consideration to the important issues concerning national parks, which are one of the most important—indeed, vital—parts of national life. In an attempt to allow as many hon. Members as possible to participate, I shall make my opening comments as brief as possible.
I represent Scarborough and Whitby and live in one of the most beautiful parts of the United Kingdom. As the secretary of the national parks parliamentary group, I know only too well that there are many rivals for that tribute. I have been able to appreciate many different aspects of national parks throughout the country and, as I look round the Chamber this afternoon, I am pleased that I have had the opportunity on many occasions to visit national parks with my colleagues. We have had some very pleasant times indeed, but the jury is still out on which is the most beautiful part of the country.
I am sure that you are aware, Mr. O'Brien, that last week was the first national park week. That important period of celebration, recently concluded, was aimed at achieving a greater understanding and commitment at two levels; first, by encouraging people to visit and enjoy a range of events and sites, and secondly, to raise the profile of national parks nationally.
I am reminded of that old public information message that a dog is not just for Christmas. I passionately believe that the national parks are for every day of the year in every weather, and are not just for holidays. I am sure that my constituents and fellow residents of the North York Moors national park agree, as, I hope, do other Members of the House.
Our special week celebrated national parks and was given an excellent opening by the Minister who announced the Government's intention to confirm the designation of the New Forest as a national park.
Mr. Desmond Swayne: The hon. Gentleman will be aware of my concern that the park as designated is too small to protect its sensitive core. The Minister has now decided to follow the inspector's recommendation and make it even smaller by excluding Lymington, Ringwood and other areas. I hope that the Minister will be open to representations on that score.
Lawrie Quinn: I thank the hon. Gentleman for his intervention. From our previous encounters on the issue

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I know of his passion for the national parks movement and I am sure that the Minister has heard what the hon. Gentleman said.
The Minister for Rural Affairs and Local Environmental Quality (Alun Michael): I want to make it clear that the points raised by the hon. Member for New Forest, West (Mr. Swayne) are not open to reconsideration. In my announcement, I sought to define clearly the New Forest national park according to the characteristics of the national park and the New Forest. He referred to urban areas. Urban areas such as Buxton in the heart of the Peak district do not need to be part of the national park area to be clearly engaged with and related to it. I suggest that both my hon. Friend and the hon. Gentleman read the details of the decision, which was clearly based on the inspector's report, the landscape expertise and the representations made during the seven months of public inquiry. The conclusions were reached carefully and the areas that remain concern three possible small additions that would improve the overall definition of the national park.
Lawrie Quinn: I thank my right hon. Friend for that quick response to the intervention. I am sure that the Official Report will be read by all of us in what I regard as the national parks family in Westminster. Indeed, it is from that sense of family that I give a warm welcome to everyone who will be part of the new national park in the New Forest; not only the residents but the authority and all the partners.
The debate will go on, with the words of the Minister regarding the remit and the necessity for designation ringing in our ears. I am sure that the future management of the New Forest will benefit from a focus not only at the national but the local level. Without doubt that national park designation can and, I believe will, allow greater community and public park participation. I want to encourage that.
The national parks movement goes back to the mid-19th century in north America. I have had the privilege and pleasure of visiting national parks across north America. It is my aim to try to emulate the high standards in national parks such as Yellowstone. It is important that we try to take a lead from the inspiration of the post-war settlement in terms of national parks to make sure that that place provides the tools for local communities to build a national park in their location in the way that they want.
The possibility of extending the national parks designation to other areas is also important and I look forward to seeing more national parks closer to more heavily populated parts of the country. Given the dynamic nature of the economy in south-east England and this capital city of ours, I hope that the landscape and the opportunities that the south downs offer will allow for a designation in the near future, if not next year. The quality of that landscape deserves the high accolade of national park status of which I am sure everyone would be proud.
Mr. David Lepper: I welcome the comments that my hon. Friend made
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about the south downs. Is he aware that a poll carried out by Meridian television showed that about 85 per cent. of people in the proposed south downs areas support the national park? There is a great deal of public support in the Sussex and Hampshire areas.
Lawrie Quinn: My hon. Friend has great experience and I recall that he had the opportunity to participate in a similar debate approximately four years ago, in November 2000. I wish him and his constituents well in bringing that forward.
The media involvement and interest in the issue gives credit to the national park movement, which has used national parks week to focus the significance of that vital part of national life across the nation. The hundreds of pieces of print and broadcast coverage during that week, both near to national parks and beyond, have allowed us to give the country a flavour of the wide variety of opportunities in national parks.
It is interesting to note that many other audiences were reached in different ways. The UK's largest outdoor retail store featured a national parks week window promotion in its 260 stores nationwide. I am sure that that has prompted many people from urban areas to find out for themselves the great attractions that national parks have to offer.
Dr. Ian Gibson: I see that the hon. Member for Mid-Norfolk (Mr. Simpson) is present. We both enjoy the delights of the Norfolk broads, but the local council is attempting to close the toilets and demean other public facilities such as refuse collection. Is not the wonderful work taking place in Norfolk and other areas undermined by aberrant councils?
Lawrie Quinn: I thank my hon. Friend for that contribution to the debate. Perhaps hon. Members will recall the incident in my part of the world where Scarborough borough council tried to close public conveniences in the same way as my hon. Friend described. Famously, the local playwright, Sir Alan Ayckbourn, who was given the opportunity to comment on whether there should be public conveniences or extra grants for his local theatre, said he did not want to get himself involved in a debate that would consider the important question of luvvies or lavvies.
At the end of the day, public opinion will doubtless win through. I wish my hon. Friend the Member for Norwich, North (Dr. Gibson) and the hon. Member for Mid-Norfolk well with their campaign to ensure that people see sense about how to spend a penny. [Interruption.] I think we will forgo that comment on rendezvous in public toilets.
To return to the comments made by my hon. Friend the Member for Brighton, Pavilion (Mr. Lepper), there was a lot of publicity during national parks week. The Association of National Parks commissioned public surveys, and the interest in national parks from the survey conducted by Meridian television that my hon. Friend has mentioned is supported by the national survey, which showed that 95 per cent. of people thought that national parks were an essential part of national life. For all of us politicians, a 95 per cent. approval rating of our work would be well received, but perhaps we can look to that only as a political holy grail.

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The key point of the debate is to support the vital work within the national parks family and to further stimulate public awareness. That point was highlighted in the review of national parks authorities published last year. One strong recommendation was that the parks do a better job of promoting their activities. On the North York Moors national park, the parks authority, those who work in the park and the friends of the national park have taken up that recommendation and done a far better job of promoting their activities.
In my part of the world and in many national parks throughout the country, a crucial component is the management of natural resources within the parks. Fundamental to that is the participation of people who work in the agricultural industry and the industry itself. The industry defines, maintains and undertakes the important stewardship of the landscape.
Over the last bank holiday, I visited the Peak District national park and, without a doubt, the landscape has been worked to provide us with a national treasure and has the acclaim of being our first national park. From conversations with farmers in the Peak District national park, we learned that Parliament must closely monitor agriculture for the next 10 years, as the common agricultural policy mid-term reform and single farm payments scheme impacts on those vital landscapes and their communities.
I hope that everyone agrees that it is essential to sustain the farming communities in the national parks. They are some of the most isolated and hard-working communities and they receive very little reward. I know only too well from my constituency mailbag how much support we should give to those communities, and the work that DEFRA has embarked on is part of the process of encouraging farmers to make more of the benefits of national park designation. The park authorities want to work more with the farming community to help it become more sustainable, not only in terms of agricultural product, but in terms of the diversification of the activities that it is able to carry out.
The parks are addressing the facilitation of the nation's sustainable development agenda. That has been helped by one of the Minister's personal initiatives; the sustainable development fund strategy. If he will forgive me for saying so, it is a passion of his. It is an exciting initiative, which involves communities and businesses in sustainable development at a practical level, and instead of just talking about the topic, it is delivering practical results in the nation's national parks.
In the North York Moors national park, a small engineering company was supported in the development of a small, environmentally friendly boiler, which is now a leader in the world market. That all started because of the support and the considered judgment of the park authority. Through agricultural and industrial support, the national parks have become an exciting place to do business. Many other organisations could take a leaf out of the national parks' book and follow their lead. They are all about teamwork and partnership and ensuring that such engagement continues into the future.
My right hon. Friend the Minister is respected among the family of national parks, principally because of his personal interest in the national park movement. I have been pleased to welcome him to my constituency on the
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occasions when he has visited the national park that covers 60 per cent. of my constituency. I particularly remember the fine day when we celebrated the 50th anniversary of the North York Moors national park. With typical style, we had a brisk ministerial moorland walk. The Minister impressed all who accompanied him on that day, not least the park rangers, who had allotted double the time we actually took to travel the route, which is a tribute to the years of training the Minister had on the slopes of Snowdonia. Without a doubt, on that day in North Yorkshire, he was not only well briefed but well booted. Many people, including rangers, still mention that day to me, and the way that he was able to get involved with discussions in the park.
For the record, we were also able to bring parliamentary colleagues from the national parks group to North York Moors national park in May 2003. There were many highlights to that trip, but one of the important things was the drive towards bringing sustainable tourism to the national parks in North Yorkshire. Last year, more than 8.5 million visitors spent time in the North Yorks Moors national park. Most would agree that that figure illustrates the importance of tourism to the area. Without a doubt, after the ravages of foot and mouth—which happily stopped halfway down my constituency, but none the less damaged many local businesses, many of which were linked to tourism—the North Yorks Moors national park sustainable tourism project allowed local businesses to understand what a special product they had and to develop the proposition that it is great to come to the North Yorks Moors national park.
The popular village of Goathland in my constituency is well known as Aidensfield in "Heartbeat" and it acts as a magnet for many people coming into my part of North Yorkshire. The special role that North Yorks Moors national park is able to perform in stimulating effective management of transport systems, effective promotion, and, above all else, a real partnership with the local community, allows us to look forward positively to the future.
I am conscious of the time. I want to allow many other colleagues to take part in the debate, but it would be remiss of me not to mention the tremendous work that has been done to debunk the ideas relating to social exclusion in national parks. People in areas such as Teesside, Humberside and other parts of West Yorkshire—people from ethnic communities in particular—have not felt that they would be afforded a welcome and hospitality when they visited a national park. The authority has done tremendous work in North Yorkshire and the Minister may recall seeing a presentation on it. It has made a huge difference and has made our national park feel like a national park, so Muslims from Teesside or Hindus from Hartlepool can come and enjoy the wonders of the fantastic moorland.
I want to mention a particular concern of mine that is exemplified by the ongoing debate about the future of RAF Fylingdales in the North Yorks Moors national park, which has made me particularly aware of the specialist and tremendous work that national park planning officers do. It gives me some concern that, as a nation, we are perhaps not sustaining and developing that particular group of professionals to allow them to undertake their specialist work of sustaining and keeping the national park together for the future.

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I hope that the Minister will consider speaking to his colleagues in the Office of the Deputy Prime Minister to examine whether there will be a development, both professionally and in terms of the training opportunities that can be afforded to that special group of people. Over the years, I have seen planning officers who have been trained up, and have become very effective in their role of working for local communities, but who have been almost seduced away from the delights of the national park movement towards private practice. That puts pressure on the ability of planning officers to work effectively for the future. The debate on RAF Fylingdales has shown me what an excellent job such people do in contributing to the viability of national parks.
There is so much that I could say, but I will finish with one final point. The Minister took over from the Under-Secretary of State for Foreign and Commonwealth Affairs, my hon. Friend the Member for Sunderland, South (Mr. Mullin), who set in train a debate about the future of national parks. At the end of 2003, an action plan for the review of the English national parks authorities was published. At the end of the debate, perhaps the Minister could take the opportunity to highlight where we are up to with the action plan, what has been achieved and whether there are any lessons to be learnt. Above all, what role can be played by local MPs, who serve these wonderful communities around the country, to keep the action plan alive and relevant and to service the needs of not only local residents but the nation?
Mr. Bill O'Brien (in the Chair): Order. Hon. Members will be aware that this debate will finish at 3.30 pm, and I intend to start the winding-up speeches at 3 o'clock. There are 35 minutes to call as many Back Benchers as possible.
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Mr. Keith Simpson: I congratulate the hon. Member for Scarborough and Whitby (Lawrie Quinn) on securing a debate on this important subject. I am lucky that my constituency straddles the broads at the eastern side. As hon. Members will know, the Norfolk and Suffolk broads are the UK's premier wetland area and have been shaped and matured since Roman times.
Agriculture remains a crucial element in the economy of the broads, but is more important today for securing the landscape and wildlife. Tourism is now the major driving force behind the economy. I know that the Minister has visited the broads in the past couple of years and that he used to go on the broads as a child, so he is well aware of the area's importance and natural beauty.
The broads were finally established as a UK national park under the Norfolk and Suffolk Broads Act 1988, which was steered through the House by my predecessor in Mid-Norfolk, who is now Lord Ryder of Wensum. That legislation is tailored to meet the specific additional interest of protecting navigation on the broads.
The broads' boundary is tightly drawn around the rivers Bure, Yare and Waverley, and encompasses an area of about 301 km of mainly open, under-developed
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landscape of water, fens, marshland and woodland. It also includes many waterside villages and towns, such as Wroxham, Acle, Reedham and Brundle, which happen to lie in my constituency, as well as many others. It is a truly beautiful area. An extensive inland waterway system, comprising 190 km of navigable, lock-free rivers and permanently open water bodies is also an important part of the broads.
The Broads Authority has three aspects to its remit: first, conserving and enhancing the natural beauty of the broads; secondly, promoting the enjoyment of the broads by the public; and thirdly, protecting the interests of navigation. One specific concern about the broads is the impact of climate change, especially the rise in sea level and the risks from flooding. Will the Minister comment on what additional action the Government are taking to protect the Norfolk broads from that growing threat?
Together with the important urban hinterland, the broads can facilitate growth and urban regeneration in that part of eastern England. Transport, including the road system, is absolutely crucial. The Minister will be aware of the vital importance to Norfolk of our main east-west road, the A47. Something that has particularly caught the local attention is the debate over the dualling of the so-called "Acle straight", the single-lane road between Acle and Great Yarmouth. The Highways Agency is due to report shortly on whether the road should be dualled.
One concern expressed by local people is that although the environmental impact is the main consideration, economic factors are not being considered at all. I spoke in a debate on transport in the eastern region the other week, supported by the hon. Member for Great Yarmouth (Mr. Wright). I know that that issue is not the Minister's responsibility, but it reinforces what the hon. Member for Scarborough and Whitby said about the fine balance in areas such as the broads between economic aspects, regeneration, and the natural habitat.
Managing the habitat is incredibly important. The wetlands and hinterlands are crucial for birds and wildlife. We must also consider the management of predators, and how they can be contained and eliminated. There particular concern in several areas about foxes; without wishing to raise a fox hair, I ask if the Minister accepts the need to cull foxes, which according to the RSPB, are a threat to birds.
The total value of tourism to the broads was £146.6 million in 1998; more than 2.3 million visitors visit the broads annually. Boatbuilding and boat hiring are very valuable to the local economy. The hire-boat industry is the single most important provider of holidays in the broads; the number of licensed boats using the broads in any year is between 12,700 and 13,200, and 4,350 jobs in the broads area are dependent upon tourism. Other recreational activities include angling, sailing, walking and horse and bicycle riding. The economic aspect of a national park such as the broads cannot be over-emphasised.
The Broads Authority, which manages the broads, has an annual budget of approximately £4.5 billion and raises about £1 million in addition from external sources. It relies on a number of services provided by district councils, including public lavatories—not

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toilets, of course—and waste disposal. As the hon. Member for Norwich, North (Dr. Gibson), who seems to be fascinated by the subject, said, we have a problem in that respect, which I shall mention briefly.
In the past few months, there has been considerable agitation in the broads area about the proposal by district councils—those that directly affect the broads and the hinterland—to close some, if not all, public conveniences. The hon. Gentleman is on record as saying that one district council in particular was being a cheapskate about the matter.
I did some factual investigation into the subject as it seemed to go beyond the national parks. I have received representations on the matter from the Broads Authority, the district council, the Broads Hire Boat Federation and from that most powerful of organisations, the Women's Institute of the village of Reedham. Quaver in your shoes, I say to the hon. Member for Norwich, North, at the thought of the WI intervening in this matter. There has been a lively correspondence in the local press about it and the Broads Authority will be discussing access to public lavatories and waste disposal at a board meeting on 16 July. Access to public lavatories on the broads and the removal of waste is very important not just for the environment but for local communities, business and tourism.
My concern in the debate is to consider the facts and to see what can be done to enlist the Minister's support where he is able to resolve the problem. He, and the hon. Gentleman, will be aware that district council funding for public conveniences is discretionary expenditure. Most district councils, especially those in Norfolk, are at a disadvantage because many of them have funds withheld by the Government and are facing problems in meeting their statutory obligations, let alone their discretionary obligations.
The future of public lavatories is a national problem and many councils throughout the country have already gone ahead and closed them. For example, Shepway has closed all 28 of its public lavatories, and South Devon district council has done the same. North Norfolk and South Norfolk district councils must also consider that solution. There is a financial problem connected with the issue, which I suspect affects the constituencies of other hon. Members whose constituencies cover parts of the national park. It will cost an,extra £100,000 for Broadland district council to modernise its public lavatories, including the provision of disability access. That appears to be a small sum of money, but translated into the council tax, it means an extra 3 per cent. It is not a small-change issue.
What is the solution? I hope that the Minister can bring some pressure to bear on his colleagues in other Departments to admit that this is a national problem, and that the decision on withholding moneys from district councils should be reversed. In particular, Broadland district council, whose policy is under question at present, should be given the moneys that it is due. I believe that the Broadland district council should continue to find local solutions to the problem of keeping those public lavatories open, such as joint financing arrangements with parish or town councils. Such arrangements already exist with two parish councils in my constituency.
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Given that the Broads Authority has recently received extra moneys for tourism and planning, it might, at its meeting on 16 July, consider some form of joint financing with local district councils for public conveniences, because those conveniences are needed by local communities, and also come under pressure from tourism.
As far as waste disposal is concerned, I know that some boatyards are establishing their own local agreements with district councils for the emptying of skips. One of the problems faced by many of our district councils is that a large amount of fly-tipping occurs around the skips, which causes major problems for the environment, as well as encouraging the rodent population. I hope that the district councils in Norfolk that cover the broads area can continue to maintain a waste disposal service for the broads, which the Government will support, and that there will also be contributions from other stakeholders.
My constituents in the broads area are privileged to live in an area of great natural beauty, but many of them also make their living from the area. They also have to extend a welcome to millions of tourists every year. The Government, district councils and the Broads Authority must resolve a number of competing issues of which, at the macro level, there is the impact of tourists on the environment and, at the micro level, the opening or closure of public conveniences.
Mr. Bill O'Brien (in the Chair): Order. There are six hon. Members wishing to speak, and we are running out of time. I appeal to them to restrict their contributions to three or four minutes each.
2.32 pm
Mr. David Lepper: I also congratulate my hon. Friend the Member for Scarborough and Whitby (Lawrie Quinn) on securing the debate. He is right that it is nearly four years since we last debated national parks, also at his instigation.
I am glad that he talked about the future of the national parks movement. I represent an area that does not yet have a national park, although a public inquiry is under way on the designation of the south downs as a national park. What is clear from the inspector's reports on the New Forest designation is his belief that area of outstanding natural beauty status is not enough to secure the protection that is needed for areas such as the New Forest and the south downs.
Reference has already been made to the widespread public support for designation in the area covered by the Sussex downs. There is public support because people see designation as a way of securing protection and conservation of a unique landscape through strategic planning. They also see it as a way of securing additional funding, through the EU or from the lottery, for example, to help with that conservation and protection. However, I want to mention one concern that is emerging in that public inquiry, although I would not necessarily expect the Minister to comment on it, because he is in a difficult position because of his quasi-judicial role.
Concern was expressed earlier about the narrowness of the boundary of the New Forest national park. There is concern that the boundary of the south downs national park might be more narrowly drawn than the Countryside Agency recommended.

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It is well known that West Sussex county council is opposed in principle to the idea of a national park for the south downs. It has reportedly set aside a budget of £200,000 to fight designation. Its current tactic seems to be to suggest that there should be a south downs national park consisting of chalk landscape only. That would leave out many of those areas recommended by the Countryside Agency, which are important from the point of both landscape and history. There were 6,000 responses to the public inquiry into the south downs national park, compared with 420 for the New Forest; 90 per cent. wanted more land included within the boundaries rather than less. I do not necessarily expect the Minister to comment because of his role, but I flag up for his attention the genuine local concern about the possible spoiling tactics being adopted by West Sussex county council.
I have been asked, as have all hon. Members, to keep my comments brief. Support for the proposed designation grows day by day. My local authority has always supported it but other authorities have now become more sympathetic to the idea. I pay tribute to the work of the South Downs Campaign, which draws together nearly a hundred organisations including parish and district councils to put the case as strongly as possible for completing the work suggested in the Hobhouse report of 1947 to include the south downs in the family of national parks.
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Mr. Patrick McLoughlin: I shall try to be brief but I want to cover a few points. I congratulate the hon. Member for Scarborough and Whitby (Lawrie Quinn) on securing this important debate. He rightly referred to the Peak District national park, which forms a large part of my constituency and which the all-party group visited a few weeks ago.
I fully agree about the importance of national parks. Colleagues have talked about visitor numbers being 2 million to the broads and 8 million to the Yorkshire moors. The Peak District national park gets 19 million visitors each year. It was once described as the lungs of Britain because it is within an hour's drive of 60 per cent of the population. It sometimes seems that they do all come. That proximity brings a lot of problems, as well as enabling people to enjoy the beauty of the Peak district. People tend to come for the day and they do not necessarily spend much money while they are there. I was impressed when I visited the Eden project to see how it has encouraged people to stay overnight. Overnight stays in Cornwall have dramatically increased. Unfortunately that does not happen in the Peak district.
I thank the Minister for listening to the representations that a number of us made about the size of the Peak District national park. It is a unique national park in that it is made up of so many authorities. I realise that that might not be the case once the south downs authority is established. The all-party group visited Chatsworth, a fantastic house and beautiful building that is a very important part of the Peak district. However, I often make the point that if anyone tried to build Chatsworth today, they would not stand a cat-in-hell's chance. I do not think we would allow even the stables to be built, let alone the house.
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That is part of the problem that I want to raise with the Minister; the question of building and allowing organic growth. I am very concerned about how house prices in the Peak district have rocketed in the past five years. I know that many areas face that problem, but for the Peak district, being so close to places such as Sheffield and Manchester and not far from Birmingham, it is especially serious.
I wrote to the Under-Secretary of State, Office of the Deputy Prime Minister, the hon. Member for Pontefract and Castleford (Yvette Cooper) on the subject. She replied:
"In carrying out its planning functions the National Park Authority must also have regard to the purposes for which the Park was designated, which include conserving and enhancing the natural beauty and cultural heritage of the Park."
Nobody would disgree with that.
"It also has a duty to foster the economic and social well being of local communities within the Park."
Many people who grow up in national park villages currently stand no chance of being able to afford housing within it, and the problem is becoming ever more serious.
We often talk about affordable housing, but affordable housing in the national park is more expensive because of planning criteria. I urge the Minister, when he meets representatives of the national park, to discuss allowing more organic growth. If local people want to build extensions to their house so that they can bring up families, that should be looked at sympathetically.
I could say a lot more, but because of the time constraints, I shall leave it at that. I hope that the Minister will consider the point. There is no easy solution, because of the complicated nature of the problem, but at the moment there is unnecessary restriction and too narrow a view taken on planning. None of us wants to see the national parks becoming the preserve of very wealthy people who can afford to pay huge prices for what are in some cases moderate houses. I urge the Minister to consider that. I accept that there are no easy solutions, but we need to address the problem seriously.
2.47 pm
Mr. Colin Pickthall: I will cut out the general material that I wanted to talk about and move straight to the issue on which I want to concentrate. I want briefly to put on record my concerns about some precious landscape between the Lake District and Yorkshire Dales national parks. I know that the Minister is aware of the problem.
Cumbria has large tracts of spectacular landscape that anywhere else in England would be in a national park but in Cumbria are not. Some of the landscape is protected—as areas, of outstanding national beauty, for example—but other parts are not. With little effort, I could make the case for including the whole of north-west England north of Carnforth in the Lake District national park, but that would be pushing it a little far.
The landscape that I am concerned about is that found between the A6 and M6 north of Kendal, the Orton fells and the part of the Howgill fells that is not included in the national park. Those areas were recognised by Dower in 1945, when he put the Howgills

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on the reserve list for future national park status, and by Hobhouse in 1947, although he did not recommend the Howgills for national park status. He did that not because of the quality of landscape, but because of the exceptional quality of the landscape that was next to them.
I want to zero in on the landscape lying between the A6 and M6 that butts on to the Lake District national park; Westmoreland Borrowdale for want of a better term. The land is under threat, although it is an environmentally sensitive area, and its landscape quality is equal to that of the Lake District national park, and potential developments there could directly affect the visual quality of the national park itself. This stretch of Cumbria consists of parallel ridges running east-west and valleys, and it is outstanding walking country. It is virtually uninhabited and was beloved of Alfred Wainwright, among many others. It has been designated county landscape by Cumbria county council. At present, one of its ridges, the Whinash ridge, is threatened by a plan to place 27 wind turbines, some of the largest ever built, along it. It is such a huge development that it has to be treated as a power station by the Department of Trade and Industry. Incidentally, it would be nice to know from the Minister what consideration Ofgem, Ofwat and other bodies have to give to the needs of national parks.
That is a threat not only to the Whinash ridge and to the visual amenity of the area but to the visual amenity of large tracts of the eastern part of the national park. That is a problem right round the Lake District national park borders, where the fells just outside the park have attracted wind turbine developers as honey attracts files. For example, the Burlington wind farm on Kirby moor is now the visual southern end of the whole of Coniston water.
Of course, if the wind farm were to appear on the Whinash ridge, any case for inclusion of the area in the national park would vanish. I do not want to make the case for inclusion simply as a defensive move to prevent a wind farm, because the area should be included in the national park on its own merits, and there is widespread agreement on that. Certainly, the district and county councils are in favour, and the process could now be one of pushing at an open door, so far as local opinion is concerned. I know that the local Member, the right hon. Member for Penrith and The Border (David Maclean), is of the same opinion.
There is an urgency to this matter, which I want to register. I am aware that the Friends of the Lake District have secured counsel's opinion from Robert McCracken QC to the effect that the Government could carry out a discrete area extension to a national park without opening the whole boundary to review, and the Minister and the Department have responded positively to that, which is great. The Countryside Agency board visited in early May and was, I under stand, impressed by the landscape, as are all of us. It has set up a working group to produce a report to the board in the autumn. That is all very promising. I hope that the Minister will keep his strong interest in this matter fresh and, in the nicest possible way, remind Pam Warhurst—if she needs reminding—of the urgency involved.
2.52 pm
Dr. Julian Lewis: As well as trying to be as brief as possible, I shall try to be as positive as possible. I apologise on behalf of my hon. Friend the Member for New Forest, West (Mr. Swayne), who is at this moment having to debate a statutory instrument in another part of the Palace of Westminster.
The announcement that the New Forest is going to become a national park has made a small group of my constituents very happy indeed. That is the New Forest, East Labour party, the only group in my constituency who consistently wished for, desired and campaigned for a national park model for the New Forest. I pay sincere tribute to Mr. Peter Sopowski, the former chairman of the New Forest, East Labour party, and Mr. Alan Goodfellow, my former opponent at general elections, because they are the only people who have consistently wanted this solution. If it works out well, it will reflect great credit on them in the future.
Most other groups in my constituency and in the New Forest area as a whole did not want this solution. That does not mean that they did not want the New Forest to be protected, but they wanted it to be protected in the future in the way in which it has traditionally been protected in the past: through special legislation. They were concerned that if a national park model were imposed on the New Forest, it would lead to rigidity, bureaucracy and the overriding of the former, consensual way of running the New Forest by a compulsory way of running it. Everything will depend in the future on the sensitivity and self-restraint shown by the people in the national park authority.
The Labour Government have a democratic mandate to carry this proposal out. They announced before the last general election that they proposed to create a national park in the New Forest, and having won that general election, they can claim a democratic mandate for what has now been done. It was never the case that the public inquiry into the proposed New Forest national park would turn it down on the basis that a national park was not the best way forward for the New Forest. The purpose of that public inquiry, as I said at the time, was simply to see whether the New Forest measured up to the criteria necessary to become a national park, and of course it did.
However, after the general election, when I went to see the Minister's predecessor—who is now the Under-Secretary of State for Foreign and Commonwealth Affairs, the hon. Member for Sunderland, South (Mr. Mullin)—he made me this promise. He said, "Julian, there will be a national park for the New Forest, but we are open to persuasion as to how it might be tweaked and tailored to suit the New Forest's particular needs."
That is why, in the few seconds that remain to me, I want to express surprise that a site of special scientific interest such as Dibden bay has been excluded from the national park, whereas Fawley power station has been included. According to a quote from the Minister in the local press, that is because otherwise
"We would have a hole in the map just because there happens to be a power station there."
I only hope that we do not, as a result, see a renewed assault on that triple SI, which only recently was, thank goodness, saved from port development.

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Finally, I draw the Minister's attention to the press release from New Forest district council. The chief executive, Mr. Dave Yates, commented:
"The Inspector appears to have accepted that it would be a good thing if the development control arrangements within the National Park were delegated back to the local authority. However, we understand that the Minister has not made any final recommendation on this".
I, for one, would take it as fulfilment of the promise made to me by the Minister's predecessor if he gave a positive response on that all-important concern.
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Kate Hoey: I do not speak on behalf of a national park—Vauxhall does not have one—but for right hon. and hon. Members' information, we have just reopened our public toilets in Kennington park.
I want to sound a note of slight discord in the debate and I am speaking particularly on behalf of many people who feel that national parks are not as welcoming and open to them as they are to others. Those are people who want to get involved in many different minority sports. I am all in favour of national parks being areas of quiet enjoyment and peace, but I have concerns where there are large areas of national park.
I am referring particularly to the Lake District national park, where there is a large number of lakes. It seems wrong that that national park has gone blindly down the line of trying to ban all water skiing and any use of the lakes by boats travelling at more than 10 mph. This issue is very important, and I have tried to secure Adjournment debates on it. Historically, Windermere, which is the largest of those lakes, has been a lake where water sports and fast speedboating could go on. It is a very large lake. In 1978, when a 10 mph speed limit was introduced on the other three lakes—Coniston, Ullswater and Derwent water—after the three-lakes inquiry, the agreement with the British Water Ski Federation was that Windermere would always remain a venue for water sports.
This has been a long saga, as my right hon. Friend the Minister knows. There was a public inquiry, but a Secretary of State in the previous Government refused to accept its findings, because he felt that there could be a management plan that allowed all users of that large lake to work together. All the users in the area of the lake have got together and they all want a solution to the problem. I pay particular tribute to what the hon. Member for Mid-Norfolk (Mr. Simpson) said, because the Norfolk broads have been an example of how, with good will and no political correctness, people can get together and work out how to allow water skiing, even on the broads.
I want the Minister to respond to this point. The issue will not go away. Let me explain the situation as from next year. Water skiing is not banned, but there is a 10-mph speed limit. That will bring on to the lake all sorts of other uses of the boats. It will put boats back on to the other three lakes. There was an agreement that the other three lakes would not have boats on them, but no one can prevent them from going back. Instead of that being an asset and something that will help the Lake District national park, we will drive away small
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businesses, tourists and people who have brought their families there; people who have been able to take part in activities on the lake with their young people and then go off and have peaceful enjoyment further into the national park.
That is a travesty. We should be reconsidering the issue and ensuring that our lakes and national parks are open for all people within reason. All reasonable people should be able to find a way to sort out this problem. Windermere is big enough for everybody.
2.59 pm
Mrs. Jackie Lawrence: I am grateful to have a chance to speak, even if it is just for a minute, as I am chairman of the all-party group on national parks. I congratulate my hon. Friend the Member for Scarborough and Whitby (Lawrie Quinn) on his contribution. It was comprehensive, but he missed one thing. On sustainability, there is an essential need for section 62 to be strengthened and re-emphasised and for all Government Departments and statutory bodies to be encouraged, if not obliged, to commit to park purposes. That would do away with the need for extra legislation.
I want to emphasise sustainability, particularly the SDF. The Minister himself, in his former capacity as First Minister for Wales, used Wales as a test bed for what has been a successful ongoing scheme throughout the UK. Just this morning, I received a document from my constituent Ridchand Blacklaw-Jones, who obtained SDF funding to examine local procurement of organic food in Pembrokeshire. Pembrokeshire has one of the largest areas of organic farming. I cannot go into the detail of what he has written, but it holds great promise for the national park and for farmers in it and wider afield.
Another element about which I hoped to go into some detail falls outside of agriculture. My hon. Friend mentioned the importance of SDF funding. The project on tidal energy, which is being funded by the national park in Pembrokeshire, also holds promise for Pembrokeshire and wider afield.
Finally, I wish to mention affordable rural housing in the parks, which has already been mentioned by the hon. Member for West Derbyshire (Mr. McLoughlin). In my area, property prices have gone up by 100 per cent. in only three years. There is a wonderful economic vibrancy in the local community, which has had a drop of more than 90 per cent. in youth unemployment. That means, for the firs time in generations, that young people are able to stay in the national park where they and their families have been brought up and to keep the area vibrant. We do not want the national park to be a place just for people from the cities to play in or, after their working lives, to retire to with income that they have accumulated elsewhere.
Within that framework, it is important that we put in place the means for local people to find housing. Pembrokeshire and Exmouth are trying. I hope that the Minister will comment on that and efforts to make affordable housing available in UK national parks.
3.2 pm
Mr. Roger Williams: I, too, pay tribute to the hon. Member for Scarborough and Whitby (Lawrie Quinn) for obtaining this debate.

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Many important issues about national parks have been raised in the contributions of hon. Members. Many of those issues actually cross the boundaries of national parks, but national parks have been able to act as a test bed for them. National parks are important to this country not only in themselves but as models of good practice for other rural areas.
I was pleased that the hon. Member for Preseli Pembrokeshire (Mrs. Lawrence) was able to catch your eye, Mr. O'Brien. I would like to pay tribute to the role that she has undertaken as chairman of the all-party group on national parks. Her energy and enthusiasm have enabled the group to stick together and do valuable work. She has indicated that she will lot seek re-election at the next general election, but I pay tribute to her work for that all-party group.
Members should remember that the national park movement was founded outside Britain, in America, by pioneers who had enough foresight to understand that, even in that huge country, the pressure of development could endanger and put an end to the qualities of the countryside that we so value. Indeed, several national parks in America are virtually uninhabited.
I went to Atlanta, Georgia, recently and was taken around the Martin Luther King area by national park rangers. I found that a little strange, given the tradition of national parks in America. That just goes to show how the national park movement is developing.
One great thing they have in America is wilderness and that is precious in this country also. The opportunity for people to walk in national parks knowing that they will not encounter elements of human development is what makes those areas so attractive. From a parochial point of view, I believe that any development of wind farms in national parks or development that encroaches on the visual aspects of national parks is entirely unacceptable. People go to those areas for recreation; not in the ordinary way but to recreate themselves and to get back the internal spiritual energy that they have lost because of their jobs and the pressures of work today. They can go to those areas, think about things, find themselves again and re-energise themselves for their tasks.
The unfortunate experience of foot and mouth disease showed without doubt how important it is to have access to rural areas and national parks. That was a lesson for us. We did not need the problems, heartache and heartbreak that the foot and mouth outbreak brought, but it taught us an important lesson. In the area that I represent there has been a greater coming together of effort and thought between the farming community and the community that is dependent on tourism and visitors than there ever was before the outbreak. I believe that the pressure and concern during the outbreak will stand us in good stead in future when more and more farming businesses become involved in tourism. One issue that will come out of the mid-term review of agriculture is that people will see that they have energies and skills that can be used outside food production. They can look after people in a huge range of ways by providing interpretation of the countryside and allowing them to take part in active holidays such as walking, climbing and horse riding. There will be more and more of that.
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I was a member of a national park authority for more years than I care to remember and chairman for a number of years. The great challenge was always to obtain a balance between the national responsibility of national parks and the needs of local people by ensuring that they were not disadvantaged by other people benefiting from the existence of national parks.
Planning authorities in national parks are often criticised for being over-zealous in their approach and preventing developments that could take place without deleteriously affecting the purposes of national parks. It is important that a number of national park authorities have now won awards for their planning work and the national parks, building on those good practices, will be able to make great advances. National parks are at the forefront of innovation in terms of rural development and should not be afraid of being innovative in the way in which they operate.
I was pleased that the review of Welsh national parks—I believe that I can speak about those, Mr. O'Brien, as we are discussing national parks as a whole—recommended that there should be direct elections to national park authorities. I do not know whether the Minister, who represents a Welsh constituency but is responsible for English national parks, feels that he could possibly comment on such a matter, but the Welsh Assembly should not be afraid of that suggestion. If there were elections and candidates supported the purposes of national parks, they would receive a huge amount of support. Indeed, that would stimulate a positive and balanced debate about how national parks should be administered and run and where their future lies.
I believe that Britain plays an important part in the national park movement throughout the world. We have many lessons that can he learned about how to manage rural areas in which people live and farm intensively. I am sure that the debate will go on. We could do with a debate on the Floor of the House to give us more time in which to examine these subjects.
3.10 pm
Mr. James Gray: In the few moments available to me if I am to give the Minister time to answer the various points raised during the debate, I will touch on two or three of those points and remind him of the questions that we seek answered when he winds up the debate. First, I congratulate the hon. Member for Scarborough and Whitby (Lawrie Quinn) on taking the initiative to call what has been an extremely useful and important debate.
It will be remembered that my hon. Friends the Members for New Forest, East (Dr. Lewis) and for New Forest, West (Mr. Swayne) raised two particular points. They drew a blind over the fact that the Minister, rather disgracefully, chose to announce the New Forest national park on the "Today" programme rather than in a statement to the House.
Alun Michael: Will the hon. Gentleman give way?
Mr. Gray: No, I will not. The Minister can answer in a moment. My hon. Friends raised—
Alun Michael: On a point of order, Mr. O'Brien.
Mr. Gray: Oh for heaven's sake!
Alun Michael: I want to make it clear that what the hon. Gentleman said is not true.
The Chairman: That is not a point of order.
Mr. Gray: The Minister will have the opportunity to respond more fully in a moment.
My hon. Friends the Members for New Forest, East and for New Forest, West raised two particular points. The first is that, as the Minister finally delineated it, the New Forest national park is 38 square miles smaller than that which was proposed by the Countryside Agency. As I understand it, the Minister himself made that decision. It misses out such important places as, for example, Dibden bay—which my hon. Friend the Member for New Forest, East referred to—with some detriment to the value of the national park. The Minister might like to tell us why that is and what can be done to make sure that it does not happen again and make sure that suitable constraints are placed on areas such as Dibden bay so that they are looked after.
Two hon. Members—the hon. Member for West Lancashire (Mr. Pickthall) and one other—referred to the issue of wind farms. That is a particularly worrying matter in the context of national parks and the areas surrounding them. Conservationists are alarmed about planning policy guidance note 22. Local authorities will be unable to create buffer zones around national parks such as the Lake District, which the hon. Gentleman referred to.
As Ruth Chamber, the deputy chief executive of the Council for National Parks, said:
"This would be an outrageous and blatant disregard of the Government's statutory responsibilities to protect these areas on behalf of the nation".
It is plain in PPG22 that buffer zones against wind farms may not be created in the areas surrounding national parks. That would have a particularly deleterious effect on national parks.
Nor may the planning authorities take any account of the cumulative impact of wind farms on national parks. We feel that that is also not right. The Minister might like to tell us fully what the policy he will adopt with regard to wind farms and national parks is.
A number of hon. Gentlemen and Ladies referred to farming. We forget too easily that farmers are the guardians of our landscapes and national parks as much as of anywhere else. If we allow farming to go the way that it appears to be going—particularly lifestyle farming—national parks will suffer as much as anywhere else. The Minister might like to touch on the Haskins review and how it will affect lifestyle farming, particularly in the uplands of various national parks.
Mr. McLoughlin: One of the decisions that the Secretary of State for Environment, Food and Rural Affairs has made is to change the designation as far as the new payments are concerned. That will have a serious effect in places such as Parwich. Farmers may farm in the same village but because one falls in a lowland area and one in an upland area or SDA—severely disadvantaged area—they will receive different payments.
Mr. Gray: My hon. Friend makes an extremely good point. I think that the mid-term review, at least as it was handled in this country, did not take account of less-favoured areas. There would have been deleterious
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effects had that not been corrected. It would be interesting to know, in addition to Haskins, how the Minister feels that the mid-term review will affect national parks.
We know that the current Government funding for the national parks authorities is about £36 million. The Minister made it plain in a recent statement that funding would not be increased by any more than inflation. In view of the announcement yesterday, it may not even be by that much. Will the Minister clarify whether the inclusion of the New Forest national park will result in a significant increase in funding for national parks in general? If the inquiry into the south downs national park were to find in its favour, would he commit the Government to providing the extra funding necessary for those two national parks?
On the subject of areas that are not currently national parks but may become so, in the aftermath of the statutory instrument debate last week about two areas of outstanding natural beauty, the Chilterns and the Cotswolds, it has been made abundantly clear to me from both places that any subsequent move towards national park status would be deeply unwelcome there. Will the Minister provide some reassurance that that is not in the Government's mind, that the AONB boards he has introduced are as far as he intends to go and that there will be no Trojan horse for national parks following on behind?
I will not tempt the Minister into any commentary on the long-running public inquiry into the south downs; that one will run and run. However, he must at least acknowledge that the fact that the public inquiry is so long running means there is a diversity of opinions. The hon. Member for Brighton, Pavilion (Mr. Lepper) told us, and he is quite right, that West Sussex county council are opposed to a national park. Its opinion must be taken into account; others are very much in favour of it.
As my hon. Friend the Member for West Derbyshire (Mr. McLoughlin) reminded us with regard to the Peak district, we must take account of the fact that large numbers of tourists being attracted to an area such as the south downs has its downsides. It is good for the local economy, but it has its downsides. One problem that my hon. Friend the Member for New Forest, East mentioned was that because the New Forest national park will be smaller than originally planned, it will concentrate tourist activity in a smaller area. That will have an environmental downside.
The Minister may like to acknowledge the diversity of opinion about the best way to treat the south downs should it become a national park or some sort of enhanced conservation board. They are difficult issues to which I do not have the answer.
Like the hon. Member for Vauxhall (Kate Hoey), I am slightly reluctant to go down the easy route and say that all national parks are good things. They are broadly good things and we are broadly in favour of them, but there are downsides to them. We do not want to turn the whole of the United Kingdom into one great national park and say, "Isn't that marvellous?" There are definite downsides to parks; they remove authority from some local authorities and there are difficulties associated with them.
It is right to address those difficulties and consider such matters as water skiing in the Lake district and the point made by my hon. Friend the Member for Mid-

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Norfolk about public lavatories and waste disposal on the Norfolk and Suffolk broads. They may sound mundane issues, but they are very important.
Broadly, everyone in the Chamber would agree that national parks have an enormous amount to recommend them and that they go some way to preserving delicate and sensitive landscapes that deserve our enhancement and protection. However, we must be aware of the problems of low-cost housing, as my hon. Friend the Member for West Derbyshire mentioned, and of water skiing in the north of England, and we must also be aware of the way in which we handle tourists. They are difficult issues that must be debated carefully. In giving the Minister extra time to reply to them, I look forward to his response.
3.19 pm
The Minister for Rural Affairs and Local Environmental Quality (Alun Michael): I am grateful to the hon. Member for North Wiltshire (Mr. Gray) for the large number of extra seconds that he has given me. I congratulate all Members who have taken part in the debate and packed so much into the time available. Like them, I wish there were more time because I would like to respond in full. I will do what I can to respond to the specific points that have been made and, where I am not able to do so, perhaps write to Members.
I congratulate my hon. Friend the Member for Scarborough and Whitby (Lawrie Quinn) on obtaining the debate and on championing his national park, second only to his championing of national parks in general. I also congratulate my hon. Friend the Member for Preseli Pembrokeshire (Mrs. Lawrence). In recent times she has been a doughty champion of national parks in general as well as those in Wales, and has been a leading influence in Parliament in raising issues that concern to national parks.
I congratulate the Association of National Park Authorities on the success of national parks week, which I hope will be the first of many celebrating our national parks, sharing them and exploring their potential. It was about letting the public know what their parks can do for them and what they can do for the national parks. One characteristic that the national parks have in common is that each of them is unique; when I visit them, people at each say that it they are different and special, which is true. They are all unique; the national parks are a very special family.
In his introductory remarks, my hon. Friend the Member for Scarborough and Whitby (Lawrie Quinn) asked about the action plan that follows the review of national parks. We are making good progress on about 50 recommendations, in line with the action plan that I published last year. I am happy to update him and others on our progress.
Section 62 of the Environment Act 1995 is an issue that concerns my hon. Friend and I can tell him that during the national parks review in 2000, responses made it clear that not all public bodies are clear about their obligations to take into account national park purposes, a matter which has been referred to in the debate. As recommended, we considered the detail of the impact of section 62 and its meaning. I will write shortly to all the bodies that will be affected by the 1995 Act reminding them of their responsibilities, and asking
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them to confirm how they are carrying out those responsibilities. The national parks authorities report annually on the observance of section 62 in their own national park, which I hope will help to follow through the issue raised by my hon. Friend.
My hon. Friend the Member for Scarborough and Whitby suggested that there might be a drift away from national parks because the planning officers were recruited elsewhere. The main drift that I have seen is the Peak district national park's recruitment of a chief executive from the Department for Environment, Food and Rural Affairs, which showed its good judgment. All the national parks in England had planning delivery grants from the Office of the Deputy Prime Minister in recognition of their good planning practice. I am not aware of a specific problem; it has not been raised with me by any of the national parks.
As my hon. Friend said, rural regeneration is very important. I am pleased to have been able to bring together the regional development agencies, national parks in England and representatives of areas of outstanding natural beauty to talk about sustainable development and the interface between national park and RDA work. Each of the national parks can make a contribution to its region.
I welcome my hon. Friend's reference to the efforts being made to welcome ethnic minorities to national parks, and the Mosaic project has shown the way forward in that matter. The parks must be for everyone if they are to be truly national parks, as hon. Members on both sides of the House will agree.
My hon. Friend and my hon. Friend the Member for Brighton, Pavilion (Mr. Lepper) were right to suggest that I would not say anything about the south downs; it would be improper to do so until I have the report of the inspector who is conducting a public inquiry into the proposed designation. However, I assure my hon. Friends that all views will be taken fully into consideration. The same applies to issues such as the Whinash proposals, to which my hon. Friend the Member for West Lancashire (Mr. Pickthall) referred, which will be the subject of a public inquiry.
The hon. Member for Mid-Norfolk (Mr. Simpson) rightly pointed out that the broads are designated under separate legislation because of navigation concerns. However, I agree with him about their value; they are fully a part of the national parks family and share its rich diversity. The hon. Gentleman was right to refer to the importance of global warming and the potential impact on the broads, which illustrates why the issue is so important to the Department for Environment, Food and Rural Affairs and such a high priority for the Secretary of State. I have insufficient time to deal with that matter and with the navigation issues, but I will write to the hon. Gentleman about them. Similarly I defer to his knowledge—and that of my hon. Friend the Member for Norwich, North (Dr. Gibson)—on the subject of toilets in the Norfolk area, except I would point out that considerable additional funds have been provided to local authorities, and those issues should be dealt with locally.
The hon. Member for Brecon and Radnorshire (Mr. Williams) rightly said that foot and mouth disease had shown how important access is to all of those in the country: those who earn their living in the countryside,

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those who live there and the farming community. It is worth celebrating the fact that the National Farmers Union has played a full part in the development of tourism and bringing people back to the countryside. There is an increasing sense of the importance of access.
The hon. Gentleman touched on the issue of direct elections, which is a matter for the National Assembly for Wales in relation to Welsh national parks. I must say that I am not attracted to the idea as far as my responsibilities are concerned. As most representatives on the national park authorities are local, and as the tendency in recent years has been to include parish council representatives, the need for those people to be rooted in the opinion of people living in the area is well catered for as far as the English national parks are concerned.
I am grateful to my hon. Friend the Member for Preseli Pembrokeshire for referring to the environmental development fund in Wales. I am pleased to say that the sustainable development fund in England, which has now been operating for two years, contributed to more than 300 projects in its first 18 months, and levered in about £13 million from other funding sources. I hope that it will go from strength to strength.
My hon. Friend the Member for Vauxhall (Kate Hoey), who is noted for her support for activities described as minority sports, is quite wrong in her criticism of the Lake District national park authority. The proposals, which were decided on some years ago, were considered carefully and at great length, and were confirmed by my predecessor, my hon. Friend the Member for Sunderland, South (Mr. Mullin). I wholeheartedly agree with the policy that has been developed by the Lake District national park authority.
The hon. Member for North Wiltshire (Mr. Gray), who has a talent for spoiling the party, was absolutely wrong to claim that I made any announcement on the "Today" programme. I did not. The first announcement relating to the New Forest was made to the House in a statement. I have made that clear.
Dr. Lewis: On a point of order, Mr. O'Brien. Following the Minister's example, it must be made clear
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that the Minister made a written statement without informing the hon. Members concerned that it was going to be made.
Mr. Bill O'Brien (in the Chair): Order. That is not a point of order.
Alun Michael: What the hon. Gentleman says is quite untrue. He knows that in advance of making that statement I undertook—and carried out the undertaking—to fax to his office a copy of the letter that had been placed on the Board so that all hon. Members directly affected heard about it at the moment when the decision was announced to the House.
Dr. Lewis: Will the Minister give way?
Alun Michael: No. The hon. Gentleman has made enough misrepresentations. Perhaps he will stand up to make a point of order in order to apologise.
Dr. Lewis: On a point of order, Mr. O'Brien. I have been accused of misrepresentation. I said that the Minister's office tipped off the BBC three days in advance of any announcement and did not tell the hon. Members concerned that any announcement was to be made.
Mr. Bill O'Brien (in the Chair): That is not for the Chair to decide.
Alun Michael: I was absolutely scrupulous in ensuring that the House heard about the matter before anyone else. The hon. Gentleman's canard is not justified.
I am very pleased that the Landscape Institute has recognised the national park movement as the greatest influence on the landscape of the UK in the past 75 years. During the past 50 years, the national park authorities have protected some of our finest landscapes and our most important natural and cultural heritage. This year, two more national parks will celebrate their 50th anniversaries, the Exmoor and Yorkshire Dales national parks. They are holding a series of events to celebrate that. I hope that many hon. Members will take the opportunity to take part in those celebrations.
It is worth remembering the roots of the parks. They were called for by the people and are truly for the people.
Mr. Bill O'Brien (in the Chair): Order.

Pension Service (York)
3.30 pm
Hugh Bayley: I begin by thanking Mr. Speaker for responding so quickly to my request for a debate on the closure of the York pensions centre with the loss of 313 jobs. I have invited the hon. Member for Ryedale (Mr. Greenway) to join me in this debate, which will show that there is all-party support in and around York for all possible action to be taken to avoid compulsory redundancies for the staff concerned.
I pay tribute to the staff of the York pensions centre and their manager, Ron Stead, who have done a first-class job to introduce the pension credit in East Yorkshire and North Yorkshire. In City of York, there are now 6,230 pensioner households receiving the pension credit, on average getting £34.90 a week, which means that an extra £217,000 a week, or £11.3 million a year, is coming to our pensioners. Can the Minister assure the hon. Member for Ryedale, my hon. Friend the Member for Selby (Mr. Grogarn)—who is also here to support me and his constituents, who are affected by the decision—and me that the quality of the Pension Service for pensioners living in York will not decline as a result of the closure decision?
The decision is a serious blow to the York economy. Although unemployment in York has fallen by almost three quarters—from some 6,400 10 years ago to 1,700 today—it was not at all helpful for my hon. Friend the Minister for Pensions to say:
"York's economy is fairly buoyant and it is therefore more likely that some of those affected will be able to find alternative work."
York's economy is performing well, but it is going through a difficult patch at the moment. Some 316 jobs at Terry's of York, the chocolate factory, will be lost when it closes next year, and 150 nigh-tech computer jobs at Norwich Union are to be made redundant as a result of the company's decision to put some of that work out to contractors. I shall do all I can to help Pension Service staff from York to find alternative work, but the Government have created the problem, and I hope that they will assure me that they will do all they can to help those staff to find alternative work and that it will be possible to avoid compulsory redundancies.
When the Lyons review was considering relocating jobs from the south of England to the north, I submitted evidence arguing York's case as a suitable location for job relocations. When the review was published, York emerged as one of the favoured locations. Before the announcement of the Department for Work and Pensions closure decision on the York pensions centre, I wrote to the Department for Environment, Food and Rural Affairs and to the Ministry of Defence to ask them whether they were considering moving jobs, under the Lyons review, from the south to the city of York. I chose those two Departments because they already have a substantial civil service presence in the city, and I received helpful responses from Ministers in both Departments.
This is therefore a time for joined-up government. The DWP must co-ordinate its decision, which will lead to job losses in York, with decisions being taken by other Departments to increase job opportunities in
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York and to try to achieve a seamless transfer so that people are not left jobless but can transfer from their current jobs to new civil service jobs in the future. I was grateful to the Secretary of State for Work and Pensions for contacting me on the day on which he made his announcement, and when I spoke to him, I asked him to get in touch with those Departments, and any others that he knew were considering moving jobs to York, to see whether such joined-up government, and coordination of Departments, could take place. I would be grateful if the Minister told us what progress has been made on that front.
I know that the Department for Work and Pensions has met the York Inward Investment Board, now known as york-england.com. I would like an assurance from the Minister that he will continue to co-operate with the local authority and the York Inward Investment Board until an alternative user can be found for the Pension Service building, Triune court.
Last week I visited the centre, which is just over the border of my constituency in that of the hon. Member for Ryedale, and met managers, members of staff and the trade union representative for the pension centre, Julie Kemp. I was pleased to see that the management and union are working together to deal with the problems that they face, but there can be no hiding the anger that staff feel at the decision. For instance, one employee had given up a higher paid job to transfer to the civil service because he believed that a lower salary was compensated for by greater job security. I met a woman who had just had a baby and is losing her job at the pension centre because of the Government's decision. Her husband is also losing his job at Terry's in York.
I was concerned to be told that many staff believe that the Government planned from the outset an early closure of the pension centre. They think that the Government opened it to deal with the peak work load when pension credit was introduced. Having worked as a junior Minister in the Department, I do not believe that early closure was planned from the start. I would be astonished if the Government had taken on a 15-year lease through their property manager, Trillium, and spent millions of pounds on equipping and commissioning the building, as well as recruiting and training staff, for a short-term purpose. However, that poses a difficult question: how did the Department get its projection of the number of staff needed for the Pension Service so badly wrong? What will the Government do to avoid similar mistakes in the future? It is important to avoid such mistakes, because they are costly, especially for the staff concerned, who think they have job security only to find that they do not and who may get in great difficulty with their mortgages or other financial commitments. It is also costly for the taxpayer if the Government invest in a new building, staffing and training, only to write off those costs after three years.
Will the Minister answer some questions of which I have given him notice? How long is Trillium's lease on the premises, Triune court? How long is the Department for Work and Pensions under an obligation to pay Trillium for using the premises? What will the premises cost his Department if left vacant from April next year, when the pension centre is due to close? What was the cost to his Department of commissioning the building—putting the walls up in the right places, painting and

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furnishing it, installing computers and cabling the building? How much has been spent on recruiting staff for the York pension centre?
The way for the Government to recoup part of those big costs is to retain the staff within the civil service when other Departments move to York and to retain the building for Government use so that the cost of commissioning it is not written off. Will the Minister closely examine other Departments' decisions to move staff to York as a result of the Lyons review, and co-ordinate the time scale for his Department's regrettable closure decision with other Departments' decisions to move jobs to York? Then there would be a prospect that some—I hope many and possibly all—staff at the pension centre could transfer to other civil service jobs in the area.
3.39 pm
Mr. John Greenway: I begin by congratulating the hon. Member for City of York (Hugh Bayley) on securing the debate. He referred to the speed with which Mr. Speaker granted the debate; it happened before I could scratch my head and work out in my diary when I could apply for a slot for this debate—as the hon. Gentleman said, the facility is in my constituency in the York suburbs.
York has four Members of Parliament, and three of us are here today. Announcements on redundancies of such magnitude transcend party politics, certainly locally, and I want to impress on the Minister the fact that we all want to do our best to represent the interests of the community that we collectively serve. That means, first, finding an alternative use for the work and pensions office; secondly, securing alternative employment if the alternative use does not allow everyone to keep their job; and, thirdly, in any event to cushion the blow to the local economy, which is suffering at the moment from other job losses at Norwich Union, the Terry's factory and elsewhere.
I, too, visited the facility, and I have some experience of private sector call centres and IT processing centres. I am bound to tell the Minister that what has been created in York is the equal of anything I have seen in the public or private sector. I have made that view clear, because the staff deserve congratulations on what they have been able to achieve in a relatively short period.
I am told that the Department for Work and Pensions is preparing the necessary data to market the site and staff to other Departments. Will the Minister confirm today exactly what his Department is doing and over what time scale the closure will take place? Yorkshire Forward is pursuing private sector means, and I believe that the facility has attractions for both the private sector and other Departments.
I particularly want to impress it on the Minister that my first preference is to find, as far as possible, an alternative use for the facility—the staff and equipment as well as the building. The last thing I want is the premises to be vacated and everything to be ripped out, only to find two or three years down the track that there is an alternative use and that we must start all over again. That would be a wicked waste of public funds for the reasons made clear by the hon. Member for City of York.
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Yesterday, the Chancellor announced the relocation of some 20,000 civil service jobs from the south-east to the regions with the idea that some would go to Yorkshire. Yorkshire was specifically mentioned in the context of the Department for Environment, Food and Rural Affairs. It is a shame that the way that our business has been organised means that the Minister responsible, who is from that Department and who was here a few minutes ago, has vanished. We would have liked to ask him about those matters, for reasons that will become obvious in a moment.
I want to stress that there is some interest and, I dare say, optimism that that relocation of jobs might be good news for York, but we must be clear about the fact that the 20,000 jobs that will come from London to the provinces represent redeployment. Given that there will be 100,000 or more redundancies throughout the civil service, competition for alternative jobs in the civil service will be extremely intense. I understand that when the Department for Work and Pensions opened the facility at Triune court at Monks Cross, a number of people were redeployed and came to York because they saw it as an attractive place to live. As the hon. Member for City of York said, some even took a pay cut to come, but a significant number were recruited locally, and we hope that that will be, the same in this instance.
The Chancellor, in his statement yesterday, referred to the potential for 250 posts from the Department for Environment, Food and Rural Affairs to be moved to Yorkshire, and just under 100 from the Department for International Development to East Kilbride. We are interested in the 250 DEFRA jobs coming to Yorkshire, and I want to impress on the Minister the history of what was previously the Ministry of Agriculture, Fisheries and Food when it moved jobs to York.
When my party was in government, we were very successful in persuading Ministers not just to create the central science laboratory at Sand Hutton in the south of my constituency on the outskirts of York, but to pull down the old Adams hydraulics factory in the Vale of York constituency. That enormous site was redeveloped with brand new office buildings occupied by DEFRA, mostly for the Meat Hygiene Service. If DEFRA wants to go to York, it may wish to take up accommodation in Kings Pool on Foss Island road, which might mean one or more of the agencies in Kings Pool, such as the Meat Hygiene Service, relocating locally. The scale of the facilities at Triune house would fit the bill.
Finally, I stress the importance, if only in terms of the human cost and the value for money cost of what has been invested in Triune house, of finding an alternative use for this facility. We need strong marketing, but the product that we have to offer is first class. I endorse what the hon. Member for City of York said about the cost and terms of the lease. All those questions are in my notes, but I shall not repeat them. We need reassurance that when the Department says it will find an alternative use, we will see evidence of action to that effect.
3.46 pm
>The Parliamentary Under-Secretary of State for Work and Pensions (Mr. Chris Pond): I, too, congratulate my hon. Friend the Member for City of York (Hugh Bayley) on securing the debate. The House knows him not only as the previous holder of the ministerial office

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that I occupy, but as an assiduous and effective constituency Member of Parliament. He has demonstrated that effectiveness in the debate this afternoon. I also want to pay tribute to the hon. Member for Ryedale (Mr. Greenway), who has also sought to represent his constituents in a constructive, but determined, way. I hope we can work with them both to find a way forward on a problem that faces us all.
My first remarks must be directed towards the staff of the Pension Service in York. I understand that this is a distressing time for many of them and that the announcement that the closure of the York pension centre is planned must have come as a shock. These are inevitably uncertain and worrying times for them. I pay tribute to the professionalism with which they have responded—one of their first concerns was to ensure the continued efficient service to the public. I therefore want to give them and my hon. Friend the two assurances that he asked for in his opening remarks.
First, the high level of customer service being delivered to pensioners will not be affected by the organisational changes we are making. Secondly, we will do everything we can to help those staff whose jobs are affected by these changes and to pursue vigorously all redeployment options where staff reductions are necessary, with the aim of helping them to find suitable alternative employment wherever possible. My hon. Friend will understand that we cannot rule out the possibility of some redundancies.
These are now matters for consultation with the unions, which is one of the reasons why I cannot give the hon. Member for Ryedale a precise idea of the time scale here. That would be premature, given the consultation process, but in a few moments I will say a little more about the practical arrangements we are making to help staff.
The situation in York should be viewed in the overall context of the changes we are mating in the Pension Service and the Department as a whole. Since 2001, the Department has been rationalising its office network. The creation of Jobcentre Plus and the Pension Service combined the old Benefits Agency and Employment Service networks in two new agencies in modern offices that are focused on the needs of our customers. That has involved moving from an organisation with hundreds of public offices to a centralised approach processing work in larger centres.
As well as the obvious economies of scale, the creation of the local service network working with partners in the state and voluntary sectors has enabled us to be more responsive to our customers' needs and to deliver services more effectively to them. When we made our plans for the introduction of the Pension Service, we did so on the basis of an unprecedented investment in the Department's future. I am talking about an investment of some £5 billion across the Department, including £2.8 billion over two spending reviews in modern IT infrastructure.
We always knew and made it clear that over time our staffing needs would peak with the roll-out of pension credit. That was especially the case given the radical approach of having five-year awards for pension credit. Greatly reducing the requirement to report changes not only improved the experience of our customers, but
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simplified ongoing administration. We set out our plans for a managed reduction in our work force of 18,000 posts in October 2002. Since then, we have had the added efficiency challenge, which was announced by the Chancellor in March. That has resulted in our having to find further savings over the four-year period to 2008.
The lessons learned from the establishment of the Pension Service and the success of the centralised process for delivering pension credit demonstrate that we can maintain high levels of service with a reduced work force. Since the budgetary announcement, further detailed planning has been taking place across the Department. This has included discussions on the future size and shape of the Pension Service, the scope for integrating benefit processing in larger centres in Jobcentre Plus, and the continued modernisation of the Child Support Agency and the Appeals Service.
From those discussions, it has emerged that, of the 29 pension centres, we have identified six that should transfer to Jobcentre Plus to improve the efficiency of benefit processing. Two further pension centres will transfer to the Appeals Service and the Child Support Agency. However, at this stage, we have been unable to identify alternative departmental uses for the two pension centres in Liverpool and York.
As requested by my hon. Friend the Member for City of York and the hon. Member for Ryedale, I can give an assurance that we are doing all we can to promote the sites and the work force to other Departments and the private sector, in the spirit of joined-up government that my hon. Friend requested. Both hon. Members know, as they know the site well, that it is extremely flexible and will be attractive in respect of other uses. Given its location, we are optimistic that, if we work closely with them and other agencies, we will be able to find alternative uses. We are working closely with york-england—formerly the York Inward Investment Board—and, as the Secretary of State pointed out when he spoke with my hon. Friend, he has been actively promoting the York and Liverpool sites to Cabinet colleagues.
The Department has an agreement with york-england jointly to market our site and our people, and I can assure both hon. Members that we are investigating opportunities with four Departments that may have an interest in the York area. Following yesterday's spending review announcement, the position of other Departments may be clearer that it was even 24 hours ago and they are therefore in a better position to assess their own needs.
Concerns have also been raised that, when the Lyons report is recommending moving jobs out of London and the south-east, these centres are being considered for closure. It is only fair to point out that when we set up the Pension Service, we did not locate any of the centres in London and the south-east. In fact, only 10 per cent. of the Department's work force is in London and a further 7 per cent. in the south-east. In the north-east, including Yorkshire and the Humber, the figure is 20 per cent.
As a responsible employer, we have been completely honest with our employees and have gone to great pains to explain the situation to them and to help them to prepare for the future. Within the Pension Service, a redeployment unit has been established to work with

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managers to find people redeployment opportunities in the DWP or in other Departments. The unit's aim is to help to find people jobs as quickly as possible and to facilitate the development of skills to enable people to take up opportunities. The unit's approach will be fair, open and transparent and it will follow DWP principles of equality of opportunity and diversity, with individuals' needs being taken into account in determining suitable alternative opportunities. In addition, the pension centre management team are in the process of creating a local redeployment service to support staff in activities such as identifying vacancies and completing training to strengthen their Cvs.
Since the announcement at York, we have ensured that the staff have access to experienced human resource professionals to advise on the detailed issues associated with redeployment and severance policies. We have also provided a counsellor from Right Corecare, one of the providers of an employment assistance programme used by the Department. I understand that most staff have attended a presentation by human resource staff and have had a personal counselling session with a human resource adviser.
I shall respond to both hon. Members on the issues that they raised about the criteria used to select York as one of the sites that would no longer be required by the Pension Service. My hon. Friend the Member for City of York raised questions about the cost of setting up the centre in the first place and the cost of closing it now. We obviously needed to balance those costs in making the decision on which of the 29 centres should be considered for closure.
The criteria covered a number of areas and were divided into two categories: the operational tests and the economic tests. The former category included things such as the quality and age of the facilities, the lay-out of the site and the site's capacity to handle larger work loads.
I hear what my hon. Friend says about the buoyancy of the local labour market, but he will agree that there has been substantial growth in employment since 1997, both in the Ryedale constituency and in the city of York. That is not why we took the decision to close the York pension centre, but it is an important part of the context.
The economic analysis concentrated on retaining sites with higher exit costs and lower running costs, including such things as staff exit costs and estates and telephony exit costs.
The suggestion was made that when we established the York centre we always intended to close it soon afterwards, and that the considerable investment we
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made was therefore irresponsible. The implication was that we were being less than honest with our staff. I give the reassurance today that that was never the case; we would never have made that investment had we not intended the provision to be long term, but circumstances have changed. The new efficiency challenge that the Department faces—a considerable challenge, but one that we believe we can meet—means that we have to make such organisational decisions across the board.
Mr. Greenway: I want to raise a separate point that is important to the people of North Yorkshire. When the office was opened, a number of smaller, local offices closed and people were advised that they could raise their queries at York. Can the Minister assure me that there will be no reduction in service for people living in the county in relation to pensions and other advice on social security?
Mr. Pond: I can certainly give the hon. Gentleman that assurance. There will be no reduction in the service. From the point of view of our customers—the pensioners whom we serve—the impact of the organisational changes will be invisible. We are committed not only to maintaining the service, but to improving it and to providing pension credit to as many people as possible who are eligible.
My hon. Friend the Member for City of York asked one or two questions about some costs involved and the period over which we have the arrangement with Trillium. Our contract with Land Securities Trillium is until March 2018, and because of the categorisation of York pension centre we can give notice to LST in April 2008 for disposal in October 2008. We may be able to reduce that commitment through a commercial negotiation with LST once a decision has been taken on the future of the York building.
My hon. Friend also asked for other specific information on costings. I will write to both hon. Members with that information, which I hope they will find useful.
In the few seconds remaining, I pay a final tribute to both hon. Members for raising the issues in the debate and, most importantly, to the staff of the pension centre in York, who have acted professionally. I reiterate my assurance that we will do everything possible to help the staff through this uncertain and difficult period of change and to ensure that we find them suitable alternative employment wherever possible. To that end, we will be working with them and their staff representatives.

NHS Funding (East Sussex)
4 pm
Norman Baker: I am pleased to be able to raise a significant matter for Lewes, namely the delivery, funding and organisation of health services as they affect my constituents.
Let me say first that I recognise that the Government have put significant extra resources into the health service, particularly in the past couple of years. That investment is welcome, and if that allows the Minister to tear up 10 minutes of her speech telling me how much the Government have allocated, so be it. This is not a plea for the overall amount of money allocated to the health service to be increased.
There are particular local factors that make NHS delivery complicated in my area and currently detrimental to my constituents. The Minister will be aware that my constituency has a significant number of elderly people, so the demands on the health service are greater than elsewhere. That is particularly true in towns such as Seaford and Polegate.
It is also true that East Sussex is not part of the rich south-east. We are sometimes wrapped up with Surrey and West Sussex and regarded as having a lot of money, but, according to all the Government's indicators, East Sussex is a poor county. Dependence on the health service is greater there, and the possibility of going private, which might be an option elsewhere, is not available to as many people. In any case, we all want to reach the stage at which the NHS is delivering so fantastically that there is no wish to opt out in that way. The Minister and I probably agree on that objective.
Let me say as a preface that nothing in this speech is a criticism of the excellent staff who work in our health service and hospitals and who look after my constituents to the best of their ability. However, there are particular problems that specifically affect my constituents.
The first is health service inflation. The Minister will know that the inflation rate for the health service runs ahead of that for the economy as a whole. That is partly to do with the ever-increasing drug budget. Will she comment on how those issues are considered by the Government? What steps can they take to ensure that drug companies do not abuse the extra money that is being made available to the health service? We all want to see the money going to the patients, rather than the companies simply cornering it for themselves.
Secondly, the Government have rightly been trying to reduce waiting lists, and they have been largely successful. However, the price of reducing waiting lists has been extra pressure, albeit perhaps only in the short term, on the acute trusts in particular. Given the historic absence of doctors and nurses, the trusts have responded by recruiting large numbers of agency staff. That has produced a gigantic bill for the local trusts, which has meant that some of the money that should be directly allocated to front-line services has been allocated to agencies that supply staff. That has been a short-term reaction to the work of reducing waiting times. The Government's ultimate objective is desirable but there is a short-term problem, and I would welcome the Minister's comments on it. I am concerned about the
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amount of money spent on agency staff by my local NHS trusts—the Brighton and Sussex University Hospitals NHS Trust, which covers the western part of my constituency, and the East Sussex Hospitals NHS Trust, which covers the eastern part.
The third issue that worries me, and which is particular to my constituency and those of other East Sussex Members, is the relationship and co-ordination between the various parts of the health service and those who are delivering health care. I refer in particular to the three trusts—the two acute trusts and the non-acute trust, the East Sussex County Healthcare NHS Trust, which delivers mental health and other such services—the primary care trusts that serve my constituents, and East Sussex county council, which is responsible for dealing with the care of those who are discharged from hospital, or not as the case may be.
Let me start with that last point. If the Minister has seen the figures for bed blocking in East Sussex, she will be concerned, as the incidence of bed blocking is unacceptably high. Indeed, her colleague, the Under-Secretary of State for Health, the hon. Member for South Thanet (Dr. Ladyman), stated in an Adjournment debate on 22 June that
"last week 10 per cent. of the acute hospital beds in East Sussex were occupied by patients who no longer required hospital treatment. That is not good enough."—[Official Report, 22 June 2004; Vol. 422, c. 1319.]
I entirely concur that that is not good enough. The figures from the East Sussex Hospitals NHS Trust for 1 July tell me that 99 people who should not be in hospital are occupying beds. More than 10 per cent. of the beds are occupied by bed blockers, and well over half of those result from the county council's failing to take responsibility for people who ought to have been discharged into county council care.
What steps will the Minister take to ensure that the county council takes its responsibility seriously and discharges people from hospital in a timely fashion, not simply leaving them in hospital beds, thereby preventing other people from occupying them? That has an impact on waiting lists, creates unnecessary costs for the NHS and, sadly, because the patients are not in a suitable environment, causes their condition to deteriorate.
The Minister may say that the Government have introduced an Act of Parliament that subjects county councils and others to a fines regime if they fail to take their responsibilities seriously. I personally do not have a problem with such a regime, but I wonder—perhaps I am being rather cynical—what the position is if a county council or similar authority decides that it is financially more advantageous to pay the fines that are racked up than to take responsibility for those who ought to be in its care? It seems that the financial arrangements are not on an even keel. I suspect that the county council is not taking its responsibilities seriously and discharging people into its care as readily as it might. I hope that the Minister will address that point.
The Minister will also be aware from earlier discussions in the House and elsewhere that there are plans to close wards in the Eastbourne district general hospital, which serves my constituents in Seaford, Polegate and elsewhere. She may have seen the front page of the Eastbourne Herald, which is one of the papers circulating in my constituency. It states:

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"Wards to be shut at DGH: This is a scandal!"
That is what my local paper is saying.
I raised the matter with the relevant PCT and also with the acute trust. They tell me that the closures are partly the result of the bed blocking to which I referred, but that they would close wards behind those who left the hospital even if the bed blocking problem were solved. In other words, the wards will shut in any case as soon as the bed blockers are discharged. Part of the reason for that is that the hospital has been set a savings target for this year of £10.8 million—more than 5 per cent. of the budget—despite the fact that its management costs have decreased by 0.5 per cent. in the past year. The difficult financial situation and the ongoing clinical review are leading them to consider options that are not regarded as acceptable or palatable by my constituents and others.
Despite the initial denial, the options include discontinuation of in-patient children's services at Eastbourne, which will be transferred to Hastings. The trust has been rather mealy-mouthed about that. It has said in public that that will not happen—indeed, the Under-Secretary of State for Health, the hon. Member for South Thanet, quoted the trust in good faith on 22 June—but I have subsequently had discussions with the trust and learned that that service is secure for only a year and that financial and recruitment pressures may force it to be discontinued thereafter. Front-line services are being affected in a way that is unacceptable and contrary to the Government's clear intentions to provide better health care services for the population at large. They have provided the money, but services are still being cut.
The Minister ought to ensure that Government money is being spent properly and that Government targets are being met. I do not believe that that is the case. It appears that the trust's deficit will rise to about £5 million by the end of the year. That means that several improvements are on hold and treatments that have been approved by the National Institute for Clinical Excellence will not be implemented or begun in my trust area because it cannot afford it. So we return to the post-code lottery of health services, which the Government tried to avoid by creating NICE, because trusts suffer from a shortage of money.
The problem also affects the other acute trust, the Brighton and Sussex University Hospitals NHS trust, which serves the Lewes and Newhaven end of my constituency. In 2003–04, the trust failed to meet its primary duty to break even, having a retained deficit of £7.9 million on total income. It has a financial recovery plan, but the reasons that it gave for the deficit are, first, the high cost of temporary staff to cover vacancies—the point about agency staff that I mentioned a moment ago; secondly, the use of the private sector to maintain levels of patient care and achieve its waiting-list targets—because it is striving hard, as it should, to meet the Government's determination to get waiting lists down, but that has a high, short-term cost; and, thirdly, the increased costs of development in medicines and supplies, which ran ahead of anticipated levels by 12 per cent. last year, and the cost of drugs. The Government need to grasp those things if they are to deliver want they want to deliver.
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Management costs, have been kept at 3.3 per cent. of turnover. The trust is not run by the bureaucrats the Chancellor wants to get rid of; there is a pretty tight management team in Brighton. It says that the 2004–05 budget will be
"every bit as challenging as 2003–04, particularly given the brought-forward deficit of £7.9 million that needs to be repaid and the underlying cost pressures that must be controlled."
The East Sussex County Healthcare NHS Trust has a horrendous problem, mainly because of spending on locum doctors and agency nurses, various private sector placements and the rising costs of drugs—the same reasons given by the other two trusts to which I spoke. The trust took up the matter with the strategic health authority, but it offered no financial support and merely said that any deficit at the end of 2003–04 would have to be repaid in full as a first call on this year's resources. It considered some serious options, including a full vacancy freeze, avoiding all private sector placements and said:
"Clearly, services, clients/patients and staff will be affected."
The trust has made desperate efforts to improve matters since then, but in its most recent statement to me it presented a pretty bleak picture of how things are. Ironically, that letter sent to me on 17 May by the chief executive Stephanie Parkes-Crick stated:
"I am pleased to be able to advise that as at the end of March, so the end of the last financial year, the Trust was £1 million overspent."
The chief executive was "pleased to advise" that she was £1 million overspent—that shows the depth that the trust had reached. There is a further £2.8 million to be realised this year, which will be provided by avoiding private bed usage, and the PCTs have said that they want a further £1 million in the course of the year from that already tight budget to contribute to the East Sussex health economy's financial gap. A trust that is absolutely strapped for cash is being asked to make a further contribution of £1 million.
The trusts say that the PCTs require too much money from them, and that they should consider savings first. I am not able to judge who is right, but I can tell the Minister that serious cuts are being made in front-line services despite the Government's extra cash to the health service. There is a dispute between the PCTs and the trusts, which the strategic health authority will not sort out, and also between the acute trusts and the county council about who is responsible for bed blocking and where the buck should stop in that respect.
It is not a happy situation. I am not particularly interested in where the blame lies; I just want my constituents to have the best possible health care. I welcome the fact that the Government have made more money available through the NHS but it is not reaching the people on the ground. That is not necessarily the Government's fault, but now that I have drawn it to their attention, it is up to them to sort it out. People are suffering; they are denied treatment that is available elsewhere in the country and that requires the Minister's help.
I will give the Minister an example. A constituent of mine, a Liberal Democrat councillor called Peter Harper, who lives in Newhaven, was in hospital for a serious operation in M arch. He has been told that he will have at least a 14-week wait for the pain clinic; he will

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have to endure three months of agony before he can be seen by someone at Brighton. That is simply not good enough. I know that the Minister and her colleagues want to deal with the problem. I hope that the information that I have given will enable her to consider the issues that I have raised and to try to ensure that the Government's objectives, which by and large I share, result in action on the ground to make life better for my constituents, particularly those in Seaford and Polegate. They are seeing services disappear from those big towns into Eastbourne, rather than having more services on the ground.
4.15 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): I congratulate the hon. Member for Lewes (Norman Baker) on securing the debate. I very much appreciate the interest that he takes in his local health services, and these matters are obviously of considerable interest to him and his constituents. I join him in paying tribute to all the NHS and social care staff who work in the local health economy. Their commitment is obviously to the continual improvement of the local NHS and social care services, which is to be commended, because they make the difference.
I will deal first with the question of national investment. I am glad that the hon. Gentleman welcomed the investment we have put in and accepted that a lot of extra money is being invested. There is 7 per cent. real growth year on year in terms of what goes into the NHS, which is considerable real-terms growth. The NHS plan, which was launched in July 2002 and drawn up with the help of staff, patients and other stakeholders, set out a programme of sustained investment to turn the NHS round, and it has delivered real progress.
Let me turn briefly to progress that has been made in East Sussex. No patient in East Sussex now waits longer than nine months for in-patient treatment or longer than 17 weeks for an out-patient appointment. I accept the hon. Gentleman's point that 14 weeks is still a long wait for a pain clinic, but we are making progress. Indeed, we have made considerable progress and we hope to make more.
Yesterday's announcement highlighted the fact that we are working towards a maximum 18 weeks from referral to treatment for every patient across the NHS by 2008. Considering we inherited IA waits of more than 18 months from out-patient clinics to treatment, that shows what a huge turnaround has been achieved and our ambitions for the service. Ninety-seven per cent. of patients in the Eastbourne Downs primary care trust area can access a general practitioner within 48 hours, and 100 per cent. of patients in that area can access a primary care professional within 24 hours.
The indications show that all primary care trusts in East Sussex are making good progress against the target for reducing the number of patients waiting six months for an in-patient appointment. The PCTs are also making good progress against the target for reducing the number of patients waiting 13 weeks for an outpatient appointment. The situation is very positive.
The new MRI scanner equipment at the Conquest hospital in Hastings is faster and 50 per cent. more powerful than the previous scanner. That hospital also
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has a new investigation suite for urology and gynaecology investigations. There is a new consultant in care of the elderly at Eastbourne district general hospital, which may be relevant to other issues that the hon. Gentleman raised.
In counter-balancing some of the hon. Gentleman's remarks, which suggested that everything is dire, I emphasise that big improvements are going on in the NHS. I am not saying that everything is all right; lots of things still need to be done. We accept that although we are making a lot of progress in the NHS, including in East Sussex, more is needed. That is why the continuing investment and reform are necessary. We continue to increase our investment—our spending on buildings and equipment—which has gone up from £1.1 billion to £3.4 billion. Without those things and without the help of NHS staff, we will not improve services and access to care and treatment.
As the hon. Gentleman knows, the funding system has changed. I will not spend too long on this point. Primary care trusts are those with the specific local knowledge and expertise that are responsible for improving health, securing the provision of the relevant local health services and integrating health and social care. I will return to the point about the relationship between health and social care in a moment.
PCTs are the cornerstone of the modernised NHS and they are best placed to reflect the needs of local communities. I am sure that the hon. Gentleman, as a Liberal Democrat, supports devolution and local decision making, because they are in common with his party's general philosophy. PCTs control 75 per cent. of the budget at local level.
The funding allocated to East Sussex PCTs comes on the basis of the relative needs of the population. A weighted capitation formula is used to determine it. I know that the hon. Gentleman started by saying that he is not concerned about the funding and that he recognises that we have put a lot more money in, but at times he was tempted to blame money for the problems he outlined, which still need to be resolved.
I am sure that the hon. Gentleman is happy that the PCTs in the constituency will receive considerably increased allocations. Eastbourne Downs PCT gets £47 million, or a 29 per cent. increase, during the years 2003–06. I am sorry that I do not have the updated figures. Sussex Downs and Weald PCT will receive a cash increase of £33.8 million, or 30 per cent. That is close to the England average of 30.8 per cent. So, they are receiving funding on a par with the rest of the country.
Norman Baker: I accept the Minister's figures on the PCTs' money, but my queries, which are twofold, are not about the overall sum. First, are the PCTs passing on the money properly or are they taking too much for themselves in management costs? What is the mechanism to deal with that? Secondly, what about the short-term pressures in the health service to get the Government's waiting lists down, which are leading to excessive short-term spending on agency staff? Those are the issues that I referred to, not the amount allocated.
Miss Johnson: I understand the hon. Gentleman's point, but I am making the point that money is going in,

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and going in based on, and in recognition of, need. The East Sussex trust has also got additional money—from £161 million in 2003 to £167 million in 2003–04—and it will get £7 million more in 2004–05. So, the picture is of additional resources going in.
As the Under-Secretary of State for Health, my hon. Friend the Member for South Thanet (Dr. Ladyman), pointed out in a debate on 22 June, which the hon. Gentleman referred to, the NHS in East Sussex has achieved and continues to achieve the national standards. That is good news, but we want to go further and build on it.
To do that, the NHS must consider how it uses the resources it receives and the health care and social care organisations in East Sussex need to consider carefully how they work. That is, in fact, what they are doing. I am glad to receive confirmation from officials that the Surrey and Sussex strategic health authority and the PCTs in East Sussex have agreed funding positions for the delivery of the local delivery targets for 2004–05. The local delivery plan describes how the NHS and social care community will deliver during the next three years. It has been agreed by all the NHS organisations in the area.
The hon. Gentleman referred to the county council. The East Sussex county council cabinet has endorsed the overall direction of travel. That envisages a reduction in the number of avoidable admissions to hospital, which is a key area and often one in which a much better performance can be secured; shorter stays in hospital, which relates to the question of people who are unnecessarily still in hospital; reduced hospital capacity; and a reinvestment in community facilities, in particular intermediate care. That also relates to issues that the hon. Gentleman raised.
In the short term, the NHS and its partner organisations need to work together to make the most of their resources. I do not know the details of the working relationships between, for example, the county council, the strategic health authority and the PCTs locally. If there are particular problems with them, I would be grateful for more detail from the hon. Gentleman about what he considers the problems to be. As far as I am aware, all the mechanisms are in place. The NHS and its partner organisations have agreed a common strategy and they are working along the same lines to achieve the progress envisaged with the issues that they face.
I would be disconcerted to hear that any county council was more interested in receiving a fine under the revised community care arrangements than making progress with the provision of better services and on the issue of delayed transfer. I understand that there are challenges associated with the delayed transfer of care, but the strategic health authority and the Commission for Social Care Inspection are working with the East Sussex PCTs and social services in the county to bring down the number of delayed transfers of care. They have recently improved systems to streamline the
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transfer of patients. I am not sure whether the hon. Gentleman's remarks take account of that or whether the arrangements have been in place long enough to be reflected in the changing figures. Improved arrangements obviously take some time to be delivered and seen in improved figures.
Mr. Nigel Waterson: Will the Minister give way?
Miss Johnson: No I am afraid that I will not.
The hon. Member for Lewes raised concerns about agency staffing. Due to our concerns about agency staffing nationally and its costs, we announced the establishment of a special health authority to tackle the problems involved. It will be responsible for the strategic oversight of the NHS temporary labour market. Obviously the NHS needs a temporary, short-term and part-time labour market because of the nature of the work that it does, but it is important for NHS trusts to try to cut back as much as they can on the use of, in particular, expensive agency staffing.
The management of the agency framework contracts, the setting of standards and the policy framework for the NHS rest with NHS Professionals, the NHS in-house agency arrangement for staffing. NHS Professionals has already had considerable success in some parts of the country in reducing the expenditure on temporary staffing, and in due course I would expect that to be reflected across the country.
I do not how much engagement with NHS Professionals the hon. Gentleman's own trusts and PCTs have had in their discussions on what can be done locally, but a local problem can easily be exacerbated by spending a lot of money on solving it. I realise that, in the short term, they need to do that, but it can lead only to further problems. That may be the downward spiral in which they have found themselves.
There are ways out of this, however, and other health economies are not in that position. On the relationship with NHS inflation, which the hon. Gentleman mentioned, there is a substantial increase in funding in any case. Although I recognise that he is highlighting problems in several trusts and PCTs in his area, if we consider medicines and supplies, there should he a wider problem across the NHS but we do not see that.
The resources are with the local health service. It is in a position to deliver and there is a recovery plan in place for three years, which amounts to some £26 million. The partners are working together; there are mechanisms for dealing with many issues that the hon. Gentleman has raised. I trust that people will work together—I agree with him here—to focus on the needs of patients and to deliver for them in the most cost-effective way possible. I am sure that national agencies and the Department are happy to help the strategic health authority and the local trusts if they need more examples of how that has been done elsewhere to deal with the issues that face us.
It being half-past Four o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.