Westminster Hall Sitting of 3 March 2004

Preamble
[MR. JOHN MCWILLIAM in the Chair]

Coal Health Claims
Motion made, and Question proposed, That the sitting be now adjourned. —[Vernon Coaker].
9.30 am
Mr. Michael Clapham: In my contribution, I want to do four things. First, by way of background I shall explain the procedure for making a coal health claim. Secondly, I want to explain the link between claims handling firms and solicitors firms. Thirdly. I shall give examples showing how mining communities are being exploited by claims handling firms and some firms of solicitors. I would say, however, that the number of solicitors firms that can be accused of being deceitful, if not dishonest, is small. Finally, I shall suggest what the Minister might do to remedy the issue; I know that he is as sickened as I am at the way in which mining communities are being exploited.
This month marks the 20th anniversary of the beginning of the year-long 1984–85 miners' strike. It should not go unnoticed that, 20 years on, we are still having to discuss how to prevent the further exploitation of mining communities.
For the record, I chair the all-party coalfield communities group and the miners' parliamentary group. I am also a member of the Minister's coal health claims monitoring group.
The coal health schemes comprise the vibration white finger scheme, the chronic obstructive pulmonary disease scheme and the coal industry pneumoconiosis compensation scheme. However, the debate will concentrate for the most part on the operation of the first two schemes. Former miners and their widows, as well as their estates, can claim compensation under the schemes, but they must register claims for vibration white finger or chronic obstructive pulmonary disease through a solicitor. Progress on the latter scheme is periodically reported to the court, along with proposed changes to the handling agreement.
The procedure for processing claims is set out in the handling agreement, and I shall explain how it works. It is an accord agreed by both sides, but it is still evolving. The claimants' solicitors group meets regularly with Department of Trade and Industry solicitors to discuss changes and amendments—or how the agreement might be tweaked. It basically identifies the information that, alongside the claims forms, is required to be completed by each claimant. That information is then passed to the insurers, formerly Aon IRISC, now Capita Insurance Services.
When the information is submitted to the insurers, it is checked and the work record of the claimant is sought in order to verify the claim. The number of fraudulent claims is extremely small, which suggests that the miner's word could be taken as the basis for claims without some of the statements that are required. When
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the work record has been verified, the claimant is referred for a medical examination. If it is a posthumous claim, records are generally sought from social security records, from the general practitioner and from hospital records to assist in making a diagnosis.
The vibration white finger scheme closed on 31 March 2003 for live claims, and three months later for posthumous claims, to date, 168,000 claims have been registered. The chronic obstructive pulmonary disease scheme is still open, but it will close on 31 March 2004. More than 400,000 claims have been registered, and I understand that they are still arriving at the rate of 8,000 a week. The Minister will be able to update us on the statistics.
To date, more than £1.9 billion has been paid to claimants under both schemes. Solicitors firms in England dealing with the claims number in excess of 500. Throughout the United Kingdom they have received about £300 million for the work that they have done. These statistics give some idea of the size of the claim overall, which I understand is the largest common-law damages claim run anywhere in the world.
David Taylor: My hon. Friend will be aware of the unfortunately numbered early-day motion 666 tabled by his Barnsley colleague, my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis). It points out that average legal fees for chronic bronchitis and emphysema claims are £2,143 and that half of all final settlements are for less than that. Surely something has got out of kilter here.
Mr.Clapham: I thank my hon. Friend for that intervention, which suggests the need for a minimum level of settlement. Perhaps we should press that with my hon. Friend the Minister.
It became clear from complaints to the monitoring group that miners and their families were being exploited. Many of my colleagues in the House say that some firms of solicitors are charging claimants, in addition to receiving their costs and disbursements from the DTI. The charges levied on the claimants vary in form. Some firms charge a success fee, while others charge an extra hourly rate for coal health work, and particularly for vibration white finger claims.
The situation is made more complex by the advent of claims handling firms, some of which have come into being only in the past few years to exploit the situation in mining communities. They collect potential claims and pass them on to solicitors. Some of the handling firms sell the claims to solicitors. In other words, they are exploiting a market that has developed.
I refer to a letter dated 20 February from a company called Zuko Legal Ltd., which was addressed to Towells solicitors of Wakefield. The letter reads:
"I understand that you may be interested in buying mineworkers claims for compensation under the DTI Scheme from us. The number of claims our company source each week continues to escalate as the cut off date of this Scheme nears. I would therefore welcome an early opportunity to discuss the development of potential relations between us. We are able to provide a large volume of extremely high quality, signed Client Claim Forms carefully vetted by in-house solicitors. We have produced so far in excess of 5,000 with only 1 per cent. being rejected on the basis of previous solicitors having been instructed."

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The letter did not give the price of each claim, but if it was between £1,000 and £2,000, the claims handling firm would have received between £500,000 and £1 million for the 5,000 claims that it handled. Towells declined that outrageous offer and passed the information on to the DTI. Perhaps the Minister, who I know is as sickened as I am by the market in claims, will say what he intends to do immediately to stop this trade in the exploitation of elderly miners and their widows.
When a payment is made to the claimant, whether it is an interim payment or full and final settlement, a proportion is paid to the handling firm. Some of these firms have adopted names such as Union and General Services Ltd. or the Miners Welfare and Compensation Agency Ltd. It is clear that the companies have deliberately tailored their names to mislead by giving the impression that they have some formal link with the mining communities, through either the union or the Coal Industry Social Welfare Organisation.
Only recently, one such firm, the Miners Welfare and Compensation Agency Ltd., wrote directly to one of my constituents, Mrs. Leadbeater, whose late husband I was privileged to know when I worked at the colliery. The firm misrepresented itself by stating that it had helped thousands of ex-miners and their families, and it offered her a service that it said was free. That free service cost Mrs. Leadbeater £9,000, and it took all my efforts and those of my hon. Friend the Member for Barnsley, Central (Mr. Illsley), along with the "Politics Show", to get that money refunded. The solicitors who dealt with the case were a firm called Lopian Wagner of Manchester.
I am aware that the Law Society does not regulate the claims handling companies. I also know that a review is to take place shortly, and perhaps the Minister will refer to that in his response. Nevertheless, I believe that because those companies are registered, the DTI could regulate or control them before waiting for the outcome of the review.
Mr. Ronnie Campbell: It is a question of the companies setting up the case and then selling it on to the solicitors. Although my hon. Friend said before that no fraud was going on, I believe that there is. The companies are setting up the case; the solicitors are used only as a postman to post the claim on to the DTI, and they are getting paid for it. The company is doing all the work, and when the payment is made, the company tells the client that they have to pay the company x thousands of pounds.
Mr. Clapham: I thank my hon. Friend for that intervention. He raises a matter to which I will refer. As I said, only recently one of my constituents had £9,000 deducted from her settlement. It took a great deal of work to persuade the company to cough up.
In general, such companies take a percentage of a claimant's damages. My hon. Friend has just made that point. Normally, the companies have an agreement or an arrangement with the firm of solicitors to which they supply cases and, in some cases, the claimant's cheque is passed on to the company first so that the claimant has to give an instruction for a deduction to be made by the handling company before the cheque is sent on to the claimant.
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I take the view that as the claims handling company deals directly with the law firms with which they have an arrangement, the firm, and not the claimant, should pay for the service. If we were to go down the route that I suggest, and the DTI were to insist that that should be the arrangement, we could restrict the operation of these companies. It is a disgrace that the companies are able to prey on miners and their families, and action needs to be taken immediately to obtain refunds. In the longer term they need to be regulated.
Mr. Kevin Hughes: Should not the message from today's debate to miners and miners' widows be that there is no need to have any truck with claims handling companies at all, but that they could go straight to a solicitor and have the case dealt with directly?
Mr.Clapham: That message needs to go out. Claimants do not need to go through an intermediary; they should immediately contact their solicitors. It is fair to say that if they were first to contact their MPs, their MPs could put them in touch with solicitors firms that do not make a charge.
Some solicitors firms have repaid claimants after being approached by constituents' MPs. Others have adopted a total refund policy—for example, Beresfords Solicitors, in Doncaster, which decided to refund all its coal health clients in cases in which an additional charge was made. Firms such as Atteys Solicitors in south Yorkshire, which charges an extra hourly rate for doing vibration white finger work, levy on the claimant a charge that is the difference between the costs that it receives from the DTI and the number of hours spent on the claim by its solicitors. That can result in the claimant having to pay the solicitor more than £1,000.
I appreciate that solicitors firms do not all have the same cost structure. It is swings and roundabouts: some cases cannot be established, but others can be set on their feet. Moreover, the risk associated with claims is substantially mitigated under the scheme, so that it is minimal. Any firm that charges an extra hourly rate without first informing the claimant, thus giving him the option to go to another solicitor, should refund that money. That is the Law Society's view.
Vendside Ltd., which operates through the Union of Democratic Mineworkers, charges claimants a fee, despite being an in-house solicitor operation. I have written to that firm on several occasions, having been approached by constituents who have been charged an extra fee. I know that the DTI said in a press announcement that it did not see the UDM charges in the same light as legal fees, but the UDM and Vendside are one and the same, and they are pocketing fees from claimants in addition to the costs paid by the DTI. Recently, there have been press reports on this issue. I have seen documents, which have been passed on to the DTI, that show that the union's two officers, who represent only 1,300 members, are both nominee directors of Vendside and that they earned £151,000 and £1 11,000 respectively in annual salary packages. Will the Minister ensure that the firm is investigated, with a view to deciding whether it should remain on his approved list?
Firms such as Kidd and Spoor Harper, and Robinson King, have replied to the Minister, stating that they do not charge clients, but have failed to mention that they

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use claim handlers, the charge for which falls on the claimant. The former firm uses P. R. Associates Advice Bureau—a claims handling firm that deals with solicitors and has an arrangement for coal health claims—whereas the latter firm deals with General and Union Services Ltd.
The Law Society has been most helpful. I know that the Minister's officials met representatives of the Law Society and found them helpful in dealing with this issue. It has sent all its members a letter advising that they should not charge coal health clients, and warning of the consequences should they do so. It has also asked its members to refund claimants in certain cases in which an extra charge has been levied.
I conclude by saying that coal health claims are helping to restore much of the damage that has been caused by British Coal's negligence. The money paid to claimants tends to go directly into the local economy and is having a noticeable effect in some areas. The business of many local solicitors firms has legitimately grown on the back of the coal health schemes. I have no objections to that, but I find it scandalous and outrageous that some claims handling firms should conspire to exploit mining communities in a manner that is tantamount to robbery.
Several hon. Members rose—
Mr. Deputy Speaker: Order. There are many hon. Members seeking to catch my eye, but if everybody speaks for 10 minutes, there will not be time for them all to get in, so I counsel brevity.
9.50 am
Adam Price: May I pay warm tribute to the hon. Member for Barnsley, West and Penistone (Mr. Clapham) for securing this debate and for the excellent way in which he set out the facts? I am sure that his concerns are widely shared throughout coalfield communities.
I should like to pick up on the comments that the hon. Gentleman made about Vendside, to which I was alerted some months ago. I wrote to the Department of Trade and Industry in July last year, when Vendside's marketing material, which boasted of an exclusive agreement with the DTI, was brought to my attention. However, that marketing material made no mention whatever of the connection with the Union of Democratic Mineworkers, and there is no reference to it on Vendside's website. Unwittingly, therefore, former members of the National Union of Mineworkers have indirectly been lining the pockets of Mick Stevens and Neil Greatrex. Whatever the legal position is, it sticks in many people's throats that union officials living in one of the most disadvantaged communities in the United Kingdom are drawing salaries of £150,000 a year, profiteering from the suffering of former miners. I see no way to defend that.
I have asked the Minister whether other unions were offered an arrangement directly to represent their members and others similar to Vendside and the UDM's arrangement. I do not think that the answer that I received was correct, although I am not making allegations. The Minister has fresh eyes, so I should like him to look again at why there was a special
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arrangement with the UDM. Also, there was no reference in the reply that I received to the National Association of Colliery Overmen, Deputies and Shotfirers. Once NACODS heard about the UDM's arrangement, it applied to have a similar arrangement but was turned down. I therefore urge him to look at why a special arrangement was made with the UDM.
I have read press statements by a DTI spokesperson defending the arrangement with Vendside and condemning the solicitors' charges— rightly, as we all agree—but saying that that case was entirely different and that it was acceptable to charge extra. However, it cannot be acceptable when, as we have heard, there are perfectly good solicitors who will not charge people. Surely the Department should urge people not to go to companies such as Vendside.
I urge the Minister to look again at the charges, because Vendside, as we have learned from the Department's figures, has a much lower average compensation payout than other firms. We should urge people not to use the firm, because the average payment is significantly lower. I looked at the figures for last year, which showed that, like for like, Vendside's average payout was £3,000 lower than the average for solicitors in England. We must seriously ask whether Vendside is doing the work on behalf of its clients. Clearly, there might be financial incentives to a quick turnaround.
I urge the Minister to suspend the exclusive arrangement with Vendside, pending a proper investigation of what has gone on in the firm. I also urge him to look at why the DTI entered into an agreement with the UDM in 1998 that was not offered to other trade unions. What was the advantage to the DTI or to former miners and their families in doing so, given that UDM and NUM members had been badly served by Vendside and the UDM?
9.55 am
Mr. Kevin Barron: I welcome this debate. I am not surprised by the number of hon. Members who are present. I first raised the issue of solicitors, trade unions and fees back in July 1999, with my hon. Friend the Member for Leeds, West (Mr. Battle), who was moved in a reshuffle shortly afterwards and sadly did not take any further action. Later that year, I referred the matter to the Law Society to investigate. I will mention one or two things that my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) said, because I take issue with him in relation to the Law Society and what has happened, and I will tell hon. Members why. However, I congratulate him on securing the debate.
The Law Society investigated the matter at the end of 1999 and the beginning of 2000. In early 2000, it was clear from a preliminary report that it was unlikely that it would take any further action. Indeed, that was the decision it came to. I had a bit of a wry smile when I read its press release of 20 January, in which the chief executive says:
"I am pleased the Law Society's Compliance Board was able to deal with this matter so promptly, following concerns raised by Ministers and MPs".
Four years ago this month, I raised the issue in an Adjournment debate. By that time, my right hon. Friend the Member for Airdrie and Shotts (Mrs. Liddell) was

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the Minister responsible. We debated it for half an hour on the Floor of the House. The hon. Member for East Carmarthen and Dinefwr (Adam Price) might like to know that his predecessor—the man he beat at the last general election—mentioned the South Wales branch of the National Association of Colliery Overmen, Deputies and Shotfirers in that debate all those years ago. The union had a levy of 5 per cent., which was similar to that of a union that I raised, and some of the awards were as high as £7,250.
I do not want to go into the detail of that debate except to say that it covered most of the issues raised in the past few months about what solicitors have and have not been doing. What was happening in coal mining communities was brought up at that time in the full knowledge of all concerned. There is no doubt in my mind about that.
Things fell down in the early stages, when we had the Law Society's preliminary report and an investigation by a firm of solicitors from the west midlands. The problem was that solicitors were still saying at that time that they were raising the money—success fees, administration fees, or whatever they were called—on a no win, no fee basis. I disputed that then and I dispute it even more now.
It is true that there was a dispute in the early days—certainly when I first raised the matter—about whether unsuccessful claims were going to be funded in any way by the DTI. It cannot be disputed that from September 1999—I think it was 24 September—when the claims handling agreement was signed up to, the DTI made some payments from public funds to progress unsuccessful claims. Yet I have in front of me—I mentioned these problems in that earlier debate—a letter from the lead group of solicitors, Irwin Mitchell, based in Sheffield. The letter is dated 24 November, but it still says:
"No costs are paid by the DTI incurred in relation to claims which are pursued in accordance with the terms of the Agreement but are ultimately unsuccessful."
In the same month, Mr. Jeremy Cousins of the Department of Trade and Industry, sent a letter to the firm of solicitors that was investigating my complaints, saying:
"There is therefore some direct recovery for unsuccessful claims."
Ever since September 1999, therefore, we have been having a fictitious debate about what solicitors are getting for coal claims.
As the lead firm of solicitors on the subject, Irwin Mitchell should have known what had happened. Last year, and indeed in the years before that, the DTI had the good grace to hold seminars to update us on coal claims, as did my hon. Friend the Member for Cunninghame, North (Mr. Wilson). I did not go to every seminar, but I raised the problem when I did. The agreement on handling coal claims is periodically reviewed, so I asked those on the platform last year—my hon. Friend was the Minister at the time—what the DTI had done about solicitors who were charging. Aside from my hon. Friend, those on the platform, who I assume were the DTI's legal advisers, just looked at one another. Then—this is only my recollection, although
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one or two other hon. Members were at the meeting—someone said, "I think some trade unions have this agreement, but I'm not too sure." There was nothing conclusive.
Within five minutes of my asking the question, however, a solicitor from Irwin Mitchell stood up—I think that he was called Mr. Andrew Tucker, but I would have to ask others who were there to be certain—and said, "The fees shouldn't have been raised after April 2000." I did not write down what he said word for word, so I am not sure whether he said that that would be "illegal", but he definitely said that it should not have been happening.
Geographically, Irwin Mitchell is close to my constituency, so the firm will have handled the cases of several constituents. We should not forget that it was the lead firm and had been negotiating with the DTI for years on the payments that would be made from taxpayers' money. As I said in that earlier Adjournment debate, I had seen evidence that Irwin Mitchell had been charging different levels of success fee—10 per cent., 15 per cent. and 20 per cent. So it struck a chord with me when Mr. Tucker said last year that what had been happening was illegal or that the fees should not have been raised after April 2000.
After the seminar. I went back to my constituency office to check some details from May 2001, when the daughter of a miner in my constituency who had died contacted me to say that Irwin Mitchell was after a success fee for her claim. I photocopied the documentation that she had received and wrote to Irwin Mitchell on 14 May. That was just before the election, so I was still working as an MP, although I was soon to be a candidate. I had a conversation with representatives of Irwin Mitchell five days later and they said that a mistake had been made.
Let me tell hon. Members what mistake that lead group of solicitors had made. In the letter to my constituent, Irwin Mitchell mentioned three scenarios for the funding of respiratory disease claims; indeed, the letter is headed "Respiratory Disease". The first scenario was:
"You may have a Legal Expenses Insurance policy".
The second was:
"You may be a member of a Trade Union or another membership organisation".
The third was:
"Legal Aid—unfortunately Legal Aid has recently been withdrawn".
That was in May 2001, many months after Irwin Mitchell had been the lead firm in signing the agreement to allow the taxpayer to pay its expenses. It is still using such scenarios.
The letter continued:
"On the basis of the information that we have relating to your claim we consider that the best funding option for you is to enter into a Conditional Fee Agreement with us. We enclose a copy of our standard CFA agreement. We have assessed the risks of your case and the percentage success fee has been calculated at 43 per cent.
That calculation of 43 per cent. was made when the lead person—he did not sign the letter—in that firm of solicitors had, I am sure told me that it was illegal to do that in 2001. I will not read the contents of the letter that

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I sent off straight away, but—this is a memory test for me—I had a phone call a few days later with the person at Irwin Mitchell whose name is on the letter. She said that a mistake had been made and that there would be no success fees in that case. I have no evidence to suggest whether that was or was not so. I asked the person concerned if she would contact me when she had been paid so that I could pursue the matter, but she did not. I have not tried to make contact with her recently.
I wrote to Irwin Mitchell on 22 December last year because of what the Law Society and my hon. Friend the Member for Barnsley, West and Penistone said in the press release about fees being claimed. He said that Beresfords was making repayments. I hope that it is making full repayments, because a BBC journalist told me a few weeks ago that it is paying them back if a claim is made. Will my hon. Friend comment on that?
Mr. Clapham: I stated that Beresfords was refunding everyone who had been charged extra, over and above the DTI cost, because it informed me in a letter that that is what it intended to do.
Mr. Barron: I take the firm's word for that and am pleased that that is happening.
I received a letter from Irwin Mitchell in early January in response to the letter that I sent asking whether it was repaying all conditional fees. The letter was from Mr. Tucker and stated that he had attended a meeting with the Minister, who
"expressed his views on behalf of the DTI."
The letter stated:

"Up until April 2000, the Conditional Fee Regulations meant that only the Claimant could pay the success fee calculated as an uplift on the costs payable by the Defendant. From April 2000 this rule was changed and since then success fees calculated as an uplift on costs have only been payable by the Defendant. Although we have entered in to Conditional Fee Agreements with mineworkers bringing Respiratory Disease claims we have not raised charges of any of them. If, however, as your letter seems to imply, you believe you are aware of such cases I would be most grateful if you would provide me with the details so I may investigate them and take the appropriate action."
Two matters arise from that. First, why was that company getting people to sign up to conditional fee agreements after April 2000 when it was not claiming any of the money and had
"not raised charges of any of them"?
Secondly, why does Mr. Tucker want me to send my evidence to him if he is not doing that? What is there to investigate on Irwin Mitchell's behalf if it is not doing anything about conditional fee or success fee agreements?
With all my good will, especially to my hon. Friend the Minister, who has been great in bringing the matter to the forefront and putting it in the newspapers—I am sure all hon. Members appreciate how the work load has risen in the past few months in relation to what he and those who work in our offices do—I must tell the Law
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Society, which I assume will read this debate, that I raised the subject four years ago this month and it should have investigated it further. It knew what was happening in 1999 but did nothing. I am pleased that it is doing something now, but, further to the comments of my hon. Friend the Member for Barnsley, West and Penistone, I would be happier if the Law Society, on learning of solicitors who have asked for money—whether or not they took it, as in the case that I highlighted—would go into their offices, review the cases and ensure that moneys that were wrongly stopped are paid. We must not forget that at least 50 per cent. of the cases are posthumous.
10.10 am
Mr. Bill O'Brien: I congratulate my hon. Friend the Member for Barnsley, West and Penistone (Mr.Clapham) on initiating this necessary debate. In particular, I wish to take up his point about solicitors exploiting our communities and the people we worked alongside who are now claimants. We saw the conditions in which they worked, we saw them when their health was broken and we watched their wives and families nurse them through their illness. Their claims were justified in every way, and we must congratulate the Labour Government on taking the initiative in helping our constituents and the people with whom we worked with their claims.
As my hon. Friend said, the records that have been produced by many of the claimants have been accepted. That demonstrates that our colleagues are honest and that they have presented their cases in a truthful manner. Therefore, the matter of the exorbitant fees charged by solicitors who work on miners' health claims must be taken seriously.
I had a case in which the solicitors asked for money up front before they would take the case. When I learned of that and wrote to the solicitors, they agreed to refund the payment. That was one case; one wonders how many other solicitors requested payment up front before accepting a case on behalf of a claimant.
Not all solicitors take claimants for a ride. My hon. Friend referred to Towells of Wakefield, with which I have worked. They are effective and efficient, and have been of tremendous benefit to some claimants; the same can be said for Raleys. However, some of the other firms should not be on the list of accepted solicitors. I ask the Minister to ensure that those solicitors who have exploited claimants should not be allowed to deal with any further claims on behalf of our colleagues. We should ensure that such practices are not allowed and that exploitation does not continue.
I wish to thank the Minister for the way in which he keeps us informed of the progress of compensation claims. In the recent newsletter, he referred to solicitors' costs and the way in which the Department views claims handling organisations and the charges, fees and other deductions that are taken from any award that is made. The situation should be investigated further, and we should ensure that solicitors who exploit our colleagues are put on a blacklist.
My hon. Friend the Member for North-West Leicestershire (David Taylor) referred to the average solicitors' fee, which can be five times greater than the compensation paid to some claimants. Again, the

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Department should investigate this matter further, because it shows that of the £1.9 billion that has been paid, an excessive amount is being paid in legal fees—an amount that is over and above the amount of compensation that has been paid. Taxpayers should not be paying solicitors for services that can be described only as partial to the claims that have been made. I hope that the Minister will take note of the concerns that we have as former mineworkers, and as members of communities that serve miners and their families. That is why I wanted to take part in today's debate: to show the support for the initiative taken by my hon. Friend the Member for Barnsley, West and Penistone. We want to show communities that we are concerned about what is happening in the mining industry and the mining communities. I urge the Minister to take note of what Members are saying this morning.
10.16 am
Mrs. Helen Liddell: I congratulate my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) on securing the debate. I put on record my recognition of the enormous amount of work that he has done in relation to coal health claims. I speak with some knowledge, as I was an energy Minister when this process was getting under way. Freed of the responsibilities of ministerial office, I can follow the example set by other colleagues and talk about my experiences as a Minister. The process was rather slow to get under way. One reason for that was the activity of the solicitors negotiating settlements. The process was slow because of the fees that they wanted to charge.
I say from the start that some of my best friends are solicitors, and I pay tribute to those who have been prepared to get down to work, boots and socks, adequately to represent the mining community, even to the extent of attending miners' welfares and helping miners and their dependants to sign the forms. Miners' welfares in Scotland do not take many prisoners. I am a reasonably calm person, but the entire process has made my blood boil. The Government acknowledged their responsibilities to the miners not so that we could help to pay the school fees of solicitors or help them to buy a little place in the Dordogne, but to accept that we had a responsibility to people who had sacrificed their lives.
As a representative of a mining community, I have seen some of the worst aspects of the society in which we live. Let me begin by talking about the claims handling companies, which masquerade as good Samaritans but are vultures hovering over the dead and the dying. Many miners are very elderly and have badly failing health. This morning, as I sat in the Tea Room, I read in the Daily Record yet another advertisement front a claims handling company—Industrial Diseases and Injuries Claims Ltd. —frightening miners and their widows into thinking that a solicitor with an English office would not be able to deal with Scots law. We all know what that company is trying to do.
I will give one example. Mr. John Gardiner is an ex-miner who did not know how to process his claim. He knew that he needed a lawyer, but was frightened of
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lawyers. He saw the advertisement in the newspaper and approached Industrial Diseases and Injuries Claims Ltd. because it said, "No win, no fee." He was moderately successful. I will not say how much he received, but Industrial Diseases and Injuries Claims Ltd. took 10 per cent. That is not the worst case. As my hon. Friend the Member for Barnsley, West and Penistone said, some companies can take as much as 40 per cent. However, 10 per cent was enough to pay for a nice Caribbean cruise for someone, but not for the ex-miner in my constituency. The company justified itself by saying that it had pointed out to Mr. Gardiner that its sliding-scale fees agreement allows clients to see instantly how much they will have to pay. It offers a 14-day cooling, off period, but at no point did it point out to my constituent that had he gone to another firm, he would not have had to pay a penny piece and would have been able to keep a nice little nest egg for himself.
What made me particularly angry is that the solicitors company, Corries of Scotland—in the Pentagon centre, Washington street, Glasgow—is on the approved list of solicitors. It is not a naive little company that did not know that the Government were picking up the tab for miners in relation to this issue.
I pay tribute to my hon. and learned Friend the Member for Dudley, North (Ross Cranston), who was the Solicitor-General at the time. He went the distance to ensure that the profession, of which he is a distinguished member, would take on some of the inadequacies that we have seen. It is irritating that much of what the companies are doing is within the law, but it is not morally justified.
A month ago, I asked my two local newspapers—the Airdrie and Coathridge Advertiser and the Wishaw Press—to publish a warning that people should be extremely careful of leaflets put through doors by claims handling companies and solicitors. People are now frightened because the gate is coming down at the end of March. My office has been inundated—like that of every other hon. Member in Westminster Hall, no doubt—with cases of companies trying to make a quick buck on the backs of men and their families who have suffered for decades.
What the Labour Government have done in relation to coal health claims has been one of their great successes. In my constituency alone, out of a number of cases that is not huge— I have had about 280 cases—we have already seen £5 million going to a few villages. That has transformed people's lives. I am proud of that, proud of the part that I have been able to play in it, and proud of the part that my hon. Friend the Minister, my right hon. Friend the Secretary of State for Wales and my hon. Friends the Members for Leeds, West (Mr. Battle) and for Cunninghame, South (Mr. Donohoe) have been able to play. However, I am ashamed that there are those in our society in the 21st century who would behave as some of the claims handling and solicitors companies have done. They should look to their morals and repay the money that they have taken away from the dead and the dying.
Mr. Deputy Speaker: Again, I appeal for brevity. I say to the right hon. Lady that the last time I was in a miners' welfare in Scotland was about 30 years ago in the company of the grandfather of the hon. Member for East Lothian (Anne Picking).
10.23 am
Mr. Dennis Skinner: I congratulate my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) on introducing the debate. It is one of many that have taken place in the course of the past several years since 1998 when the court decision was made. I shall refer briefly to that because it was one of the saddest days of my life as someone who worked underground for 21 years and experienced the pneumoconiosis settlement in 1976 under a previous Labour Government. At that time, we in the NUM begged and prayed of the people who were taking the Pickles case, "For God's sake don't take it into court. Settle it on the steps, because if it goes into court, the net result will be that all the miners in Bolsover and the rest of the country will have to fight a common-law settlement on an individual basis for every pneumoconiosis case."
Fortunately, the Amalgamated Engineering and Electrical Union at that time was smart, and it agreed not to take the matter into court. It was settled on the steps. What did that mean? It meant that the Labour Government had to pick up the pieces, as they usually have to do after the Tories have been in power for so long. We decided to pay out the pneumoconiosis settlements on the basis of a sliding scale. No fly-by-night solicitors were involved. The only solicitors involved were those who represented each of the 15 regions in the NUM and NACODS. The net result was that every pneumoconiosis payment was made within the space of nine months. That was a massive settlement and a great success story.
The real tragedy of the current issue, and the fact that we have to deal with fly-by-nights, vultures and all the rest is down to the decision of Welsh NACODS to secede from NACODS generally Bleddyn Hancock, the Welsh nationalist, with the house on the hill, decided to take the matter to court. He had his 15 minutes of glory on television. It was sad for me, because I knew that we were not going to get a repeat performance of the pneumoconiosis settlement, and that the process would drag on.
The result is that tin-pot solicitors have become involved—none of whom was available for the 1984 strike. We looked for solicitors when 10,000 miners were arrested, but the tin-pot solicitors could not be found to make representations for our people to the police. I agree with everyone who has a crack at them.
When, in 2001 at the manifesto meeting, prior to Labour's second success, I learned what money had been provided for the settlement of the claims, I told the Prime Minister and the Cabinet, "I think you'd better at least double that amount, because this is going to cost a lot more." I said, "I want to make a plea: for God's sake, when we double the amount from £2 billion to £4 billion," which I think will have to be doubled again the next time I go to the manifesto meeting—I am serious; it will probably be a rise of that proportion—"I hope you will not allow any more of the money to find its way into the pockets of the likes of Vendside." That goes for
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the rest of them that have been mentioned, with their houses in the mountains in Wales, or wherever—it is not just the Dordogne.
That is the biggest problem and why we are here today. The sad thing is that we should be having a meeting with 20 miners' MPs and people who represent miners, congratulating the Government on picking up the bill for this massive common-law claim. I say to the media that this is not state benefit. I want them, for God's sake, when they write their little pieces, to tell people that it is not a state benefit like the old age pension. It is a common-law claim—just the same sort of claim that is made if someone has a car accident. Every one is different.
I hope that the Minister will manage to keep ahead of the game and the solicitors. My hon. Friend the Member for Barnsley, West and Penistone mentioned problems in an earlier phase of the process, but one of the major problems recently has been the cut-off date. We had to set one, but the result is that all the solicitors have come out from under their stones and said, "Christ, I'd better make a packet here, before it finishes." They have been making massive money fast.
One of the real problems now is that we must deal with miners who worked for British Coal and then went to mining companies one, two, three and four. That means that there is an aggregate claim, not just one simple claim against British Coal. It is not only the solicitors: some of the mining companies are just as bad. They refuse to pay for the two years or nine months when a miner worked for them, with the result that the British Coal claim that would be settled by Aon IRISC and the Government is being held up.
I thank my hon. Friend the Member for Barnsley, West and Penistone for raising the matter. As I said at the outset, it would have been wonderful if we had been here today to appreciate how great the scheme is, and the way in which the Government have footed the Bill. It would have been even better if the matter could have been settled after 12 months by the mining regions and the solicitors.
10.29 am
Mr. Kevan Jones: I, too, congratulate my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) on securing a debate on a subject that is of keen interest to many of my constituents. Individuals have had their compensation plundered by people whom they trusted to represent their best interests. I agree with other hon. Members that the way in which claims have been dealt with is nothing short of a national scandal. If it had been happening in the leafy suburbs of Surrey or the southeast, the issue would have been in every national newspaper, and people would be asking for action to be taken at the highest level, but because it is happening in coal communities, it is ignored.
On 18 December 2003, in the Christmas Adjournment debate, I raised the case of a Newcastle-based firm, Mark Gilbert Morse. Not content with the £10 million that it had received in fees from the Department of Trade and Industry, it was deducting up to 25 per cent. of victims' compensation in my constituency. Since I raised the case of Mark Gilbert Morse, many other

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people have contacted me. It appears to be paying money back to victims—where people complain, I hasten to add.
I still have concerns about why it deducted the money in the first place. I am also concerned about the comments and contradictions made by the firm in the Newcastle Evening Chronicle, which I must congratulate on the forceful manner in which it reported the story, in justifying its actions. For example, on 22 December 2003, the firm told the newspaper that it was deducting money only from claims lodged before April 2000. The senior partner, Mr. Morse, was quoted on 13 February 2004, saying that the problem stemmed from a change in the handling of mining claims in 1999, when the Government accepted liability.
That is complete nonsense. I have that agreement with me. It is dated 24 September 1999. I also have a copy of the agreement's schedule I and its annexe listing the solicitors who were party to the agreement. Turning to page 4, the name that appears at No. 17 is Mark Gilbert Morse. So, not only did the firm know, in 1999, that it was getting its costs covered, but that part of the agreement on costs. It may make excuses that it did work before 1999, but I understand that there were separate schedules to cover any work that had taken place.
Why did the firm deduct from my constituents' settlements if, in 1999, it knew that it would get its costs paid? Mr. Morse told the Newcastle Evening Chronicle, on 13 February 2004, that the firm had decided midway through 2003 that its policy of charging clients part of payments was unfair as the Government were already paying it £1,800 for successful cases. Why did the firm make its decision in mid-2003, if it already knew, and was part of the settlement, that costs would be covered in 1999? Even Mr. Morse's statement about changing the policy in mid-2003 does not hold water. I have a constituent, Mr. Steele of Stanley, from whose settlement it deducted £2,180.80 on 29 September 2003—hardly mid-2003.
John Mann: Is not the key point in law that the solicitors never told my hon. Friend's constituents that they had the alternative of going to another solicitor who would provide the service for free? Therefore, along with all the other firms—Richmonds, Raleys, Avalon, Hickmotts, Moss, Gorman Hamilton, Frank Allen Pennington, Graysons and Colemans—the Government could mount a legal challenge to get the money back.
Mr. Jones: I think that there might be a legal challenge on the individual cases. In many cases, the firm did not give client letters explaining the terms of the cases that were being pursued. I ask why one of my constituents, Mrs. Elliott, who contacted the firm in April 2003, was told that she was not entitled to get her fees back? She has now successfully had her money returned with interest. I also note that I have constituents, such as Mrs. Greener, who are still waiting for the interest on their payments.
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I congratulate the Law Society on its handling of the case, as it is taking a robust stance against the firm and is investigating, although I understand that Mr. Morse told the Newcastle Evening Chronicle that no such investigation is taking place.
Finally, I touch on the issue of claims handlers. It is important that they be exposed. I refer to one company in the north-east in particular: Industrial Diseases Compensation Ltd. of Ashington, Northumberland. It charges a registration fee simply for accepting claims. It is not a firm of solicitors—it passes claims on to solicitors. In some cases, it takes a proportion of the claimant's award. I was outraged when I saw that it had taken more than £5,000 from an individual award, not for doing any work but simply for taking the case. The Law Society is now considering that case. Unfortunately the individual does not want his name mentioned. If it is scandalous for solicitors to deduct money, claims handlers are doing nothing except acting as unelected middlemen. It makes me angry.
Mr. Ronnie Campbell: As we have stressed before, is it not important that now, before the deadline, when the hawks are out and the vultures are around, we should tell our people in Northumberland, Yorkshire, Scotland and Wales that they must not sign up with claim handler companies but should stick with the union solicitors?
Mr. Jones: I entirely agree with my hon. Friend's sentiments. The way in which some people have preyed—motivated by sheer greed—on the poor and sick makes me very angry. If those same individuals had robbed those old people using force, there would be universal calls from here and elsewhere for them to be locked up. Action must be taken, and I urge the Minister to continue the good work that he is doing so that he can right the wrong that has been done to many of my constituents and those of other hon. Members, many of whom are present.
10.36 am
Jeff Ennis: I will keep my remarks brief to allow as many Members as possible to enter the debate; an hour and a half is not long enough to discuss this very important issue.
I congratulate my hon. Friend the Member for Barnsley, West and Penistone (Mr. Clapham) on initiating the debate, and on the amount of time, effort and research that he has put into the matter. Money is being put into the pockets of miners and I congratulate the Government on the scheme. According to the latest figures, my constituency has received more than £33 million for vibration white finger, which is the biggest VWF settlement of any constituency. For chronic bronchitis and emphysema, we received £29.5 million. More than £63 million is going to former miners and their families in my constituency, and no one can take away the credit due to the Government for funding the scheme.
I shall comment on the take that is currently being paid out by the Government. Of all the money that has been paid out so far, 77 per cent. has gone to the miners; 13 per cent. has gone to the contractors such as Healthcall which are dealing primarily with health claims, such as medical assessments and so on; and 10

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per cent. has gone to the solicitors, which most Members are focusing on today because solicitors are doing very nicely out of the scheme.
If we consider the top 10 solicitors, in the top three, Hugh James Ford Simey has received £35.8 million so far; Thompsons has received £34.6 million; and Raleys in Barnsley has received £23.7 million. Number seven on the list happens to be an organisation called the Union of Democratic Mineworkers. The list does not mention Vendside. The Department of Trade and Industry responded to a question of mine by stating that it was the Union of Democratic Mineworkers and not Vendside that received £8 million.
So, the solicitors are doing very nicely. As some of my colleagues have already said, on average a solicitor receives £465 for dealing with a VWF claim and £2,143 for dealing with a CBE claim. I shall focus on the average fee for CBE claims. Using last November's statistics, by then about 85,700 miners had received full and final payment settlements for CBE claims. Out of those, more than 40,000 had received less than the average amount that the solicitors claim—in other words, 40,000 miners received less than £2,143. Out of those 40,000, about 3,162 had received less than £200, decreasing to about £50 for the lowest payment.
When I found out that information in November, I wrote to the Minister in the following terms:
"Dear Nigel,
As you are probably aware I have recently been tabling a number of questions concerning the amount of money that is going to miners for CBE and VWF, and the money paid to the solicitors. I enclose PQ4282, which has drawn attention to the fact that we now have over 3,000 former miners who have received a full and final settlement of less than £200. Whilst at the same time the average, being paid to solicitors, dealing particularly with CBE claims is over £2.000.
I fully realise that the solicitors' fee has already been agreed by your Department over that course of time. However, I cannot believe that it is right that in some cases that the solicitors are being paid over 1,000 per cent. more than a claim settled at under £200.
There are two issues I would like to bring to your attention from this PQ. Firstly is it possible to review the charges that are currently being paid to the solicitors so that more money can be channelled to where it is needed, this being the miners. Secondly I believe that if we are paying such vast amounts of money out to solicitors and the final settlements are less than £200, then in order to make the scheme fairer consideration ought to be given to allowing a minimum compensation fee to be paid for every individual case. I would suggest that we look at the possibility of establishing a minimum £1,500 payment for a successful claim. This would then avoid the current embarrassment being generated by the solicitors' fees issue. I would appreciate your observations."
I received a reply from Ann Taylor, who was the head of the coal health claim unit at the DTI on the 28 November:
"Dear Mr. Ennis
Thank you for your letter of 10 November regarding solicitors' costs and minimum payments to claimants. I note the points you raised in your letter. The Claimants' Solicitors Group recently made a proposal to the Department regarding minimum payments to claimants, and the fees they receive. The CG are currently discussing the issue with all of their members, and hope to reach a decision shortly."
I understand that that review has now been completed, and I would like the Minister to inform the House of the result. If it was negative, I would like to ask the Minister how he intends to address this iniquitous situation? If we cannot establish a minimum £1,500 fee, as we should,
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that is why I have tabled early-day motion 666, which I hope hon. Members will sign at the conclusion of this debate, if they have not already done so.
My final point, given the amount of time that is available to us, is that many former miners are still under the impression that the compensation scheme is being paid out of the mineworkers' pension fund surpluses, which are being generated from the two pension schemes. I know that that is not correct, but I would hope that the Minister would address that issue in summing up.
10.43 am
John Mann: The list of solicitors has been outlined. I would stress to the Minister that every claims handling company requires a solicitor who is prepared to take on the work. All the 18 firms that I have a dispute with have been named today.
I want to concentrate on the point in law. According to the chief executive of the Law Society, when I discussed the issue with her, it is very straightforward. Did the solicitors, or did they not, tell the individual client that they could go to another solicitor and get this work done for nothing? If they failed to do that specifically—I would suggest in writing as well as verbally—the case in law against them seems absolute. It is not about them um-ing and ah-ing about whether they choose to give good-will gestures, and some of these companies have written to me saying that they are sending cheques back to my constituents. It is about whether they should be struck off by the Law Society, which is the action the Law Society should take, or whether they should be sued by the DTI.
Therefore, I would like to ask the Minister two questions. First, will he, on behalf of the Government, request that the Law Society strike off the register all firms of solicitors that have failed to tell people about the claims handling agreement and the fact that individuals can get this work done for nothing? Secondly, is he prepared to launch legal action against all those companies, where it can be identified that they have double charged, so that the money can be returned to the people who should rightfully have it—miners, miners' widows and their families?
Mr. Deputy Speaker: There is little time left. I thank the Opposition Front-Bench teams for saying that they will co-operate. I apologise to the Minister, but there has been a great deal of interest in this debate, and most hon. Members have not been able to speak in it.
10.45 am
Brian Cotter: Thank you, Mr. Deputy Speaker. We will severely cut our remarks in view of the time constraint.
I thank the hon. Member for Barnsley, West and Penistone (Mr. Clapham) for raising this matter. It is very timely as time is running out for claims. I thank also the many other speakers, including the right hon. Member for Airdrie and Shotts (Mrs. Liddell), who said that her blood is boiling and referred to vultures. It is a revelation to people like me, who have done some work on this issue within my party, to hear what has been going on.
In support of the hon. Member for Bolsover (Mr. Skinner), I very much hope that there will be widespread publicity after this debate, not only in local newspapers in

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Wales, or wherever, but nationally. This is a scandal, and it must be addressed. I hope that the Minister will take on board the points that have been made—the description of a market developing, of vultures, as the right hon. Member for Airdrie and Shotts said, the exploitation of elderly miners and their widows and the tailoring of names by firms to try to make them sound reputable, relevant and semi-official. There are many issues involved, including that of payments up front.
As it is so important for the Minister to be able to respond to the points that have been raised, I resume my place and allow him to do so.
10.46
Mr. Laurence Robertson: I, too, will not detain the Chamber for very long, because it is important that we hear from the representatives of mining communities—I am not one, although my father was a miner, and therefore I feel sympathy with the points that are being made.
I know that the Minister has done a great deal to help. Given the fact that claims are being made in relation to work carried out when mining was a nationalised industry, that there is a great deal of taxpayers' money being spent, not only on compensation but in paying solicitors to carry out the work, and that the situation does not have to arise in the first place, the only point that I would seek to make at this late hour is to ask the Minister whether there is any more that can be done to educate people who are about to make claims.
Huw Irranca-Davies: Would the hon. Gentleman now put his party on record as supporting calls for retrospective action against those companies that are refusing, against Law Society advice, to pay back this money, so that miners can claw it back one way or the other?
Mr. Robertson: It is an avenue that I do not think I should go down at this late stage. I certainly take the point on board, and I promise that I will discuss it further. I would ask the Minister whether there is any way in which a process of education of claimants can be embarked on, to let them know that there is an alternative, and that they do not effectively have to pay twice. I know that Labour Members will not take my brevity as meaning that I am not interested in this issue. I am simply allowing more time for the Minister. I congratulate the hon. Member for Barnsley, West and Penistone (Mr. Clapham) on raising this issue and on the passionate way in which he and many other hon. Members have addressed it.
10.49 am
The Parliamentary Under-Secretary of State for Trade and Industry (Nigel Griffiths): This debate is about justice and fairness, which is why it is so well attended—indeed the attendance here exceeds that in the main Chamber—and why so many hon. Members have spoken with such eloquence and informed the Chamber so well. It has been one of the best-informed debates of the Session, and nobody has been better informed than my hon. Friend the Member for Barnsley, West and
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Penistone (Mr. Clapham), whom I congratulate on securing this debate. It is about justice because it aims to remedy an injustice that saw hundreds of thousands of miners suffer from terrible, crippling lung diseases, and other diseases that rob them of the use of their hands. Furthermore, hundreds of thousands of them died without one penny in compensation. The scheme was designed to ensure that every sick miner, their widow if they are no longer with us, or their family if both parents have passed on, receive the compensation to which they are due. In 1997 and 1998, court judgments established their right to secure compensation for those diseases.
At that time, the Department for Trade and Industry agreed a claim handling agreement with solicitors representing claimants. That agreement was, as my hon. Friend the Member for Bolsover (Mr. Skinner) said, to avoid miners individually having to go through the court one by one settling on the steps of the court. The agreement included specifically a payment to solicitors for handling successful claims. It was not just the successful claims. An element of that sum—we are reminded that it was on average about £2,100—was to cover them for the claims that were unsuccessful. That was accepted as a convenient arrangement by all and we did not expect it to be abused.
As a result 371,000 claims have been met and £1.7 billion has been paid out on both schemes. Levels of compensation range from £350 to £350,000, but the average for both schemes is £7,700. My hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) urges on us the need to consider a minimum figure and suggests £1,500. The judge has considered that figure in consultation with us but has some reservations about it, one of which I will share with hon. Members. If a minimum amount is set, all those who currently fall below are likely to be excluded from it, which would not be just. Those are the issues that we are wrestling with and trying to reach a fair and balanced view on, so that no one is discriminated against and everyone receives compensation.
I became aware early as Minister about what appeared to be gross overcharging by solicitors. Therefore I undertook to write to all solicitors, having studied the claims handling agreement, to spell out to them that every penny of that £1.9 billion—it could rise to £6 billion; the largest scheme of its sort in the world—should go to the sick miners, their widows or their families, and that not one penny of that compensation was to go to the solicitors, because under the claims handling agreement that we reached, solicitors were amply recompensed.
One firm, Mark Gilbert Morse, which my hon. Friend mentioned—I am pleased to confirm that a team from the Law Society is investigating it and reporting regularly to me—has received £10 million. The compensation has been generous, as has been said. I wrote to all 500 or so solicitors on our list and asked them to confirm that they were not double charging, and asked them also what action they were going to take to repay any double charging. Two hundred had responded to me by last month, so I had 300 immediately removed from our list. The Law Society has written to them separately.
Two hundred more firms have additionally come to my notice, to which we have also written. The Law Society, I am pleased to say, agreed that they were in

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breach of its codes and requested that the money be refunded. There was some concern expressed by myself and other Members that the refunding process might involve said miners unhooking themselves from their ventilators and going to the solicitors to say, "Please can you revisit my claim and pay me back?" I was not having any of that and neither were other hon. Members.
I said to the Law Society that I thought it was only fair that all solicitors should be asked to investigate every record and to make repayments in the event of double payments. I am pleased that the Law Society wrote to me on 27 February in complete agreement, and has made that request. It is also writing to the additional firms that we now know about over and above the original 515 firms that we believed were handling claims to instruct them to make repayment. My hon. Friends know me well: we shall be monitoring the situation vigorously.
I want to cover all the issues that have been raised, but I know that there have been time problems with the debate, because of the intense concern of hon. Members.
Huw Irranca-Davies: I hope that DMH is one of the firms that are being looked into. It replied to Mr. Cosker in my constituency, saying:
"Having consideration to the Law Society's recent guidelines, we do not believe that we are under any obligation to reimburse Mr. Cosker the contingency fee charged."
It may not be under a legal obligation, but for goodness' sake, it is under a moral obligation.
Nigel Griffiths: I shall pass my hon. Friend a copy of the Law Society's letter. His interpretation is the same as the Law Society's: the firm is under an obligation. I shall take a personal interest in that firm.
The role of claims handlers also causes considerable concern. I am informed that the DTI does not endorse claims handlers, and never has. The message is clear: we have an agreement with the claimants' solicitors, and claims can be submitted only via solicitors. That allows the Law Society and others to regulate them.
The important issue of claims handlers and unregulated claims handlers is part of the review being carried out by David Clementi for the Department of Constitutional Affairs, which was announced by my right hon. Friend the Secretary State. Mr. Clementi is
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due to publish his initial findings in a consultation document later this month. I have spoken to many hon. Members with an interest in this matter, reminding them of the review and asking them to give Mr. Clementi evidence of gross abuses of claims handlers that have in part been highlighted in the debate. It would clearly be helpful if such evidence could inform the consultation document before it is published. However, once the document is published, we shall want to ensure that the concerns are reflected and that whatever action is recommended to the Government is studied seriously and taken.
We have also written to the Law Society about a number of firms that are in partnership with claims handlers, so that it can examine the relationship between solicitors and some of the claims handlers whose abuses have been highlighted today and elsewhere. It appears that such relationships may contravene the Law Society's rules. I shall keep hon. Members well informed and briefed on that issue too.
My hon. Friend the Member for Bolsover rightly referred to the cut-off dates for claims. The cut-off date for the second respiratory claims scheme is the end of this month. The cut-off date for the vibration white finger scheme was some time last year. Hon. Members will be reassured to know that there was not the chaos that had been predicted. That is a tribute to the terrific staff we fund at the DTI to look after the schemes. They have done a tremendous job, and I was grateful for hon. Members' words of appreciation. As hon. Members can imagine, they have never been busier.
I want to echo the important message that has emerged this morning. Everybody who thinks that they may be eligible to claim for a respiratory disease—not just those who are sick, but the widows of miners or their children if the parents are no longer with us—should submit a claim now, through an approved, reliable and trusted solicitor. I know that all hon. Members who have been busy assisting, counselling and even, I am sure, helping to complete some of the forms will be active over the next few weeks.
If there are any other matters that I have not dealt with, I shall be happy to report back to the working group and to other hon. Members who have raised valid points.
Mr. Deputy Speaker: I thank hon. Members for their co-operation, and for the quality of debate.

Cold Callind
11 am
Mr. Paul Truswell: I do not intend to cover every aspect of cold calling. My objective is to secure three things from the Minister: first, a recognition of the scale of the problem; secondly, a readiness to take serious and robust measures; and, thirdly, an assurance that the Government will take a joined-up approach.
Cold calling covers a multitude of sins and some not so sinful activities. I shall concentrate on the unquestionably criminal activities of distraction burglars, con merchants and fraudsters, as well as those activities that although not necessarily illegal, are immoral in the true sense of the word.
Although we are all potentially vulnerable to crime generated by cold calling, research shows that the typical victim is an 81-year-old woman living alone. With the exception of crimes against children, nothing fills me with greater anger and disgust than the actions of those who cynically target and exploit vulnerable older people, robbing them not only of their pensions, their savings and their treasured possessions, but of something far more damaging—their pride, their self-respect and, in some cases, their independence and even the will to live. No criminal better deserves the description of scum of the earth.
Cold calling is called the Leeds crime because it started there in the 1960s following heavy, destructive storms. The resulting damage presented con men with a heaven-sent opportunity. It is fitting that Leeds should remain at the forefront of tackling the crime.
My involvement with cold calling and distraction burglary goes back about six years. I have been closely involved in a campaign against a rogue company called Midland Coating. Its tactic was to offer people free property surveys, to scare them into believing that their homes were about to fall apart, and then charge the earth for unnecessary, negligible and often shoddy work.
As a result of a successful campaign to get Midland Coating closed, in which the Yorkshire Evening Post played a brilliant role, I was contacted by Claire Morrow of the Leeds distraction burglary project steering group. It soon became clear that although Midland Coating represented the bad side of doorstep calling, distraction burglary was downright ugly.
I was pleased to assist the project in lobbying the Home Office for a grant of £500,000. That was money well spent on a wide range of valuable initiatives. I am sure that a great deal can be learned nationally from that experience. I was delighted that lottery moneys enabled a successor project, the Leeds community distraction burglary initiative, to follow in its footsteps. It was a privilege to be asked to launch it a few weeks ago.
My involvement brought me into contact with Brian Steele, a former detective chief superintendent, who became the project's co-ordinator. His infectious, crusading spirit and his advocacy played a key role in moving distraction burglary up the agenda, not only locally but nationally. I am aware that my hon. Friend the Minister knows Brian only too well.
When the project came to an end, Brian's obvious expertise was snapped up by the astute head of North Yorkshire trading standards, Stuart Pudney, on behalf
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of a consortium of northern trading standards authorities. I am now working with them and the Trading Standards Institute on a parliamentary campaign for a law to ban cold calling for the purpose of offering property repairs. That would help to address the favourite modus operandi of distraction burglars and other criminals. It would also deal with those whose unscrupulous activities, while not necessarily illegal in the strict sense, are designed to fleece vulnerable and unwary people.
My hon. Friend will be aware of early-day motion 219, and the Property Repairs (Prohibition of Cold-Calling) Bill, adopted by the hon. Member for Blaby (Mr. Robathan), which is due to have its Second Reading on 12 March I look forward to that. He will also be aware of the excellent and hard-hitting newspaper campaign undertaken by the Yorkshire Evening Post in our area. Indeed, newspapers throughout the land have conducted impressive campaigns, including the Nottingham Evening Post and The Northern Echo.
I appreciate that the Minister awaits the Office of Fair Trading's report into the National Association of Citizens Advice Bureaux's super-complaint on cold calling. That has taken considerably longer than we all anticipated, although I appreciate that one of the main reasons is the commissioning of extra research on the prevalence of nefarious cold calling, which is still underestimated. I also realise that any Government would introduce a ban only as a last resort. However, I hope that my hon. Friend will appreciate that those who must grapple with the issue daily are now talking about a ban as a last resort, having tried other approaches.
My hon. Friend will have heard Brian Steele describe how, as head of the West Yorkshire murder squad, he investigated the cruel and vicious murder of Isobel Gray. Isobel, an 82-year-old lady, severely disabled with curvature of the spine, was a serious victim of bogus property repairs and was eventually murdered by distraction burglars. They violently forced their way into her home, tortured her to discover the location of the cash that they knew she kept there, broke her back and left her to choke to death on her own vomit. That case in particular leads me to call a cold calling Bill "Isobel's Bill". It is said that good cases make bad law, but that is so when ill-considered legislation is rushed through as a knee-jerk reaction. Isobel Gray died seven years ago this month, so Isobel's law would not have been conceived on such a rushed basis.
My hon. Friend will also be aware of Brian Steele's research into distraction burglary, which involved interviewing a significant number of distraction burglars in prison. He describes graphically how they showed not the slightest remorse for their crimes; how older people were mere impersonal objects in their cunning and proud trade, as they saw it; how they could "smell" the money in an older person's home; how they were prepared, if thwarted, to do what they called "a naughty one" and use violence to achieve their ends; and how they bought and sold the names of victims—victims, presumably, like Isobel Gray. We need to operate at every level, from the Government down, to block the distraction burglar and literally form a human shield against the con artist and the rip-off merchant.

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That will not be an easy task. Last year, the Trading Standards Institute published a survey about doorstep selling. Some 9,000 randomly selected householders across the UK were asked to give their views on, and experiences of, doorstep callers. Not surprisingly, 96 per cent. said that they did not want doorstep sellers at all and only 0.1 per cent.—my arithmetic tells me that that is nine people out of 9,000—welcomed doorstep calling. It can therefore be said with some justification that in terms of public support we are pushing at an open door in calling for restrictions on cold calling. In the survey, 61.5 per cent. of householders reported receiving cold callers in the previous month, which is a very high rate indeed. Worryingly, up to 21 per cant. of householders reported having had a bad experience with a cold-calling doorstep seller, but only a small proportion of those reported it to the authorities, either to the police or trading standards.
Also of great concern was the low level of household security. Only 13.4 per cent. of people reported ever asking for identification and only 1.3 per cent.—a handful—ever checked it out. Even such basic measures as the use of door chains were disappointingly low, with 40 per cent. of householders having had one fitted, but only 6 per cent. ever using it.
The survey on bogus caller crime that Help the Aged conducted in summer 2003 added weight to those findings. According to the survey, police reports from 2001–02 and 2002–03 showed an average of 19,030 reported distraction burglary crimes in England and Wales a year. The survey, however, suggested that between 300,000 and 400,000 people aged 60 or over in Great Britain may have been approached by suspicious callers or distraction burglars in the past year alone.
Clearly, not all of those callers will have been distraction burglars. However, the results do show the level of cold calling and the potential for such crimes. Findings from the survey would also suggest that suspicious callers have gained entrance to the homes of approximately 180,000 people and that they will have stolen from approximately 122,000 of those.
The apparent underestimate of levels of distraction burglary may be down to a number of factors, which have been well rehearsed in the past. Those include inconsistencies in the way in which police forces collect figures. Victims of distraction burglary may also choose not to report the offence because of embarrassment or for other reasons. Many people have a fear of engaging in the criminal justice system and a fear that it will increase their vulnerability by identifying them as potential victims of crime. Some victims may even fail to recognise that valuables are missing from their home or may not link stolen moneys to a previous distraction burglary incident.
Many older adults—39 per cent. in the survey—did not report their experience of a suspicious caller to the police, particularly when the caller did not gain entrance to the home. Encouraging the reporting of such incidents to the police could greatly assist the identification and mapping of the activities of those particular criminals. Alarmingly, 25 per cent. of older people reported that they did not regularly lock their doors, making them even more vulnerable to such
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opportunistic crime. When faced with an unknown caller, 25 per cent. of respondents reported that they opened the door without taking any precautions.
Almost one third of respondents reported feeling worried some or all of the time when answering their door to someone they did not know. A huge proportion of people over 60 are fearful of what is waiting for them on the other side of the door. Eleven per cent. of respondents reported that they wanted help with the upkeep of the outside of their home, 9 per cent. wanted help with repairs to the inside of their home and another 9 per cent. wanted help with their gardens. Such a degree of need and of unmet need is obviously fertile territory for the operation of distraction burglars and bogus property repairers.
Local projects, such as the Leeds distraction burglary project and its successor, can of course do their utmost to reach vulnerable older people and raise awareness. We can give out the message about getting a chain and using it. We can tell people to check identity. We can make our targets harder. We can develop cold-calling protocols with utility companies and local authorities. However, people will always continue to remain vulnerable, too trusting or confused and will need far more help than that. That is why we need a multi-agency approach, not only locally, but underpinned by a similar cross-departmental national approach at central Government level.
The murkier side of cold calling presents a challenge that cannot be tackled by one Department or by one Minister, no matter how much we love and respect him. It is when community safety meets consumer protection, public health, social services and housing services. Community safety and crime are clearly the responsibility of the Home Office. However, the lead role now placed on local authorities means that the Office of the Deputy Prime Minister is also a major player. The Department of Trade and Industry is responsible for consumer protection. The ability to cope at home, especially for our more vulnerable citizens, whatever their age, is a concern of the Department of Health, and of social services. Housing—a crucial part of the process—is a principal responsibility of the ODPM.
It is crucial that at least those Departments form the four legs of a sound stool, and not four separate stools through which the issues and, more importantly, the victims can fall. That is why we need a national taskforce to tackle the issue and the problems that it creates.
If a bogus caller gains entry and steals something, that is currently the responsibility of the police and the Home Office. However, if the caller claims to have carried out some work, no matter how minimal, shoddy or unnecessary, and then defrauds the householder of hundreds if not thousands of pounds, that is the responsibility of trading standards and the DTI. Both trading standards and police forces have many initiatives under way locally and nationally, but at a national level there needs to be joined-up thinking and joined-up working. A national taskforce would help to achieve that. The message to fit and use door chains is not just relevant to home security, and hence the Home Office, but should be reinforced by other Departments, such as the DTI, the Department of Health, the ODPM and others who deal with older and vulnerable adults.

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We have a single assessment procedure whereby people, particularly older adults, are assessed for the services that they need to maintain an independent lifestyle in their own homes. The scheme is a wonderful opportunity to assess home security and to take a few minutes to talk to people about dealing with doorstep callers. However, that rarely happens because the scheme operates under the aegis of a particular Department.
I shall finish as I started. This is a huge problem. We do not want to frighten vulnerable people, especially older people, but we do need to protect them, and we cannot play down the problem of cold calling. We can protect them only if there is a recognition of the scale of the problem, a readiness to take firm action and a coordinated response at national and local levels.
11.15 am
The Parliamentary Under-Secretary of State for Trade and Industry (Mr. Gerry Sutcliffe): I congratulate my hon. Friend the Member for Pudsey (Mr. Truswell) on securing the debate. He knows that I share his concerns. I am well aware of his interest in cold-calling crime and consumer detriment. I attended the seminar organised by him and the Trading Standards Institute on 4 February. It was a very worthwhile event, and I listened with great interest to what was said. I commend my hon. Friend and others who spoke—the hon. Member for Blaby (Mr. Robathan), the head of North Yorkshire trading standards and regulatory services, and former Detective Chief Superintendent Brian Steele—on their hard work in drawing attention to what I fully acknowledge is a serious problem. I was as alarmed as anyone to hear about the case of Isobel Gray and the torture that she suffered at the hands of people who dealt with her unmercifully. I know Brian Steele well. His portrayal of that event was very graphic but very relevant to the problem we face.
Cold calling by bogus or exploitative traders, who usually offer overpriced or substandard goods or services, is economically detrimental to consumers. Moreover, the targets for rogue traders in that sector are often vulnerable people, so detriment is often compounded by distress. That is clearly unacceptable. I am aware of the evidence linking cold calling that offers property services with crimes such as distraction burglary, which adds another unacceptable perspective to the problem. Sadly, such crimes have also been linked to cold callers claiming to represent a range of commercial and public bodies, including the utility companies and the health and social services. For those reasons, I am perfectly willing to agree that we must seriously consider tackling the problem and protecting consumers.
I am very conscious of the fact that the problems related to cold calling can be compounded by the fact that straightforward consumer detriment is a matter for local trading standards and that doorstep crime is a matter for the police. This reflects existing law and the role of the enforcement authorities, but the rogues can exploit the situation, as my hon. Friend said. Several initiatives aimed at improving co-operation between trading standards and the police are already tackling the problem with some success and I want such cooperation to become the norm throughout the country.
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There is also scope for closer co-operation between Departments with a policy interest in the subject to support the necessary co-operation at local level. My hon. Friend the Minister for Crime Reduction, Policing and Community Safety referred to that in a similar debate held before Christmas. She emphasised the importance of not allowing the problem to fall between the gaps that exist between departmental responsibilities. I endorse that sentiment wholeheartedly and would be happy to work with ministerial colleagues to help to develop more coordinated approaches to the problem. Officials in my Department and the Home Office have been in close contact on the issue for some time. As my hon. Friend the Member for Pudsey said, however, other Departments need to be involved, and I have suggested to my hon. Friend the Minister that we set up a cross-departmental committee of Ministers to examine the problem in greater detail.
The problems associated with the cold calling practised by various types of rogue trader do not exist in a vacuum. My hon. Friend is aware that the Government are already committed to a thorough review of the doorstep selling market as a whole. He referred to NACAB, now called Citizens Advice. It published "Door to Door", a report on doorstep selling, in 2002. The report contained evidence of the problems experienced by clients of citizens advice bureaux with a range of goods and services. It also contained several recommendations for improving consumer protection, which included the recommendation that traders trading in consumer goods should be under a general legal duty to trade fairly in the United Kingdom and in all other European Union states. That should be enforceable through stop now orders.
The report also recommended that the regulations on doorstep selling should be changed to provide a cooling-off period of 14 days for all contracts made in consumers' homes, irrespective of whether the visit was solicited by the consumer. Another recommendation is that the provision in the regulations on doorstep selling, under which the right to cancel in effect falls if a purchase is incorporated into the home during the cooling-off period, should be changed so that the cancellation right remains for the full period.
In addition to the obligatory mention in the sale contract, consumers should get a separate notice explaining their right to a cooling-off period and to cancel a contract. All consumers should be given a standard leaflet during any doorstep sale. It should be independently produced and include key information about the consumer's rights, questions to ask the salesman and sources of further information and advice, including how to complain and report traders who do not comply with the law.
The NACAB report was submitted to the Office of Fair Trading as a super-complaint under the terms of the Enterprise Act 2002. During national consumer week 2002, the OFT announced that it would investigate the super-complaint. The investigation has considered practice in other European Union member states and the problems of bogus and exploitative trading. Possible outcomes of the investigation include: enforcement action by the OFT's competition enforcement and consumer regulation enforcement divisions; referral of the market to the Competition Commission;

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recommendations for changes in laws and regulations; recommendations to regulators. self-regulators and other bodies to consider changes to their rules; and campaigns to promote consumer education and awareness.
As my hon. Friend said, the investigation has taken longer than expected. That is partly because it has been necessary to consider many issues across various sectors in the doorstep selling market as a whole, but the OFT is expected to publish its report and recommendations in April. I look forward to the report and assure hon. Members that any recommendations will be carefully considered.
There is no doubt that cold calling by certain types of rogue traders may be a source of consumer detriment and distress. However, we must also recognise that although unscrupulous traders operate in the doorstep selling market, there are also a great many legitimate and reputable traders conducting business. Of course, it is clearly in the best interests of legitimate traders if the rogues are put out of business, not least because that would remove unfair and unscrupulous competition. When the OFT first announced that it would investigate the doorstep selling market in response to the super-complaint, it made it clear that it did not consider doorstep selling intrinsically wrong and that it could even be useful for some people, such as the housebound. I agree with that.
By way of example, the Direct Selling Association, which imposes stringent codes of practice on its members, estimates that that form of trading is a distribution channel which in the UK accounts for sales in excess of £4 billion per annum across a wide range of products and services. The DSA also estimates that almost 500,000 people are engaged in direct selling either full or part-time. Those are significant figures.
Mr. Truswell: We accept that it is because of the arguments that the Minister deploys that the Property Repairs (Prohibition of Cold-Calling) Bill is narrowly and specifically focused on those who solicit work for property repair or maintenance purposes. As such, it has the support of the Federation of Master Builders.
Mr. Sutcliffe: I appreciate the comments of my hon. Friend, who acknowledges the need for that narrow focus. I just wanted to describe the market's wider position.
The consumer protection measures that are in place provide the context for the OFT investigation and the NACAB report. Consumers purchasing goods or services at the door are directly protected by legislation known as the doorstep selling regulations, which consist of the Consumer Protection (Cancellation of Contracts Concluded away from Business Premises) Regulations 1987, as amended by the Consumer Protection (Cancellation of Contracts Concluded away from Business Premises) (Amendment) Regulations of 1988 and 1998. My hon. Friend knows those regulations well. Collectively, they give consumers the right to a seven-day cooling-off period during which they may cancel an agreement to buy goods or services worth more than £35 from a trader whose visit was unsolicited. The regulations also provide that consumers who agree to a visit following an unsolicited doorstep approach retain
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their right to a seven-day cooling-off period. In addition, traders who fail to inform consumers in writing of their right to a cooling-off period commit a criminal offence. Door-to-door sellers must provide a notice setting out cancellation rights when any agreement is made. Failure to do so makes the agreement unenforceable, whether a deposit is paid or not.
Since the first set of regulations implemented the doorstep selling directive in the UK in 1987, the protection for consumers has been further improved by subsequent regulation. I would expect the OFT to consider the effectiveness of the protection that the regulations now provide.
The Government are committed to placing empowered consumers at the centre of an effective competition regime. That means that consumers should be properly protected and informed to promote effective competition. Bogus or exploitative traders represent unfair competition to legitimate businesses. To help achieve their objective, the Government have introduced several new measures to protect and inform consumers.
The Enterprise Act 2002 introduced the new concept of super-complaints and provided the legislative framework for the Office of Fair Trading to conduct an investigation of the doorstep selling market. It also included provisions to strengthen the powers available to enforcement authorities to tackle the activities of rogue traders. Stop now orders, which were introduced in 2001 by implementing the injunctions directive, created a new enforcement regime across a wide range of consumer protection legislation. Designated enforcement authorities could then apply to the courts for stop now orders to stop the practices of rogue traders if they went against the collective interests of consumers. The Act has extended that protection across an even wider range of consumer protection legislation, particularly in the service sector.
Another way in which we are informing and empowering consumers is by developing consumer support networks, which bring together organisations to plan and deliver better, more accessible and more joined-up support for local consumers. Throughout Britain, the networks are helping to raise awareness of consumer issues. That includes placing considerable emphasis on issues relating to sales in the home, particularly where vulnerable or older consumers are involved.
The Government have also made up to £30 million of new money available over a three-year period to roll out a new national consumer helpline—Consumer Direct—which is perhaps the most exciting development in consumer advice for a generation. With a single, widely publicised number, it will be a powerful tool for providing consumer advice throughout Britain. No matter where consumers live, they will be able to access reliable, independent help on consumer matters via their own phone for the price of a local-rate call. For those who prefer it, the service will be available online. At the beginning of the year, I announced the four regions that would start operating as pathfinders for the Consumer Direct service this summer. They are Scotland, Wales, the south-west and—my hon. Friend will happy about this—Yorkshire and Humber. Taken together, those measures strongly demonstrate the Government's real

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commitment to protecting the interests of consumers—particularly vulnerable consumers—from the activities of rogue and bogus traders.
My hon. Friend will know that the Trading Standards Institute launched a national survey on cold calling at the same time as the Office of Fair Trading announced its market study of doorstep selling. The result of the TSI survey was a report entitled "Door to Door Cold Calling of Property Repairs, Maintenance and Improvements—Long Overdue for Statutory Control". The report concluded that there was clear evidence to demonstrate significant consumer detriment from cold calling in relation to property services. In addition, the TSI concluded that the sector attracts criminal elements who, as my hon. Friend said, are willing to take advantage of consumers and to engage in more direct criminal activity. The report's recommendations included introducing a statutory prohibition on salesmen calling on householders unannounced to offer home improvements. The report has provided the OFT market study with important input by highlighting problems in the property services sector, and I commend the institute on its valuable work.
As my hon. Friend said, the report led directly to the private Member's Bill to be introduced by the hon. Member for Blaby. The Bill calls for a ban on cold calling to offer property repairs and maintenance. We are all looking forward to its Second Reading on 12 March. I have had two useful discussions with the hon. Gentleman about the Bill and its aims. I have not yet seen it in its published form and it would, in any case, be inappropriate for me to comment on it before Second Reading. However, the Office of Fair Trading expects to make public both its position on a cold-calling ban and its full market study report in anticipation of next week's debate. I cannot anticipate what those will say, but they will clearly help to inform the debate, and I welcome such action.
I am genuinely grateful to my hon. Friend and his associates for their excellent work in focusing attention on the serious problems associated with some types of cold calling. I assure him that I am sympathetic to their aims. As the Minister with responsibility for consumers, I take all forms of rogue trading, and the detriment and distress that they cause, very seriously. The impact of such practices on consumers—not least vulnerable consumers—is unacceptable and we must make every effort to put the rogues out of business. The Government have shown a strong commitment to protecting consumers' interests. In keeping with that commitment, I can assure my hon. Friend that all the options for improving protections for consumers from bogus or exploitative cold callers will be carefully considered.
11.29 am
Sitting suspended until Two o'clock.

Osteoporosis
2 pm
Dr. Vincent Cable: I am grateful for the opportunity to introduce the debate, which I have secured for several reasons. Like a great many Members, I have received lots of letters and cards in connection with a recent campaign by the National Osteoporosis Society about the recommendations of the National institute for Clinical Excellence. Several of the moving and affecting letters that I have received led to complicated casework, which has highlighted some of the difficulties of the matter.
The issue affects many people in the House. I note that 161 Members signed the early-day motion in the name of the chairman of the all-party group on osteoporosis, the hon. Member for Erith and Thamesmead (John Austin), and that another 72 signed a virtually identical early-day motion in the name of the hon. Member for Westbury (Dr. Murrison). I am not sure why there should be any tribalism on the subject, which is fundamentally non-controversial. However, as a result of those two initiatives, more than 235 Members have expressed their support for the society and its work, and their concerns about the problems that the widespread illness presents.
Another reason why I have a personal interest in the matter is that one of the first initiatives that I took after entering the House in 1997 was to introduce a ten-minute Bill on the role of the elderly more generally in the national health service. I tried, as one does, to introduce provisions on non-discrimination in the health service as it affects elderly patients. However, a lot has happened since then: the national service framework has been introduced, and there is now much greater sensitivity toward osteoporosis, which has become a pretty central issue. Much progress has been made, but there are serious problems.
The osteoporosis arguments are very much at the heart of bigger debates on the health service and how we shift the emphasis from dealing with disease to prevention. Although that is an attractive slogan, it is difficult to realise in practice, as this case makes all too clear. I want to focus on the issue too because it raises some challenging questions about the role of the National Institute for Clinical Excellence. Most of us accepted that the underlying philosophy behind NICE was right. We thought it important to have an independent body to make professional, objective assessments of drug; rather than to rely on lobbying by companies, fashion, doctors or press campaigns. The aim was to have an objective, detached institution that was separate from Ministers to make such judgments.
Although the role of NICE has been vindicated, what has happened with osteoporosis is alarming: in many ways, the initial ruling—the technical assessment— appeared to cut the ground from under the argument in favour of prevention One is left with two potentially alarming explanations. One is that the methodology employed by NICE is flawed. If the health economics that underlie it are unsound, that raises wider questions. The second explanation, which is even more alarming, is that the case that most of us made for placing much more emphasis on prevention rather than dealing with disease may be flawed. The first explanation is likely to

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be the issue. Therefore, the case of osteoporosis raises not only specific issues but more fundamental questions about what NICE is doing and about its reputation, which has been somewhat damaged by this episode.
All that means that we are in a worrying position: many people, particularly won't have been left stranded, because they have been advised by doctors and the media not to take hormone replacement therapy. Some 1.7 million women use HRT; they have been advised that it enhances the risk of cancer. Indeed, if they read this morning's Daily Mail, they will also have been advised that it enhances the risk of stroke. Many of them are ceasing to use it, but they are in a kind of limbo in which alternative drug treatments appear uncertain and NICE is unwilling to make positive recommendations—certainly on newer drugs. Therefore, such women have been left in what has been called NICE blight—an unsatisfactory situation that is unlikely to be resolved until June 2005, when a revised version of the NICE report will be published.
I want to set out a few of the basic facts, with which the Minister and many hon. Members will be familiar, although it does no harm to rehearse them. Osteoporosis is an extensive illness that affects one in three women over the age of 50 and one in 12 men—3 million people altogether, of whom probably 250,000 have an acute form. It almost certainly leads to about 300,000 fractures a year. There is a much uncertainty about the specifics, because in many cases the disease is difficult to define precisely, but probably between 70,000 and 85,000 are hip fractures and another 50,000 are wrist fractures. I have seen quite wide variations in the estimates, but there are probably 100,000—perhaps fewer—spinal fractures a year. The literature suggests that the position is not static, but that the incidence of the disease and of fractures is growing rapidly, and for simple demographic reasons: the population is getting older, and there are more frail and elderly people, particularly frail and elderly women, who are prone to the illness.
The consequences of osteoporosis are not simply the obvious ones. Once a fracture has occurred, not only is the probability of a repeat fracture considerably enhanced, many people become crippled, with the attendant consequences of immobility, care costs and so on. Moreover, the illness gives rise to enhanced rates of mortality, as apparently 20 per cent. of those who have hip fractures die within a year. There may be other reasons for that; it may not be a direct cause and effect, but it is a rather worrying link.
The impact on the NHS is substantial. It has been calculated that the cost to the NHS of hip fractures alone is about £1. 7 billion—so it is much higher for osteoporosis in general. Osteoporosis also makes a heavy demand on orthopaedic beds, accounting for an estimated 800,000 bed nights. Probably at any one time, 20 to 25 per cent. of beds in orthopaedic wards are blocked—I know that that is a pejorative term and we should perhaps be careful with it—mainly by elderly people with osteoporosis.
I want to touch on two issues relating to the policy response. The first is the role of the national service framework, in which the Government have been central. Secondly, I want to say something further about NICE, its recommendations and their consequences. I believe that there is general acknowledgement among those
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involved with the disease that standard 6—the step forward taken in 2001—was positive. Tribute has been paid to those who campaigned for that and to the Government's role in delivering it. It was a big step forward, and I have no criticism of it. It had several positive outcomes. It led to awareness of the need for osteoporosis work at primary and secondary care level; to the need to deal with falls and their prevention; and to greater concern about prevention and risk assessment.
Mr. David Drew: I apologise for missing the hon. Gentleman's first words. I want to raise a problem with the issue of falls and osteoporosis. A retired general practitioner, Dr. Jonathan Bayly, who produced a report for the National Osteoporosis Society, did some valuable work on fall prevention. Of course, it involves trying to prove a negative. The local primary care trust has been unwilling to widen the scheme beyond one practice, where it tries to pinpoint women who are likely to suffer from osteoporosis. Is that not a particular problem? It is difficult at present to prove how valuable preventive work is. What does the hon. Gentleman feel about that?
Dr. Cable: That is a thoughtful and appropriate intervention. Concern about the problem that the hon. Gentleman describes is quite widely shared. When NICE published its report on falls and how to prevent them, the National Osteoporosis Society described its work as muddled and lacking in cohesion. Even the experts have had the same difficulty in linking the various elements as he and the GP whom he mentioned have had, so the point is perfectly valid.
Although the national service framework has been launched with the positive objectives that I described, those who have been following the issue most closely have several concerns. Despite the creation of the framework, there is, for example, little evidence that many PCTs are taking the issue very seriously. I think that only 20 per cent. of PCTs even mention the framework in their local plans. Also, very little monitoring is being done. Clearly, one does not want to argue for a large bureaucracy and monitoring for its own sake, but there appears to be little monitoring other than that which the society conducts.
The skeletal evidence that exists suggests that Britain still lags way behind other European countries in the extent of scanning. Large numbers of people with fractures are still released from hospitals without having been scanned. There is also a lack of linkage between the genuinely pioneering preventive work in primary care and that in the secondary care sector, where such standards are not matched. The national service framework standard 6 is an important step forward, but the big question is how we put more energy into it and take it forward.
The other policy question arises in connection with NICE and its technical studies, particularly those on three contentious drugs that required evaluation, of the five drugs that were studied. Those drugs were—I am not a scientist, so I shall have to read their names to ensure that I do not get them wrong—bisphosphonates, raloxifene and teriparatide. Three major conclusions were derived from that technical work, which have rather worrying implications for osteoporosis sufferers.

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First, NICE strongly advised in its initial draft that there should not be preventive use of drugs by people who do not have a fracture. In other words, NICE questioned the principle of using drugs for prevention. Secondly, even for people who have fractures, there is a tight definition of risk that excludes many of the variables that people in the field recognise as important predictors, thereby considerably narrowing the range of drug use. Thirdly, the lack of confidence in raloxifene and teriparatide prevents the use of drugs for dealing with spinal vertebrae osteoporosis and fractures resulting from it.
The society and many people who have written to us were alarmed by those outcomes for several reasons—one of which was that they appeared totally to contradict the work in the national service framework and to undermine the current preventive work, let alone its expansion. The findings have also opened up the possibility that people who cannot use bisphosphonates—the established drugs—because of their side effects will have no other drug treatment open to them.
As a consequence of the objections that were raised, NICE is having a fresh look and a report will appear in just over a year's time. The result of the whole exercise, however, has been to raise doubts about the methodology. Again, I am not a specialist or scientist in the field, but critics of the process made some rather obvious points that question the basic scientific rigour.
For example, it was noted that the studies failed to establish the connection between the use of such drugs for osteoporosis and their value in other fields such as cancer prevention. They appeared to assume that each fracture had equal value for health economics, when in fact repeat fractures increase the probability of a return. Simple mistakes seem to have been made—a serious consequence of which is that the lives of large numbers of people, particularly women, are blighted because they cannot progress with drug therapy and it is uncertain which treatment is appropriate.
An unintended consequence of the uncertainty surrounding the subject has been that it has drawn attention to one area in which prevention can be improved: people's lifestyles and diets. We all pay lip service to lifestyle and diet, but they are becoming the first line of defence in the absence of a satisfactory agreement on drug treatment. Some of the conclusions that emerged from the dietary research underline much of what we say about other diseases: smoking and alcohol add to the risk; plenty of exercise reduces risk; and fruit and vegetables are good preventers. All those good messages are reinforced in the case of osteoporosis.
In addition, there is a large body of evidence on the importance of calcium in milk drunk at early stages of growth and of vitamins D and K. Milk is important. Some 30 years ago, I was part of the campaign to try to stop the withdrawal of milk from schools. It was a major political issue more than a generation ago, but the battle was lost. The rationale for withdrawing milk was that it was originally provided to deal with rickets, and that as rickets was disappearing, we might not need to worry
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too much about it in future. However, evidence is emerging that lack of milk in early years is a major factor in increasing the risk of osteoporosis later in life. The National Dairy Council is quite properly putting the issue back on the agenda. I am not suggesting that the spending commitments of the Government or the Liberal Democrats should include free school milk; as the Liberal Democrat Treasury spokesman, I would not be very popular with my colleagues if I suggested that. None the less, reintroducing milk as central to preventive care is an important theme.
Dr. Andrew Murrison: I was one of the primary school children who were affected by the withdrawal of milk. My childhood memory is of leftover crates of milk, because the milk was invariably of poor quality, it had usually gone off, and was rarely drunk. Does the hon. Gentleman accept that bone mineral density is certainly increased by diet and by milk, but that the evidence relating to the incidence of fractures and their prevention is less clear-cut?
Dr. Cable: The hon. Gentleman speaks with medical authority. His conclusions, which I read in the literature, are straightforward, and I accept his point.
Another finding concerns acidity and relates—I believe—to the risk of fracture rather than to bone density. The hon. Gentleman has not yet referred to that finding, but it is quite interesting, and perhaps he will comment on it later. A conclusion that is emerging about diet is that all that sparkling water in this Chamber is extremely helpful in preventing osteoporosis fractures. There is, however, a negative side to the story: Coca-Cola and Pepsi-Cola are risky substances that appear to be very damaging to our hone structure. I do not know whether the Minister intends to campaign against those companies, but if he reads the literature, he will probably conclude that he should.
I draw my thoughts together by asking the Minister a few questions. This is not a highly polemic subject, let alone a party political one, but there are issues that we need to address. First, how do we bring energy and life into national service framework standard 6, given the somewhat negative and even cynical comments about its effectiveness at grass-roots level? What can be done to reinvigorate it?
Secondly, what happens when what NICE says diametrically opposes the national service framework? Will Ministers express a view, or will they let the process of professional comment and interaction between bureaucracies work itself out? There is clearly a problem. Thirdly, w hat happens about blight? We are in a difficult position because women, in particular, are highly uncertain al out what preventive measures to take, given that all such measures are unapproved or risky. What advice is given? How does one reduce blight?
Fourthly, is the Department monitoring hormone replacement therapy? Are there numbers to show how rapidly it is tailing off? Given the frequent changes in clinical assessment, what advice is now being given? Lastly. the importance of lifestyle choices is growing, although some are controversial, while others are not. What role do the Government have in ensuring that lifestyle choices are improved, particularly as regards osteoporosis?
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Mr. Russell Brown: I congratulate the hon. Member for Twickenham (Dr. Cable) on selecting this subject for debate. I also apologise to you, Mr. Deputy Speaker, to the Minister and to others in the Chamber, as I must leave just before 3 o'clock for another engagement.
I must declare an interest as a patron of the Dumfriesshire osteoporosis support group, which has been in existence for about six years. The group's chairman, Mrs. Margery Wilkins, is a trustee of the National Osteoporosis Society. As such, she represents all sufferers and support groups in the United Kingdom.
The hon. Gentleman mentioned NICE, to which I shall return later. I fully appreciate that it covers only England and Wales, and not Scotland. When I spoke to the Minister, he assured me that NICE's recommendations on a host of issues were recognised throughout the world, but not in Scotland. I am sure that he will enlighten us about that.
Sandra Gidley: I believe that Scotland has a separate system called SIGN, or the Scottish intercollegiate guidelines network. When the Select Committee on Health examined the phenomenon—I hesitate to say problem—that is NICE, it was supportive of the Scottish system, which seemed to be quicker and to provide more practical advice.
Mr. Brown: I thank the hon. Lady for her comments. She is right. Although we have devolution in the UK, practice on either side of the border is not completely at odds.
As I said, my local group has been in existence for about six years, and I want to give colleagues an indication of some of the good work that it is doing. The group produced the National Osteoporosis Society healthy bones packs and, with a grant from the Lloyds TSB Foundation for Scotland, it distributed them to all the primary schools in Dumfries and Galloway 10 months ago. That goes back to the point about prevention in the early years, when people can take on board issues that will help in later life.
In my area, people initially went to West Cumberland hospital in Whitehaven for DXA scans. If necessary, that was followed by a meeting with the bone nurse. Given the pressure in the area, we purchased a DXA scanner through public subscription. However, even after many months, it was receiving little usage. People were still going to Whitehaven, and those who know the geography of the area will know that getting there and back is a significant journey. I added my support to the local osteoporosis group and we were able to put pressure on the local health trust to develop a strategy to enable better use of the DXA scanner. I am delighted to report that an expanding service is now being provided to sufferers and that the group is now well established at Dumfries and Galloway royal infirmary.
The chairperson of my local group contacted me in early January because NICE had published on its website the consultation document prepared by the technology appraisal committee. She was considerably concerned as the document was in draft form. I want to give hon. Members a flavour of the concerns that arose from that initial posting, although I appreciate that the
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consultation period finished on 23 January, that we have moved on and that the Minister will update us. The chairperson wrote:
"To deny a DXA scan to those over 65 with a broken bone is to deny them and their doctor a base line from which to assess whether their bisphosphonate treatment is effective or not".
In her case, the scan results showed that the bisphosphonate drug Fosamax alone was not proving effective, and until Fosamax was combined with HRT, calcium and vitamin D, her bone density continued to decline. Had she been denied a scan, none of that would have been discovered.
She went on to say:
"For those under 65 to have to wait for treatment until their T score is as low as stated by the NICE proposals, is counterproductive in terms of fracture risk and positively cruel. Many people with T scores less severe than this do suffer pain from wedged vertebrae."
The big question was: were they being denied the basic human right to have the disease arrested and further fractures prevented? All in all, the draft proposals that were posted caused concern. I am delighted that that letter allowed me to take the opportunity to write to Lord Warner, the Minister with responsibility for NICE, who got back to me and fully explained what was happening.
I said that I would keep my comments brief, and that is basically as much as I want to say. Again, I congratulate the hon. Member for Twickenham. As he has said, this is a debilitating illness. Early intervention is vital. I have given the example of my local group, which believes that the starting point should be in schools. Those who suffer need to be listened to, and I hope and pray that they are. The National Osteoporosis Society, an extremely well-organised national body, needs to be listened to. The real test will be whether we see a dramatic fall in the number of sufferers over the years on the back of NICE's recommendations. I apologise again that I have to leave the debate early, but I will read the Minister's response in Hansard tomorrow with great interest.
2.28 pm
Linda Gilroy: It is a pleasure to follow my hon. Friend the Member for Dumfries (Mr. Brown); I always want to call him the hon. Member for Moffat, where I was born, but he is the hon. Member for Dumfries. It is also a pleasure to share his experience. There must have been a drive six years ago to set up local osteoporosis societies, when I became a patron of my local society. I remember the inaugural meeting at which well over 100 people—there could have been more than 200—turned up. That was an early lesson to me about the impact that osteoporosis can have on people's lives.
We have probably all been active members of the all-party group on osteoporosis, which has been ably supported by the National Osteoporosis Society. I wish to take this opportunity to pay tribute to the former director of the society, Linda Edwards, who sadly died an untimely death at an early age last year. On a nice sunny day such as today—well, it was a nice sunny day—I well recollect some of the events that were organised. We were invited to take our bones for a walk and to have our photograph taken with Oscar the skeleton. I have still have a photo up in my office of me shaking hands with the skeleton.

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I congratulate the hon. Member for Twickenham (Dr. Cable) on initiating this timely debate. He has already referred to the NICE appraisal. As that appraisal continues, it is important not only for the individuals concerned but for Government policy that we make robust representations. As he mentioned, the NHS currently spends £1.7 billion a year on mending fractures. We are talking about 86,000 hip fractures and 310,000 osteoporotic fractures. That is a huge cost on the health service and it is largely preventable. That is one of the reasons why the work of the all-party group on osteoporosis and the National Osteoporosis Society is important. When working out how one spends one's time, this is an area in which Members should try to ensure that a programme that addresses the issues is carried forward.
The NICE technology appraisal on drug treatments is in progress. The preliminary recommendations that it was considering caused significant consternation. It is important that patients and carers get clear, authoritative advice on the sort of care that might be appropriate and what can be expected from the NHS. That consternation was largely well founded. The hon. Gentleman has already referred to some of the concerns expressed by individual patients suffering from osteoporosis and also to the concerns of the National Osteoporosis Society, which I recently met. It is important that the final appraisal determination reflects those concerns. Some signs that that is the case might already be emanating from the recent meeting of the appraisal committee. I hope that the Minister will assure us that he is putting his weight behind ensuring that the many representations that were made in the early parts of the process are taken heed of.
It is difficult to believe some of the grounds on which the initial recommendations were made. Take the example of women over 65 with fragility fractures receiving treatment without a DXA scan. That could immediately have an impact on women with old traumatic deformities, Scheuermann's disease or osteoarthritis of the lumbar spine, who could wrongly receive treatment if the decision is based solely on an apparent vertebral fracture. The apparent proposed treatment restrictions in the case of post-menopausal women below 65 would mean that, unless there was a T-scan or other risk factors, they would be excluded. In reality, it is difficult to use an absolute cut-off of the type that is proposed. I know that both NICE and the World Health Organisation are considering more sophisticated approaches, and I understand that there may be further reflection on that issue in future stages of the appraisal process.
On restrictions on treatment, there is the idea that no treatment should be given until a woman has a fracture, and the proposal that we should move away from the sort of primary prevention that we have all been working hard to encourage in our local primary care trusts among those at highest risk. Women are at much greater risk of subsequent fractures following the first fracture. As the National Osteoporosis Society said in its representation to NICE:
"just as high blood pressure and raised cholesterol are treated to prevent heart attack and stroke, so osteoporosis should be treated in those at high risk".
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The National Osteoporosis Society expressed a number of other concerns to me about the restrictive criteria being proposed for the use of teriparatide, and the way in which it was proposed that calcium and vitamin D supplements should be used. It was also concerned that raloxifene would no longer be available to prevent fractures in those at higher risk, especially as it reduces the risk of breast cancer and is an alternative to HRT, which has been the subject of much topical concern. That needs to be looked at far more closely. Women who are at risk of vertebral fracture often cannot tolerate the side effects caused by biophosphonates or cope with complex treatment regimes. Several other concerns were expressed alongside those.
As an illustration, I wish to refer to a letter from a local constituent, as it shows how some of the issues that I have described can impact on and worry some of our constituents. The lady in question writes:
"I was diagnosed with osteoporosis in 1992 after suffering excruciating back pain, clay and night. The rheumatologist arranged a bone density scan."
That density scan revealed that her bones were indeed in a bad state, and she continues:
"I was unable to take Didronel because of quite severe side effects, so I was treated with HRT patches. Over the ensuing months and years, the pain decreased dramatically and mobility was restored."
After five years, she had another scan that showed a great improvement in her bone density and HRT was continued for another five and a half years. However, from time to time she developed painful cysts in her breasts that had to be aspirated.
A year ago, although the breast clinic was of the opinion that to protect my constituent's bones, it would be good on balance for her to remain on HRT and to keep the situation monitored, her GP and rheumatologist—presumably against the background of concern about HRT and breast cancer that I have described—thought that it might be better to give her different medication, at least for a while. She has been trying different regimes of medication, such as Evista, which did not suit her, and Actonel—both the one-a-day and one-a-week versions—but that caused her considerable pain. She has now settled with the one-a-week version, but that will have to be reviewed in a year's time. She also writes:
"It needs no stretch of the imagination to envisage my despair when I read that it was being proposed that this drug 'should not be available to post-menopausal women with osteoporosis and at high-risk of fracture until they have fractured already'."
In that one case alone, we can see almost all the points of concern that the National Osteoporosis Society raised in its representation to NICE on the initial proposals.
I hope that the Minister will be able to offer us some reassurance that he will be encouraging NICE to continue to listen to representations such as those from my constituent. Indeed, that lady did in fact submit her views to the NICE committee. I hope that he will give that reassurance not only for all the reasons of personal distress and anxiety that the letter illustrates, but also because of the contribution that getting the correct balance between prevention and secondary care can bring to reducing the £1.7 billion bill that I mentioned at the beginning of my remarks.

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I hope that the Minister will take a close interest and encourage the more strategic and flexible approach that appears to be beginning to emerge, and that he will not hinder implementation on falls and fracture prevention in standard 6 of the national service framework. Extending the appraisal period as NICE now intends to do will be a noteworthy effort to evaluate primary and secondary treatment. It will give a chance to do that evaluation and to create the best guidelines for both pre and post-menopausal women.
If the draft had stood as it was originally presented, there would have been an increase in falls that would have had disastrous effects on the health and lives of many women. There is no logical sense in creating guidelines that are so strict that they overlook the needs of patients. Patients should definitely come before guidelines. Patient needs must be assessed in a more flexible approach that allows treatment to ensure that that first preventable fracture never occurs.
2.40 pm
Sandra Gidley: I congratulate my hon. Friend the Member for Twickenham (Dr. Cable) on securing the debate. I am a little surprised that there are not more Members present, because I for one have received a large number of cards on this subject. We all know how easy it is to arrange a postcard campaign, but what struck me particularly was the number of people who also took the time to write to me to tell me how the recommendations would affect them if they were implemented. That is powerful; people do not lightly write to an MP.
Osteoporosis is a prevalent issue, but I sometimes cynically ask myself whether it is so ignored and underestimated because it mainly affects women. If it were a male disease, would more research be devoted to the subject? That is probably a little churlish. The answer is that I do not know why there is not more research or why something that affects such a large number of the population—affects their mobility and the way in which they can look after themselves when elderly—does not receive the attention that is given to other matters.
Linda Gilroy: Will the hon. Lady concede that the disease not only affects women but is prevalent in older age? It is only in recent times that we have begun to take it much more seriously and not just to put it down to something that is inevitable in old age.
Sandra Gidley: Sadly, despite some of the Government's best efforts, there is all too often an institutional ageism in the NHS. If one looks closely at the NICE guidelines, one sees that if somebody is much older—over 80 years old, for example—the cost benefit of treating them is much better. Any Figures that showed such cost benefit across the age range would suggest that such people should receive treatment So, I wonder whether there is almost an element or ageism in some of the NICE conclusions.
Clearly, there is a big problem. Many statistics have been mentioned today, but the one that I was particularly taken by is that every three minutes somebody has a fracture owing to osteoporosis. More seriously, 14,000 people die as a result of an osteoporotic hip fracture.
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It has already been mentioned that if one has one fracture, another is between half a likely and twice as likely to occur. I did some work on the matter—I think that it was with the National Osteoporosis Society—a couple of years ago. I was not sure what part I was meant to play, as there was a very young, glamorous model, a very small old lady and me in the middle. I think that I was there in my capacity as an MP, but the age range was quite stark. We were posing with dummies in a shop window. Members could make a lot of political capital out of that should they be so cruel.
The dummies were in various stages of disrepair, and the point that we were trying to get across was that, as a young woman one was unlikely to suffer breakages. The first break is often of the wrist or a lower arm fracture, which should be treated as a sign that the case should be investigated and, perhaps, that treatment for osteoporosis should begin. Sadly, not everybody has a less serious fracture first. Many women—and some men—who suffer from osteoporosis, first know of it when they have a more serious fracture.
The point of that campaign was to try to encourage young women, in particular, to exercise. It is with dismay that, in reading for this debate, I discovered that the jury is still out on whether exercise is a good thing. Clearly, exercise provides other health benefits, but from the point of view of osteoporosis, it is not as clearly beneficial as it might be.
Dr. Morrison: Perhaps I can help the hon. Lady. I think that it is proven that bone mineral density increases on exercise. The question is whether the incidence of fracture goes up or down.
Sandra Gidley: The hon. Gentleman is correct. It must be pointed out that not just any old exercise will help; it has to be weight-bearing exercise to have a beneficial effect.
Sadly, some of the women who wrote in—my hon. Friend the Member for Twickenham referred to this point—felt a double whammy. HRT had been taken away from them as a recommended treatment. Many women were taking HRT and thought that it was doing them good. There seemed to be evidence that it was helping with osteoporosis, but the problem was that the benefits did not appear to outweigh the risks.
There is some interesting research that suggests that it might not be the hormones in themselves that have a beneficial effect. One effect of taking such hormones is to alter the acid-alkali balance in the body; the body becomes less acidic. That has been shown to have a positive effect on bone density and—possibly—on whether someone gets osteoporosis. We should be investing in research around food and Coca-Cola. Incidentally, I have switched to drinking sparkling water. It would be interesting if the Minister could tell us exactly what research is going on. Setting aside the recommendations for a moment, I found it particularly interesting that NICE recommended further research. It struck me again, most powerfully, that we simply do not have all the answers that we need in order to come to an informed decision.
NICE has arrived at a different decision from a number of other bodies. I mentioned the Scottish intercollegiate guidelines network—SIGN—in an intervention. It has come to a different conclusion:

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"Postmenopausal women who have had low BMD confirmed by DXA scanning should be considered for one of the following options",
and it goes on to name some treatments. The Scottish Medicines Consortium appraised teriparatide in 2003 and recommended that it be used by osteoporosis specialists following assessment of fracture risk and bone mineral density. I think that assessment of fracture risk is important. An action plan on osteoporosis in the European Community published in November stated:
"Many interventions, such as bisphosphonates and raloxifene are cost-effective if targeted at individuals at high-risk of osteoporotic fractures."
We have to develop a much more robust way of identifying who is at high risk than merely saying, "Well, you've had a fracture, clearly you must be high-risk." That needs looking into.
Some of those comments bear out the NICE proposals for further research. NICE can make proposals for prescribing that must be adopted, but I am not clear whether if it proposes further research there is an onus on anybody to conduct it. How can the Government and drug companies work together to make sure that we have the answers sooner rather than later?
I do not want to dwell too much on quality-adjusted life years, which NICE uses to measure whether a drug is cost-effective. I have alluded to the fact that that changes according to the age of the patient. However, when the Select Committee on Health looked into NICE, it was clear that the science around health economics, health benefits, quality-adjusted life years and the like was very new and inexact. Sometimes figures must be treated with a little caution; one must find out exactly what criteria were used in order to ensure that the figures were not blurred. In fairness to NICE, it is improving in that regard, but I am still not sure that its systems are state-of-the-art.
I turn to the link with falls and the standard in the national service framework for older people. NICE is producing clinical guidelines on falls in August 2004, and it is producing a separate set of clinical guidelines on osteoporosis in June 2005. It seems that there is scope for overlap, so is there not a case for amalgamating the studies or at least for ensuring that enough account is taken of the former? It would clearly be ridiculous—it has not happened yet, and there are no signs of it happening, but it may happen—for different groups within NICE to produce guidelines that are slightly at odds with each other. The thinking should be joined up more efficiently.
There has been little evidence of progress or of joined-up thinking on the matter. In January, I asked the Minister this question:
"What estimates the Department has made of the potential savings to be made by preventing osteoporosic fractures"
rather than treating them? Sadly, the reply said:
"The Department has made no estimate of the potential savings to be made" —[ Official Report, 5 January 2004; Vol. 416, c. 203W.]
It then went on to refer to NICE. Clearly, NICE does not feel that it has the right answer. The preliminary revised statement was very welcome, in that—
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hopefully—there will be a review of cases to examine how high-risk patients can be assessed and whether there is any way in which they can be treated before they suffer a fracture, but I must admit that I found the reply a little disappointing.
I started to think about the slightly wider implications. It may have been t he hon. Member for Dumfries (Mr. Brown) who mentioned bed blocking; my hon. Friend the Member for Twickenham may also have done so. I tabled another question:
"What assessment has been made of the link between osteoporosis and bed-blocking?"
Clearly, a large number of patients with osteoporotic fractures are, because of their age group, unable to rehabilitate easily at home. It would be useful to try to get a grip on the scale of the problem—but no. The answer stated:
"The Department of Health does not collect data on the precise medical conditions of patients delayed in hospital".
It does not mention falls or osteoporosis.
The National Osteoporosis Society has discovered that osteoporosis is still not sufficiently prioritised and that services are not established in line with the national service framework. Although falls have been included in primary care trust local delivery plans, very few plans contain direct references to such measures. I asked for the Minister's assessment of whether identifying osteoporosis had become a priority in primary care as suggested in the national service framework for older people. I do not propose to read out the full answer, which is quite long, but it ends:
"The most recent reports we have from strategic health authorities indicate that all but a few of the primary care trust local delivery plans include actions to achieve the 2005 falls milestone. We have collected no systematic information on what local plans cover."—[Official Report, 12 January 2004; Vol. 416, c. 618–9W.]
I am not quite sure who has got it right. Perhaps the Minister needs to talk to the National Osteoporosis Society. Clearly, there is a great difference in perception between the answer to my parliamentary question and the survey by people on the ground. If he can elaborate on that, it will be useful.
I wondered whether the Government had a good initiative on falls, and became excited on finding a press release stating that falls had been halved. Sadly, the small print revealed that that was not for the whole country, but in one primary care trust area that had issued gripper slippers to older people at risk. Although that is a welcome initiative, it is disingenuous to put a bold headline on the website claiming that the problem is well on the way to being reduced, when close inspection does not bear that out. I hope that the Minister will assure me that that measure is not the only one that is to be introduced. He may want to announce a roll-out of the slipper scheme today, so that the number of people in hospital can be reduced. Any progress on that initiative will be welcome.
The National Osteoporosis Society said that
"there is still a long way to go in implementing Standard Six, particularly with respect to better co-ordination between primary and secondary care services."
Its audit also highlighted a lack of progress towards implementation and focused on several cases. I have been doing a preliminary survey of my own, and my findings are closer to those of the National Osteoporosis Society than to the Minister's.

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The subject is an important one. I look forward with interest to the Minister's reply—particularly with regard to whether the Government will help to fund any of the research projects identified by NICE. We would, I think, all agree that preventing an accident, or preventing the deterioration of osteoporosis, is in everyone's best interest.
2.58 pm
Dr. Andrew Murrison: There have been some thoughtful contributions today. It is a pity that there have not been more of them. That may be the case because of the trade justice debate that is happening under the auspices of the official Opposition on the Floor of the House, but it is a pity nevertheless, because the subject is important.
I pay tribute to the National Osteoporosis Society for its hard work in highlighting a subject that is one of the forgotten areas of medicine. I am mindful of my time about 20 years ago as a house surgeon in Bristol in orthopaedics, dealing with orthopaedic fractures, including hip fractures. At that time, the condition was pretty well ignored. If someone had a fracture, they had their hips repaired and either got better or did not. By and large, no real thought was given to the treatment of their underlying osteoporosis.
I wonder whether, 20 years on, a great deal has changed. I suspect that it probably has, although perhaps not quite as much as one might have liked it to change over two decades. In so far as there has been change and improvement, a great deal of it has been down to groups that have brought the condition into the public arena. Of those groups, I would obviously single out the National Osteoporosis Society.
I congratulate the hon. Member for Twickenham (Dr. Cable) on initiating the debate, which is very timely. We have recently heard a great deal about NICE and its consideration of osteoporosis. White I would hope to avoid the temptation to use the present occasion as an opportunity to criticise NICE, it is right to highlight the fact that that episode has perhaps not been the most glorious in its history, and it may wish to reflect upon that.
The impact of osteoporosis on people's health and its economic impact on the national health service are underestimated. I recall broken hips and vertebrae, wedge fractures and the classic dowager's hump. Osteoporosis is often passed off as part of the natural ageing process when it can be treated quite satisfactorily. It is a great pity that even now, in the 21st century, we are prepared to pass it off as a normal facet of ageing. It is also a great pity that many radiologists will not comment on wedge fractures, in an elderly chest X-ray, for example, and that they will not be recorded in notes, even less subjected to any formal assessment of treatment. There is a long way to go in raising awareness among the public and professionals.
The NICE appraisal consultation document has been subject to criticism both by the National Osteoporosis Society and the public, as is evidenced by the mailbag that NICE has received. It has been criticised by the industry, and in particular by Lilly, which is responsible for producing two of the products, in question—the selective oestrogen receptor modulator, raloxifene, and teriparatide, which is better known as parathyroid hormone.
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We must welcome last month's announcement that there will be a separate appraisal of primary and secondary prevention, which probably follows criticism of NICE and its work to date on osteoporosis. The announcement is welcome because the two forms of prevention are quite different and need to be addressed, and the work to date has not been as comprehensive or forensic as one might have liked.

There have been big problems with the consultation document. Its ethos appears to conflict with the national service framework for older people of 2001, of which standard 6 has been cited. It seems to be preoccupied with treatment rather than prevention of fractures. It is a pity that it should simply deal with the situation after somebody has sustained a fracture. We hear a great deal about public health, and we have had a Minister with responsibility for public health since 1997. Osteoporosis is a public health problem, as it applies to the population, and we could have done more over many years in this area of public health.
There are several conflicts with the NICE guidelines and those issued by the Royal College of Physicians in 1999, which are the trade standard for treatment of osteoporosis. They are exceptionally good. considering that it is sometimes difficult to make head or tail of some of the college's paperwork: they clearly set out what works, what does not and what might, and they give reasonably clear guidance to professionals working in the field. The NICE guidelines appear to row back from many of those recommendations, which is why the National Osteoporosis Society said that they are a retrograde step. It is a great pity when NICE is cast in the guise of an organisation that is removing rather than promoting that which is good.
It is true to say that the guidelines produced by the Royal College of Physicians and the remarks of the National Osteoporosis Society reflect the importance of compliance. One or two hon. Members, including the hon. Member for Plymouth, Sutton (Linda Gilroy) in particular, mentioned compliance in relation to fragility fractures involving the spine, and alluded to the fact that it can cause digestive problems. That becomes a particular problem with biphosphonates. People are often unable to cope with biphosphonates because of gastric upset. We are then left asking what on earth they are going to use for their treatment because they are left with calcium and vitamin supplements—and the answer is not a great deal.
It is important to note that, if someone feels unhappy with a treatment and if it upsets them, they are probably not going to take it. We find that that is the case with high blood pressure and the treatment of hypercholesterolemia—conditions that do not cause great problems from day to day. We do not go around complaining about high blood pressure or about high cholesterol because they hurt, but we have them treated because we fear the long-term consequences. It is difficult to insist on compliance in those circumstances, and we know from studies that it can be poor.
I suspect that if we do not give people a treatment with which they can cope in this field, they will not take it. That is why it is important that, as the national osteoporosis society is right to insist, we give people a range of treatment options. If one option does not agree with them, there is a possibility that they can have another.

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It is also probably true to say that affordability has not been adequately assessed by NICE in connection with selective oestrogen receptive modulators. We know that raloxifene protects against breast cancer, but there is a bit of a paradox here, because HRT was associated at the tail end of last year with stories about a possible risk of breast cancer. Here we have a treatment for the same condition that appears to protect against it. We do not see any evidence in the recent NICE information about the protective effect in respect of breast cancer. If we are going to make a serious economic appraisal, we need to factor in such possibilities. Apparently, there is a protective effect on the heart, but we see no evidence of that. It is probably true to say that we need to have a bit of a rethink. To that extent, I welcome the recent announcement by NICE that it is going to look at the issue again.
NICE seems to be relying on the lack of evidence for a reduction in the incidence of hip fracture in respect of raloxifene in making its conclusions about whether the treatment can be recommended. That is a pity, because such an approach underplays the importance of fragility fractures in the spine. The inference is that there is no evidence that the treatment can be used effectively to prevent hip fractures, which are, by implication, more important than vertebral fractures. I am not sure that that is right. Surely, we cannot be saying that we cannot recommend that treatment purely on the basis that there is no evidence that it will be any good for treating one particular subset of the range of conditions that can be provoked by osteoporosis. That is a non-sequitur.
Equally, we must recognise that there are some good things about the NICE appraisal; it would be remarkable if there were not. A consensus is emerging, and the Royal College of Physicians and the society certainly appear to believe that there is no reason to go for population screening, attractive though such options often are. A more selective approach is required, involving so-called case finding.
We need to make provision for the possibility that there may be technology in future enabling us to embark on screening the population, possibly using ultrasound scanning or indeed bone-turnover markers. I agree with the hon. Member for Romsey (Sandra Gidley) in her assessment of the need for further research in this area. As an aside, I shall comment on her suggestion that the condition has not been given the attention that it deserves because it predominantly affects females. It crossed my mind that if one were to compare the incidence of research on breast cancer and prostate cancer and the money spent on such research, a parallel could be drawn. The situation may not be as straightforward as she suggests.
It will be interesting to see in August what I hope will be NICE's formal recognition of the importance of a fall-prevention strategy. One or two hon. Members have touched upon that subject. Again, I think that we shall see a consensus among NICE, the Royal College of Physicians and the society on the need to prevent falls. The issue is not only about dishing out pills for the condition; at the end of the day, it is okay to have osteoporosis provided that one does not have fractures. One prevents fractures by not falling—or by not coming into contact with immovable objects. We may want to
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think about how to reduce that risk, particularly among the at-risk elderly population. I look forward to seeing the guidelines, which I understand will be published in August.
Exercise will help it certainly increases bone-mineral density. A little more controversial is the question whether it prevents fractures. We could say that more exercise means a greater possibility of falling and a greater chance of fractures, but the matter may not be as straightforward as it seems. Equally, tobacco and alcohol increase the risk of osteoporosis. That is a particular concern for women, because we know that they drink and smoke more than previously; their habits have come to approximate those traditionally associated with men. We may be storing up problems for the future.
In our public health strategy—I know that the Government are keen on it—we should focus on the reduction of osteoporosis not only in the elderly, but in the younger population, by ensuring that attitudes to exercise, alcohol and smoking are changed at an early stage. We can then ensure that bone structure is enhanced at that formative stage and that attitudes are developed that will promote long-term skeletal health.
Osteoporosis has, been ignored over the years for several reasons. One is its lack of ownership by a medical specialty. In my earlier experience as a junior orthopaedic surgeon, it seemed that no one was particularly worried about osteoporosis as a medical condition. It seemed to fall between specialties. In my day, surgeons were by and large concerned with fixing people's fractures. I suspect that a residue of that attitude remains, arid that osteoporosis has suffered as a result. Its treatment is multi-disciplinary. It is a pity that people who suffer from fragility fractures do not get the gold standard treatment of physiotherapy, hydrotherapy, pain management and so on that they really ought to receive. I genuinely feel that that is a reflection of the fact that no specialty has gripped the illness or taken ownership of it.
It is a sad fact that the UK ranks behind almost all European countries in its provision of dual-energy X-ray absorptiometry. That is a great pity, because we know that existing treatment is best targeted at those who are at high risk. That is a reflection of their bone-mineral density, and the only way to assess it accurately is by DXA scanning. We also know that poor intra-centre comparison of the results of DXA scans is a problem for screening. One of the reasons why we could not screen the population, even if it were possible to do so, is that it would be difficult to compare the results from one centre with those from others. We clearly need to work on that. It would be interesting to hear from the Minister whether any of the £3 million that his right hon. Friend the Secretary of State announced last week for radiology will be devoted to that area.
Self-help has been somewhat neglected. Many constituents feel strongly about the use of food additives for treating chronic conditions such as osteoporosis. I could cite others. In that connection, the European food supplements directive has caused a great deal of distress to many people, as it appears that many of the remedies that they think help their condition will be harmonised out. That leads to a conflict: as a science-based person, I believe that evidence must sustain any backing of a treatment, but if I were honest, I would say that that was

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an arrogant view. Many people insist that additives and supplements make them feel better, and that really is the bottom line. It is not for any of us to say otherwise if people believe that what they buy in the shops helps them. Many of the products in question have been used perfectly safely in this country for many years, and people feel that the EU is doing them down by removing them. I am pleased that the Alliance for Natural Health has taken a case to the European Court of Justice in connection with the European food supplements directive, and I await the outcome with interest.
The Minister would be somewhat disappointed if I did not take this opportunity to point out that the Government's obsession with targets, predominantly for acute conditions, has, in our finite system, inevitably impacted adversely on long-term and chronic conditions. We can more or less take that as read. I am pleased that he and his colleagues have decided at this rather late stage to change tack somewhat. I welcome the implications that that may have for the management of chronic conditions.
Twenty years on from my own rather unsatisfactory experience of dealing with osteoporosis in hospital orthopaedics, I ask myself whether things have improved much. I have to admit that they probably have done so, but not really as much as I would have hoped them to do in two decades. I look forward to the NICE reappraisal of its draft proposals and hope that they will at least be a step in the right direction.
3.17 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I begin by thanking the hon. Member for Twickenham (Dr. Cable) for initiating this debate on this important issue, which is of great concern to many of our constituents and which affects many people in Britain today. I share his concern and that of other hon. Members about reducing the suffering of those who have osteoporosis and about putting in place prevention strategies.
As has been said, osteoporosis an important subject. Why? One in three women and one in 12 men over the age of 50 will develop the disease. Almost half of all women experience an osteoporotic fracture by the time they reach 70. Some 90 per cent of osteoporotic hip fractures result from a simple fall from standing height or less. After an osteoporotic hip fracture, some 50 per cent. of patients lose the ability to live independently, and 20 per cent. die within a year. As those figures suggest, the disease is a terrible burden to individuals, their family and friends, the national health service and their community. That is why the Department of Health, the NHS and others have put in place a programme of work to help minimise the harm done by the disease.
The Department of Health and the Welsh Assembly have asked the National Institute for Clinical Excellence to develop two clinical guidelines and a technology appraisal to provide the best available evidence covering falls, fractures and drug treatments, and to assess that evidence. It is probably appropriate that I stress that at this point.
The response to some of the comments that have been made during the debate—I highlight the difficult case outlined by my hon. Friend the Member for Plymouth,
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Sutton (Linda Gilroy) and cases mentioned by other hon. Members—is that the issues are complex. If they were easy, if some fact were crying out "You do this, and people will get better", it would not be necessary to have bodies such as NICE, because doctors themselves would be able to make such assessments. NICE must look at the available evidence, balance the complexities and give us guidance about the most appropriate treatment for the most appropriate people.
I caution hon. Members that, when they are communicating with their constituents on these matters, what will obviously be right for one constituent will not be right for every other constituent who presents at a doctor. NICE must ensure that the information is available to allow doctors to make those difficult decisions.
The hon. Member for Twickenham referred to NICE blight. It is true that while NICE is considering these complex issues, there is a period of what may appear to some to be limbo. During that time, and even when the NICE guidance is published, it is up to doctors to make their own judgment for the care of the individual patient. Therefore, nobody should delay making recommendations—
Sandra Gidley rose—
Dr. Ladyman: I shall not give way to the hon. Lady. I have only nine minutes and hon. Members have asked me a lot of questions. I want to deal with as many of them as possible.
The perception of NICE blight should be rejected. People should press their clinicians to make their own judgments in the absence of firmer NICE guidance.
The clinical guideline on the assessment and prevention of falls in older people is currently out for consultation. Falls are a major cause of disability and the leading cause of mortality resulting from injury in people aged over 75 in the UK. One third to one half of those aged over 65 fall each year. Up to 14,000 people die annually in the UK as a result of an osteoporotic hip fracture. Falling, therefore, has a considerable impact on quality of life, health and health care costs. Although osteoporosis does not cause falls, it significantly increases the likelihood of a fracture when a fall occurs. The falls guideline will provide recommendations for good practice based on the best available evidence of clinical and cost-effectiveness and is due to be completed in August.
A second clinical guideline has been commissioned to assess fracture risk and consider the prevention of osteoporotic fractures in individuals at high risk. Osteoporotic fractures can lead to pain, disability, greatly reduced quality of life and premature death. The guideline will look at all high-risk groups and will examine interventions used to prevent an initial fracture and those used to prevent subsequent fractures where one has already occurred. The guideline is due in June 2005.
NICE is also conducting a technology appraisal of the drugs used in the prevention and treatment of osteoporosis. The initial findings have recently been out to consultation and, as several hon. Members have said, have elicited a large response and considerable controversy. However, I want to assure hon. Members

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that this consultation document does not constitute the institute's formal guidance. Recommendations of this type are preliminary and may change after consultation. It would have been nice if one or two hon. Members in the Chamber had given NICE a pat on the back for listening to the consultation and for announcing that it intends to amend its work as a result.
The institute has accepted the independent appraisal committee's recommendation to separate the appraisal into two parts. The first will address the treatment of existing osteoporotic fractures in post-menopausal women—so-called secondary prevention. Further analytical work will be done on that before the appraisal progresses to the next stage, as several hon. Members requested. A new timetable for the work will be published shortly.
The second part of the appraisal will address the prevention of fractures in post-menopausal women who have not yet had a fracture—primary prevention. To inform recommendations on the clinical and cost-effectiveness of treatments for primary prevention, more data are needed that will assess the contribution of risk factors in the development of fractures. The data will be informed by work being done by the World Health Organisation and the NICE guideline development group on osteoporosis. The data are expected towards the end of the year and the institute will publish a separate timetable for that part of the appraisal.
I should like to thank all who have responded to the consultation, including the National Osteoporosis Society. Those individuals and groups have highlighted the need for additional information and analysis, which is being built into NICE's work. I regard that as a good example of what consultation is about. NICE has listened to the views that other experts and members of the public have expressed and has adapted its work to take account of their concerns. That shows that the process of consultation is working. The National Osteoporosis Society has welcomed that development.
The hon. Member for Romsey (Sandra Gidley) asked several questions about research that might have been identified as necessary during the process. The Department of Health funds the NHS research and development programme, which aims to identify NHS needs for research and to commission research to meet those needs. Commissioning is undertaken through national programmes of research, such as the health technology assessment programme, through which three projects have been funded, two of which have now ended. The topics include treatment of osteoporosis—a systematic review and cost-utility analysis—and selective oestrogen receptor modulators for osteoporosis. Research on the cost-effectiveness of different strategies for the management of steroid-induced osteoporosis is due for completion in the middle of this year.
The main Government agency is of course the Medical Research Council. In the financial year 2001–02, the MRC spent an estimated £6.9 million on
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research into osteoporosis, which included a randomised trial of vitamin D and calcium for secondary prevention of osteoporosis-related fractures in the elderly. It was therefore a little churlish of the hon. Member for Romsey to say what she did. [Interruption.]I do not know why the hon. Lady is looking aghast—she suggested herself that she was perhaps being churlish when she implied that there were restrictions on research in such fields. It is important to remember that we are not the only country in the world conducting such research. Research is conducted all around the world, as well as in the UK, but the work done here is extensive. The MRC welcomes good quality research proposals at any time, so I encourage anyone who has such ideas to put them to the council.
Falls services, incorporating those for osteoporosis, are covered in the national service framework for older people. I am grateful to the hon. Member for Twickenham, who said some nice things about the framework. It is important to recognise that the framework has been well received and is doing some good work. However, I should point out to the hon. Gentleman that the framework is a 10-year programme and that we are only three years into it. He asked what I was going to do to put energy into the programme. The answer is that, as the implementation of the national service framework for older people falls within my portfolio, I welcome any suggestions that he has for sustaining the rapid pace of reform. However, given the time since the rational service framework was published, it is making stupendous progress. I do not say for one second that I here are not huge areas in the health service or our social services that we cannot improve. Demonstrably, much work remains to be done in many areas; however, the national service framework is making huge inroads in those areas. The people who are involved in it and who drive it forward should be congratulated on their work.
The NSF sets clear milestones for the planning and development of integrated falls services and provides the basis for a service model that will deliver the improvements in prevention, care, treatment and rehabilitation that many hon. Members have mentioned. The framework aims to reduce the number of falls that result in serious injury and to ensure effective treatment and rehabilitation for those who have fallen. The Department is undertaking detailed work in conjunction with professional and voluntary bodies to support time delivery of the NSF's integrated fall service. For example, we have worked with Help the Aged on its "Avoiding Slips, Trips and Broken Hips" campaign. I cannot promise that we shall announce a national gripper slipper campaign—
Mr. Deputy Speaker (Mr. John McWilliam): Order. Time is up. I should point out that the Minister had only 13 minutes in which to reply. Even after only an hour and a half of debate, a Minister should have the opportunity to reply effectively to the hon. Member who introduced the subject. The Minister was so constrained in this case because Opposition Front Benchers took 37 minutes.

Out-of-Hours Medical Services (Hampshire)
3.30 pm
Sandra Gidley: I welcome the opportunity to highlight the important issue of out-of hours medical services in my locality, and I shall begin by setting the scene.
As MPs, we all receive complaints from time to time, and that is par for the course, because life simply ain't perfect. However, alarm bells ring when we suddenly receive a cluster of complaints about a service that has hitherto ticked over in the background without coming to our attention. Alarm bells certainly rang when I received complaints about the out-of-hours medical services, and it rapidly became clear that all was not right.
Most of the letters highlighted the service—or lack of it—that patients received when they, tried to obtain the services of a doctor at the weekend and in the evening. As the Minister will be aware, GPs are currently responsible for providing out-of-hours emergency cover, but many, particularly in my area, have opted out of the scheme and paid a deputising service to take over. In my part of Hampshire, that service is provided by an organisation called Primecare.
It might be helpful if I outline some of the problems. First, patients must play a game of telephone hurdles, and the typical scenario is as follows. The patient rings NHS Direct for advice and is told to ring their GP. When they do so, an answerphone service asks them to contact the out-of-hours service—probably Primecare. The patient rings the number, which is for a call centre in Birmingham, and encounters someone called a call taker, who asks them a few questions and refers them to a triage nurse. The nurse then rings back. Indeed, there is a standard governing such things. I do not think that it is being met, and although that is not the main complaint, what if the patient calls from a call box? Not everyone has a phone at home, so ringing patients back is not without its problems. That aside, the patient is then given an indication of how long—be it one hour, two hours or four hours—they might have to wait for a home visit. Some hours later, the doctor might contact them again to see whether they still need a home visit and to ask further questions.
There are, therefore, several phone calls, not all of which would be necessary in a joined-up service. It is immediately apparent that that is not a good use of resources, but I shall return to that later when I discuss how the system is likely to change in July, when primary care trusts take over responsibility for providing out-of-hours services.
In many cases, patients are asked to attend an out-of-hours centre. One constituent was asked to travel from Longparish to Southampton—a journey of approximately three quarters of an hour—and that person told me of a young relative who had had a similar experience. In that case, family members were so concerned that granddad decided to take the child to the minor injuries department in Andover. When they said which surgery they were from, they were told that the child would be unable to see a doctor, because staff were fed up with seeing patients from that surgery.
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The practice manager has said that anyone who is concerned about the length of time that Primecare takes to respond should attend accident and emergency and call an ambulance if they are not fit enough to travel by car. Indeed, it is quite a common feature of the correspondence for people to be told, "If you are concerned, call an ambulance." Sometimes, Primecare staff deliver that advice. In that respect, the Minister might not be aware of an Adjournment debate that I secured on the response times of the Hampshire ambulance service. The service is now heading in the right direction and is just starting to hit its targets, so it can do without unnecessary pressures from another part of the health service. It is easy to see that an extra burden will be placed on the system if people are regularly advised to call an ambulance. If patients are being made to wait for too long, they will be tempted to call an ambulance. I have spoken to paramedics who have also mentioned occasions when deputising services have asked paramedics to visit and assess on their behalf, and occasions when inappropriate requests for an ambulance have been made, some when the medic has not even seen the patient face to face.
I am also aware of an occasion when a call from a GP was rerouted to a deputising service. That service did not have the GP on its list and so refused to provide a response. What other option does a sick person have under those circumstances than to call for an ambulance? This clearly has a knock-on effect on patient emergency care, and I ask the Minister to investigate this for himself.
There are others who are reluctant to call out an ambulance under any circumstances. Another of my constituents had a stomach ache, went to the NHS Direct website and was quite alarmed to be given the advice that he should ring 999 for an ambulance. He thought, "I only have a stomach ache. It seems a hit extreme. I will just call the doctor. I do not want to call out an ambulance unnecessarily." He contacted Primecare. The triage occurred, but the patient, despite having gone through the NHS Direct protocol and come up with a 999 response, was advised to go to a walk-in surgery, as there might be a long wait to see a doctor. My constituent lived alone, some distance from the surgery, and there was no one he felt able to ask for a lift. He decided to wait. He had originally rung the out-of-hours service at 2.30 in the afternoon and received a telephone call at 8 pm advising him that he would probably have to wait a further three hours. At half past 11, some nine hours after the initial call, a doctor arrived and immediately called an ambulance.
I could easily spend the remaining time outlining further stories, but I will leave it at that, apart from reinforcing the point that most of the complaints have been about the protracted nature of the process, the pressure to travel to an out-of-hours centre when unwell, and the length of time it has taken to secure a home visit and for a health professional to arrive. I have met representatives from Primecare and there is some focus on trying to improve the service being provided, but it is still not good enough. There was a Radio Solent phone-in this morning and the lines were red hot with people ringing in from all over the area with similar experiences.
What is of more concern to me at the moment is that the new GP contract means that the primary care trust will be taking over responsibility for out-of-hours

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medical services. I am beginning to wonder, having done some research, whether this is an opportunity that is likely to be squandered. I have been told that the four primary care trusts in the area—Southampton City, Eastleigh and Test Valley South, Mid-Hampshire and New Forest—are liaising on the provision of a new service. I wrote to the primary care trusts that serve my constituency in December last year. I also wrote to the ambulance trust.
Most responses try to provide a bland reassurance, but there were some worrying responses tucked away. For example, Chris Evenett, chief executive of Mid-Hampshire PCT, said:
"As part of this development work, being co-ordinated across three PCTs in mid and west Hampshire, we are assessing demand. It is fair to say that there has not been a robust activity monitoring of out of hours provision in the past and therefore we have to develop estimates based on best available information."
John Richards of Eastleigh and Test Valley South PCT seemed to have slightly more information about what was going on in his particular primary care trust. He told me that there were approximately 14,000 calls each year to the out-of-hours service, 40 per cent. of which required some sort of face-to-face consultation. He went on to describe how he thought the service might develop. He said:
"The plan is comprehensive and includes call centre facilities, communications hub, primary care centres, transport and visiting … Initially the service will be GP-led but, over time, we hope to increase the involvement of nurses, paramedics and others to ensure that patients are seen by the most appropriate health care professional."
Sounds okay.
The response from Brian Skinner of Southampton City PCT was quite interesting, because he stated:
"As a primary care trust we have seen an increase in the visit rate from 15% of our total out of hours activity to 25%in the last two years. It is too early to say at this stage whether the effects of the changes we are currently making to the service are reducing the demand for visits. It should be noted that an out of hours GP can carry out the equivalent of 1.5 visits per hour as opposed to a GP or nurse in a primary care centre who can see seven patients per hour."
He went on to mention that there had been a number of new initiatives, such as walk-in centres and NHS Direct, which had to be monitored to assess the impact on the demand for services.
The letter of 19 January from Claire Severgnini, the chief executive of Hampshire Ambulance Service NHS trust, was of the greatest concern. She says:
"The ambulance service has seen an increase in demand as a consequence of the changes and particularly to poor systems Primecare have in place."
More positively, Claire Severgnini mentioned a new initiative called "see and treat", which is being piloted. She says:
"increasingly we could provide care in the community and minimise the number of patients being brought into already busy A & E Departments."
The obvious question is where we go from here. It might be useful to refer to the Carson standards, which were produced in an attempt to provide a minimum standard of service for out-of-hours care. They are what
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local service providers should be taking into account when developing new services, and to which they should aspire.
In March 2000, Dr. David Carson produced a report, which states:
"the purpose of out-of hours services in primary care …to meet those urgent patient needs that cannot safely be deferred until the patients own GP practice is next open."
It also recommended that
"All patients should have access to the same high quality, out of hours services, regardless of the part of the country in which they live."
I am not sure that that is happening.
Recommendation 1 states:
"A new model of integrated out of hours provision should be accessed by patients via a single telephone call, routed in the first place through NHS Direct, passed where necessary to the appropriate providers of out of hours services in that locality."
I have already described the problems. The verdict is that that has failed.
Recommendation 3 states:
"Sufficient primary care centres should be provided to enable out of hours providers to meet the Quality Standards set out in the review."
Current provision is very patchy, which may explain the difference in the figures for Test Valley and for Southampton, which has better provision. People do not want to travel a great distance when they are ill, which is overlooked. My constituents in particular will miss out, because, I believe, none of the planned centres will be based in my constituency.
More worryingly, I have been told that there are differences of opinion between the four PCTs, even though they are supposed to be liaising with each other to provide a service. Eastleigh, Test Valley South and Mid-Hampshire PCTs want to direct as many people as possible to the Winchester and Southampton PCTs. However, Southampton City PCT, where the Southampton hospital is based, does not want the service to be based in the hospital, but prefers to direct people to the two walk-in centres. New Forest PCT wants to use separate locations.
What hope do we have for a decent service by July if the PCTs cannot even agree where they want the service to be based? I strongly believe that consideration should be given to basing t service at Romsey hospital, which was used by GPs when they provided the service. The verdict is "Fail". If a he Minister is inclined to say "Pass", will he say what journey time he believes is reasonable for anyone wanting or having to access these services?
Recommendation 9 states:
"A fully integrated out of hours service should be planned by the PCT/G in each locality, bringing together all appropriate service providers."
There is total lack of co-ordination in the provision of community-based minor injuries management. There are walk-in centres, minor injury units, community care centres and proposed diagnostic and treatment centres, all of which have little or no night provision. I have described the series of telephone hurdles that one encounters before one can access the service.
It would be sensilb1e to co-ordinate more efficiently the expertise of NHS Direct, the out-of-hours providers, the emergency services and the PCTs. The lack of co-

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ordination between PCTs is particularly worrying. I have learnt that some PCTs intend to fill the void with paramedics, while others intend to use community nurses. I do not have a problem with that, but there has been no work force planning exercise, and no thought has been given to consistency of training and standards. Again, the verdict is "Fail".
Recommendation 19 states:
"Other than in exceptional circumstances, patients should he able to receive the medication at the same time and in the same place as the out of hours consultation".
I am not sure that that happens at the moment, as I have received a number of letters stating that, when the local supermarkets that have pharmacies shut, which on a Sunday happens at 4 o'clock, it is almost impossible to obtain medication. The demise of the neighbourhood chemist living above the shop has added to the crisis. My area local pharmaceutical committee has developed a community pharmacy on-call scheme, which works with NHS Direct. That is clearly to be welcomed, but it does not meet the provision in recommendation 19 of the Carson standards. Verdict: "Fail".
Recommendation 22 states:
"The fully integrated model of out of hours provision set out in the Review should be achieved by all GPs and out of hours providers by 2004".
I will concede that when the recommendations were made, the change in the GP contract was probably but a twinkle in a Minister's eye. Even when allowances for that are made, I can only despair at how things seem to be shaping up. There is an inadequate grip on what is needed. Nobody seems to know who will be able to travel and who will require a home visit, and there seems to be too little forward planning about training the necessary staff. The guidance of the strategic health authority seems to be absent.
We have a golden opportunity to provide a service with well-staffed local centres, augmented by a mobile fleet of health professionals including nurses and paramedics. Access to the service would be by a single phone call. The service provider should be able to coordinate that with NHS Direct and the ambulance service. Future changes should be communicated to all residents so that they are aware of what the most appropriate course of action is and what they can realistically expect if they are ill in the evenings or at weekends.
I finish by returning to Primecare, where I started. It admits that it experienced a large number of problems when it moved its call-handling service from the Southampton area to the centralised area in Birmingham. That experience should not be allowed to repeat itself. We must learn from the mistakes of the past. Any new systems will have teething problems. In cases dealing with sick people who need an emergency response, we must make sure that the teething problems are not serious and do not cause worse illness, or even death.
3.47 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. I know that it will be of great importance to her constituents. I also congratulate the staff of the national
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health service across the whole of Hampshire on their work. I thank them for their efforts to deliver high-quality services. I know that they are dedicated to producing good services for everyone and they deserve our admiration. No doubt they will take the hon. Lady's concerns on board and have a constructive approach in doing what they can to address them.
All hon. Members rightly attach great importance to developments in the national health service in their constituencies and in the ability of local people to access high-quality health services as and when they need them. The need for access is particularly important in the evening and at the weekend, when many people feel isolated from convenient local health services. That is why, in March 2000, the Department of Health commissioned an independent review of GP out-of-hours services. The report that followed, "Raising Standards for Patients: New Partnerships in Out-of-Hours Care", also known as the Carson report, resulted in the Government endorsing the view that a new, modern and integrated out-of-hours service was a crucial component in delivering safe and reliable health care. That new model of service is set to ensure that a high-quality out-of-hours service is available to everyone, irrespective of where they live and who provides it.
We have put in place new quality standards and are working towards close integration between NHS Direct and GP out-of-hours services. By 2004, a single phone call to NHS Direct will be a one-stop gateway to out-of-hours health care. Calls will be passed on, if necessary, to the appropriate GP co-operative or deputising service. I was pleased to hear that NHS Direct gave the correct advice to the hon. Lady's constituent immediately. I would encourage all constituents to act on, and not second-guess, the advice that it gives because it is starting to produce advice to a very high standard.
GPs have a statutory responsibility to provide out-of-hours care before 8 am and after 6.30 pm and at weekends and bank holidays. The majority of GPs, as is the case in the hon. Lady's constituency, delegate that responsibility either to a GP co-operative or to a commercial service, so patients do not usually see their own GP for an out-of-hours consultation.
From April 2004, subject to PCT approval, GPs can choose to hand over responsibility for out-of-hours care of their patients to their local PCT. PCTs will have a legal responsibility to ensure that patients are well cared for out of hours and continue to be offered safe, fast and convenient care, delivered to nationally set quality standards. Strategic health authorities will performance-manage PCTs in the transition period. We are in discussions with SHAs to ensure the robustness and sustainability of PCT plans. I will ensure that the SHA serving the hon. Lady's constituency is sent a copy of Hansard so that its staff can read her comments. However, as her speech raised many matters for her local SHA and PCT, I encourage her to engage with them and make known her concerns so that they can act on them.
The opt-out was a key factor in our being able to win support for the contract among doctors. It enables GPs to opt out to improve their working lives and it will have a positive impact on GP recruitment and retention and increase capacity in primary care, which will be

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important to our constituents. It will also provide PCTs with a greater opportunity to commission an integrated service that brings together out-of-hours services with emergency care, NHS Direct and ambulance services, and covers the whole range of unscheduled care. The hon. Lady is right to identify it as an opportunity to get out-of-hours services right in her constituency.
The vast majority of practices in the hon. Lady's constituency have said that they intend to opt out of their responsibility for their patients' care out of hours, opting instead for transferring that to the PCT. It will contract a commercial provider that is able to offer a single point of access and a thoroughly integrated service to ensure that care is offered to the patient on a case-by-case basis by the most appropriate health care professional.
Sandra Gidley: I understand that the planned service will not provide a single point of access using NHS Direct. If people ring NHS Direct they will be referred directly, which is a step in the right direction, but they will not be encouraged to ring it in the first instance. I do not know whether that is a capacity problem or whether sufficient thought has not been given to it.
Dr. Ladyman: I cannot tell the hon. Lady exactly why she has been given that information. I can only tell her that it is our ultimate intention to make the NHS a one-stop shop. In planning the out-of-hours service with the commercial provider, the PCT must ensure that it is working to achieve those objectives. Perhaps there are local reasons why the PCT does not think that appropriate in her constituency, and it must meet her, as constituency MP, to discuss that further. This is a matter for local planning and consultation.
In many places, elements of the out-of-hours services are already configured in the way that I described, with existing out-of-hours providers typically covering areas encompassing more than one PCT. In those circumstances, it is easy to understand why co-operation and co-ordination among PCTs is essential and why certain economies of scale have led to the development of a cost-effective and more comprehensive and integrated service.
PCTs should build on the strengths of existing providers and work closely with them and other PCTs to plan their out-of-hours provision. SHAs will support them in that process. The aim is to introduce out-of-hours services that provide care that meets the quality standards and provides a basis for integrated networks of unscheduled care, including out-of-hours care. The PCTs, supported by SHAs, should develop commissioning solutions that fit local circumstances and meet the priorities.
We now have 34 exemplar sites that test current models of integration and partnership working. They provide single-call access to out-of-hours primary care services through NHS Direct and cover 10 million people. If the hon. Lady has been told that that is not an option in her area, she should take the matter up with her PCT and suggest that it obtain guidance from the exemplar sites to determine what might be achieved.
Additional resources of £110 million over three years from 2003–04 have been announced to help fund the PCT with the provision of out-of-hours services. A
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further £28 million was announced in November last year, to be focused on those PCTs facing the biggest challenge in developing their out-of-hours services.
PCTs in Hampshire have been working collaboratively with stakeholders, including the local medical committees, to develop out-of-hours services and to ensure that patients continue to gain access to health services whenever and wherever required. I understand that four PCTs in west Hampshire, a cluster that covers the hon. Lady's constituency, have joined together to develop effective out-of-hours arrangements for their population. I also understand that that project is being co-ordinated by a steering group with clinical representation from the four organisations, together with further representation from the local medical committee and NHS Direct. If she thinks that that group has not consulted her on the matter in some way, she may wish to contact her PCT and insist on a discussion with it.
From July 2004, the four PCTs in west Hampshire will contract with Primecare for out-of-hours services for one year. That will involve the provision of call handling and triage for local providers. In addition, locally trained staff will assist with priority calls, triaging calls from a central position in Hampshire. Decisions will be taken laterally about how out-of-hours services are provided, depending on the development of local services. I am confident that that will build on the current out-of-hours service for the residents of Hampshire.
I am aware that there have been some challenges and problems associate d with the out-of-hours service provided for the west Hampshire population by Primecare. The hon. Lady expressed those concerns eloquently. The concerns and challenges have, in the main, related to the quality of the call-handling service and the delays encountered by patients attended by on-call doctors. The majority of those complaints relate not to clinical performance but to delays in response times.
PCTs must ensure that the out-of-hours services that they commission or provide meet the national quality standards set out in regulations, to which all significant professional bodies are signed up. All organised out-of-hours providers must meet those standards in the transitional period between 1 April and 31 December and all providers will have to meet the revised quality standards, which are under review by an expert group.
It is important that the momentum for improvement is not lost. I understand, for example, that the PCTs are in continuous dialogue with Primecare to explore concerns and to identify opportunities for improvement, which to date include improving Primecare call handlers' local knowledge, enabling them to manage calls quickly and safely, and establishing a group dedicated to the assessment of performance and to ensuring service quality for out-of-hours services.
I understand that work is also under way to integrate primary care out-of-hours services with out-of-hours arrangements in mental health services, social services and transportation I am assured that the Hampshire and Isle of Wight strategic health authority is taking a strong role to ensure that out-of-hours services are developed and delivered appropriately for their area. As well as having a performance role, I understand that the SHA is securing the support of national advisers as well

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as facilitating joint work across the county on issues such as the work force, education and training. There is significant evidence to suggest that the Hampshire and Isle of Wight health system has identified the matter as their priority for development. I understand that the health community has invested an additional £3 million.
Mr. Deputy Speaker (Mr. Frank Cook): In anticipation of the Division, that is about to be called, and to avoid unnecessary disruption of the opening comments of the next speaker, I suspend the sitting for 15 minutes.
4 pm
Sitting suspended for a Division in the House.

Call Centres (Offshoring)
4.18 pm
Mr. Bob Laxton: I am pleased to have been granted this debate because it gives me the opportunity to raise the concerns of a sizeable number of my constituents and those in surrounding constituencies who will either lose their jobs or find that their jobs are at risk because of decisions by a number of companies—two in my constituency—that have decided to offshore some of their call centre work to India.
To set the scene, around 6.000 call centres operate in the United Kingdom, some small and some sizeable. They employ around 500,000 people, which is equivalent to about 1.7 per cent. of the total work force. Call centre work has developed and a number of years ago, when we had high unemployment, that work was often directed into areas where traditional manufacturing work had disappeared. Call centres have been a mainstay of some of those areas ever since.
A research study by Mintel showed that competition from low-wage rival call centre companies in India could mean the closure of perhaps one third of all call centres by 2005. That would equate to about 90,000 jobs. Other pundits have said that hundreds of thousands of jobs could go as call centre work is offshored, not just to India but to other parts of the globe as well. However, I do not believe that that will be the case.
There has been a lot of debate in the media about protectionism—about how the Government can engage with this process and stop it from happening. In reality, they cannot, and should not, be in the business of passing legislation designed to protect call centre work in this country. I am not about to argue that protectionism should be introduced in any way, shape or form. There are benefits in some of the work going to India or wherever. As the economy develops in countries such as India, there will be a ramping up of trade and we will see other benefits as a result. Protectionism should not feature in the debate.
For some, the argument might, from a simple point of view, involve protectionism. However, it is not a case of protectionism versus free trade but of quality of service versus as yet unproven levels of savings from offshoring call centre work. Even the national Call Centre Association admits that there is evidence that organisations that have taken the offshoring route because they thought it would be an effective way of making savings and improving quality of service have failed to realise those benefits.
There have been two announcements in my constituency. Some 170 jobs will go from the Abbey bank call centre based in the city centre by the end of the year. I contributed to a debate on BBC Radio Derby and listened to what people who rang in before and after the debate said. What was interesting was that almost to a man and a woman, all of them said, "We are not happy about Abbey bank doing this. We have been with the Abbey bank and its predecessor, the Abbey National building society, for many years. but if UK jobs are being lost through the work being offshored"—although not necessarily to India—"we'll remove our accounts and place them elsewhere." Companies need to take serious note of that.

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The other jobs that will be affected are those in the National Rail Enquiries service. It is a complex process operated by the Association of Train Operating Companies. The private rail companies that operate the National Rail Enquiries service contract the work out to BT, which sub-contracts it to a company called ClientLogic. A decision has been taken to offshore 50 per cent. of the National Rail Enquiries service. That work will be going out to India later this year. As a direct result, nearly 400 jobs will go from the ClientLogic call centre in Derby. Very regrettably, that poses some threat to the whole ClientLogic call centre operation in Derby, which employs about 700 people.
The Call Centre Association has raised issues relating to quality of service. Unlike Abbey bank, where individuals can say that they are not happy with the company's policy and move their accounts elsewhere, the National Rail Enquiries service is a national, single point of service and there is no alternative for customers. We are, therefore, left with that service. If it deteriorates, the customers ringing it will not be interested in whether it is the fault of the Association of Train Operating Companies or the National Rail Enquiries service, BT or whatever. The buck will stop at the Government's door. I have had some discussions with the Secretary of State for Transport on my concerns about that.
Mr. David Clelland: Is my hon. Friend aware that Lloyds TSB is proposing to close a call centre in my constituency with a loss of 1,000 jobs barely two years after the call centre was opened with a fanfare of trumpets and a promise from the chairman that they would be long-term sustainable jobs? Does he think that Lloyds TSB should have some loyalty to this country and its employees? If it and other companies are not going to be loyal to this country, that will fall at the Government's door, as he said. It is not good enough for Ministers to say that this is a global economy. With thousands of jobs under threat and others haemorrhaging from this country as a result of offshoring, surely the Government have to do something.
Mr. Laxton: Both my hon. Friend and I will listen with great interest to the Minister's comments. I am aware of the decision taken by Lloyds TSB. It must take account of the impact that that will have on its customer base if customers are not happy with the work going to China, India or wherever. If they are not happy that it is being offshored, they have the opportunity to move their accounts elsewhere, which would he to the overall detriment of Lloyds TSB. My point about National Rail Enquiries is that as customers we have no alternative as to where we place our business if we are unhappy with its decision to offshore its work.
In some of the discussions bandied around and some of the Select Committee meetings that I have sat in on, I have learned that the National Rail Enquiries service expects to save around £25 million in the cost of its operation as a result of offshoring. There are, however, concerns about the quality of service. Some interesting research has been undertaken. One of the studies by an industry analyst, ContactBabel, published in January this year, found that the service provided by offshore
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Indian call centres was not all that it was made out to be, but I am sure that there are good and bad call centres in India, as, of course, there are in the UK.
The general analysis was that calls were answered more quickly because the staffing levels were higher than they would be in the UK, but from a customer's point of view problems are answered, dealt with, expedited and resolved much more quickly and simply in the UK, which is something that businesses must take into account. Cost savings can be made by offshoring, but in my view they will he outweighed by frustrated and angry customers if they do not receive the quality of service that they expect.
Research carried out by Phil Taylor at the university of Stirling and Peter Bain at the university of Strathclyde also found communication difficulties. That might be a problem in the UK. I would have difficulty understanding some of the regional dialects of people in the part of the country represented by my hon. Friend the Member for Tyne Bridge (Mr. Clelland). However, customers and companies need to take those issues into account rather than just looking at the bottom line and saying, "We can make lots of savings—let's go for it."
We have carried out research on other call centres in my constituency. Egg, which is the banking arm of the Prudential, is committed to keeping its work in the UK and in Derby. It uses few external consultants and does pretty much all of its work in-house. Companies such as Alliance and Leicester, Northern Rock and mmO2 said that the cost-savings from offshoring would be modest and outweighed by the loss of control over their operations. They also thought that offshoring would mean losing their most vital form of communication with their customers, which they believe to be a good way of generating business.
Nationwide has also pledged not to move work offshore and is opening a new centre in Swansea. Some 20 per cent. of its business comes from UK call centres. It has stated that it is staying put because it values having roots in the community. It has also said that there has been an overwhelming customer response to its announcement that it will stay in the UK. I am sure that the Minister will pick up on my point, which I repeat ad nauseum, that this is not just about companies saying, "We can make huge savings by offshoring"; they need to consider the other side of the equation as well.
There is a wider impact. The UK service sector makes up about 70 per cent. of gross domestic product, and many call centres are concentrated in areas where there used to be manufacturing jobs, including both my constituency and that of my hon. Friend the Member for Tyne Bridge. Of course, offshoring does not only involve call centres. We might be seeing the start of many jobs being moved offshore, including those that require workers of low or medium skill, or perhaps even those who are highly, skilled. What impact would that have on the service sector and our GDP?
I reiterate that the issue is about companies weighing up the economics of moving work offshore. They must consider the costs, benefits and the supposed gain from lower-cost services. It is also about weighing up the politics. I cited as an example the possible deterioration of National Rail Enquiries. That would be a political issue because the buck would stop with the Government, not with the companies involved. The

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problem is companies thinking in the short term, by putting immediate and unproven cost-cutting and profitability above quality of service.
The Government need to help UK companies to innovate and invest so that there s employment and growth in the service sector. There is already some growth in that sector and new call centres are coming online. We hope that that will continue. From a fiscal point of view, the Government should consider the situation with regard to VAT. The way in which it is currently imposed encourages firms to offshore because they do not then pay it on certain elements of their business activities. The Treasury should consider the fact that that acts as a financial incentive for companies to offshore. It has closed a loophole but opened another of which companies may wish to take advantage.
Those are the sorts of issues that the Government should consider. We have nothing to fear from offshoring, but we need to help companies. We need the Government to say to them, "Look it isn't just a simple matter of saving costs. That has to be balanced against the impact that it may make on your company's productivity and the level of business activity within your company." I wait with interest to hear the Minister's response to my comments, in particular about how Government can assist companies in this context.
4.35 pm
The Minister for Energy, E-Commerce and Postal Services (Mr. Stephen Timms): I congratulate my hon. Friend the Member for Derby, North (Mr. Laxton) on securing this debate on an important and topical issue. The House last debated it in Westminster Hall on 10 December 2003, and it seems that hardly a week goes by without an announcement of one kind or another about intentions to offshore, or concerns about the impact on jobs in the UK.
The bulk of the announcements, as my hon. Friend said, have related to call centres. The debate in December followed some high-profile announcements by companies in the financial services sector of intentions to place both call centre and back-office processing work overseas, and in India in particular. The IT sector, as I have seen on a couple of visits, including one just a few weeks ago, is another area where India is very strong; a quarter of the 1 million graduates that it produces each year are qualified in science and IT.
We need to keep the issue in perspective. Outsourcing is not new. Companies have been buying in services, instead of providing them in-house, for years. Most outsourcing by UK companies is still placed with other UK companies. Even offshoring—that is outsourcing abroad—has gone on for a long time. British Airways first offshored some of its business processes to India in the early 1990s.
The advance of new technology, however, and the development of e-commerce, have certainly increased the scope for services offshoring. Communication costs have fallen and speed and efficiency have increased. For example, the cost of a telephone call from India to the UK has fallen by more than 80 per cent. in little more than three years.
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The recent spate of announcements has given the impression of an increasing trend. My hon. Friend made a valid point about this: offshoring will suit some companies, but not all. He mentioned some companies, to which I would add the Royal Bank of Scotland, Alliance and Leicester, and Nationwide, which have all announced their intention not to offshore. Others have tried offshoring and decided to return work to the UK. Littlewoods, for example, recently announced that it would be closing its Indian call centre and returning the operation to the UK.
Offshoring is not, therefore, a one-way street. Not every service, in any case, can be delivered across borders. However, where that is possible, other factors such as customer relationships of the kind that my hon. Friend spoke about can have an impact on the offshoring decision.
We need to remember that this is not a zero-sum game. Last year in the UK we succeeded in attracting 700 inward investment projects into the UK, including 19 from India. India is becoming a major inward investor into the UK. Those 700 inward investment projects generated between them nearly 35,000 new jobs; the figure included 35 new customer contact centres.
Globalisation is a reality that means more opportunities, including opportunities for the UK. We are not, as my hon. Friend said, in a position to stop it, but neither should we want to, because the UK in particular is a large net beneficiary of what is happening. A point on which I agree with my hon. Friend is that the UK call centre sector remains a UK strength. Despite the apparent trend towards offshoring there are still 5,500 call centres in the UK, employing about 400,000 people. The evidence, as my hon. Friend said, is that that figure is continuing to rise.
There is much going on, and still much that we need to know. To deepen our understanding of offshoring and the current drivers, my right hon. Friend the Secretary of State for Trade and Industry announced, in December, three important initiatives. First, we published a consultation document asking for comments and reaction by the end of January. We received 40 replies, which we are now studying. The consultation document was called "Services and Offshoring: the Impact of Increasing International Competition in Services". It is still available on the Europe and world trade section of the DTI website; indeed, we would still be glad to receive further responses to it. Having studied all those replies, the Government will respond to the consultation in the White Paper on trade and investment that, as my right hon. Friend announced recently, will be published in the summer.
Secondly, we commissioned an independent study of the competitiveness of UK call centres. We have appointed a consortium of three firms, including ContactBabel, which is due to report to us in April. Call centres have a huge variety of roles, from direct selling to customer relations management, across nearly all commercial and industrial sectors, as well as the public sector. There are a great many conflicting predictions about current trends in call centre numbers and employment. The study will therefore capture a fuller picture and identify the UK industry's main strengths and weaknesses. I also hope that that analysis will

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inform actions that the industry can take, in partnership with the Government or alone, in response to the increasingly competitive worldwide market for call centre services.
Thirdly, my right hon. Friend hosted a round table early last month at which a number of businesses, trade unions and academics gave their views about offshoring. That round table was held under the Chatham House rules and a report was not published, but there were some important messages of consensus. The first is that companies' decisions on location in the era of global competition must be commercial. If Governments sought to interfere in those decisions, there would be a greater risk of business as a whole being driven offshore, with the loss of even more jobs. It is important, however, to involve the work force in the decision-making process. That is why I warmly welcome the examples of Barclays and HSBC, with which Unifi has reached a consultation agreement. I also welcome the example of BT, which has a similar agreement with Connect and has successfully undertaken offshoring, but by agreement.
Secondly, in reaching decisions on where to locate, companies need, as my hon. Friend rightly emphasised, to consider the business case carefully. There was broad consensus at the seminar that the UK cannot compete on labour costs alone and should not try to do so. Offshoring decisions are driven principally by low labour costs, but, as my hon. Friend rightly said, businesses need to take account of other factors as well, because if standards of customer service decline, they will soon see the impact on their business. Companies understand that, but it is important that they do their homework carefully, as my hon. Friend said.
Where decisions to offshore result in the loss of UK jobs, we must do all that we can to get people back into work as quickly as possible. Jobcentre Plus, our rapid response scheme, can play a key part in that, by intervening when there is a problem. The regional development agencies can help by encouraging new businesses into towns or regions that are affected by offshoring decisions. The learning and skills councils can help people to learn new skills and improve their employment prospects.
Mr. Clelland: What would be the point of Jobcentre Plus, the learning and skills councils or anyone else encouraging people to take up jobs in call centres, for instance, when the evidence shows that there is absolutely no security of employment?
Mr. Timms: I do not think that that is the position. As I have said, the number of people working in call centres in the UK continues to increase. We shall see what the study that we have commissioned says when it reports at the end of April, but we are determined to do what we can to work for the competitiveness of the UK call centre industry in the competitive conditions in which it
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operates. At the moment, around 60 per cent. of jobseeker's allowance claimants leave the register within three months of joining it and 80 per cent. leave within six months. We have the lowest levels of unemployment in the UK that we have seen for three decades or so.
The seminar's third key message, which reflects the growing consensus in business and trade unions, is, as my hon. Friend was right to emphasise, that recourse to protectionism is not the right way forward. We are a trading nation, and are heavily dependent on open markets throughout the world for our exports of goods and services. We are the second largest exporter of services in the world. We export more than £85 billion-worth of services, compared with imports of £70 billion, and simply cannot afford to close our markets to services provided from abroad, because we would lose far more employment than we could possibly gain. Closing our markets would also be inconsistent with our aim of helping developing countries out of poverty through trade. Indeed, it would be perverse to do so when countries such as India are growing through the sort of international trade that we in the United Kingdom have encouraged. Fortunately, no organisations on this side of the Atlantic are calling for protectionist responses, unlike organisations on the other side of the Atlantic, whose calls I noted when I was in Washington last week. Such steps would be profoundly mistaken and would severely damage the UK and our trading partners.
Offshoring is an innovative business process. It can drive down costs and drive up productivity, benefiting firms and consumers. For the UK economy as a whole, offshoring brings opportunities as well as challenges. That was well illustrated to me in a couple of discussions that I had when I was in India last month, in which we talked, among other things, about outsourcing and offshoring. The UK deputy high commissioner in Mumbai told me that a group from Germany had travelled to Mumbai just before Christmas with the brief of trying to persuade Indian companies to form exactly the sort of partnerships with German companies that they had formed with UK companies. The German group was there because it could see that the UK is developing a significant competitive edge and is attracting more inward investment into the UK because of the competitiveness benefit of such partnerships between UK and Indian companies.
I also had a discussion with Mahindra British Telecom, an enterprise that started as a straightforward offshoring of BT software development activities, but which has become an important supplier of software to the telecoms industry in its own right. It is now investing back in the UK, and has its European headquarters in Britain. It is employing people and creating new jobs in the UK, based on the success of its previous activities.
We need to bear in mind the full scope of what is happening and rise to the challenges that offshoring offers us.
It being twelve minutes to Five o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.