Westminster Hall Sitting of 11 May 2004

Preamble
[SIR NICHOLAS WINTERTON in the Chair]

Dental Provision (Devon)
Motion made, and Question proposed, That the sitting be now adjourned.—[Ms Bridget Prentice.]
9.30 am
Richard Younger-Ross: Mr. Deputy Speaker, today's debate revolves around the words of my constituent, Mrs. Thresher from Teignmouth, who said:
"Why should I have to give up my heating to get my teeth fixed?"
She was interviewed in the Sunday Express on 8 February, following a survey by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow), who is with us today. She also said:
"There are no NHS dentists where I live that are taking new patients. I've been told to go to one in Torquay, which is 14 miles away, but I don't see why I should be expected to travel miles. I've paid my tax and my national insurance all my life and I'm entitled to free dental care but I can't get it."
She went on to say that the Government had generously given her £200 to pay her heating bill. If she has to go to a dentist in Torquay or to a private dentist with Denplan, however, that £200 will go towards dental care not heating.
Mr. Anthony Steen: Will the hon. Gentleman give way on that point?
Richard Younger-Ross: It is very early to be giving way, but I shall do so.
Mr. Steen: I congratulate the hon. Gentleman on securing the debate, but I must tell him something that I am sure he will find interesting. National health service dentists in Torquay are not taking patients either. If his constituent had gone there, she would have wandered around and seen that wonderful resort, but she would not have found a dentist.
Richard Younger-Ross: The hon Gentleman is ahead of me. If he is patient, I will come to the fact that there are no dentists in Torquay or Paignton. Over the past year, people have been directed to those towns, and they are now being directed to places such as Barnstaple, Plymouth and further afield. I shall come to that later.
The essential question is why my constituent, who has been given extra money for heating to ensure that she does not suffer hypothermia, should be expected to put her health at risk by cutting her heating bills to pay for her dental treatment. The Government talk of giving people choices, but that is not the sort of choice that they should be encouraging.
This is not a new problem; we had a similar one in the early 1990s, when no NHS dentists were taking on new patients in Teignbridge. As hon. Members may remember, we had a Conservative Government in those
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days. The crisis continued for some time, and the health authority told my predecessor that it would deal with the matter. It made provision for an emergency dentist in Newton Abbot hospital, and the arrangement was heralded as a success at the time. However, as most people will know, emergency dentists do not provide ordinary dental care but deal only with emergencies and patients in pain. Furthermore, although the hospital still has an emergency dentist as a consequence of the authority's decision, people in wheelchairs cannot gain access to the hospital and must still go all the way to Torquay for emergency dental treatment.
Relief did come when new dentists decided to set up practices in Teignbridge. For a short while, it was fairly easy to register with a new dentist. There is a certain bitter irony for local people in that many of those new dentists who set up have now de-registered as NHS dentists. That is part of the reason for the current crisis in the south-west, Teignmouth, and especially Teignbridge. The Minister will no doubt tell us about the action plan for the south-west peninsula—we have an action area because we have a crisis area. I hope that the Minister's response will take into account my comment, which I am sure will be echoed by other hon. Members from Devon, that we have a crisis that needs urgent and rapid action.
I shall concentrate for a moment on my area, which is primarily covered by the Teignbridge primary care trust. In June last year, 46 per cent. of the population of 109,000 were registered with national health service dentists. The Minister and hon. Members will know that that is below the national average of 48.6 per cent; we were already doing badly last June. The crisis began in February last year and has continued, with the figure for April this year falling to only 42.12 per cent. That is a disgrace and a sad reflection on the state of the Government's policy on dental care in the south-west. For those who are statistically minded, that is a decrease of 8 per cent. The figure for under-18s is better—56 per cent.—but the figure for the over-18s, which is a true reflection of the situation of the elderly in my constituency, is 39.49 per cent.
The national figures often quoted in newspapers are for the number of dentists per thousand of the population, and I am horrified at how few dentists there are in some areas. However, that figure does not tell the whole story. In Teignbridge we have 44 dentists; there are 56 NHS contracts in 20 practices. However, we must consider how many patients they take on. Of those 44 dentists, only three have more than 2,000 NHS patients, which is the UK average. Fifteen of the 44 dentists have fewer than 500 NHS patients, and five have fewer than 50. The number of dentists per thousand of the population is a meaningless statistic. We must consider the number of people who can register with an NHS dentist.
We started writing to the Minister at the beginning of last year, saying that we again had a growing crisis. The Minister helpfully wrote a letter to one of my constituents on 21 December last year. In it she said:
"On 18 September I announced additional funding of £65.2 million to support change and help improve access, quality and choice for patients. The funding will be targeted at those PCTs where access is a real problem. There is also a further £1 million now to help PCTs, local dental committees and dentists to prepare for the change in the way dental services are commissioned. In 2004–5 an additional £15 million revenue funding will be made available to PCTs."

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Those are fine words, and I would hate to accuse the Minister of spin because I suspect that it is not, but since the Minister said that that money was being made available, 7,000 more patients in Teignbridge have been de-registered as five dentists have retired or gone private and have not been replaced.
Dentists are entitled to retire—we all reach that stage at some point, or at least most of us hope to do so—but they are fed up with the current contract. Peter Zeltmann, of Salisbury Villa dental surgery, is one of the dentists who moved into the area in the mid-1990s and was a saviour. In a letter to his patients, he says:
"For several years now we have postponed making any changes in the hope that the situation would improve but unfortunately there is little sign that it will. Consequently I have concluded that it is no longer feasible to continue seeing adult fee paying patients under the NHS."
Mr. Zeltmann concluded that he could no longer continue, and recommended that his patients go to Denplan. As the Minister knows, many people cannot afford to do so. Mrs. Thresher, whom I mentioned, is on income support and cannot afford it. She cannot afford many luxuries, and dental treatment has become a luxury to her.
Mr. Hugo Swire: In Brent, East the Liberal Democrats produced £100 vouchers to give back to everyone in council tax. Having heard their leader on the "Today" programme this morning, I believe that that is no longer their policy. If the Liberal Democrats had stuck to that pledge, however, the hon. Gentleman's constituents would be £100 better off. Would not that have put Mrs. Thresher in a better position to afford dental treatment?
Richard Younger-Ross: I am not sure whether the hon. Gentleman is actually following the debate. I thought that we were talking about dental provision in Devon. He wants me to go down a route that I am sure you would not wish me to follow, Mr. Deputy Speaker.
Mr. Deputy Speaker: You are quite right.
Richard Younger-Ross: I am grateful for your guidance, Mr. Deputy Speaker.
When the PCT considered the community consultation, which was conducted by the district council in 2002, it found that dentistry was the first health priority for local people. Currently there are no NHS dentists in Teignbridge. I do not think that there are any in Exeter. I note that the hon. Member for Exeter (Mr. Bradshaw) is not here. Nor are there any in Torquay, South Hams or south-west Devon. People are still being told to go to Plymouth. The hon. Member for South-West Devon (Mr. Streeter) is indicating from a sedentary position that there is no NHS dentist in Plymouth.
Mr. Gary Streeter: I shall enlighten the hon. Gentleman later.
Richard Younger-Ross: The hon. Gentleman will enlighten us later should he catch your eye, Mr. Deputy Speaker.
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People are being advised to go to Barnstaple. It is easy enough for people to say, "Why not Barnstaple? It's in the same county. It's not far, is it?" Those who suggest such things know very little of Devon's geography. Barnstaple is 50 miles away from Teignmouth. It takes two train journeys to get there, and one would have to take a taxi at the other end to find the dentist's, having taken a taxi to the railway station in Teignmouth in the first place. The cost of such a journey is high and unacceptable. It is not a journey that an elderly or frail person should be expected to take. Surely, the elderly, the infirm and those on income support or on low incomes—in fact, everyone—deserve to have a dentist within fairly easy reach.
Another constituent wrote to me to say that he had two children. His dentist had gone over to Denplan. He was told that he could go on to Denplan and that if he did, the dentist would continue to treat his two children, who were aged 10 and 12, on the national health service. Clearly, that is a form of blackmail. It was made clear to my constituent that if he did not sign up to Denplan, his children would no longer be accepted for NHS treatment at that practice.
That put my constituent in a difficult spot—an unacceptable spot, some may say. He was given a hard choice: should he take up Denplan at £17 a month or leave that dentist and take his children out of school to travel to Torquay, where a dental practice was then available? The hon. Member for Totnes (Mr. Steen) should note the time span. Today, my constituent would have to take his children to Barnstaple, and how long would that journey take? A visit to the dentist which would take most of us out of work or school for an hour or two would have taken a whole day by the time he had got to Torquay and back again.
I hope that the Minister will not say that everything is rosy in the garden—I am sorry; that was an unintended pun. I hope that she will not say that everything is well and that the world will be all right because the Government understand the problem. There is a crisis, and action is required now. One dentist in my constituency has made a planning application to expand a practice and bring in some foreign NHS dentists. What can the Minister do to help dentists to do that?
I hope that the Minister will tell us not just that money is available, but that it is available now to aid the bringing in of dentists from abroad. The national papers yesterday were saying that Britain was well down on the dental league table and that we needed about 5,000 new dentists. Will she tell us what she can do to provide dental hygienists and nurses, because there is also a shortage of those? Will she address the concerns of those in the industry who are worried about the new contract? I have been told that there is inadequate information about it. Can she shed some light on that? In particular, will she address the rumour that the start date of April next year will be put back?
Teignbridge district council, which is not statutorily required to assist, carried out a survey that showed that, given the opportunity, 10,000 constituents in its area would go back to a national health service dentist. That would mean that we were close to the average figure of

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those registered with NHS dentists rather than being dramatically below it. I commend the district council for its work in highlighting a concern outside its responsibility and for its work in partnership with the primary care trust. I also commend the fact that it has made available funds to help to establish some dental practices in Teignbridge. I hope that its generosity and quick action and reaction is matched by that of the Minister.
I could go on at length quoting my constituents, who feel bitter about the situation. However, I shall finish with a quote from a doctor. When doctors start writing to MPs regarding lack of provision, we know that something is seriously wrong. He wrote:
"I write to express my worry that several of my vulnerable, low-income patients, including one with cystic fibrosis, have had problems with securing national health service dental services".
When doctors worry, we should all worry, as we should when constituents such as Mr. Brookes have to make 340-mile round trips to Bridgend, because that is where they used to go to the dentist, and they have continued to do so. Similarly, last Saturday, when canvassing, I met a constituent who had moved to Teignbridge three years ago and was still going back to Berkshire for dental treatment. There is a crisis in dental provision in Devon. I hope that the Minister will tell us how she intends to address that crisis now—not in six months or a year or two years' time. What can she do in the next month to help to provide dental services in Devon?
Several hon. Members rose
Mr. Deputy Speaker: I want to help the Chamber. I intend to start the winding-up speeches by calling the Liberal Democrat spokesman at 10.30 am. I hope that the four Back-Bench Members seeking to catch my eye will bear that in mind.
9.51 am
Mr. Anthony Steen: I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on being such a model of a modern Liberal Democrat MP. Jumping on bandwagons is one of their specialities, and sitting on them so comfortably is another. More seriously, this is a problem for the whole of Devon, and I pay tribute to him for taking the trouble to raise the matter, as do south Devon colleagues who are concerned about it.
Richard Younger-Ross: I thank the hon. Gentleman for his kind words. I carried out my first dental survey in Teignbridge in 1992. I do not think that that constitutes a bandwagon—there was not one rolling at the time.
Mr. Steen: If the hon. Gentleman is not aware, I was in touch with both the Torbay and the South Hams and West Devon primary care trusts about the matter last August, and my hon. Friend the Member for East Devon (Mr. Swire) raised the matter in this Chamber some months ago. I am not trying to gain brownie points, but the Liberal Democrats do not, thank goodness, have a monopoly on dentists.
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On 11 November last year, I received a letter from the chief executive of Torbay primary care trust, who said:
"From April 2005 the PCT will be responsible for commissioning and contracting with dentists. In developing our approach, we will be consulting with the profession and public as to the best approach to ensure improved access. This may result in us recruiting dentists to work in a salaried post, or directly contracting with dentists for NHS sessions. This should enable us to secure a more consistent level of provision than at present—"
you can say that again—
"where with three months notice large numbers of patients can be disenfranchised."
The situation has been well rehearsed by the hon. Member for Teignbridge. In a letter dated 17 February, the chief executive of South Hams and West Devon primary care trust—not Torbay; I have two or three PCTs in my area—wrote:
"South Hams & West Devon Primary Care Trust (PCT) has been struggling with dental access for a number of years. During the past months the situation has worsened with practices in the area de-registering large numbers of NHS patients. The fact that South Hams & West Devon PCT is very rural means that every time an NHS practice decides to de-register a patient, if they are able to find a practice accepting NHS patients they must travel a considerable distance to access the service."
It is rather like the middle ages, when people travelled by horse and cart throughout the county to find a dentist. The only practice that currently accepts NHS patients in South Hams and West Devon is in South Brent on the edge of Dartmoor, which has a bus service once a day and which no one can reach conveniently. Incidentally, South Brent has the highest levels of radon gas in Devon. I am not sure whether that is a relevant factor—it is just an aside.
The chief executive goes on to say that dentists are independent contractors—we know all about that. He then wrote:
"The PCT has very limited influence",
which worried me a bit,
"on NHS dental practices operating under the NHS contract".
He goes on to say:
"There is a national shortage of UK qualified dentists who wish to work within the NHS. Increasingly established dentists are moving into private practice. Although in past years Dentists have been attracted to the UK from Scandinavia and Denmark, this supply now seems to have halted. I am told that qualified dentists from outside Europe are put-off by the amount of bureaucracy they have to go through to enter the UK to work."
Well, who is responsible for that? Is it the EU, the Government or the dental practice? The Minister needs to deal with the matter. I have a letter from the chief executive saying that
"dentists from outside Europe are put-off by the amount of bureaucracy."
Having dealt with the numbers, let me help the Minister and the Chamber. In the past three years, 4,000 full-time students have been on undergraduate courses in dentistry in Great Britain. That is a large number. However, in 2000–01 only 618 graduated. In 2001–02, 591 graduated and in 2002–03, 549; those figures are for England only. The figures that I was given show that in Great Britain there are 4,000 full-time students but roughly only 600 or fewer graduate in England alone. I do not know quite why that is, and I do not know why they are not interested in staying in the national health service. However, dentists are clearly not taking any notice of the Government. I am amazed by the numbers.

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Do the Government wish us to believe that the answer is outside the EU? I remember a market in Marrakech in Morocco, where there is a stall that boasts a man with assorted pliers, who will pull out teeth for a modest fee. Is that what we want here? Is that what the Minister is going for: not a farmers market every Saturday, but a local artisans market where our teeth are wrenched out with pliers?
The Minister of State, Department of Health (Ms Rosie Winterton)indicated dissent.
Mr. Steen: The Minister shakes her head, but I would like to know what my constituents are supposed to do if they do not and cannot find an NHS dentist.
We know that dentists are leaving the NHS in droves. There is now a stampede. They are abandoning the NHS ship, which has been scuppered by the Government and is going nowhere but the seabed. The Government have an interesting answer to that, and I want to read it out. The Minister herself gave me the following answer, which is full of wonderful words:
"On 18 September 2003 we announced new investment totalling £65.2 million for dentistry."
Well done! It continued:
"This consisted of £35 million capital for dental access and quality, £30 million for dental information technology"—
I am not sure that we want information; we merely want dentists—
"and £200,000 for developing dental leadership."
I wonder what dental leadership is? Is it the molars? There has been £200,000 given to that. She goes on to say:
"This was on top of revenue funding we announced in August of £9 million for targeted support on dental access and £1 million for organisation development."
That is wonderful bureaucracy, but the proof of the pudding is that we have no dentists in south Devon. None of that money is going to south Devon.
The Minister adds:
"The £30 million investment in IT will facilitate integration of dental practices with wider NHS information technology systems and will support local contracting."
However, we do not have any local contracting. She continues:
"The IT investment and solutions for dentistry consistent with other NHS information technology initiatives are being taken forward within the national programme for IT."—[Official Report, 23 February 2004; Vol. 418, c. 274W.]
She then goes on to talk about the balance of £59 million, and this and that—but it is a lot of garbage. It is hogwash. These are enormous sums but, as far as we can see, none of it is coming to our area. That money is available for a wonderful list of things, but not for dentists in south Devon.
You rightly pointed out, Mr. Deputy Speaker, that many of my colleagues wish to speak about such problems in their constituencies. I shall therefore touch on only two cases. The first is a single mother who lives in East Prawle, a wonderful but God-forsaken place that is difficult to get to. It is in the middle of nowhere;
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it is one of those remote villages that people aspire to go to until they find that there is no means of transport other than the car.
The single mother has two children, aged five and seven. They are patients of a dental surgery in Kingsbridge. In February, the mother arranged the six-monthly appointment for the family, but she was telephoned on the day of the appointment to be told that it would have to be rescheduled. She then received a letter from the owner of the surgery advising patients that a new dentist would be taking it over.
No one telephoned the mother to rearrange the appointment, and although she had contacted the surgery a couple of times to get a new date, it was in vain. However, she received a letter from the primary care trust on 7 April advising her that a new dentist, Mrs. Stembridge, wished to give notice that she was ending the arrangement for providing dental care on the NHS from 28 June. What that single mother was told is simple: unless she registered with the dentist privately, her two children would not receive treatment. That is a form of dental black mail. As a result, she can get dental treatment for her children only if she, a single parent of restricted means with no means of transport, can get to Kingsbridge and have private treatment for herself. That is not acceptable.
The next case is equally unacceptable. Another constituent of mine has a 90-year-old father and a 92year-old mother living in Brixham. However, there are no dentists in Brixham, Paignton or Torquay—nor, as the hon. Member for Teignbridge said, in that town. My question to the Minister is, what are those people supposed to do if they do not have the money? We do not choose to have teeth. Some of us think that it is rather bad planning that we should have teeth, but we all have them and we all need to have them seen to.
Are the Government suggesting that we should go to the dentist rather as we take the motor car to the garage, and that just as we pay for our MOT certificates and car repairs, so we should pay for repairs to our teeth? I would have nothing against that if it were the Government's policy, but the Government say that it is not their policy. They say that their policy is to provide free dental services, but the policy is failing.
What the Chamber wants to hear is not how much money the Government are putting into the dental service nor how many people are being trained, but why dentists in the entire swathe of south Devon—probably in the whole of Devon—are not prepared to work for the NHS. We want to know why hundreds of thousands or even millions of people are going around with substandard teeth and suffering pain and discomfort. It affects their work, their jobs and their relationships, and it is inexcusable. I hope that the Minister will not give a trite response but will say how to deal with that serious problem.
10.4 am
Linda Gilroy: The hon. Member for Totnes (Mr. Steen) entered into the debate with characteristic gusto, but I think that he had a degree of selective amnesia. The roots of the problem go way back to the early 1990s when there was a contract that resulted in a very unsatisfactory position that has undermined dentists' confidence in providing care under the NHS. I will return to that in a moment.

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The hon. Gentleman also accused the hon. Member for Teignbridge (Richard Younger-Ross), whom I congratulate on securing this debate, of jumping on a bandwagon. None of us is jumping on a bandwagon. We are all seeking to represent the interests of our constituents and to raise a serious issue with the Minister. I hope that her response will show that we are at long last pointed in the right direction in terms of how we provide for NHS dental care in the 21st century.
Like other hon. Members, I have found that the problems are reflected in my casework at both ends of the age scale. Just yesterday a mother with four children aged two to 14 came to me. She was desperate for care for the two-year-old. She has had to turn to Derriford hospital for help. She moved to Plymouth two years ago. The person I most recently saw at the other end of the age scale, whom I met when I was out and about in Efford, also moved to Plymouth recently. Like many people, she has experienced problems with her dentures, which are probably past their sell-by date and need attention. She cannot find an NHS dentist who is willing to take her on that side of town. Like many older people, as the hon. Member for Teignbridge pointed out, she would have difficulty in travelling any great distance even within Plymouth, let alone facing the challenges that some people in rural constituencies face.
Richard Younger-Ross: Will the hon. Lady give way?
Linda Gilroy: I am sorry, but I will not give way. I have a lot to say and I want to stick within the time limit.
Those are two of the many problems that have been brought to me. It may have come a little later to Plymouth than to some of the rural areas, but there are other ways in which I have a sense of the problem escalating in Plymouth. I see it in the number of people who seek my help as their Member of Parliament; GPs report increased numbers of patients turning to them for help with pain and gum disease; the primary care trust reports increased numbers of calls on dental matters and, whereas the evening paper would cover the occasional story, there is now regular coverage of problems with dental services. Most recently, in a particularly alarming case a dentist dumped 7,000 NHS patients. That was one of the more recently qualified dentists. There is still a strong commitment among longer qualified dentists to try to engage with the NHS. We need to find a way forward with the Minister's help today.
The first sign that there might be light at the end of the tunnel is the work, to which the hon. Member for Teignbridge did not refer, which is going on across the local authorities in the area. As I understand it, each local authority scrutiny committee is bringing together and taking evidence from the players in dental care about the way forward. There was a joint conference at St. Mellion in February bringing dentists and others together with people from the primary care trust to explore the problems and the options for dealing with them. It is always a good sign when people recognise that the way forward is not one to which anyone has the
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sole or monopoly answer. The Government cannot have that: it will take everyone getting together to resolve the problem.
The problem goes a long way back. One of the big hurdles that we have to overcome is that dentists distrust the present set-up. They distrust the NHS and the new proposals as well as the new money that is on the table. A lot of confidence-building is needed. Dental schools have been closed. There is a lack of understanding about how the new contract will work. There may be a lack of information from the Department of Health on that or it may not be getting through. I understand that there has been a delay in the time taken for funding streams to reach the PCTs from the NHS. The incentive scheme money that was promised last year has yet to reach Plymouth, and I ask my hon. Friend to look into the matter.
There are proposals for the new contract and there is new money, which was announced in the debate secured by the hon. Member for East Devon (Mr. Swire) in Westminster Hall on 11 February. In Plymouth, there is an oral health programme. The board was set up under the first wave of health action zones, and it has been running for five of the seven years for which money is committed to it. It is a catalyst that has led to several schemes being set up, including free tooth brushes in some of the poorest communities, and, importantly, the programme for vocational dental training in Plymouth. There is a dental access centre in Plymouth and in Cornwall, but other PCTs have not set them up and as hon. Members have said, there is considerable pressure from elsewhere on the dental access centre in Plymouth.
Plymouth is an "Options for change" field site; it is a testing ground for the new way forward on contracting locally with dentists. I understand from the primary care trust dental lead that two practices are moving to the new service agreement this month and several more will follow shortly, which will have advantages for dentists. It will bring them a steady and predictable income throughout the year, and because it is based more on patients than treatments it will reduce the bureaucracy that was built into the disastrous contract developed in the early 1990s. It has the potential to enable the PCTs, which will take responsibility throughout the country from March next year, to focus support on preventive health care, which will be a considerable help to certain communities. At present, any dentist, anywhere, who is willing to do NHS work is very welcome.
In Plymouth, there are 41 dental practices, with 86 general practitioners working as NHS dentists, carrying between 50 and 1,500 patients each; that is the scale of the challenge. In Devon, the average list size has decreased by 31 per cent. since the disastrous 1992 contract. Some people who have lost their dentist have gone private, a few happily but most reluctantly. The chair of the Plymouth health scrutiny panel, Councillor Mary Aspinall, told me that a recent survey in Plymouth suggested that between 6 and 10 per cent. of adults were not registered with a dentist. Some of them are just allergic to dentists, but some are the sort of people I described earlier. About 20,000 people in Plymouth are not registered, which is a matter of considerable concern. If 2,000 patients per dentist is the right figure, it means that about 10 dentists are needed in Plymouth alone.

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What is being done to get the dentists we need? As my hon. Friend the Member for Falmouth and Camborne (Ms Atherton) argued in the previous debate, we urgently need to consider setting up training in the far south-west of the peninsula, as an outpost of the nearest dental school at Bristol, or as part of the new peninsula medical school. When people are trained in an area, at least 25 per cent. stay there. That would help to increase the number of dentists, just as it helped to increase the number of doctors. We knew that we were under-doctored when we argued for the peninsula medical school, because, per thousand young people, there were not enough to come forward as doctors. I suspect that the same is probably true in respect of dentists.
In the mean time we need to try to attract dentists from abroad. I understand that there are people in Poland in particular who are keen to come and work here under the accession agreement. Is that true? What is the Minister doing to encourage that? Does she agree that that would have a particular relevance for Plymouth, which has a strong historical link with Poland, through the population that came over in the second world war?
What can we do to secure the position of those who are fortunate enough to have an NHS dentist? What is the way forward for the vocational dental service? It is funded until 2005 through the workforce development confederation and is an essential tool to encourage people to train and work in the area. Its continuance beyond 2005 is essential. We need to ensure that primary care trusts have the resources and back-up to give current NHS dental practitioners the confidence to continue.
The good will of dentists is strained to the limit and they lack confidence. I believe that most want to ensure that those who need NHS dentistry can have it, and that they are willing to play their part. Localising the commissioning of NHS dentistry and engaging dentists through membership of the executive committee of the primary care trust will enable local stakeholders to play their part. I look forward to hearing what the Minister has to say about what the Government will do to assist them in returning confidence to a vital part of the health care system.
10.16 am
Mr. Hugo Swire: I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on being lucky enough to secure this debate. It follows on from a debate that I instigated on 11 February, so I am not quite sure why the debate is taking place. Perhaps in the intervening period the Minister will have come up with some answers. I am sure that she will do better than her colleague, the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson), did in February.
The issue is the stuff of headlines. It is a problem not only for Devon or East Devon. The headline in the Daily Express of 18 February was "Government must act as dentist crisis begins to bite." This crisis is a byliner's dream. Under the headline, "A kick in the teeth", the
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Daily Mail of 10 May reported:
"The critical shortage of NHS dentists has been dramatically exposed by an international study.
Research ranks Britain last in terms of dentists per head of population. Greece has nearly three times as many, while in France and Germany it is almost double."
The Express and Echo, a local newspaper reporting on another local problem, used the headline, "Chloe told to wait as dentist crisis rages". In Torquay, the Herald Express announced:
"Experts get teeth into dentist crisis"
when it reported in February that an estimated 700,000 people in Devon and Cornwall do not have access to any dental services and that local councils have decided to join forces to tackle the problem.
We know what the problems are. These reports come on the back of pledges made time and again; for example by the Prime Minister at the Labour party conference in September 1999.The Times reported on 29 September that he pleased activists with a pledge that everyone would have access to an NHS dentist within two years.The Independent on Sunday reported on 13 August 2000:
"In stating that Blair's pledge on dentists was impossible to meet the Chairman of the British Dental Association Dr. John Renshaw stated: 'The Prime Minister went and shot his mouth off without speaking to us. He didn't ask us whether we could deliver on the promise he was making. The target is very, very difficult but with the timescale it makes it impossible'".
The article continues:
"'The BDA believes that all the dentists who have left the NHS, or have only tiny numbers of non-paying patients, need to be attracted back to the public sector"'
and adds:
"Dr. Renshaw on outlining this requirement commented: 'I don't believe that the Government has any intention of even trying.'
He went on to conclude: 'We have had enough of talk. We are sick of it. We are fed up with listening to the talk. We need some action'."
What did we get? More talk and no action. On 17 May 2000 at Prime Minister's questions, the Prime Minister said:
"We have set the date for the end of next year to make sure that everyone who wants access to NHS dentistry can have it"— [Official Report, 17 May 2000; Vol. 350, c. 331.]
On 19 June 2002 he said:
"The changes that we have made mean that anyone who wishes to do so can contact NHS Direct or other NHS services and get the name of an NHS dentist whom they can visit."—[Official Report, 19 June 2002; Vol. 387, c. 276.]
On 26 February 2003 at Prime Minister's questions, the right hon. Gentleman said:
"The reason we are putting so many additional resources into the national health service is precisely in order to ensure that people get proper access to it."—[Official Report, 26 February 2003; Vol. 400, c. 257.]
On 15 October 2003 he said:
"We have made huge attempts to make sure that people can get access to NHS dentistry."—[Official Report, 15 October 2003; Vol. 411, c. 106.]
Mr. Deputy Speaker, you may think that I attempted a trivial diversion earlier when I intervened on the hon. Member for Teignbridge to talk about pledges, but I believe that the collapse in people's support for the political parties and interest in politics has something to

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do with broken pledges. Despite all the pledges made, by people from the Prime Minister down, my constituents and others in our part of the world are fed up. It is another case of being let down by Labour.
I alluded to the Liberal Democrats doing a complete volte-face on their promise to give everyone £100 back on their council tax; they are now changing their policy on that. It is about time that we were more honest. Perhaps the Minister will admit this morning that the Government are unable to deliver on the Prime Minister's pledges, and we can consider together a way of dealing with the problem. Little has changed since my debate in Westminster Hall on 11 February. If anything, the situation in East Devon has got worse since Bernard Jones retired last week: an additional 2,500 patients are now looking for an NHS dentist. There is a continuing problem since Mr. Alistair Danby's attempt to secure premises on Rolle road was rejected by East Devon district council because of a highways problem.
The situation is bad and was highlighted excellently by my local newspaper the Exmouth Journal: I congratulate it on its "plug the cavity" campaign, which seeks to attract more dentists to east Devon and which has attracted 1,044 signatures. I have, nothing further to add, although I am surprised that we are having this debate. There is an element of the Liberal Democrats jumping on the bandwagon, but I want to leave the maximum time for the Minister to answer some of the questions that have been raised, both in this debate and that in February.
10.22 am
Mr. Gary Streeter: I can be blisteringly brief, because much of what I wanted to say has been covered. I pay tribute to the hon. Member for Teignbridge (Richard Younger-Ross) for securing the debate, which is important and timely and builds on the debate inspired by my hon. Friend the Member for East Devon (Mr. Swire) earlier this year.
Whether it is the right policy that every person who wants access to an NHS dentist should have it is a matter that we can debate. However, as has already been said, it is this Government's policy. It was spelled out by the Prime Minister in his party conference speech in 1999 and put into the NHS plan in 2000; it is a clear Government pledge and commitment that anyone who wishes to have access to NHS dentistry can have it. As hon. Members have heard, in our part of the world, as in other parts of the country, that is not the case. I am the first to admit that the problem pre-dates 1997 and has been an issue for a number of years. However, the Prime Minister made his commitment in 1999—five years ago—and the Labour party has been in government for seven years. As I shall demonstrate with some correspondence, the situation is not getting better in my part of the world: it is getting worse, week by week and month by month. The Government have made a firm policy commitment and promise, and are failing to deliver. Many people are suffering and are becoming distressed as a result, and I look for and to the Minister dealing with that important point.
It has not been said yet, but I pay tribute to the many NHS dentists in Devon who are continuing with NHS dentistry, often at personal expense to themselves, working under extreme pressure and not enjoying the
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same rewards as those taking the independent route. From time to time we should say, "Thank you and well done" to them. My concern about the matter has been rumbling on for a number of months. It has been exacerbated, as the hon. Member for Plymouth, Sutton (Linda Gilroy) mentioned, and as the local newspaper reported, by a practice crashing recently and 7,000 people being told that that they could no longer have NHS dentistry. That was in my constituency in Plympton, and the situation has caused major concerns.
I shall quote from a letter from the South-West Peninsula strategic health authority. I often write my initial inquiries not to Ministers—they have plenty on their plates—but to the chief executives of the SHAs who are administering the primary care trusts. I received a letter quite recently, on 28 April, from the chair of the local SHA, who said:
"With the exception of one surgery in Tavistock which was registering NHS charge exempt patients all the others shown on the list"—
she had previously sent me a list—
"were only registering children as NHS patients. Unfortunately there were, and are,"—
here is the killer phrase—
"no dental practices in the Plymouth area registering charge paying adults for NHS treatment."
I do not want an NHS dentist myself. For many years I have, rightly or wrongly, been on a Denplan arrangement, which has cost an arm and a leg. My wife and I pay about £50 or £60 a month for cover, which is a lot. My wife has very bad teeth—I should not have said that, but now it is on the record. If anyone sends her a copy of the Hansard report, they will be in big trouble with me. Paying between £50 and £60 a month, or even £20 and £30, is simply not within the reach of some of the people on low incomes whom we have heard about today. That is why the issue is so important to such people. There are people who, on a point of principle, insist on NHS dentistry. That is what they have always had, what they have paid into over the years—they think—and what they still want. We should meet that demand, and the Government have promised to do so. Many others simply cannot afford any alternative treatment.
It is not only in the Plymouth area and in the city where there is a massive and growing problem and where constituents are distressed. A constituent came to my surgery about three weeks ago. She was a single parent. She brought along her three lively and lovely children to explain that she, too, had received a letter about a practice in Kingsbridge, which my hon. Friend the Member for Totnes (Mr. Steen) mentioned, and a Mrs. Stembridge, who is no longer taking on NHS patients. The letter reads:
"However, after that date you will no longer be entitled to emergency cover, or treatment provided by your current dentist under the NHS.
Unfortunately at the time of writing this letter there are no NHS Dentists accepting new patients in the South and West Devon area."
That is a pretty big area, but there are no dentists accepting new NHS patients there. My constituent asked me, "What can I do when the time comes for my children to receive their regular check-up? I can't afford to go private and they won't be accepted under the

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NHS." I suspect that there have been many children over the past two or three years who have not received their regular dental check-ups, and that many will miss them in years to come. We are storing up a health hazard for the future.
The problem is hugely important. The Government have had long enough to put in place changes that should by now have worked through on the ground. I recognise and accept that we are talking about the individual choices of dentists about how they wish to organise their practices. However, the Government must also accept that they have made promises. They have had long enough to introduce arrangements that can work on the ground. If the Minister cannot satisfy us that patients in our part of the world will soon have access to NHS dentistry, we shall have yet another example of failure to deliver by a Government who have promised so much.
10.28 am
Mr. Paul Burstow rose—
Mr. Deputy Speaker: Order. May I make a plea to the Liberal Democrat spokesman and to the spokesman from Her Majesty's Opposition to allow adequate time for the Minister to reply?
Mr. Burstow: Thank you, Mr. Deputy Speaker. I thank the hon. Member for South-West Devon (Mr. Streeter) for keeping his remarks brief and to the point. I congratulate my hon. Friend the Member for Teignbridge (Richard Younger-Ross) on securing a debate lasting an hour and a half on the important issue of the supply and availability of dentistry in Devon, because it enables us to explore the issues that have led to the crisis there, but which apply also to many other parts of the country.
It is to my hon. Friend's credit to have secured the presence of a Minister of State, because in the half-hour debate in February we had only an Under-Secretary. On that occasion, the hon. Member for East Devon (Mr. Swire) raised a number of important issues concerning East Devon's dental services and the difficulties that his constituents were experiencing. However, I fear that it is a little churlish to suggest that a Member who has persistently pursued dentistry issues and consistently surveyed the availability of dentistry in his constituency since at least 1992 is on a bandwagon. If he is on a bandwagon, it is one that he built and which he has been on for a long time.
The debate has demonstrated that there is a serious problem with the supply and provision of dentistry in Devon. There is a parlous state of supply in Teignbridge and in the constituencies of other hon. Members who have spoken today. I was interested to hear the remarks of the hon. Member for Totnes (Mr. Steen), particularly those about the availability of radon gas, although I am not certain that they play directly into today's debate.
Yesterday, we saw some interesting reports, which graphically demonstrate the shortage of dentists throughout the UK and tell us that Britain has fewer dentists than Poland. It is important to understand what has happened with dentistry in the past few years, and
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how we reached the current situation. It is worth bearing it in mind that, according to a parliamentary written answer that I received earlier this year, over half of the population in England are without an NHS dentist. I believe that the hon. Member for East Devon referred to an article in the Daily Express that published that parliamentary written, answer to the world. It is essential that we reverse the trend of people being deregistered and losing access to dental services. South-west peninsula residents are undoubtedly among the least well served when it comes to dentistry services, but that problem is not confined to that part of the world.
Two key decisions had a serious impact on dentistry, and brought us to where we are today. The first was the decision to introduce the 1990 contract and, more importantly, the unilateral decision of the Department in 1992, to cut—first by 23 per cent., and then by 7 per cent.—the fees that it was paying to dentists. That unilateral decision, more than anything else, undermined the dental profession's confidence in what the Department was about and whether it was really committed to sustaining a universal service of free dental care. It accelerated dentists' disengagement into an exodus from NHS provision. Rather than delivering the hoped for focus on prevention, it sped up the treadmill that so many dentists talk about: the drill-and-fill state of affairs—no time to talk, no time to prevent dental decay. The second important decision was the closure of three dental schools, which undoubtedly had disastrous implications for the long-term viability of the work force.
My hon. Friend the Member for Teignbridge ably documented the impact of that mismanagement in the 1990s on the oral health of his constituents, as have other hon. Members. Is there any comfort on the horizon for our constituents? Will dental services improve? Since 1997, a host of initiatives has been introduced—I am sure that the Minister will rehearse them for us today—but in 2001, the Select Committee on Health recorded its view that the Government had a quick-fix approach, which did not go to the root of the problem.
What is next? We now have legislation that provides for primary care trusts to pick up responsibility for commissioning. That is the biggest shake-up for a quarter of a century. A new base contract is being developed and piloted, which will move dentistry away from drilling and filling and toward promoting prevention.
Access to NHS dentistry is a serious problem because dentists are doing less NHS work and we have poor work force planning. What assessment has the Minister made of the British Dental Association's estimate that the number of new dental students needs to increase by 25 per cent. to meet demand? Does she agree with John Renshaw, the chair of the BDA executive board, that we do not have enough dentists?
That brings me to what is, from my review of parliamentary answers and other literature of late on this issue, the key question: what do the Government mean by "shortly" as in, "We will publish a report shortly"? In 2001, the Department announced the first review of the dental work force since 1997, which was completed last autumn—another of those vague terms. In a written answer on 2 February, I was told that the report would be published "shortly". Will the Minister

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tell us in which month the report was completed and, more importantly, when it will be published? That report must be the basis on which we will move forward the development of the work force.
With changes to the contract due in April 2005, clarity on work force issues and the direction of travel has to be essential to bolstering the confidence of which the hon. Member for Plymouth, Sutton (Linda Gilroy) spoke. We have 13 dental schools—this relates to a point that the hon. Member for Totnes made—and, UK-wide, 800 extra dentists coming in every year. We imported 456 dentists from overseas last year.
It will be difficult for the Government, if they intend to grow our own dental work force, to do so without knowing the current position of the work force. The report has not yet been published, and it is therefore difficult to ascertain whether there is the right mix of training places, and whether the training "pipeline" is adequate to produce not only dentists, but therapists, nurses and others complementary to dentistry. Those questions need to be answered now, because if those extra dentists and others do not come through the training system, we will not be able to deliver the quality service that we should all expect for our constituents, in Devon or anywhere else in the UK. Can the Minister therefore tell us what "shortly" means in this context, and when we will see that report and the necessary action to turn its recommendations into reality?
At the BDA's conference on 6 May the Minister made an important speech, and was asked a number of questions by members of the association, not least about the timing of the implementation of the new contracts. The Minister said that she would examine that matter in the weeks subsequent to the conference. Can she tell us whether the Government are minded to amend the timing and, if so, in what way? W ill she also tell us whether there will be further announcements about additional funding to underpin the PCTs' capability to implement their new roles as commissioners? When will that money be announced, and when will it reach the front line, so that it can have an impact?
The dentistry sector has been neglected for so long that it has, in many areas, lacked the necessary investment in infrastructure. How will the infrastructure—premises and equipment—be improved for those who have slogged along and stayed with the NHS? What are the Government's plans in that area?
My hon. Friend the Member for Teignbridge has done the House a service by initiating this debate so that the Minister can respond to the concerns of hon. Members. NHS dentistry is in poor shape. There is a growing underclass of people who do not have access to NHS dentistry; for them it is a pipe dream. The scale of the task is clear, but the Government's response is still too vague. Can the Minister give us confidence that we will begin to see a dentistry service fit for the 21st century, fit for the people, and free on the basis of need?
10.37 am
Dr. Andrew Murrison: I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on introducing the debate, and also congratulate my hon. Friend the Member for East Devon (Mr. Swire) on initiating a similar debate in February. The debate today is an opportunity for the
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Minister to give us a progress report on the response made by the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield (Miss Johnson) in that earlier debate.
However, I believe that the glass is half full rather than half empty, and that many dentists would take exception to some of the remarks made by the hon. Member for Sutton and Cheam (Mr. Burstow). It is true that there are problems in accessing NHS dentistry—that is the subject of the debate, and rightly so. However, we should recognise the huge strides that have been made in dentistry over the past couple of decades. It is important to bear it in mind that part of the current problem of access to NHS dentistry is related to the standards that we expect today, which did not apply 20 or 30 years ago.
Nevertheless, we have seen what might be described as the decline and fall of NHS dentistry which, ironically, has occurred since the Prime Minister made a categorical statement at his party's conference in September 1999 on access to NHS dentistry for everyone. It was a brave thing to say but, in the fullness of time, that policy has been seen to be undeliverable. I hope that the Minister will respond to that point in her concluding remarks.
Some 1.5 million fewer people are now registered with NHS dentists than in 1998, which is a huge decline. There has also been a reduction—from 4.4 per cent. to 3.1 per cent.—in the proportion of the health budget devoted to dentistry. I fully accept that the NHS budget has expanded, but that proportional decline gives some indication of the priority given to dentistry within the NHS. Will the Minister comment on that matter? The BDA seems to think that the proportion of total NHS spending on dentistry is declining even further.
The analogy that my hon. Friend the Member for East Devon drew between the Liberal Democrats' pledge of £100 during the Brent, East by-election and the Prime Minister's remarks in 1998 was spot on. We need to restore trust in politics. The Prime Minister making promises in 1998 and failing to keep them, and other parties making wild pledges during by-elections and then rescinding them, does none of us any good.
The BDA is clearly concerned about "Options for change". We have great hopes for "Options for change", as I am sure the Minister does. The measure will apparently revolutionise dentistry. I think that the BDA started by being quite positive about "Options for change", but it appears that it changed its mind, as so often happens, when it read the small print. We have seen time and again that when organisations read the small print of things that Ministers say, they often have second thoughts. A recent MORI poll suggests that 57 per cent. of dentists now oppose "Options for change", 15 per cent. support the measure and the rest simply do not know. Perhaps they have not been sufficiently apprised of the implications of that revolutionary measure that will apparently change their lives. I find that deeply worrying.
I received a letter recently from a general dental practitioner who is deeply concerned about "Options for change". We heard that the Liberal Democrats view

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the contract that was introduced in the early 1990s as a disaster. Well, we all need a little humility in politics, and we have to accept that in retrospect that may have been the case, but I hope that Ministers will reflect on what is going on at the moment, so that they do not make the same mistakes. Clearly, the gentleman who wrote to me feels that they are about to make similar mistakes. His comments are well put. He says:
"Put bluntly, dentists can expect to do 50 per cent. less work and still expect to receive their previous gross. They will work fewer hours, take more holidays, attend more courses, spend more time with each patient and carry out minimum invasive treatment. They will not touch a patient whose treatment plan involves high laboratory costs. The losers will be social classes D & E whose dental needs are the highest. They will be confined in ever increasing numbers to access centres, community and hospital services … The reform is guaranteed to exacerbate existing dental inequalities."
I find that particularly difficult, given that the Under-Secretary of State for Health, the hon. Member for Welwyn Hatfield, in her response to the remarks by my hon. Friend the Member for East Devon in February, made great play of addressing dental inequalities. I should be interested to hear from this Minister whether, in the months that have passed since, she has given further thought to how we might best do that. Indeed, I should be interested in her reflections on how dental inequalities may have been exacerbated since 1997.
This debate is about dentistry in Devon, but the problems that have been experienced there, which hon. Members have eloquently described, reflect problems in the country as a whole and particularly in areas where the population is relatively sparse. Devon has an elderly population. It is a rural area, with all that that implies for transport and access. The number of dentists in Devon seems to have declined significantly since 2000, and the dental work force is apparently quite elderly.
In that context, it is important to ask again, as several hon. Members have, when we will see the dental work force review that we have been promised for so long. It is important to know where we are going. I have said before in the House that many of the problems stem from the 1970s, and I believe that to be the case. We failed to predict adequately then what our dental needs would be now, and we are suffering the consequences. The review is welcome and we need to have it urgently, without any more delay. I hope that the Minister can shed some light on that. Given that we want her to have sufficient time to respond to the important questions that have been posed, I shall call it a day at this point.
10.44 am
The Minister of State, Department of Health (Ms Rosie Winterton): I congratulate the hon. Member for Teignbridge (Richard Younger-Ross) on securing this debate. I realise how important the subject is for his constituents. I certainly will not give the impression that everything in the garden is rosy, but I hope to show how we are tackling the long and short-term problems. My hon. Friend the Member for Plymouth, Sutton (Linda Gilroy) eloquently put her finger on the button in saying that we have inherited the problem from the previous Administration, who introduced a deeply unpopular contract, closed not three but two dental schools and cut
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dentists' fees. That was when dentists started walking away from the NHS and we are dealing with the consequences of that.
The hon. Member for Sutton and Cheam (Mr. Burstow) spoke about some of the difficulties, not just in Devon but across the country, and drew attention to the report published yesterday. I do not deny that there is a problem, but that report was misleading because it did not take into account the number of hospital or community dentists. The fact is that there are more dentists than ever before. The problem is that fewer of them do work for the NHS. To address that, we are negotiating with the British Dental Association over the introduction of a new contract. It has told us that dentists have difficulties with the treadmill effect of the current contract. They find it bureaucratic and say that it does not allow them clinical freedom to work with patients, so we are changing it. I take on board the comments of the hon. Member for Westbury (Dr. Murrison) about a particular dentist who feels that that is not the right way forward. However, a lot of effort has gone into negotiations with the BDA to try to find a different style of contract to suit dentists better.
Secondly, we ire devolving the money that is currently held centrally. By next year, that will be about £1.5 billion. The hon. Member for Westbury asked about the proportion of NHS funding spent on dentistry. The difficulty is that if an NHS dentist withdraws from providing NHS treatment in an area, the money that they would be paid returns to the centre. Therefore, that money cannot be made available locally and offered to other dentists. We will devolve the money held centrally so that local commissioners can properly plan with local dentists for the provision of dentistry in the area. That is the way forward.
Many hon. Members asked about the start date for the new contract. The BDA has said that it needs more time to conclude negotiations. We have listened to the points made by the BDA and I will make decisions on that after further discussions.
My hon. Friend the Member for Plymouth, Sutton raised the issue of work force training and she is absolutely right. My hon. Friend the Member for Falmouth and Camborne (Ms Atherton) made the point in the previous debate about how we can get trainees into an area and keep them there. It is a point well made and something that I am examining. It can be difficult to force people to go to a particular area, as they take lots of things into account when they move somewhere. However, I want to see whether there are ways to persuade people, because many people tend to stay around the dental schools instead of moving elsewhere. It is an issue that we need to consider.
The hon. Member for Totnes (Mr. Steen) spoke about international recruitment and his experience in Marrakech. To a certain extent, he cannot have it all ways. We want to consider increased international recruitment, but it is also important to ensure that practising dentists are of a high standard. That is dealt with by the General Dental Council, which requires some candidates to take exams. I suspect that that is the bureaucracy that he mentioned, but those checks are important in ensuring that dentists are practising to the highest standard.
Dr. Murrison: The Minister needs to recognise that it is the European Commission that is holding up the registration of many professionals from the European Union accession states. Will she admit that, and not just blame the regulators of dentistry and other professions?
Ms Winterton: I will come on to some of our discussions about that point. While ensuring that we can recruit from other European countries, we must ensure that we are not denuding another country's health service. We are undertaking discussions on that.
I will turn to Devon, as I know than that is what hon. Members have come to debate, but before that, I want to touch on the dental work force review, as it was raised by several hon. Members. We will be publishing the review in the not-too-distant future, but I want to ensure that we not only analyse the problem but come up with the solutions. That is why I have been keen to have all the questions answered before we publish. It is true to say that several conclusions have emerged, but I want to ensure that we can also define the solutions.
The long-term work involves what we are doing with the new contract, commissioning locally, the dental work force review and increasing; training. Some immediate access problems remain at a local level, to which many hon. Members have referred today. The PCTs throughout Devon have been working hard to develop a range of local solutions and I shall run through some of them before I talk about what more can be done.
The north-east Devon dental access centre opened in 2001 and now has three centres fully operational in Exeter, Crediton and Barnstaple. That scheme has recently been extended to Exmouth, where a drop-in arrangement is now in place. There is a salaried community and emergency dental service based in Newton Abbot in Teignbridge. There is also one in Torquay, which is due to expand will additional central funding. For the past three years, a mini personal dental scheme has been running in Tavistock to treat unregistered patients who are in pain and need emergency treatment. In Plymouth a walk-in dental access centre opened in December 2002 to offer a wide range of services and specialist support, including same-day treatment for patients in pain and emergency cover during weekends and bank holidays. Those are some of the schemes that are up and running to tackle the dental access issues that hon. Members mentioned.
The whole of Devon is part of the "Options for change" peninsula field site. Hon. Members have mentioned the fact that the BDA says that there is not enough information about how the new system will work. We have been setting up field sites and pilot sites for five years to ensure that the new system builds on the best practice that has been developed at such sites when it is introduced. It is important that Devon is part of that process, which will enable practices to move to the new
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system before next year, remove the uncertainty that some dentists face and provide an opportunity to influence the changes and achieve a secure income.
We have ensured that there is a project co-ordinator in Devon working for the Modernisation Agency. The co-ordinator, Andrew Harris, is based in a PCT in Devon and provides dedicated support to local dental practices and local PCTs to facilitate the move to the new system. Eighteen practices in Devon and Cornwall have adopted the new contracts under "Options for change", and we are looking to 20 more to move to do so in the next couple of months. That means that up to 45 dental practices and 100 dentists in the south-west peninsula will be part of the new system by July.
I have tried to make sure that the Department works closely with local NHS organisations to ensure that there is appropriate support.
Mr. Burstow: Will the Minister give way?
Ms Winterton: No, I cannot. Last week, officials from the new special health authority for dentistry met representatives of all the PCTs in Devon and Cornwall to discuss the progress that has been made in expanding the field site and to consider the PCTs' dental action plans. A specific meeting also took place with Teignbridge PCT, and the moves that are being made were discussed.
Additional funding has meant that PCTs are now in a position to develop plans for the future. Some £1 million of national access funding, which I announced last year, will be used in Devon to support capital developments to increase capacity. PCTs are developing dental action plans setting out how they will use that additional funding. I take on board the point made by my hon. Friend the Member for Plymouth, Sutton about whether the funding is getting through. The funding is there, and it has been confirmed that PCTs will have it. That is why the dental action plans are being developed.
On international recruitment, we have had discussions not only with Poland but with Spain, Denmark and Germany, where we are building on established links to recruit additional dentists to the NHS. We will be working with strategic health authorities to target international recruits at areas with the most acute access problems. I can confirm that Devon will be one of the first areas to receive new recruits when they start to arrive later this year.
So, there are some immediate problems, but I hope that hon. Members will accept that we are looking for a viable longer-term solution to the difficulties that we have inherited. We are also taking action to address the immediate, short-term problems that hon. Members have raised. The package that we have put together, which we have worked out with the profession, will lead to better working lives for dentists and improved services for patients.

International Air Transport Association
11 am
Andrew Selous: It is a pleasure to raise this important matter on behalf of one of the major employers in my constituency. The debate is to do with competition policy and the International Air Transport Association, which is giving the company, the Official Airline Guide, great cause for concern. OAG Worldwide Group Limited is a private publishing and data business and the premier supplier of consolidated scheduled airline information to the airline and travel industry. It has been the international leader in its field for more than 70 years, and has 470 staff, some 300 of whom are based at its headquarters in Dunstable.
It is a high tech business, at the heart of airline schedules distribution in both the business-to-business and the business-to-consumer sectors. It is a core source of operational critical data for many airline reservation systems—the global distribution systems that feed the world's travel agents—and its direct consumer reach of more than 1 million people is growing rapidly as internet and mobile distribution grows.
OAG works independently, not beholden to any airline, travel company or other organisation. Its strength lies in the quality, depth and breadth of its regularly updated and meticulously checked global flight schedule database. It uses datasets, key raw data for industry capacity and route development analysis, with past and future data available. The data are distributed via data feeds, online, on CD-ROM, mobiles and personal data systems and in books of several sizes. It is an outstanding British company, investing heavily for the future. I recently had the pleasure of going round its offices. It has an outstanding staff with many years' experience, and it is investing significantly in the latest information technology. It is just the sort of company for which the country needs to guarantee a bright and prosperous future.
IATA is causing OAG serious concern, in that its officers claim that they have been given a brief by the airlines to destabilise OAG. OAG does not believe that that is the case so far as the airlines are concerned. It has evidence that IATA has sought to destabilise it by telling competitors that it is going bankrupt. I have, as evidence, a letter concerning disparaging remarks made by an employee of IATA to a representative of Golden Ware Travel Technologies. The letter, from Mr. Michael Feldman, IATA's director of passenger services, was faxed to Mr. Rory Veevers-Carter, vice-president of sales and marketing of Golden Ware. It begins:
"It has been brought to my attention that Mr Juan Catala recently made comments to representatives of Golden Ware Technologies ('GoldenWare') which have been misunderstood by Golden Ware as questioning OAG's financial standing. OAG has an excellent and long established reputation within the airline industry and IATA is not aware of any basis for questioning the company's financial or trading status. As such, on behalf of IATA, I wish to unequivocally and unconditionally correct any inference to the contrary which may have been derived from Mr Catala 's comments."
It continues:
"IATA sincerely regrets any adverse imputation concerning OAG which may have been drawn from Mr Catala's comments and apologises unreservedly to OAG for any such imputation."
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IATA has tried to obtain OAG's pricing via IATA meetings, and has questioned OAG's customers about the value of its products. IATA has also asked airlines to commit to its service, which it calls the schedule reference service.
Individual airlines currently provide their flight schedules through various distribution channels to consolidators and intermediaries, such as OAG, who create their own data products and services and distribute them to airlines, businesses, passengers and the travel industry. As I said, however, IATA is establishing the schedule reference service—the SRS—which is an industry-wide consolidation service designed to provide, in IATA's words,
"a single, neutral industry schedule database for the collection, verification and onward distribution of schedule information for the whole air transport industry".
That simply proves that IATA wants to replace OAG as the industry's core schedules database. It wants not to provide an alternative data source, but to take sole control in an entirely unacceptable, monopolistic way. It is actively seeking to further its ambition by partnering, endorsing and entering into an exclusive marketing agreement with a small, historically loss-making US company, Innovata, to provide a competitive service and leverage IATA's industry status to help this player to take business from OAG. Innovata is the appointed operator of the SRS, while IATA claims that it is responsible only for marketing and promoting that service to the airlines. As the leading trade association for the airline industry, however, IATA's strong position unquestionably enables it to advance the interests of the Innovata-SRS service and to put direct and indirect pressure on its member airlines and, indeed, on other airlines in the industry.
OAG pointed out to me that this monopolistic channel of supply will have serious anti-competitive consequences, as IATA, through its member airlines, will be able to control the way in which the data is distributed. Inevitably, the loss of competition would increase prices, stifle technological innovation and reduce choice for users of airline information. Fundamentally, IATA is an association of competing airlines, and, as such, frequently can operate only on the basis of specific exemptions. To our knowledge, no such regulatory approval or exemptions have been granted to IATA for the SRS. Expecting IATA not to leverage its dominant status would not correspond with its ambition or track record. For example, IATA recently told OAG that it would take it out of the cargo business. Its tactics were successful in the cargo rates area, in which it dramatically increased OAG's data supply cost. It is currently trying similar tactics to suppress OAG's desire to distribute cargo rules.
There are clear analogies to be drawn between IATA's conduct in relation to cargo rates and its anticipated monopolistic behaviour in relation to flight schedule data through the SRS. As with cargo rates, IATA could simply impose unreasonable prices or terms for the supply of consolidated flight schedules.

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There is no future for OAG if IATA achieves a monopoly in the flight schedule sector. Some 300 of my constituents' jobs could be lost. OAG's existence is therefore under direct threat from IATA. The knock-on effect would be the loss of jobs in Dunstable, about which I have already spoken. What is worse, however, is that this would seriously damage the UK's leading position in this sector.
IATA's aforementioned actions are questionable for the following reasons. In view of IATA's position as the airline industry's leading trade association, it is wholly inappropriate for IATA to align itself with particular suppliers to the airline industry. A trade association, which is a grouping of competitors in the industry, must remain neutral with respect to the products and services that its individual members buy in the marketplace. IATA holds huge sway in the airline industry and manages a breadth of committees that influence the way in which the industry operates and the standards that it adopts. Should IATA be allowed to masquerade as a trade association while furthering its own commercial interests?
As a result of IATA's actions, OAG made a formal complaint to the European Commission on 12 September 2003, a copy of which was registered with the United States Department of Justice. As I explained, the complaint details IATA's desire to establish a monopoly SRS. However, the complaint has so far not been progressed. OAG has corresponded with several MPs, but the British Government seem to have washed their hands of this complaint, stating that the complaint is an issue for the EC's competition directorate.
On 29 April 2004, I received a letter from Mr. Mario Monti, the European Commissioner which states:
"This complaint is currently being examined by my services. Given the complexity of this case, it will take some more time before my services are able to come to a preliminary conclusion about the possible existence of an infringement of competition rules by IATA. I hope you will therefore understand that I am not able at this stage to take a position on the merits of this case."
Considering the prolonged delay in receiving a response from the European Commission, which lasted seven months from the date that the complaint was officially submitted, what can the Minister do to help the interests of a fine market-leading British company? If the complaint does not progress as soon as possible, OAG's ability to continue to provide an independent service to the industry will be irreparably damaged.
May I summarise the problem for the Minister? Essentially, the ramifications of IATA's actions are potentially immeasurable. The negative aspects of a monopolistic service will be felt by all players within the travel market including application service providers, global distribution systems and publishers, as well as the airlines that generate the data in question and the ultimate consumers of that information, namely the purchasers of airline and other integrated transport-related services and publications. No part of the schedules supply chain will be immune from the negative pressures that the SRS is expected to exert on it.
I hope that the Minister will declare that the arrangements are in breach of article 81 of the EC treaty and are not capable of individual exemption under that
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article. He should investigate the complaint, which covers the agreements, arrangements and practices within IATA and includes the marketing agreement with Innovata for the implementation of the SRS, and he should have that agreement with Innovata terminated. I hope that he will ensure that if the schedule reference service proceeds, it will not become an exclusive channel of supply. First, he should ensure that the airlines continue to provide raw flight schedules data to OAG on terms that do not discriminate in favour of the SRS; secondly, that the airlines and other users have an unrestricted right to source consolidated flight schedules data and other data products from competing consolidators such as OAG; thirdly, that IATA does not misuse its position as a trade association to favour the SRS.
In summary, I ask the Minister to champion the interests of a leading British company. All the issues that OAG has raised with me are highly worthy of debate as they seriously question both the role of IATA as a trade association and its future role as a competing commercial organisation. The Government, up until now, seem to have handed the buck to the European Union, but the complaint has been held up in the European Commission for nearly eight months. Surely the commercial interests of one of the UK's major employers should take priority? Can the Minister seriously let a trade association behave so anti-competitively? Should a trade association be allowed to undermine a company in such a blatant fashion?
OAG's criticism of IATA's anti-competitive behaviour is serious enough to merit an investigation, and I hope the Minister will investigate the matter further. I hope that he will in particular put pressure on the European Commission to take the action that I have outlined, in the interests of British business and British jobs as far as they affect my constituents.
11.14 am
The Parliamentary Under-Secretary of State for Trade and Industry (Nigel Griffiths): It is a pleasure to be here with you again, Mr. Deputy Speaker, and to congratulate the hon. Member for South-West Bedfordshire (Andrew Selous) on securing this debate on an important issue.
OAG has a proven track record of providing a first-class service to business and the Government take this issue seriously. I shall outline the steps that have been taken so far. I would like to reassure the hon. Gentleman that the Government have acted properly on the matter, and I will take him through the procedures.
Commissioner Monti, who is responsible for competition matters, has agreed to open a formal investigation of OAG's complaint concerning IATA, which will be carried out under article 81 of the treaty. The Commission must carry out a thorough investigation in accordance with competition-related criteria. The Enterprise Act 2002 took Ministers and politics out of competition decisions in the UK in the interests of producing a more transparent and predictable system for the consideration of competition cases. The decision to do so was based on three principles: that competition-related decisions are best

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determined by the competition authorities according to competition-related criteria; that Ministers should avoid undermining the regulators or appearing to influence them in carrying out their independent functions; and that Ministers should seek to support competition regulators in their work. Although the policy was primarily developed for a domestic regime, it applies equally to competition investigations carried out by the European Commission.
Commission investigations are legal processes under article 81 of the treaty. The hon. Gentleman voiced his concern about the time that the investigation might take, and yesterday, at my instigation, officials at the Department of Trade and Industry checked with the Commission and made our view clear about the need to expedite proceedings. As it is a legal process, the Commission will give interested parties the opportunity to submit evidence, and the party under investigation—in this case IATA—will take every opportunity to defend itself as it sees fit.
I want the Commission to resolve the investigation as soon as it can. The Commission has recognised that there may be a case to answer and is formally investigating the complaint. I shall ensure that the hon. Gentleman's contribution to the debate, and my response, is forwarded to Commissioner Monti.
Andrew Selous: I am grateful to the Minister for giving way and for his Department's action on the matter yesterday.
On the time scale of proceedings, can the Government exercise any influence to ensure that this serious matter, which has been with the Commission for eight months, is expedited as quickly as possible?
Nigel Griffiths: We have left the Commission in no doubt that delays in handling competition matters can damage all the parties involved, and I am sure that the Commission has taken that message to heart.
Our position on competition policy is clear: we believe that strong competition benefits businesses and consumers. For business, it sets out a level playing field on which it can compete fairly; for consumers, strong, fair competition can set downward pressure on prices and upward pressure on quality. The overall aim of competition policy is to encourage and enhance the competitive process to bring wider benefits to the economy in increased productivity. In recent years, the Government have taken active steps to modernise and strengthen the UK's competition laws as part of our wider agenda of promoting competitiveness and growth. The stated cornerstones of that modernisation are choice and value for consumers and dynamic and innovative markets, such as the one that the company in question has created from its base in the hon. Gentleman's constituency.
The mainstay of our competition regime is the Competition Act 1998, which I had the honour of taking through the House of Commons as the competition Minister. That Act is closely modelled on the EC treaty, particularly articles 81 and 82, which it mirrors, and replaces earlier legislation, including that relating to restrictive trade practices. We have moved away from
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public interest tests by means of consolidation in the Enterprise Act 2002, in order to take the politics out of competition decisions in all but a narrow set of circumstances. It is important to stress that such decisions are now taken by the independent expert competition authorities, using competition-based tests.
The rigorous enforcement of rules by the relevant independent competition authorities is important—whether by the Office of Fair Trading, the Competition Commission or the sectoral regulators in the UK or, as in this case, the European Commission, where intra-Community and global trade are involved. The Commission is widely respected for its independence and its balanced and rigorous approach to enforcing EU competition rules in a number of landmark cases. I hope that that will reassure the hon. Gentleman and his constituents.
In the UK, the Competition Act, which mirrors articles 81 and 82 of the treaty, constitutes the basic EU competition rules. Under the treaty, the Commission—specifically, the director general for competition—has sole responsibility for enforcing the EU's competition rules and considering individual cases under the rules. Article 81 prohibits agreements between undertakings that prevent, restrict or distort competition in intra-Community trade. Article 82 prohibits the abuse of a dominant position with no exemption possible. Those areas were elaborated on by the hon. Gentleman.
Turning to the technicalities, exemption from the prohibition of article 81(1) is possible under article 81(3), which lists four conditions that must all be satisfied if an agree rent is to be exempt from the general prohibition. The agreement must contribute
"to improving the production or distribution of goods or to promoting technical or economic progress, while allowing consumers a fair share of the resulting benefit, and … not:
(a) impose on the undertakings concerned restrictions which are not indispensable to the attainment of these objectives;
(b) afford such undertakings the possibility of eliminating competition in respect of a substantial part of the products in question."
In straightforward terms, those conditions are answered by one question: are the restrictive aspects of the arrangements in question indispensable to improving the product or benefiting consumers? If a case fails that test. any anti-competitive behaviour is prohibited and any anti-competitive agreements are declared void. In extreme cases, parties infringing the rules can be fined a maximum of 10 per cent. of their turnover, so the stakes in such an investigation are obviously very high. That is one of the reasons why the competition, following due legal process, must give any parties to an investigation every opportunity to submit their side of the story. Obviously, the Commission sets down a reasonable time scale for that, but I want the Commission to ensure that no parties take advantage of its procedures to delay and drag out the proceedings unnecessarily. As I said, I recognise the damage that that does to other parties and, quite often, to the party under investigation as well.

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I know that the hon. Gentleman will continue to monitor the situation carefully, as will my hon. Friend the Minister for Employment Relations, Competition and Consumers, who is unable to be here. I shall ensure that he, too, is fully aware of the contribution that the hon. Gentleman has made and of the follow-up actions that I have given a commitment to undertake.
11.25 am
Sitting suspended until Two o'clock.

Mersey (Second Crossing)
2 pm
Mr. Mike Hall: I hope that you, Mr. Deputy Speaker, pass on my thanks to the Speaker for granting this Adjournment debate on a subject that is of great importance to the economy of the north-west. I want to start by briefly examining the history of crossings over the River Mersey. There is some debate as to whether the Romans built a bridge over the Mersey between what is now Widnes and Runcorn, but there is no doubt that there was a fording place in the Warrington, South area in Roman times. In 1905, the transporter bridge was built. The current Silver Jubilee bridge—there is an argument over whether it should be called the Runcorn-Widnes bridge or the Widnes-Runcorn bridge; its nomenclature depends on which side of the river people live—was built in 1961, widened in 1977 and renamed the Silver Jubilee bridge.
For some time in our area we have struggled with extreme congestion on the Silver Jubilee bridge. In the early 1990s, the then hon. Member for Halton and I pursued the Transport Minister to see whether a new river crossing could be built, and a case study was commissioned in 1991 to determine whether that was possible. The resulting report confirmed that the bridge was congested, but argued that since it was of no strategic importance to the north-west, a second crossing should not be paid for out of public expenditure.
The Silver Jubilee bridge has a capacity of 65,000 cars a day. About 75,000 cars a day were using it in 1993 and the average is now more than 80,000 cars a day. Moreover, on some days last year, 92,000 vehicles used the bridge, so it is clear that it is severely congested. The Oscar Faber report, published in 1997, concluded that by 2016 between 115,000 and 150,000 vehicles might cross the bridge, which would be massively in excess of its current capacity. The report also concluded that that was a constraint, not only on the economy of Halton and north Cheshire, but of Merseyside and the greater north-west region.
When the then Secretary of State for Transport turned down our appeal on the basis that there was no strategic need for the bridge, he said that we might seek a local solution to the problem. We therefore set up a consortium of local authorities. Some 80 per cent. of the traffic that uses the bridge is not local; 40 per cent. goes straight through the borough and 40 per cent. ends or begins its journey in Halton. It is therefore clear that the congestion is not just related to the borough of Halton.
In 1995 Halton borough council became the lead member of a group of Merseyside authorities—Liverpool metropolitan borough council, as it then was, the councils of Wirral, St. Helens, Knowsley and Sefton, Warrington borough council, and Cheshire county council—which formed a consortium with Merseytravel, the local chambers of commerce, English Partnerships and Peel Holdings. The aim of the consortium was to devise a local solution to the problem. More recently, the North West regional assembly and the Northwest Development Agency have joined the consortium to give real impetus to the demand for a new crossing over the River Mersey.
Mrs. Louise Ellman: I agree with the important points that my hon. Friend makes about this being a regional matter, reinforced by the involvement of the Northwest Development Agency. Does he agree that it is of specific interest to the development of Liverpool and particularly the port of Liverpool? The movement of traffic and the prevention of congestion are critical to developing the port's trade, and the building of a second crossing would be an essential factor in achieving that.
Mr. Hall: My hon. Friend makes a valid point. I was not going to cover it, but she draws attention to the fact that the port of Liverpool is very important to the economy of the north-west. If we are to have a new crossing over the River Mersey, it will enhance the port, the economy of Liverpool and the wider region.
There are two tunnels under the River Mersey directly in the Liverpool area. The first crossing over the river is the Silver Jubilee bridge. There is a very local crossing in Warrington, South—in the town centre in Warrington. Anyone who has needed to travel through Warrington or Runcorn when the Thelwall viaduct is closed will know just how unsatisfactory that is for any strategic access into the north-west. Then we have the Thelwall viaduct itself. A huge amount of money has been spent on dualling the viaduct, only for us to find out that the structures of one carriageway have been seriously corroded. Traffic is now restricted on the viaduct and will be for quite some time. For a 24-mile stretch of river, we have only three significant crossings. That is why another is essential.
In 1997, my hon. Friend the Member for Halton (Derek Twigg) and I continued to press the Government to consider the issue, so that we could take forward the ideas coming out of the new Mersey crossing consortium. We were able to persuade the Secretary of State for Transport to provide a £600,000 grant for a feasibility study of where the bridge might cross the River Mersey and what its impact would be in the local area and more widely in the north-west region. As a direct result of that money, we have a clear idea of where we want the bridge. Perhaps I can give a plug to Halton borough council. It has produced on a CD a powerful case for the new Mersey crossing. The CD is available free at the point of need. It explains in graphic detail the benefits of the crossing and shows in interesting diagrammatic form what the bridge will look like and where it will go.
The debate is about whether we should dual the Silver Jubilee bridge or go elsewhere. Clearly, the cheapest option would be to dual the existing structure, but that would have a severe environmental impact in the Dukesfield area of the constituency of my hon. Friend the Member for Halton, which covers Widnes. That option would not be acceptable. We want a better strategic route across the river. The local authority consortium has settled on a link from the Speke Road dual carriageway in south Widnes to the central expressway in Runcorn. That is a fascinating piece of the jigsaw puzzle, because it will provide a strategic link from the M56 to the M62, so creating another piece of improved infrastructure for our area as well as providing a significant crossing of the River Mersey.
The consortium did not stop at considering where the crossing should be. It decided that we needed a road
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bridge, but there was also the question of whether we could use the structure for something else. The structure is designed—I must read out this technical term—as a multiple cable-stayed bridge with a box structure providing the necessary stiffness. The structure will also provide the ability to use the lower deck for other modes of transport, such as a light railway. Merseytravel and Halton borough council are seriously considering that. They have declared that they are committed to extending Merseytram line 3 to Halton, and the bridge may be the way to enable that to go forward.
There are key benefits to providing a second crossing over the River Mersey. It will provide regional regeneration and better public transport. It will help business with better transport, and the links between Manchester and Liverpool and to Liverpool John Lennon airport will be greatly improved. It will also improve communications in the north-west. Traditionally, communications go east to west, but we want them to go north to south. It is very important for us to establish another strategic north-south communications route in the north-west.
Mr. David Watts: My hon. Friend spoke about the benefits—for example, the links with Manchester—that can be derived from a second major river crossing for Liverpool. Does he agree that that is crucial for areas such as St. Helens because 90 per cent. of people who wish to cross the river from St. Helens use the Runcorn bridge?
Mr. Hall: Indeed, they do use the Silver Jubilee bridge. If the second bridge across the River Mersey is agreed, there will be implications beyond the road network for areas such as St. Helens. Both my hon. Friends the Members for St. Helens, North (Mr. Watts) and for St. Helens, South (Mr. Woodward) have rightly tabled questions on the issue. We must be alert to the possibilities for development north of the borough of Halton if the proposed crossing gets the go ahead.
The project will bring 3,350 permanent jobs and 1,600 temporary jobs to the area; it has a £15 million development value, and it will have a return of £666 million, which is a sound economic investment in the region. Last summer, we were given a good nod from the Department for Transport in relation to the benefits that the scheme will bring. The consultants submitted their views to the Secretary of State and just before Christmas he gave the project "super work-in-progress" status, which was extremely well received in the area. It indicated that at long last we had been able to persuade the Government that the second crossing was essential.
However, several matters are still outstanding. The Government asked for an assessment of the impact that the traffic will have on the major highway networks, including the M6, the M56 and the M62, which is now under way, as is work on the hydrodynamic impact of the bridge on the River Mersey. The best and most effective ways of procuring the bridge and the procedural routes that need to be followed are being considered, and also whether tolling should fund the project.
I understand that the Government want us to consider whether the new bridge could be a toll bridge because every avenue of finance must be explored, but

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my view is that the bridge should be free to users. The Government are prepared to invest in crossings of the River Thames, of which there are 36–27 between Vauxhall and the M25 and nine between Tower bridge and Dartford—and they have just agreed to partly fund the new crossing over the Thames gateway. It is therefore not too much to ask them to fund the new crossing of the River Mersey. It has few strategic crossings, but the stretch of water is just as significant as the Thames.
My attention was brought to the significance of the river crossings when John Bell, a business development partner at Glenny, said:
"The question isn't so much 'should Thames Gateway Bridge be built?' but rather 'when?'. It will help to remove the physical barrier that the Thames creates for business investment and stimulate property development either side of the river, as well as easing congestion on the existing crossings which are at breaking point".
If the River Thames needs Government investment because bridges are congested in the London area and along the river, there is a strong case for Government funding towards a new crossing of the River Mersey.
The borough of Halton is listed at No. 14 in the 2004 deprivation index. It would boost the economy if we avoided imposing tolls for using the new bridge and ensured that there was no barrier to investment and economic development in the area.
Halton, as lead borough, and the consortium for the new crossing, will submit their plans to the Secretary of State for Transport in the autumn. I hope there will be a decision before the end of the year, giving the green light to go ahead with the project. Then the procurement procedures and the necessary legal processes to agree the line of the bridge, which includes holding a public inquiry, can be sorted out, and construction can begin in 2007. The sooner construction begins, the better. There are city of culture events in Liverpool in 2008 and it would be helpful if the infrastructure were in place by then. The area is of strategic importance in that respect. I know that that is a tall order, but we are looking forward to making real progress.
My hon. Friend the Member for Halton and I have worked extremely hard on the project. It is a tribute to the partnership of the new crossing consortium that we are now close to realising the dream of a new crossing over the River Mersey. Part of our contribution has been to invite successive Transport Ministers to Halton to see the problems. There have been a number of visits, including recently by the Under-Secretary of State for Transport, my hon. Friend the Member for Harrow, East (Mr. McNulty). That was a seminal visit in the campaign to establish the case for going ahead with the second crossing of the River Mersey. I congratulate the consortium on the work that it has done under the leadership of Halton borough council.
I finish by summarising the case that I have tried to set out. The Silver Jubilee bridge is seriously congested, a situation that will only continue to worsen. The lack of a new crossing over the River Mersey is a continuing constraint on the economic health of our region. There is a strong strategic case for the construction of a new crossing of the River Mersey, for the reasons highlighted this afternoon. The preference is for a bridge that is free to users. It would be a sound economic investment with a guaranteed good return. It would also be a positive
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demonstration of the Government's commitment to strengthening the economy of the north-west. I hope that the Minister will be able to reassure us that the project remains high on the Government's list of priorities and that we can be confident that the scheme will go ahead.
2.16 pm
Helen Southworth: I congratulate my constituency neighbour and hon. Friend the Member for Weaver Vale (Mr. Hall). He will be familiar with the issues that I will raise because he used to represent the southern part of my constituency before boundary changes, so he realises the local impact as well as the strategic significance across the region.
I know that you are well aware of the area, Mr. Deputy Speaker, but I wish to draw attention to some of the relevant geography. The Mersey is a big and strategically important river. It is very important to the north-west, which, as we both know, is the most important region in the United Kingdom. The first fordable point of the River Mersey was at Latchford in Warrington. It was identified by the Romans, as my hon. Friend pointed out, and is the reason for the name Latchford. That is also why Warrington, like London, has developed on either side of the river, with the river passing through the centre of the town. As my hon. Friend pointed out, the next two bridges along the river to the east are in my constituency, and one of them is directly in the town centre. There has been a bridge at that point since medieval times and the medieval market went along the same street as it does today to supply the sub-region, as Warrington still provides services for the local area.
For 2,000 years, Warrington has been a centre of north-west communications because it has been the point at which one can cross the Mersey most effectively. That has given us tremendous benefits over the years. During the industrial revolution, we had the first navigable waterway, the Sankey canal, which was constructed in Warrington. The Manchester ship canal passes through my constituency, as does the Bridgewater canal, the west coast main line and the Liverpool-Manchester railway. We have developed the M6 and M56, which go through the constituency, and the M62, which borders the constituency. They have brought tremendous benefits to Warrington and the sub-region over the years, but there have also been challenges.
Those challenges, particularly those relating to river crossings, have serious and significant local consequences. Local residents and businesses must cross the Mersey over the small bridge in the centre of town to get from one side of the town to the other. That bridge is considerably and detrimentally affected if there is any problem on the Thelwall viaduct or the Silver Jubilee bridge. Sadly, because it lies between those two points, the town centre is affected by both. As we all know, and as I have said in the Chamber, the impact of the Thelwall viaduct repairs has been significant. The fact that it is advertised throughout the north-west and, unfortunately, on traffic programmes on national radio, demonstrates the significance of the river crossing and very adequately supports the consortium's claim that we need another strategic bridge across the river.

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Significant numbers of local people and organisations in Warrington support my hon. Friend in the debate. The leader of Warrington borough council sends the support of the council, which has been a supportive and enthusiastic part of the consortium and recognises the urgent need for the new river crossing and its strategic impact on Warrington, the north-west and its economy. The northern growth corridor in the north-west between Liverpool and Manchester will bring substantial opportunities for economic growth and development for the constituents of my hon. Friend and his neighbours who are in the Chamber, as well as those of hon. Members who could not get here today. My borough council wishes to express its support for those opportunities.
Warrington chamber of commerce totally supports the proposal. It is very concerned that the current bridge is supposed to carry 60,000 cars a day, but in fact carries 90,000 cars a day between Runcorn and Widnes. We recognise the local impact on congestion in the town centre, as well as on business costs incurred by people experiencing delays on the three bridges. The chamber of commerce recognises that a new bridge is essential for the economic development of Warrington and its sub-region. It pointed out the need to support the Omega site, to which I shall refer in a moment.
The small business service in Warrington also supports my hon. Friend's efforts. It believes that investment in the second bridge will greatly improve the efficiency of the sub-region and asks that the request for another bridge is supported. The regional development agency, which is based in my constituency on the edge of the river, also recognises the strategic impact on the sub-region and the region as a whole as well as for people moving in and out of Warrington.
In short, my constituency is at the centre of a thriving and growing economic sub-region. We are a hotbed of enterprise, technology, science and competitiveness, and the only town north of Birmingham with a top 25 location rating. Our unemployment rate is impressively low and our forecasts predict that the Warrington economy will outstrip national growth by more than 300 per cent. by 2015. We are not, however, complacent about such economic strength. We recognise that the sub-region is a significant centre of employment for parts of Halton, St. Helens and Wigan.
Many thousands of people come to Warrington for employment and service support, but we also want the sub-region to thrive so that unemployment in colleagues' constituencies, which has plummeted as a result of the Government's support, will continue to decrease. We want to continue to have considerable extra employment in the area. The business and academic networks in Manchester, Liverpool, Warrington and the areas in between are very significant. There is a tremendous development of skills in the area, and we want the infrastructure to support it.
We still face the challenge of tackling remaining areas of deprivation in our borough and the surrounding sub-regions. According to the index of multiple deprivation, two wards in my borough are still among the most deprived 10 per cent. nationally, and other wards in Warrington are among the worst 20 per cent. The council and its partners are keen that support for
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continued economic development should focus on providing opportunities for people in the borough who are suffering deprivation and not getting the full benefit of the employment possibilities that are opening up. We would also like to see significant developments in that respect in neighbouring constituencies and boroughs.
A significant part of Warrington's importance to the sub-region lies in the opportunities for further development and growth. We already have development plans, which are incredibly important for the sub-region. However, they depend on an effective transport infrastructure, and one is not currently fully in place. We must see movement on the issue.
Warrington is already the site for the global headquarters of United Utilities and the regional headquarters of companies such as Hewlett-Packard, AirMiles and O2. However, we want more companies to be based there for the benefit of not only my constituents but the whole region. I am sure that that you, Mr. Deputy Speaker, will support that concept, as you so often do.
I referred to the northern growth corridor, but I want specifically to mention the Omega site, which is very important for the strategic sub-region. It is located in the west of Warrington, towards the area that is being considered for the river crossing. It is adjacent to and bisected by the M62 motorway, to which it has direct access via the new junction 8. We are thankful to the Government for making the necessary investment, and we are looking forward to further investment to ensure that we get the new river crossing. The Omega site is widely recognised as one of the largest and most important strategic development projects in Europe. It gives us an opportunity to bring many more jobs and considerable investment into the area.
I want to raise what is perhaps a side issue, but it is important. We are all looking with considerable interest to the Lyons review, in which we see opportunities for our region. There is the Omega site in my constituency and my neighbour's constituency. There are also further proposals for high-quality business developments at Centre Park, where the Northwest Development Agency has its headquarters, at Lingley Mere, where United Utilities has its global headquarters, and at several other sites. The neighbouring constituencies are also identifying excellent opportunities for civil servants to move into our region and pursue effective career development.
For those reasons, we deserve a better river crossing. The partnership has been very effective, and we have worked together well to ensure that we get the opportunities that we need. We deserve them because our region is effective and has the resources, and because our constituents are working to ensure that there is thriving economic growth in our region.
In the recent past, we have not had the opportunities that we should have had, but we are now being given them under this Government. We want more such opportunities, and I support my hon. Friend in asking the Government to invest in our region so that we can grow, thrive and contribute to the economy as we have always done and as we have every intention of continuing to do.
Mr. Deputy Speaker (Sir Nicholas Winterton): I want to help hon. Members. It would be appropriate for the winding-up speeches to start at about 3 o'clock. I spot at least three hon. Members trying to catch my eye, and there may be more. Hon. Members should bear that in mind in respect of the length of their speeches.
2.29 pm
Mr. Peter Kilfoyle: I, too, congratulate my hon. Friend the Member for Weaver Vale (Mr. Hall) on securing the debate and on giving us the opportunity to record our support for the project. That support is very widespread. I also congratulate my hon. Friend the Member for Halton (Derek Twigg), who has been an enthusiastic advocate of the project. In some quarters, he has earned the appellation Turnpike Twigg, because he is so keen to push forward the idea of a second crossing, which we need.
My hon. Friend the Member for Weaver Vale mentioned the bridges in London and the preferential treatment that they are afforded. We should bear it in mind that the Mersey is a mighty river from Halton to its mouth. It is not a piddling little stream like the river here in London. Its geography, submarine morphology and hydrology mean that the only practical place to build a crossing is from Halton. going upstream. The need for an extra crossing is without question.
I am probably one of the few people here who recalls travelling across what we called the old transporter bridge when I was a boy. It was a cable-drawn bridge. I watched with increasing awe and wonder as the new bridge was built, but it was not always heavily used. I recall reading an article. in the dark days after the 1981 riots, by a famous Liverpool journalist called Stanley Reynolds, in which he referred to the museum of the horrifying example. The article was so good that it ended up in international copies of The Guardian, so it was read all over the world. To give a sense of the downward spiral of Liverpool and Merseyside, Reynolds discussed the lack of a rush hour. He said that nobody rushes and that there was nothing that one would recognise, in metropolitan terms, as people going to and from work in rush hour, and he was right. The bridge was like that, but that is no longer the case. That is a sign of the changing times, which can be seen by anyone who uses the bridge, as I do, between what used to be the independent boroughs of Widnes and Runcorn, which have now combined to become the successful unitary authority of Halton. The bridge is now used quite frequently.
My hon. Friend gave the percentages of who goes where and who uses the bridge. The only issue that I take with those figures is that I would have used a starting point of 200 per cent. because I reckon that half the people who would use the bridge actually turn around and go back because they see the snarl-ups as they approach it. Such delays are a tremendous inconvenience to businesses and private traffic, such as commuters.
I must make a point, which I have made to my hon. Friend in fun, about the new phenomenon after the rush hour when the bridge is jam-packed and the milk floats come out. Someone might be trying to get to a station, or a business might be trying to get its products across the bridge, when the electric milk floats appear, as they
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do with regular and depressing monotony, and there is a second back-up because the traffic is all stuck behind them. There is no other option: people have to go across the bridge because there is no other viable way of going about their business.
You and I both know, Mr. Deputy Speaker, that on many occasions in the past, it has been extremely difficult to get Merseyside MPs to agree on anything—even the time of day.
Mr. Watts: To be fair to the milkmen driving those milk floats, does my hon. Friend agree that it is not just milk floats that cause delays on the Runcorn bridge? It can take up to 20 minutes to cross the bridge. Does he think that that would be an acceptable length of time to spend crossing a bridge in London?
Mr. Kilfoyle: No, it would not be acceptable.
Other problems are caused by the bridge being used to overcapacity and by the constant maintenance work. It is an incredibly difficult issue. It is important to recognise how important Runcorn railway station is, not just to right hon. and hon. Members who catch trains from there to London, but to the many business men who use it for the same purpose. It must be no fun for someone who has an important business meeting in London to be stuck in a traffic jam that they cannot avoid because there is no way around it.
The point that I was making about MPs not previously agreeing on things is that we certainly agree on the need for a second crossing. I notice that hon. Members representing Merseyside, Cheshire and Lancashire constituencies are in the Chamber. There is even one, my hon. Friend the Member for Eccles (Ian Stewart), who is trying, I think, to catch your eye, Mr. Deputy Speaker, who represents the far-flung reaches of Greater Manchester. That shows what a regional asset the new bridge would be and how important it is to us all, not just to Halton or Warrington. Even in your celebrated part of Cheshire, Mr. Deputy Speaker, I am sure that people would cry out with joy if the Minister were to confirm that the bridge is to get the go-ahead and the priority that it deserves.
2.35 pm
Mr. George Howarth: I add my congratulations to those that have been offered to my hon. Friend the Member for Weaver Vale (Mr. Hall) on securing the debate and on his thorough introduction of the topic.
Some context may help to explain why the bridge is important to me and my constituents. We need to recognise that although there are still some serious black spots on Merseyside, the economy is gaining strength. Many kinds of evidence for that can be found in all sorts of places. The Liverpool Daily Post pointed out that some major investment decisions could be contingent on the second crossing going ahead. I refer, of course, to Jaguar, which is considering what investments it will make in future and how those would fit into the regional transport system.
The decision is certainly important to the industrial centres of Kirby in my constituency, Huyton and parts of Sefton. As my hon. Friend the Member for St.

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Helens, North (Mr. Watts) pointed out, it is also important to those in St. Helens who conduct business further afield.
My hon. Friend the Member for Liverpool, Walton (Mr. Kilfoyle) was exactly right when he said that serious traffic problems did not arise in the 1980s but now happen during the day all over the region—I prefer to call it that rather than a sub-region, but we shall not pursue that argument today. In parts of my constituency and in Liverpool and elsewhere there are serious congestion problems. However, it is on the bridge that some of the biggest problems arise, several times a day. As my hon. Friend pointed out, the congestion sometimes has very unexpected sources.
Transport links are important and several new developments are taking place. We have a tram scheme that will link Kirby in my constituency with Liverpool city centre. There are still some arguments about that, which it would not be appropriate to go into today, but nevertheless the development is strategically important to my constituency and to north Liverpool, which is so often neglected, particularly by Liverpool city council. It is also hugely important to many people who want to find or keep employment and who move about the region.
After a long campaign, and a great deal of support from Ministers in the Department for Transport, we now have direct flights to and from London. That is important in two ways: first, it means that there is a cheap, quick and efficient link between London and Liverpool John Lennon airport, and, secondly, it provides some competition for the west coast main line and Virgin. Any regular traveller on the route will have felt the consequence of that.
Before I finish, I want to stress a point that my hon. Friends the Members for Liverpool, Walton and for Weaver Vale both made in a slightly different way. The local authorities on Merseyside, in which I include Halton, have strongly supported Halton in the work that has been done on the second crossing. They have done so because, as my hon. Friend the Member for Liverpool, Walton explained, some solidarity has emerged between the areas in recent years. I should want to encourage that to develop further.
A second reason for the local authorities' attitude is their recognition that, because of the development's strategic economic importance to the region, it is logical for them to support the important and excellent work that Halton has done with the other partners.
Ms Christine Russell: I just want to put it on the record that Cheshire county council is a key supporter of a new Mersey crossing, as is the local authority of the city of Chester. I am sure that you, Mr. Deputy Speaker, are aware of that. The support for the crossing goes wider than simply Liverpool and Merseyside; it stretches throughout Cheshire.
Mr. Howarth: I am grateful for my hon. Friend's intervention, which is timely because my next point is that the crossing is strategically important to Cheshire. I know, Mr. Deputy Speaker, that everything that has to do with Cheshire is dear to your heart, too. If the
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development goes ahead, it will be a win-win situation and, as my hon. Friend said, there will be cries of joy in Cheshire. People will be dancing in the street in Knowsley if the scheme obtains approval. It will not be a pretty sight, but I shall be dancing alongside them.
Mr. Deputy Speaker: I am sure that the hon. Member for Ellesmere Port and Neston (Mr. Miller) will be dancing too.
2.41 pm
Mr. Andrew Miller: Not a pretty sight, my hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) and me dancing. I want to start with an apology to my hon. Friend the Member for Liverpool, Walton (Mr. Kilfoyle). When he described watching the bridge being built, as a small boy, I had always assumed that it was the transporter bridge that he saw being built in 1905. That was an extraordinary piece of engineering, and a great credit to the engineers of the time, but it was built at a time when nobody envisaged the growth of personal transport. At its height, just before its closure, it was carrying a volume of only about 1,000 cars, which was an extraordinary feat for that technology. When the new bridge was opened in 1961, it carried about a quarter of its supposed total capacity—just over 11,500 vehicles. It was never assumed that it would carry the current volumes. By 1999, the figures had risen to in excess of 80,000 vehicles. which is way beyond the bridge's design capacity, and the volume is still growing. The report to which my hon. Friend the Member for Weaver Vale (Mr. Hall) referred—I know that he is an excellent MP because he is my MP—spells that out: the average number of vehicles is now more than 80,000. One day last year, it cracked 92,000, and by 2016, the predicted figure is somewhere between 115,000 and 150,000 vehicles. That is a crazy number of vehicles, which will bring the whole network to a halt.
One thing is certain. Despite the minor differences between Merseyside and Cheshire Members about tunnel fees, one thing on which we agree is the need to maintain the circular network around Greater Merseyside. If we do not keep traffic flowing in the area, business and commerce will grind to a halt. The current situation, as was described earlier, is that at certain key times of the day, the traffic backs up both ways. Not only does that cause disruption to business and commerce but it is starting to create a danger because traffic wanting to go on to the southern side of the dual carriageway and slip off to Runcorn station finds itself banking up with traffic queueing for the bridge. That is inherently a dangerous situation, which is likely to cause road traffic incidents. In turn, that disrupts passenger access to Runcorn station. When we consider the traffic heading south to London and the traffic trying to get across the bridge, it is becoming a serious crisis.
When I first moved into the area in 1977, one could cross the bridge without impediment at any time of the day or night. That is no longer the case and it is putting the long-term economic future of the area at risk.
Those of us living on the south side, such as you and me, Mr. Deputy Speaker, may want to use John Lennon airport from time to time. However, the route is not reliable simply because of the blockage that occurs when

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crossing that bridge. Let us take as an example the superb new flight that goes from John Lennon to London City airport, which should he immensely convenient for businesses in and around my constituency. However, they cannot use that flight because of the uncertainties of crossing the bridge at key times of the day. Work needs to be done to maintain the strong circular infrastructure around Greater Merseyside's road network.
As my hon. Friend the Minister is aware from arguments that have come through his Department and the Strategic Rail Authority, we need to get the railway network around Halton curve resolved once and for all, so that we have a bi-modal arrangement that enables us to have a proper integrated transport structure serving Greater Merseyside, Cheshire and Lancashire. The whole of the sub-region will benefit if that investment takes place.
The Minister is faced with a dilemma. The projects are enormous and the cost will be in the multimillions. I think that the current projected figure is £300 million, a serious sum by any standard. An assessment needs to be made of the kind of payback that the region will receive. My hon. Friend the Member for Knowsley, North and Sefton, East has already referred to one of the key business decisions that may be in jeopardy if we do not take a positive view of that.
The opposite side of the issue is whether we can look at the cheap solution. As my hon. Friend the Member for Weaver Vale described, the cheap solution was dualling the existing arrangements. The problem with that is that, notwithstanding the huge disadvantage to the immediate residents of the area, it would be massively disruptive during the construction period. The kind of imminent decisions to which my hon. Friend referred would still be put in jeopardy if we had a protracted period of several years of construction during which the bridge was almost unusable.
On those grounds, I am delighted to give support to my hon. Friend the Member for Waver Vale and his silent partner, the hon. Member for Halton (Derek Twigg). It is extremely pleasing to k now that feeling in the area extends across all the political parties and that there is unity on the issue. There is also unity with the business community. The key environmental issues are solvable, and I urge the Minister to do all that he can in his office to ensure that the project goes ahead.
2.50 pm
Ian Stewart: Some people may be surprised by the hon. Member for Eccles. which is in the city of Salford in Greater Manchester, rising to pass comment on what is apparently a Merseyside concern. I would argue that although it is first and foremost an issue for the people of Halton and the wider Merseyside area, transport issues are inextricably linked across the breadth of the north-west. Whatever happens in Merseyside has an effect on Greater Manchester, Lancashire, Cumbria and Cheshire.
The Minister should be aware that taking part in this debate are my hon. Friends the Members for Preston (Mr. Hendrick) and for Workington (Tony Cunningham), who represent constituencies in Lancashire and Cumbria respectively, and myself, whose constituency is in Greater Manchester. That
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indicates the breadth of interest in what initially appears to be a local issue. Furthermore, my constituency mailbag tells me that transport, in particular public transport, and the highways are among the greatest interests of my constituents; they are up there with crime and health.
We must recognise the historical problems that we have created for ourselves. In the past 20 to 30 years, local authorities' budgets granted by the Government have reduced year on year. Understandably, many local authorities vired money from leisure and highways to protect education and social services. I would have supported that political decision in those years, but the consequence for our north-west region is that its roads, which are some of the most used and oldest industrial roads in the world, have been in great decline. My constituency includes the Worsley interchange. People speak about the spaghetti junction in Birmingham, but it is not the most congested interchange; indeed, the Worsley interchange is the most congested and used interchange in the whole of Europe.
Our road infrastructure and rail network are a wonderful facility and something that we should be proud of, but we should recognise that they are so well used and have been under-funded for so long that their problems need to be addressed strategically. The Chinese have the aphorism that says when a butterfly flaps its wings on this side of the world, a hurricane is created on the other. My view is that whatever happens in Halton is of interest to people in Eccles and Greater Manchester.
Mr. Mike Hall: I tried to make the point that the issue does not concern Halton or Merseyside exclusively, but is a regional issue for the north-west as a whole. The link between Manchester and Liverpool airports will be substantially enhanced by a new crossing of the River Mersey, as would the concept of the M62 corridor that the Deputy Prime Minister is keen to develop. I am sure that my hon. Friend, as an MP for a Greater Manchester constituency, would agree with that.
Ian Stewart: I do and I shall expand on that a little more. My hon. Friend the Member for Knowsley, North and Sefton, East (Mr. Howarth) made the same point. Transport infrastructure has a knock-on effect for employment mobility. Indeed, if there were a better transport infrastructure in the Manchester-Liverpool ship canal corridor—I believe that a new bridge would create a better transport infrastructure—people from Greater Manchester would be attracted to travelling to work in the Merseyside area and vice versa.
Mr. Kilfoyle: I hope that my hon. Friend is not suggesting that our jobs be exported to Manchester. We need as many jobs as we can get on Merseyside for Merseyside's unemployed people.
Mr. Deputy Speaker: The hon. Gentleman should not be diverted by that provocative intervention.
Ian Stewart: My hon. Friend is, of course, baiting me. He will not be successful. However, the importance of what he said is that all of us in the region—whether in Manchester, Merseyside, Cheshire, Lancashire or

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Cumbria—should be interested in how to generate more wealth and more jobs, and how to improve transport across the region. In that sense, I agree with him.
Important as employment is, the debate is also about leisure. The development of Liverpool John Lennon airport has been important for the region. It is the only airport that gives people from the east of the region access to low-cost airlines, which is a significant development. I hope that Manchester airport will offer that service at some point, but for now John Lennon airport is the only such facility. Although that might not be a permanent arrangement—it depends on the development of civil air transport—it is important to note that the initiative was taken on Merseyside, rightly attracting people from Greater Manchester to Merseyside to use the facility.
Mr. Kilfoyle: Does my hon. Friend see the good sense of the project in allowing for the potential for a light rail link that would, presumably, link the two airports so that they could act in concert?
Ian Stewart: My hon. Friend again anticipates comments that I want to make. I am well known at the Greater Manchester end of the region for my commitment to the development of transport. My constituency benefits from the excellent facility of the Metrolink in Greater Manchester. I have been in discussion with colleagues from Warrington and other areas in Greater Manchester and Cheshire about the potential for a Metrolink between Manchester and Liverpool. The Minister might say that that is not the most appropriate mode of transport. Fine; that might be the case. However, I hope that he will acknowledge that we should discuss what is, strategically, the most appropriate type of link to enhance transport in the region.
Going by what I currently know, I have a negative view about tolls. The tolling of such a bridge would decant the congestion problem elsewhere, so I remain to be convinced that tolling would be an appropriate method of funding the project. Although I am not a local MP directly involved with the matter, my impression of the debate is that it is an awareness-raising exercise. Colleagues are not expecting an answer from the Minister, but are raising the issue on the basis that an answer might come at an appropriate time, after consideration.
Finally, if we are to consider the interests of people in my constituency and the surrounding area of Salford and Greater Manchester, when such a significant development is proposed and we think that it is right, we should say so. I think that it is the right thing to do.
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Dr. John Pugh: I congratulate the hon. Member for Weaver Vale (Mr. Hall) on raising this important issue and other Members on speaking with such eloquence and passion. This is an important cause for the whole of the north-west. I preface my remarks by saying that although I am not a Liberal Democrat transport spokesman on a normal day, I seem, after my Mersey tunnel experience, to have become the unofficial spokesman on Mersey crossings.
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I live in the north-west, which adds to my credentials. My son goes to Runcorn every day across the bridge. Like the hon. Member for Liverpool, Walton (Mr. Kilfoyle), I am old enough to recall the transporter bridge. I found it a rather scary experience, as I was always afraid that it would drop me in the middle of the sea.
Mr. Howarth: Particularly if my hon. Friend the Member for Liverpool, Walton was on it.
Dr. Pugh: Yes. The north-west is booming, as a consequence of two things. First, we have pulled ourselves up by our own bootstraps. Secondly, we have made effective use of regeneration funds. Surely, we can all agree that the biggest brake on further development in the north-west is transport links. The two biggest bottlenecks for most people travelling in and out of the north-west is the route around Birmingham and the crossing over the Mersey. The route around Birmingham has been enormously improved by the new toll road. It has certainly been the best £2 that I have spent recently.
The crossing over the Mersey is still an outstanding issue. Every time one approaches the Thelwall viaduct one hopes that it will get better. It never does. The M6 remains one of the worst motorways in Europe as both a driving experience and a transport route. Increasingly, to avoid that route and hold-ups through Liverpool and across the Thelwall viaduct itself, people use the Runcorn bridge. Inevitably, there is a problem, as has been well identified and outlined. The present bridge was built to take 42,000, but takes more than 80,000. It is a scandal. As a number of hon. Members have highlighted, London has so many bridges and the Lancashire-Cheshire area has so very few. I shudder to think what would happen if London were treated as badly as we have been.
The proposal is a good one and I endorse it. There are still some uncertainties. Perhaps the Minister can assist me and perhaps other hon. Members can intervene and help me, too. On two different websites from two different engineers, I came across two different prices; £300 million on the Clifford website and £200 million on the Herbert Smith website. There is an uncertainty about costings and about the mechanics of the finance. Will it be publicly financed? Will it be PFI? Will there be tolls? There is a further uncertainty with regard to time. Will it all be agreed in 2004, or turned down in 2004? Will it be ready in time for the capital of culture?
The fundamental uncertainty that I guess we are all here to resolve is the extent of Government support. The debate endeavours to test that. The Government, unlike hon. Members present, have to choose priorities. Funds are not unlimited. As the Minister would recognise, huge amounts are needed for the north-west. I am sure that you, Mr. Deputy Speaker, agree that huge amounts are needed for the north-west. We could talk about the west coast main line, but we must not. We could talk about Liverpool trams. We could talk about a host of less glamorous schemes. I was hoping that the hon. Member for West Lancashire (Mr. Pickthall) would remain long enough for me to put in a plug for the A570 improvements between Southport and Ormskirk. So be

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it. The Heysham bypass, the Piccadilly intersections; there are so many examples that I could give.
In the north-west, by and large, we adopt a supportive attitude to one another's schemes. It is not a question of "either or"; inevitably it is a question of "both and". However, the reality that we all know as experienced politicians is that Governments have to choose because resources are finite. Hopefully when they choose, they choose in terms of long-term, non-partisan public interest, rather than party preferences and so on. On that basis, the bridge would meet most criteria that one wants to set. It would score highly.
I conclude on a personal note by giving a word of advice. It so happens that a bridge is being opened this week in my constituency by Her Royal Highness the Countess of Wessex. It is a much smaller but attractive, modern bridge, linking the Southport seafront to the retail shopping area. It replaces a wrought iron bridge, of which people were very fond, but which corroded over the years and became unusable. The new bridge is now massively popular. I campaigned for it, with the help of the Merseyside passenger transport association, and we succeeded in getting funding. From the experience of making a bridge happen, I learned two things.
First, I learned of the poetry excitement of bridges; there is a kind of symbolism about it. I believe that design matters for bridges. We have probably not said enough about design. because bridges have also an economic dimension, but for those driving across them, they have an aesthetic character. I should have liked to hear more, not about what the bridge will do in economic terms but how it will look and how it will affect the Mersey landscape, which is more important.
Secondly—this may have more relevance to our debate—I learned that the best is often the enemy of the good. Some people in Southport, including myself, would have preferred not to have a modern bridge but a wrought iron replica. Equally, most wanted the new bridge to be all that was specified and to be toll-free. It certainly should be and I hope that it can be.
Mr. Christopher Chope: The hon. Gentleman thinks that the bridge should be toll-free. Why, then, was he in favour of extra tolls on the Mersey tunnels?
Dr. Pugh: I was not in favour of that. If the hon. Gentleman had followed the debate more closely, he would know that we were working out a new mechanism for tolls. For as long as I have lived in Merseyside—I have the advantage in that respectߞthere have always been tolls on the tunnels.
I shall press on. If resources do not match ambition, I accept that there may a need to review the design potential of the bridge. One can wait for perfection, but at the end of the day, Halton, Runcorn and everyone wants results; politics is the art of the possible. I hope that we can get everything. I hope that we can get the bridge as designed; toll-free and attractive, a real visual amenity and an economic benefit to Merseyside. We shall hear from the Minister how near we might get to that.
3.7 pm
Mr. Christopher Chope: I, too, congratulate the hon. Member for Weaver Vale (Mr. Hall) on introducing the debate so eloquently. I congratulate Halton borough council and the other local authorities on pursuing the suggestion, first made by a Conservative Secretary of State, that they should find a local solution. They have made an enormous amount of progress towards that end. The Government have helped by giving £600,000 for a feasibility study. However, I am still concerned about the delays that seem to be built into the Government's consideration of this and other projects, because it took five months before they made their response to the study. As so often in the past, that response was a whole lot more questions and the need for yet more work to be done, a pattern of procrastination that is associated with the Government's attitude to the transport infrastructure.
Mr. Mike Hall: Will the hon. Gentleman put the record straight and say that the then Conservative Secretary of State for Transport turned down the original request for a strategic crossing over the Mersey?
Mr. Chope: That is right; but as we heard this afternoon, the traffic in those days—was it 12 years ago or even longer?—is very different from what it is now. The Secretary of State turned it down; he said that there was a need but that, as a local need, it should be satisfied by local people getting together. That is what the local authority has done.
Mr. Hall: The then Secretary of State for Transport turned it down in 1995, when the traffic flow on the bridge was 75,000 plus vehicles. That was already 10,000 above the capacity figures. The bridge was clearly congested, which was recognised by the Secretary of State. However, he said that he saw no regional significance in the fact.
Mr. Chope: In that case, I stand corrected by the hon. Gentleman. I thought that it was 1991, but if the figures show that it was 1995, it probably explains why he said there was a need but that it should be satisfied locally because it was not of national strategic importance.
Let us try and be more positive, because it has been a joy to behold today the spectacle of seven Labour Members and two Liberal Democrats arguing eloquently and persuasively in favour of substantial additional spending on roads. Whatever happened to the Deputy Prime Minister's pledge to reduce road traffic in absolute terms, which was the Government's transport policy for years? At last, they recognise that an inherent part of economic prosperity is having a transport and road infrastructure to support it. The debate is part of the wider debate, which has been won by those who argue consistently for further investment in transport infrastructure; they are well represented on the Conservative Benches.
The issue of tolls has been mentioned in the debate. I hope that the Minister will say exactly where the Government stand on support for the project. Only when they declare openly how much they are prepared to invest in the project will local people be able to decide whether they wish to proceed with it and raise extra

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funds through private finance and toll income, or whether it should be funded wholly out of taxpayers' money. Who would be surprised if local people and their representatives said that they would prefer the whole thing to be funded out of money from national taxpayers?
I hope the Minister will say how much money the Government will put in and then the local people can decide.
Mr. George Howarth: Can the hon. Gentleman tell us the official Opposition's view? Does he believe it should be a toll-free crossing?
Mr. Chope: That is an interesting question. We believe that if infrastructure has to be developed and the only way to afford it is through tolls, better to have a toll crossing than no crossing at all. UnfortunatelyߞI regret it every day of the week—we are not in government and we do not have the Minister's great challenge: and to consider all the competing road projects up and down the country, and decide what priority to give them and how to spend the resources. However, when the time comes and we are in government, I shall be happy to give the hon. Gentleman a clear and unequivocal response to his question. I hope he will not have to wait very long for that response from a Conservative Minister.
It is important to give the Minister the maximum time to respond on the issue, which many hon. Members from a particular part of the country have supported in the debate. Part of the Government's agenda is to try and divert responsibility for this type of debate away from Parliament, the centre of our democracy, to regional assemblies. Many who are in this Chamber today are against the idea of an elected regional assembly in the north-west and they are right to hold that view, because it would devalue the importance of debates such as this, in which we can hold the Minister to account instead of being told that we must sort these matters out with the assembly.
The House remains the place where the decisions have to be taken and where the Government are held to account by representatives of the people, elected under a one-person, one-vote system of individual constituencies. I hope the Minister will take the points made to heart, and in that spirit, and come up with the answers that local people want.
3.14 pm
The Parliamentary Under-Secretary of State for Transport (Mr. Tony McNulty): I start by telling the hon. Member for Christchurch (Mr. Chope) that if he is so enamoured of parliamentary and governmental decisions taken in Whitehall, he might remember the 1995 position when the Tories turned down the scheme in the first place, and not try to elide that basic fact of history. I shall return to that point later.
This has been a useful and interesting debate, apart from, as ever, the contribution by the hon. Member for Christchurch. Every Back Bencher who opened his mouth revealed a good knowledge of the history of the north-west and of governmental processes and decision making, but there was precious little on the Opposition
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Front Bench. That is a matter for regret, because—save for the last, rather poisonous contribution—my right hon. and hon. Friends are right that there is cross-party support for the project. That is certainly true in the north-west. I do not think that any Conservatives in the region have raised their voice against it, although it would have been nice if any opponents of the project had turned up to the debate.
I listened carefully to the hon. Member for Christchurch but I do not think that he said whether he supported the project as it had developed thus far. We are therefore none the wiser—or otherwise—about his position; it was just the usual hysteria.
Mr. Chope: I must say unequivocally that we support the project. I thought that that was quite clear from my remarks.
Mr. McNulty: It was not clear at all. I am sure that my hon. Friends will be grateful for the hon. Gentleman's clarity now, after the hysteria.
Before I move on, I want to make one more partisan point, because I must. Indeed, it is terribly important. The cross-party support for the scheme—I shall come in a moment to the details and to where we are as regards a decision—extends to the Liberal Democrats, and I am grateful for that. The hon. Member for Southport (Dr. Pugh) started by saying that "the north-west is booming," and I exhort all my hon. Friends, who have elections coming up in their areas in the next four or five weeks, to hold him to that. They should see whether Liberal Democrat leaflets seek, as ever, to talk down the area and to traduce the Government's economic record.
I am not, by any token, a son of the north-west, although I was at Liverpool university from 1979 to 1981. However, I saw the devastation caused by the empty vessel that is the Conservative party, as the lifeblood was drained out of an area that I have since grown to like and which I have enjoyed on numerous occasions.
As many hon. Members have said, the great joy of this debate lies in the fact that we have congestion and extra economic activity only because affluence, economic development and prosperity have increased, although I am the first to say that they do not cover every part of the region. It is important to make that clear.
In passing, it is worth dwelling on the fact that 15 MPs from the area have been in full agreement today, and that is a real testament to them. As my hon. Friend the Member for Liverpool, Walton (Mr. Kilfoyle) said, the region stretches from Merseyside to Cheshire, Lancashire and Cumbria. As ever, Mr. Deputy Speaker, you have been dispassionate and objective, although you have harrumphed at the right points to move things forward. That is very important.
As my hon. Friends the Members for Eccles (Ian Stewart) and for Ellesmere Port and Neston (Mr. Miller) suggested, I will not give a definitive decision either way at this stage because we are only some way through the process. However, everyone involved should be congratulated on that process, which has been open and transparent, and my hon. Friend the Member for Weaver Vale (Mr. Hall) alluded to some of the details. Incidentally, I am sorry that I did not

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congratulate him when I started, but I was attacking the hon. Member for Christchurch. That aside, the process has been carried out in a mature and sophisticated way.
If the hon. Member for Southport knew anything about such processes, and if he had listened carefully to my hon. Friend the Member for Weaver Vale, he would know that certain outstanding issues need exploring before we can move on. However, I forgive him. The answer to his immediate question is roughly £335 million. I would love to know where he saw the figure of £200 million, because if the costings stood up, they would make the case all the better. However, the figure is £335 million.
Thus far, the Mersey Crossing Group has done important work in garnering support and forming an alliance across the region.
I shall not make any jokes about the unity of the north-west Labour group. Its members are here, and that unity is palpable today. I welcome the group, and long may it continue.
As the Department has said, we recognise that the crossing is a significant issue for the region. We accept that there are significant congestion problems on the Silver Jubilee bridge. I shall not make a joke about the fact that, on the three or four times that I have been up there recently, the bridge was empty. It was halfway through the day, but I take the point that there are real problems at peak hours. Coupled with that, as hon. Members have said, is the fact that any incident that causes it to be closed can cause massive traffic chaos in the entire area. Because of over-use, maintenance is a significant factor; doing it on an ongoing route is clearly problematic.
Mr. Kilfoyle: I beg the Minister's indulgence, but I have nothing against milk floats, or milkmen, but they have no way of going about their legitimate business other than by crossing the bridge. It may seem odd to be obsessed about that, but it is no joke when there are huge queues behind the milk floats on the bridge.
Mr. McNulty: I heard that point, but I shall move on. I have never seen a milk float jam when I have been in the region, but I bow to my hon. Friend's greater experience. Major disruption cannot be avoided when maintenance is required or there has been some incident. I understand that this June, a 14-week programme will begin to renew the 40-year-old expansion joints. I do not need to repeat or rehearse what my hon. Friends have said about having tunnels in one. direction and the Thelwall viaduct in the other, or about the crossing in Warrington.
I understand what the Mersey crossing group and Halton have said about the bridge being strategic, with the Silver Jubilee bridge being the local bridge, and that approach is appropriate. If, as the group is planning, the new crossing were to prevail, the carriageway of the Silver Jubilee bridge could be reduced to two lanes, and all the difficulties caused by maintenance would be markedly reduced. There would be sufficient space on the deck for good cycling or pedestrian benefits.
I do not need to repeat the key benefits that Halton claims for the project: better public transport, help for business, better links between Manchester and Merseyside, more than 3,000 new permanent jobs, £15
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million of development value and a scheme that has a return in excess of £600 million. Those points have been well made by my hon. Friend the Member for Weaver Vale. They will also know that just before Christmas, we announced, in response to Halton borough council on the 2002–03 local transport settlement—
3.23 pm
Sitting suspended for a Division in the House.
3.38 pm
On resuming ߞ
Mr. McNulty: As I was saying before I was so rudely interrupted by the Division, just before Christmas, we announced—in our response to Halton borough council on the 2003 local transport settlement—that we recognised the scheme's importance and high profile, but considered that further appraisal work was needed.
The Secretary of State will make a decision once Halton borough council has completed the additional work that has been requested. That will, of course, be subject to funding availability. We also stressed to Halton the importance of getting the further appraisal work right and explained that we could if necessary be flexible in considering the scheme outside the normal local transport plan timetable. None of that is about procrastination on an important decision. It is a matter of getting the decision right, not just for Halton borough but for the entire region, as my hon. Friends have all suggested.
I congratulate Halton on the way it has taken to the task and brought matters to this point. As my hon. Friend the Member for Weaver Vale said, the Department has been very supportive of Halton in its efforts to assess the feasibility of the new crossing. We have already provided £600,000 to fund preparatory studies and are liaising closely with Halton on a range of issues further to the initial submission to the Department, which we have asked it to follow up.
My hon. Friend alluded to those issues and our requests are not a way of kicking the matter into the long grass. They are intended to enable a serious decision to be taken on a serious proposal that merits serious assessment, something that it did not receive in 1995 when the Government of the day dispatched it rudely without fear of the consequences for Merseyside. As my hon. Friend said, we do need to consider the matter further and assess the impact of the bridge on the strategic highway network.
My hon. Friends have talked at length about how the project plugs into, and interacts with, the surrounding transport infrastructure and network. We do have to examine in more detail the hydrodynamic impact of the bridge on the River Mersey, a major waterway and river of some significance. There are also serious environmental as well as engineering construction dimensions that need to be considered in some detail. Equally, we must decide on the most effective procurement of procedural routes, and consider whether tolling could help to fund the project. I shall return to that issue shortly.
Government officials have already met officials from Halton, the Government office for the north-west and the Highways Agency to discuss these matters, and we

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will meet them subsequently to give them all the help that we can to complete the assessment. The new bridge will have a widespread impact on travel patterns, so we need to understand any knock-on effects such as additional traffic on other roads, including the trunk road network, if I may be the butterfly in the Chinese aphorism cited by my hon. Friend the Member for Eccles.
The Mersey estuary is environmentally sensitive and we need to ensure that the impact on the river and wildlife are fully understood and can be properly mitigated where necessary. Equally, the proposals are expensive, and Halton will want an investment of some £350 million in the new crossing, although the figure could well turn out to be at the upper end of the scale. The budget is limited, and there are competing priorities. As my hon. Friend the Member for Weaver Vale kindly said, I have visited Merseyside a couple of times and have seen from the top of the chemical museum the glory of where the bridge may go. I have seen the much loved car breakers yard that, sadly, will have to go to facilitate the road network around the bridge. I am also all over the Widnes Weekly News this week in an article about guide dogs and free private hire passage—an equally important project introduced by this Government—but that is entirely incidental and has nothing to do with this debate.
It is important to dwell on funding, although Opposition Members have raised the issue spuriously and speciously in this debate. In the end, the funding may be a mixture of PFI and tolling, or it may be delivered entirely through public procurement. I simply do not know until we explore the matter fully.
In passing, I should say that a mixture of PFI and tolling is exactly the way forward for the Thames gateway bridge. The suggestion that the bridge would be funded entirely through public procurement is wrong. I should also say that a tiny, tiny weakness in the case put so eloquently by my hon. Friends was the beggar my
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neighbour approach taken by competing deprived areas. Halton may well be fourteenth on the list, but Newham, which is eleventh on the list, will gain much from the gateway bridge. That is minor point, but the argument that the nation gave cosseted, fat and bloated Londoners another bridge, so Merseyside should have one, is not the best way to make progress in the debate.
A good deal of real work needs to be done. We should not procrastinate.
Mr. Hall: The Thames gateway is part-funded by taxpayers' money. If part-funding is good enough for Newham, part-funding for the new Mersey crossing would be good enough for Halton.
Mr. McNulty: We will leave the circularity there and move on, although we may return to the subject later.
Halton is cheerfully carrying on with the task. The council leader, my hon. Friend the Member for Halton (Derek Twigg) and others in Halton and beyond will have their own views on what the mix of procurement should be and will make those views well known, but it is important to discuss the matter. Halton must assess the cost, time scale and impact of this major project and the appropriate procurement route, and I know that it is up to the task. It is pushing ahead with the work with a view to returning to the Department for Transport in the autumn, which it may well do. We will consider the scheme carefully once we have received that extra material. In the meantime, my Department will continue to liaise closely with Halton as it prepares its case, and we hope to help it to take the right decision on an issue that is significant not only for Halton and Merseyside, but for the whole area.
In the remaining 30 seconds, I apologise for taking no interventions and again congratulate all Back Benchers who have contributed to the debate. In terms of parliamentary procedure, these one and a half hour debates in Westminster Hall are ill-served by fatuous shadow Front-Bench contributions.

Maternity Services
3.45 pm
Mr. Mohammad Sarwar: I am grateful for this opportunity to debate maternity provision. The Government have made a firm commitment to improve quality and safety in maternity care. That is at the heart of the reform agenda in our health service. Every year, the NHS spends £1 billion on maternity services, which affect all our lives, accounting for one in seven hospital admissions and 600,000 births across the country. The subject provokes emotive debate in our communities as we face major changes.
Last summer, the Health Committee raised concerns about women receiving variable care in different areas. That is unacceptable and I welcome the Minister's work to tackle inequalities in service access and health outcomes for mothers and babies. More women are now encouraged to have the birth that they want but the main barrier to equality and choice has been the shortage of midwives and obstetricians.
There have been different responses to the problem across the country. In Scotland, Ministers promised to train 375 more junior doctors. South Tees Hospitals NHS trust closed a unit due to a shortfall of 14 full-time midwives. Neath Port Talbot had to close several times due to a consultant shortage and is now developing a midwife-led centre. The Oswestry unit had to close for six months when 22 midwives became pregnant. A lack of Leicester midwives resulted in a drive to attract new recruits and entice former midwives back. Flexible working was seen as the key. Will the Minister assure me that extra resources will continue co be prioritised for recruitment?
Investment in NHS maternity services has increased. The £100 million upgrade of 200 units in England has made a real difference. Last year, the Commission for Health Improvement found that maternity units were often the best run in NHS hospitals. Many showed best practice in patient involvement and risk management. It is important that units share ideas to deliver improved services and tackle inequality.
We clearly saw the disparity between hospitals in different regions two years ago. A Dr. Foster survey identified the busiest units and also found low staff levels, often in the south-east, an area of special interest to the Minister. Twenty-one hospitals had more than one baby born for each delivery bed per day. The national average was 0.76. Large hospitals in our cities faced the greatest pressure. Smaller units and community hospitals with a midwife-led service tended to have fewer births. Since the survey, Ministers have reaffirmed their commitment to consistent standards for all mothers.
We are now seeing more involvement for mothers, and midwives, doctors and hospital managers listening more to mothers' views. It is vital that women feel that they can make an informed decision about their care. As Professor Hewison concluded in her August report, antenatal care is strongly influenced by the type of care that each GP wishes to provide. We need women to be better informed at all stages of pregnancy. To that end, I welcome the "You're Pregnant" magazine launched by the Minister in December. It provides free local information about maternity services to women in a
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clear and presentable format. It is important to have choice in planning individual care and involvement in planning local services. That is vital with regard to formal consultation and can address inequality effectively.
The Select Committee identified problems with access to interpreting services for women who do not speak English as a first language. That may contribute to the high perinatal mortality among Pakistani-born mothers; it is nearly double the UK average. We see good practice to rectify that in Leeds. Local women work with midwives to translate antenatal classes into three common languages and to base them in community centres, reaching out to diverse groups and reducing inequality in the service. In areas with the highest numbers of asylum seekers—not only London and the south-east, but places such as Glasgow—more women are being offered appropriate care through awareness of the wide range of languages spoken, which can change each month.
I recognise the importance of maternity services being covered by the children's national service framework. I am sure that the Minister can assure me of further progress in that area of modernisation. The role of midwives is crucial, as they often lead reform. In Manchester, they improved the service for drug-dependent mothers, while Derbyshire midwives increased breastfeeding by using mothers who had breastfed to encourage others.
In breastfeeding awareness week, I must congratulate the national health service and the breastfeeding initiative in my home city. Glasgow's rates are increasing faster than those of anywhere else in the UK; 36 per cent. of women are breastfeeding at six weeks compared with 25 per cent. seven years ago. New mums appreciate backing from other mums who have breastfed successfully.
We have significantly more midwives and midwifery students than we did in 1997. The "Celebrating Midwifery Leadership" event and the Royal College of Nursing conference have taken place this past week. I hope that the Minister shares my optimism about the future of those important professions and support for their enhanced role.
The biggest area of contention in maternity services is the balance between consultant-led services and midwife-led units. There have been different responses throughout the UK. Merging North and South Durham NHS trusts meant that Bishop Auckland maternity unit was run by midwives, with mothers transferred to Darlington if a doctor was needed. The new board felt that the link between them would mean shared skills and ensure greater choice for mothers, with faster access and better clinical care. In Liverpool, plans were made to transfer neonatal and obstetric services from Aintree to Toxteth. The falling birth rate could no longer justify the provision of specially trained staff on each site, but antenatal services were kept at both and jobs were not adversely affected.
More recently, the transfer of the Mary Rose unit in Portsmouth was announced. The local branch of the National Childbirth Trust criticised the lack of consultation, as managers were not quick to consider midwives' and patients' views. It called for a midwife-led

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unit on Portsea island, as losing the Mary Rose unit would mean
"no local option other than a home birth".
Consultation on such changes remains the most important arena for genuine patient involvement, as communities must have confidence in major decisions made locally by the NHS. That affects both rural and urban communities.
The low number of births at Caithness made it difficult to retain consultants, and a report stated that the service was unsustainable. Last month, the need for change was compounded when the remaining consultant went on sick leave. NHS Highland is consulting on a new midwife-led unit, but critics say that there is no understanding of rural geography, arguing that Norway and Canada design their services around the patients in remote communities.
There is also concern at the impact on other local services. There are good examples of patient involvement in Wiltshire. In July, West Wiltshire trust asked mothers, staff, unions and key groups to take part in a wide-ranging assessment of its services. Gloucester and Somerset mothers accessing care in Wiltshire were included in the consultation. Neighbouring Kennet and North Wiltshire trust asked all women who gave birth in 2002 and 2003 what they thought of local services and where they would prefer to deliver. It also reviewed two units where only one bed in three is used and the birth rate is dropping. Locally, the hospitals are considered to be vital community resources. Last month, the board gave the consultation a welcome extension.
Last year, Scarborough and North East Yorkshire trust proposed ending maternity services at three sites. The board appointed a non-executive director to measure public opinion and gave an assurance that any change would not place lives at risk. In Northern Ireland, every woman will live within an hour of a consultant-led unit but there is more choice through new midwife-led units and other approaches. In Downpatrick, for example, a new hospital offers antenatal and post-natal care but the falling birth rate does not justify a maternity suite.
After nine years of vigorous debate over potential sites, a decision has been made on Belfast's new maternity unit, which will also act as a regional speciality centre. The Royal was finally selected after detailed consultation by the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for Basildon (Angela Smith). Every neonatologist and paediatrician taking part said that it would provide the best possible service. Millions of pounds have been spent on the new children's hospital, offering strong links to full neonatal services for premature and sick babies.
In Scotland, the report by the expert group on acute maternity services said that our current set-up was "no longer sustainable". The birth rate is the lowest since records began; women are having fewer children, later in life. The working time directive is another major factor. There are also pressures on training and a need to ensure clinically safe, cost-effective practice. The group said that care should be provided as close to women's homes as possible. Those with low-risk pregnancies should be
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able to give birth in midwife-led maternity units that are supported by specialist care for those at risk of complications. Scottish midwives accepted that such changes would not be easy but the response to similar moves in England had been positive; women enjoyed having the choice, backed up by specialist care if needed.
In the west of Scotland, consultant-led care is centred on Paisley's Royal Alexandra hospital. Mothers still have a choice of care, but Inverclyde and Vale of Leven are becoming midwife-led. NHS Argyll and Clyde considered its consultation to be "transparent and robust", using market research and discussing the plans with professionals, Voluntary groups and the public in open forum. Although most mothers should be able to give birth in community units, low-risk births can quickly become high risk, and 10 to 20 per cent. of women will be transferred to consultant-led care during labour, mostly for epidurals.
Scotland's Health Minister approved the plans but was unconvinced by the numbers assumed to opt for Paisley rather than Glasgow. It is important to look at patient choice between the two. Taken alongside plans for Glasgow, this concentrates consultant services for one in four Scottish women at two hospitals only seven miles apart. In 1999, the Greater Glasgow board decided that it had one hospital too many, due to falling birth rates. A pre-consultation proposed the closure of the Queen Mother's hospital, concentrating maternity care at the excellent Southern General hospital, and the new Princess Royal hospital in the east end. There followed a three-month consultation period, during which a strong campaign was mounted by the Evening Times, which amassed 156,000 signatures in support of the Queen Mother's hospital.
The biggest fear was a reduced standard of care. Glasgow would no longer have a leading position in the UK, with an integrated service; the Queen Mother shares its Yorkhill base with the Royal Hospital for Sick Children. The hospital is seen as a national centre of excellence, with eight national services for women and children, including the specialised ECMO life-support system, one of only four in the United Kingdom. The hospital treats babies from every health board in Scotland and from further afield.
However, almost all city clinicians accepted the reduction to two hospitals, and NHS Greater Glasgow felt that the decision could not be delayed. The board said that its plan involved the least risk to mothers and babies, as the Queen Mother's hospital offered intensive care only for children whereas the Southern General could provide intensive care for both. The Scottish Parliament Public Petition Committee was not impressed by the consultation; nor were a number of experts in the field. None the less, Greater Glasgow insisted that its pre-consultation and consultation process exceeded current guidelines. Last month, the closure was endorsed, but on the basis that Scottish Ministers must be satisfied with the substance of the proposals and the adequacy of the public consultation.
In responding to the need for change, NHS Greater Glasgow recommenced measures to provide sustainable and safe services for mothers and babies, including a new public health midwife service and midwife delivery beds in the hospitals That is commendable, but it also seems right to have a real centre of excellence that is integrated and co-located. However, the actual site is

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less important than delivery of integrated care. The board will now consult on whether the Royal Hospital for Sick Children should be moved to a site alongside adult and maternity hospitals.
It is crucial that there is more patient involvement in planning maternity services throughout the UK. It is also vital to maintain a high level of reform and investment in the NHS. If those are coupled with the Government's commitment to increasing the number of midwives and consultants, we will see lasting improvements to an excellent service.
Mr. Deputy Speaker: I call the Minister for his first stint in Westminster Hall this afternoon.
4.3 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I am grateful to my hon. Friend the Member for Glasgow, Govan (Mr. Sarwar) for introducing the debate. I am tempted not to reply to it, since he has done such a thorough job of setting out the issues that affect maternity services in the UK and of explaining both the strides forward that the Government have taken and the challenges that face us in the future. However, I am pleased to have the opportunity to add a few comments.
My hon. Friend will appreciate, however, that I cannot comment on some of the local issues that he raised in respect of Scotland, since those are matters for the devolved Administration, and my brief is for England. I hope, however, that my response will be of general interest to him and his constituents, and I am sure that he can arrange for his comments in the Official Report to be made available to Members of the Scottish Parliament and to Scottish Ministers.
The Government recognise that women and their families throughout the UK currently benefit from a high standard of maternity services provided by dedicated and hard-working NHS staff. I would say that those services are possibly the most successful of the NHS services. Huge advances have been made in the last few years in changing the experience of women during pregnancy and childbirth. Over the past 50 years, the NHS has made childbirth a much safer process for both mothers and babies, and women are now more actively involved in making decisions about the maternity care that they receive.
The NHS, throughout the UK, offers birth facilities of various types and sizes in maternity units in different locations, as well as at home. We do not support one model over others, but want diversity of provision, so that each woman can choose what best suits her needs and wishes. Real progress has been made in recent years towards providing a more personal, woman-centred service, tailored to meet the health needs of the local population. Maternity services have led the way in partnership working and midwives have played a key role, working with women and with other health professionals to ensure that NHS maternity services are safe and comfortable.
Of course, the rate of improvement and availability of choice may be governed by the recruitment of midwives. My hon. Friend highlighted that issue. The number of midwives working in the NHS is increasing, I am glad to say. There are now 1,560 more midwives working in the
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NHS in England than there were in 1997. Also, since 1999 more than 1,200 midwives have returned to the NHS, and another 270 are in the process of returning.
Despite what I have outlined, we need to do more and we want to build on those successes and boost the rate of growth. That is the reason for the midwifery recruitment and retention six-point action plan in England. It incorporates actions to help midwives return to practice, giving them better working terms and conditions, raising the profile of midwifery and improving training and leadership. It also involves our studying the geographical variations in vacancy levels. Thus I can give my hon. Friend the assurance that he wanted that we shall continue to put resources into the recruitment of midwives. For the record, I take no responsibility for the 22 midwives in Oswestry who all became pregnant. It was none of my doing.
My hon. Friend is aware that we are also developing a national service framework for children, which will cover maternity services. The aim of the maternity module of the national service framework is to ensure that modern maternity services place all women and their babies at the heart of acceptable services designed around their needs. Those services must also provide flexible and equal access to high quality clinical care and support for all women.
The two key issues to be dealt with in the NSF will be the reduction of inequalities and the increase of choice. I make no apologies for placing the issue of inequalities first. My hon. Friend referred to many of them. Fifty years ago, the Department of Health took the unprecedented step of setting up a confidential inquiry into all maternal deaths, a system that is still in place today. The results have led to many important changes in obstetric and midwifery practice, and it is a source of pride to me and my colleagues that that methodology is now being implemented in many other developed and developing countries to help to improve clinical maternal care.
It is also a source of pride that our NHS has helped us to achieve one of the lowest overall maternal mortality rates in the world. However, our confidential inquiry still has important work to do, and has recently been examining the wider determinants of maternal health. The findings of the last report show that women from the most disadvantaged groups in society are about 20 times more likely to die from factors related to childbirth than women in the highest two social classes. Their babies are more than twice as likely to die before their first birthday.
The infants of women born in Pakistan have particularly high rates of stillbirth and infant mortality. They are nearly twice as likely to be stillborn and more than twice as likely to die in infancy, compared with the average. Those are horrifying figures and we must get to grips with them.
Overcoming those inequalities in outcome, some of which can be helped by improving access to antenatal care services, is perhaps the biggest and most important challenge for us. We know that women from the most vulnerable groups in society often find it difficult to gain or maintain access to maternity services and have poorer maternal and neonatal outcomes.
Although we may not be alone in facing such problems, as surveys in other developed countries have shown, what makes us unique is the opportunity that we

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now have to tackle them through the forthcoming national service framework. We will grasp the opportunity with both hands. It is vital that a modern maternity service should ensure that women from all groups of society have easy and equal access to the full range of high quality services to ensure that the needs of the most vulnerable are given equal importance.
That means enabling every woman to seek early in pregnancy care that she feels happy with and to continue to maintain regular contact throughout her pregnancy and in the post-birth period. That is what we intend to achieve through the provision of individualised and flexible care plans designed by the woman and a health care professional to meet her specific needs and wishes.
Pregnancy, particularly for first-time parents, is the beginning of a process of transition to lifelong parenthood. It can be a period of great joy, excitement and anticipation, but may be combined with concerns about the health of the mother and baby, the process of birth and the prospect of becoming a parent. Pregnancy, birth and the post-birth period are also significant events for the wider family, taking place within their own social and cultural context and beliefs. The care and support given during this period is crucial to help expectant and new parents enjoy as straightforward a pregnancy and birth as possible and start to adapt to their new roles and responsibility before the baby is born.
High quality maternity care does not just provide a supportive clinical environment to ensure a healthy pregnancy, delivery and post-birth period; it also provides a gateway to other services and helps to achieve the best possible start to life. Those services include birth and parenting classes and the provision of multidisciplinary support for women with particular medical, social or psychiatric needs and for those from the more vulnerable groups in our society. It is vital that a modern maternity service ensures that women from all groups have easy and equivalent access to the full range of high quality, antenatal services and that the needs of the most vulnerable are treated with equal importance. That means enabling every woman to seek the care that she feels happy with early in pregnancy and to maintain regular contact throughout her pregnancy.
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The NSF is not the only work being done to shape maternity services. For example, our work with the National Institute for Clinical Excellence has led to the publication of several clinical guidelines to be implemented throughout England and Wales. We already have guidelines on induction of labour, the use of electronic foetal monitoring and antenatal care. Guidelines were recently launched on the use of Caesarean section, and guidelines on the management of uncomplicated labour and birth and the post-partum period will follow later. Those guidelines will complement the national standards set out in the NSF.
Another area of our activity is based around choice, and my hon. Friend highlighted several of the steps that we have taken. Maternity services were included in the national consultation exercise "Choice, responsiveness and equity", designed to improve patient and user experience in the national health service. The results of the consultation were published on 9 December 2003 in "Building on the best: choice, responsiveness and equality in the NHS", which encourages local health services to publicise contact details for midwives and promote the use of birth plans.
That is why one of the first outcomes of our drive to improve choice was our work with Dr. Foster to produce the "You're Pregnant" local maternity guides, to which my hon. Friend referred. They enable women and their families to make real choices about the type of maternity care that they wish to receive. Without information, choice can be just a theoretical exercise, but "You're Pregnant" gives women the information that they need to make it a practical reality.
I hope that I have demonstrated the Government's commitment to maintaining and improving the quality of maternity services. I want all women to have the birth experience of their choice in the environment of their choice, to have access to midwife-led and doctor-led units and, subject to their safety, to make the choices that meet their own needs. However, the rate of improvement can be governed by factors such as resources, the speed of building projects and the pace of recruiting more midwives.
Our highest priority is to tackle inequalities in access to services and health outcomes for women. We are also committed to improving and promoting choice for all women and their families in use of maternity services. I am delighted that my hon. Friend approves of so many of the initiatives that the Government have taken, and I look forward to having further discussions with him in the coming months.

NHS Clinical Networks
4.14 pm
Dr. Richard Taylor: I start with a profound sense of relief, because I had thought that I was the only Member to have such Adjournment debates with just a Minister present. I have just seen another hon. Member having a one-to-one debate, so I am delighted.
I thank the Minister for attending a second debate. I know that he knows a lot about the west midlands and about my patch in particular. I can reassure him that I will talk about my patch only in passing and will mainly talk about ways in which I think that the NHS can be helped overall.
Despite the vast amount of money that the Government are quite correctly putting into the NHS, there are tremendous challenges to be met in the new ways of working. One of the crucial debates that must take place is that of safety versus access. To my constituents and to others throughout the country, access means proximity to services. It is easy, from the medical point of view, to say that safety has to be the number one priority, as it is in the interests of the patients, and there are inevitably fears of litigation. However, it is arguably not quite a definite winner for the patient. There are pros and cons both ways. Safety is important, but there have to be slight compromises on occasion because proximity to certain services is crucial for some groups of people. I am not arguing that access to everything for everybody is possible, and I never have. Obviously that is not possible.
There were a lot of misconceptions about why I stood for Parliament and the campaign that I headed. People often thought that we were fighting to keep everything, which was never the case. We accepted from the beginning that high-powered things were done better where they were done more often particularly things such as vascular surgery. Patients are perfectly prepared to travel for the high-powered services, complicated elective work, complex cardiac work and complex specialist cancer services. They are used to seeing helicopters taking families to major trauma centres for major accidents and major burns. However for absolutely straightforward bread-and-butter emergencies, access—meaning proximity—is essential.
This debate is about managed clinical networks. I believe that if they are properly instituted and agreed to by all partners, such networks could answer the problem in terms of safety and proximity. The networks came to prominence in 1998, with the acute services review in Scotland undertaken by the Scotland Office for the Department of Health. In Scotland there are obviously large areas with sparse population, so problems of access and proximity are particularly bad. However, the lessons learnt from that review could also be drawn to this country. I have a couple of quotes from the report:
"As an alternative to the 'hub and spoke' model, some of the networking systems described to the Review feature the sharing of patients, expertise and resources, rather than unidirectional centripetal flow."
"Sharing" and "partnership" are the crucial words. The report also states that
"the critical mass needed to achieve the benefits which might flow from increased volume of activity can come through managed clinical networks rather than the centralisation or concentration of services."
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That addresses the issue of safety. Although those points were made so powerfully in Scotland in 1998, there are fears that centralisation is occurring and that even in Scotland managed clinical networks are becoming a bit of a euphemism.
Turning to England, networks are obviously well established for complicated matters, such as cardiac surgery, cancer services and diabetes. I wonder whether it is a coincidence that those three all have national service frameworks. Networks for such matters are absolutely essential and valuable. As I have said, a full range of services cannot be provided everywhere and citizens accept the need to travel. They welcome going to the best place and patients with a rare cancer will travel for miles to go to the right place.
We need a network in accident and emergency departments more than anywhere. People need that service close to home; I am talking about the common, bread-and-butter emergencies, such as those that happen without warning, and for which nobody can make plans. The kids might be at school, or one could be elderly. One might be taken away suddenly or from one's partner and unable to let anybody know. Not everybody has a car or a mobile phone to let people know what is happening. Just closing an accident and emergency department and substituting it with a minor injuries unit is not acceptable to local people. That is what propelled me to this place.
I am looking not back, but forward; to the Minister's relief. I am considering how to avoid the same situation elsewhere and how to improve the situation for my friends at home, because it is eminently possible to do so. I realise, before the Minister tells me, that he has no power to make things happen locally, although I am glad about that. In 1998, the Government had no power to dictate what happened locally and, if the Government's overview and scrutiny committees had been in place, the Health Service Journal wrote recently that the same events would not have occurred in Kidderminster.
Returning to accident and emergency networks, how will they help local situations and above all, how will they help the Government politically? What should they be like? As I have said, a network is a partnership and a sharing. In accident and emergency, it is a sharing of the district general hospital's all-singing all-dancing accident and emergency department with its outlying minor injuries units, particularly those in downgraded DGHs such as that in Kidderminster. That network shares patients, expertise and resources between the A and E department and the minor injuries unit. It will widen the range of patients that the minor injuries unit can see, and lessen unnecessary trips to the A and E department, so lightening its work. I raised the matter last week in health questions and the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton) agreed that networks in A and E could be helpful. She mentioned emergency service collaboratives and emergency care networks, and I welcome the Minister's comments today about those because I have a feeling that such collaborative and networks do not involve local minor injuries units, as they should.

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I have quoted Andy Black's work before, but I am going to do so again because it is so important. He is a well respected health service management consultant, who recently wrote in aBritish Medical Journal leader:
"If the price of moving the complex emergency to an appropriate centre of expertise is that this patient is accompanied by another nine or ten patients who are not complex acute cases, then another set of problems is launched."
We have seen all too clearly the social problems of suddenly uprooting somebody and taking them 18 miles away, and the financial problems that they have finding their own way home at bank holidays or at weekends. In the same leader, Andy Black also asks
"how 'managed clinical networks' could be introduced so that local emergency units can flourish while complex emergency cases can be swiftly funnelled towards the appropriate specialist centres."
There are more details of his ideas in the Nuffield Trust paper, "Local Medical Emergency Units", published in 2000.
The key is to share and rotate medical and nursing staff between such units. In the old days, when a minor unit referred a case to a major unit, the major unit thought nothing of the minor unit and would repeat everything that had been done. What a waste of time! In Worcestershire, there is no doctor in the minor injuries unit at Kidderminster, so everything that could conceivably require a medical opinion has to go 18 miles away. Time after time, the patients who go there are discharged as soon as they are seen and they have the problem of getting home.
Consultants in Worcestershire currently do outpatient clinics at the Kidderminster minor injuries unit, but they do not see any emergency patients. The sharing of a doctor on a network for back-up to the nurse practitioners would make a huge difference and would widen the scope of patients that the ambulances could take. Even the medical director at the treatment centre now agrees that we need a doctor in the minor injuries unit.
A true partnership, which is a network and two units sharing services and patients, could increase the range. It would fit with the Government's paper "Keeping the NHS Local—A New Direction of Travel" which states that
"the objective is to provide as a minimum a 'first port of call' (a service able to receive and provide assessment, initial treatment and transfer where necessary)".
I appeal to the Minister to see the logic of this case nationwide and to support the need for a trial of such an A and E unit working in partnership with the minor injury unit to pilot staff reaction. Would they accept it? What about stress levels and waiting times? Would a widened ambulance protocol be possible? Would it reduce trips to the major centre?
It would be subtly different from the trials already ongoing in "Keeping the NHS Local" at Penzance, Bishop Auckland and Downpatrick because it would fill a gap lower on the scale to any of those. If it were suggested as a pilot at Kidderminster, it would be welcomed with open arms. This could provide an opportunity for the Government to show that if a local hospital that is under threat is downgraded, there is an
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outcome a bit less severe than what happened at Kidderminster in 2000. This could help the Government to take the politics out of it.
I quote again from "Keeping the NHS Local":
"Making greater use of networking between community minor injuries units and acute centres and other redesign approaches will be needed to ensure that people have locally accessible emergency care."
I have 72,000 constituents who, together with about 70,000 neighbouring constituents, do not have locally accessible emergency care. I will battle until they do. This pilot trial would give an opportunity for the whole NHS to see that something like this could work to allay the anxieties of people in Hartlepool and Banbury and several other places that I could list at length. I will not do so.
4.28 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): As you said, Mr. Deputy Speaker, this is my second run-out of the day, the second of four this week. I am not complaining—I do not want the Prime Minister to think that I need any relief from my duties—but it means that I get a fairly eclectic choice of subjects to which to respond. I am grateful to the hon. Member for Wyre Forest (Dr. Taylor) for calling the debate and for putting his ideas on the record. He is right: most of these debates tend to be one to one, but I thought that that was something I was doing rather than the fact that he was involved. All my debates seem to be carried out on a one-to-one basis. If we do not get big audiences, at least we get top quality contributions.
The hon. Gentleman talked about proximity and safety. I agree that both have to be taken into consideration. I just wish—I do not criticise him for this because he has just taken an objective view—that there was more objectivity in discussing this. In my experience—my constituency in east Kent has gone through a painful reconfiguration—clinicians are devotedly attached to the notion of centralisation until decisions about reconfiguration are taken and they feel that their hospital is likely to come out of it worse than they thought, whereupon they immediately become converts to the idea of managed networks and distributed systems that allow far more centres to remain open.
I wish we could generate a more objective and considered debate on the matter, and understand the nuances and difficulties of balancing proximity and safety. The Government published "Keeping the NHS Local—a New Direction of Travel" to try to provide that additional guidance.
Dr. Taylor: This is exactly where the Government fit in. The professions are clamouring for patients to be made to understand the need for changes that are perhaps for the benefit of the professions. The Government must somehow engage with the professions to convince them that there are other ways of doing things.
Dr. Ladyman: I take the hon. Gentleman's point. By publishing "Keeping the NHS Local", we were trying to start that debate. In these days of "Shifting the Balance

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of Power", it is not for me to devise pilot studies that might meet local needs and balance proximity and clinical safety, but for clinicians, the primary care trusts and the acute trusts that serve the hon. Gentleman's constituency to come up with ideas. The Government—certainly this Minister—would not be interfering if they came up with something that they felt gave a better balance of access to services, while maintaining the necessary levels of safety. I encourage the hon. Gentleman to ensure that clinicians, managers and planners in his local area are aware of his ideas and engage with him in the objective debate that he is trying to stimulate now.
The hon. Gentleman has given me the opportunity to talk about how we are transforming accident and emergency services throughout the country and I shall not miss that opportunity. A little over a year ago, only about three quarters of A and E patients were admitted, transferred or discharged within the national health service target time of four hours. In March, that had risen to 94 per cent., and most patients are dealt with well within four hours. In human terms, that means thousands more patients getting faster treatment every day; at this rate, by next year we will be able to claim a standard of accident and emergency performance that no other country in the world will offer to its entire population. That is a major transformation, which requires the sort of difficult decisions to which the hon. Gentleman referred. It also requires us to have incentives in the system and to stimulate people to take the necessary decisions. Within the last few weeks, 87 acute trusts—more than half the total—received £100,000 each to recognise their outstanding progress in accident and emergency; trusts that did not qualify for the first payment are getting tailored support and trusts that continue to improve can earn £500,000 by this time next year.
If anyone objects to my focusing on total time performance, I can tell them that the clear message from patients is that that is what matters most to them. It is not the only thing that matters, which is why we appointed the first national accident and emergency patients' champion and offered every modern matron in A and E £10,000 to improve their patients' overall experience. All of that is making a difference and time and again front-line staff tell me that the atmosphere of accident and emergency has changed for the better. That would not have happened without the Government's determination to drive up the performance of accident and emergency, without our taking tough decisions and without the investment that we pumped into the health service, nor would it have happened without the dedication and hard work of front-line health service staff.
The transformation could not have been achieved without the sort of co-operation and networking that the hon. Gentleman recognises is essential. The Government recognised the importance of networks at the beginning of the process; alter we published our strategy "Reforming Emergency Care" in 2001, we made extra resources available specifically to fund emergency-care led staff in every trust and to establish local emergency care networks. All emergency care networks should have four fundamental objectives. First, to create a partnership between all the health and social care organisations within a geographical area;
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secondly, to break down artificial boundaries between services to help patients to gain access to better care; thirdly, to establish agreed shared objectives and shared responsibility for meeting those objectives; and, fourthly, to ensure that initiatives and developments spread throughout the system and produce system-wide improvements. As the hon. Gentleman knows, there is a Worcestershire emergency care network, which is chaired by the acute hospitals trust chief executive and meets regularly.
One reason why networks are important is that patients now have more options for unscheduled care than ever before, especially for relatively minor illnesses or injuries. As well as using A and E or the ambulance service, people can use their GP, NHS Direct, pharmacists, minor injuries units and NHS walk-in centres. Those are all popular with patients and are vital components of networks. The minor injuries unit at Kidderminster hospital is considered to be one of the most successful of its type and is used by 20,000 patients a year, three quarters of the number of people who used to go to the A and E department there. I was immensely impressed by the department when I visited recently. The nurses at Kidderminster hospital have telemedicine links to consultants at Worcester and Redditch.
Dr. Taylor: I would argue with the Minister about those figures. The last figure for people attending Kidderminster A and E department, when it was in existence, was about 43,000, whereas the numbers of people attending in Redditch and Worcester, in the same county, was 44,000 and 45,000 respectively—almost equal. The figure of 20,000 for the MIU does not give quite the proportion that the Minister suggested.
Dr. Ladyman: The figures that I have are from the local trust, but I shall certainly check them, and I undertake to write to the hon. Gentleman. If I have misled him, I apologise, but I believe that the figures that I have been given are accurate.
I was making a point about telemedicine links to consultants at Worcester and Redditch. The evidence shows that, as the MIU has developed and the nurses' confidence has grown, reliance on the link has greatly diminished. Meanwhile, I understand that the MIU has been treating all its patients within four hours and 70 per cent. of them within one hour.[Interruption.]
Mr. Deputy Speaker: Order. Is the Minister going to be a lot longer? I see that a Division has been called in the House. If he is going to be more than a couple of minutes, I shall have to suspend the sitting. Is that the case?
Dr. Ladyman: I fear so.
4.36 pm
Sitting suspended for a Division in the House.
4.47 pm
On resuming—
Dr. Ladyman: Before the Division, I was saying that the MIU in Kidderminster treats all its patients within

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four hours, and 70 per cent. of them within one hour. The trust has launched a number of initiatives to improve the performance of its accident and emergency department, including an integrated health and social care discharge team. It is important that patients understand that positive options such MIUs are available to them, which is why the Department of Health has organised several communication exercises better to inform patients about their choices for treatment. There are also numerous local campaigns.
Networks are not just about where patients receive treatment. The behind-the-scenes co-operation is just as important, as that determines the quality of service that patients get. That means that there should be good teamwork within acute trusts, and that acute trusts should work closely with ambulance trusts, primary care trusts and social services.
The hon. Gentleman spoke about the importance of managed networks. It is certainly true that they have been a success in other fields, but what matters most is that emergency care networks are effective, not how they are managed. All networks are led or managed in one way or another, but our approach has been to encourage and facilitate, not to dictate from the centre. We want to allow local networks to meet local needs. If trusts are to meet the NHS plan target by the end of the year, and we are determined that they will, they will need effective networks. We encourage and facilitate, and we have made available resources to set up networks. We have published guidance, which is now being updated and amplified, and will be reissued shortly.
I also mentioned the incentive scheme for accident and emergency departments' performance, which recognises the pivotal role of networks. Acute trusts can qualify for up to £500,000, but ambulance trusts that improve their performance can also qualify for significant monthly payments. Mental health trusts that improve their 24-hour crisis services can get £200,000, and primary care trusts that plan and deliver high quality out-of-hours services will get £100,000.
We do not accept that there are any obstacles to effective networks that cannot be overcome by committed, motivated and local clinicians and managers who are supported by sound advice. Taken together, the imperative to reach the accident and emergency target, the financial incentives and the new guidance are a powerful encouragement to progress. There is also good practice for others to follow. For example, in Manchester, the ambulance trust and NHS Direct work together to provide a gateway for unscheduled care and to guide patients to the most appropriate treatment. In Essex, the ambulance trust no
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longer automatically takes its patients to accident and emergency, and it takes the lead in providing out-of-hours unscheduled care. In London, the ambulance trust has started to divert calls that clearly do not need an ambulance response to NHS Direct.
The hon. Gentleman has mentioned many times what he believes to be the potential effects of the European working time directive. We see the directive as an integral part of the modernisation of services that the NHS must plan for as it plans for all contingencies. Therefore, every trust has been asked to prepare an action plan for compliance. We believe not that services will close either solely or primarily as a result of the directive, but that networks will be vital to improving the level of services and to meeting the contingencies of the directive.
We are committed to maintaining local access to services, and we recently published guidance to that effect called "Keeping the NHS Local—A New Direction of Travel". We are not complacent, and we recognise that a small number of specialties, and certain types of organisation, face significant challenges. As well as providing direct support to individual trusts that are experiencing problems, we are funding 20 pilot projects and four "hospital at night" projects, which test approaches to achieving compliance with the directive, and develop ways of helping people to work better in partnership.
On top of that, the NHS Modernisation Agency has been running trials and pilot projects considering ways to free doctors' time, rearrange traditional rotas to support accident and emergency departments for 24 hours a day, and develop other new ways of working.
It is fair to say that the hon. Gentleman and I share some common ground, although we do not agree on everything. He will always press for more services to be delivered through the Kidderminster site, and no doubt the local NHS will want to accommodate him, subject to clinical safety and quality, and the local priorities that it sets. I reiterate my opening remarks, in which I encouraged the hon. Gentleman to talk to the local NHS about his ideas, which he is already doing. As I have shown, many of the ideas that he has highlighted are being tested and piloted in various parts of the country. If what he proposes is a good option for Kidderminster and is safe for his constituents, I have no doubt that the local NHS will want to explore it with him.
I assure the hon. Gentleman that the Government will continue to place a high priority on emergency care, and take a close interest in the development of effective networks and the way in which they can improve access to care and quality for all our citizens.
Question put and agreed to.
Adjourned accordingly at seven minutes to Five o'clock.