Westminster Hall Sitting of 26 May 2004

Preamble
[MR. FRANK COOK in the Chair]

Lupus
Motion made, and Question proposed, That the sitting be now adjourned.—[Margaret Moran.]
9.30 am
Mrs. Janet Dean: I am delighted to have secured this debate on behalf of the all-party group on lupus. The group was formed just over four years ago and has almost 100 members from both Houses of Parliament, many of whom were encouraged to join by constituents suffering from lupus. The debate is timely, in that it enables us to recognise the achievement of the international lupus community in celebrating world lupus day on 10 May 2004. That was the first world lupus day, and it was held in conjunction with the seventh international congress on systemic lupus erythematosus and related conditions in New York city. The congress brought together hum reds of doctors and researchers, as well as representatives from patients' groups from around the world.
World lupus day focused on the need for increased research into the causes of, and a cure for, lupus, improved health care services, diagnosis and treatment of the disease, and better epidemiological data on lupus globally. It highlighted the fact that researchers believe that at least 5 million people worldwide have lupus, with more than 100,000 cases developing every year.
Lupus affects people from all countries, but it disproportionately affects people c f certain races and ethnicities, and women are nine tithes more likely than men to suffer from it. Increasingly, there is worldwide collaboration on studies and clinical trials of potential new therapies for the condition, and efforts to identify a cause and cure for lupus are being co-ordinated internationally.
World lupus day was under the direction of an international steering committee of 11 people, who represented 21 countries on several continents. Lupus UK's director, Brian Hanner, was one of the main forces behind the initiative. Lupus UK is Britain's national charity dedicated to the support of lupus patients and celebrated its 25th year in 2003. I was extremely proud to be asked to be a national patron of the charity last year.
I should like to say a little more about the disease. When I was fortunate enough to secure an Adjournment debate on lupus in April 2001, I explained the name systemic lupus erythematosus. "Systemic" means throughout the system. "Lupus" is Latin for wolf, and refers to the wolf-like rash across the cheeks of many lupus sufferers. "Erythematosus" means reddening or inflammation. Such reddening can affect most parts of the body. There is another form of lupus called discoid or cutaneous lupus, which is limited to the skin.
Systemic lupus erythematosus is an auto-immune disease, in which the body attacks itself rather than the bacteria or viruses that the immune system is designed
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to attack. The resulting inflammation can affect many areas of the body and can cause many different symptoms. Some people get only a few; others may have most of them. Nearly all patients with lupus suffer arthritis. About half have diseases affecting their lungs and/or heart, and skin rashes affect about two thirds of patients. Almost half of patients are photosensitive, a third have kidney problems, and about a quarter have central nervous system involvement.
Other symptoms include Raynaud's syndrome, in which the patient's fingers turn white, red or blue in the cold, and hair loss, mouth and nasal ulcers, fatigue and weakness. The body's temperature control can go wrong, causing both shivers and sweats. Inflammation of the kidneys can cause protein in the urine, kidney impairment and, in some people, renal failure, resulting in the need for dialysis or kidney transplant. When the central nervous system is affected, symptoms can range from headaches or migraines to seizures. Patients can suffer transitory visual problems, grand or petit mal seizures, and involuntary tics or muscle twitches. Patients can also suffer from depression and cognitive dysfunction, with effects such as short-term memory problems. Lupus and the associated anti-phospholipid antibody syndrome, or Hughes syndrome, can also cause miscarriages.
With such myriad symptoms, one might think that lupus would be easy to diagnose. Yet, in many cases, it takes several years for a diagnosis to be made. Patients may present to their GP one or two of the symptoms at any one time, but most will never have all the symptoms, so GPs do not necessarily immediately think of the possibility of such a little-known disease. That is why we must continue to raise the condition's profile.
Last weekend, I attended the Lupus UK national conference in Bristol. One speaker—a consultant in maxillofacial radiology—told delegates that all dental undergraduates are taught about the oral manifestations of lupus. I was greatly cheered by that, and I would be grateful if the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), told us whether the manifestations of lupus also form part of a GP's training. It is vital that primary care practitioners faced with a patient with several of the symptoms should consider whether those symptoms are linked and there is a possibility of the patient having lupus.
To endeavour to get the message to primary care trusts, and hence to GPs, I, as chairperson of the all-party group on lupus, recently circulated to all Members of the House a booklet, entitled, "The Big 3", written by Dr. Graham Hughes, the eminent consultant rheumatologist at the Louise Coote lupus unit at St. Thomas's hospital. I am pleased and appreciative that the document was passed to primary care trusts by many MPs.
It is right that we attempt in any way we can to raise awareness of lupus in the medical profession and the wider community. I am therefore delighted that the information on lupus that appears on NHS Direct Online has been updated this week. I commend the information that it contains. Not only does it list the various symptoms and the possible causes, which include sunlight exposure, stress, viral infection,

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hormonal factors and genetic tendency, but it explains how diagnosis is made and outlines the various treatments available for the condition.
There is no cure for lupus. Treatment depends on the severity of the disease in a particular individual and can range from non-steroidal anti-inflammatory drugs used to treat arthritis, to anti-malarial medications used in the treatment of skin rashes, tiredness and muscle and joint pain, through to much more aggressive treatments using steroids and immunosuppressant drugs, such as cyclophosphamide and azathioprine. Although most of the drugs used have not changed during the past 20 to 30 years, the methods of administration have improved, thereby reducing the serious side effects, such as thinning of the bones caused by high doses of steroids.
Survival rates for lupus patients have greatly improved over the past 50 years. As with many medical conditions, it is sometimes difficult to balance a description of the many manifestations of the condition without scaring people into believing that their situation is dire. Many people have mild lupus and live well into old age. There are those who have it severely, but it settles down and, for a long time, they may be in remission after the initial aggressive treatment. Some women sufferers find that their lupus subsides with the menopause. Others have such severe symptoms that treatment fails. There remains a considerable high mortality rate from the disease in its early stages, and young people, sometime in their teens and 20s, can lose their fight against the disease.
Other people who might die prematurely are those who have had the disease for many years, where their internal organs, including their heart and lungs, have become damaged, either from the disease itself or from the necessary toxic drug treatments that they have received over the years. Often, such people will not have lupus stated on their death certificate, so it is impossible to assess the full extent of the mortality rate of lupus.
The good news is that many lupus patients who might once have died from kidney failure now survive because of dialysis and transplants. It is vital that more research is carried out into the causes of, and treatment for, lupus. I commend charitable organisations, such as Lupus UK and the Arthritis Research Campaign. for the way in which they fund research into lupus. ARC funds projects throughout the UK, including in London, Manchester and Sheffield. ARC's remit is to fund other rheumatic diseases as well as lupus, but Lupus UK was set up solely to support lupus patients, their families and their carers, to increase awareness of the disease and its impact, as well as to fund research and to educate general public and health professionals about lupus.
Mr. Dennis Turner: My hon. Friend has achieved a great success in initiating this debate. I invite her to pay tribute to Yvonne Norton, chairman of our west midlands lupus group and vice-chairman of the national group. She has made a majestic contribution, although a lupus sufferer herself. I record the thanks of our parliamentary group and thousands of lupus sufferers
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throughout the country for her dedication and commitment. She is a wonderful person, and we are very grateful to her for all her efforts.
Mrs. Dean: I do indeed pay tribute to Yvonne Norton. Without her the all-party group would not exist and Lupus UK would certainly be the poorer. She has done wonderful work in the west midlands region and nationally. I also pay tribute to the chairman of Lupus UK, Ronnie Gourley for his hard work, and we should remember the founder of Lupus UK, Cheryl Marcus, who was at the conference at the weekend. Without her interventions and forethought in the early days, the charity would not have been established. Our thanks go to all of them.
There are currently around 7,500 members of Lupus UK, with 30 regional groups, which are governed by voluntary committees. I pay tribute to all at Lupus UK and all the individual members, some of whom I had the pleasure of meeting at the recent national conference. The national support group is invaluable. Lupus UK members not only lobby their MPs to join the all-party group on lupus, to attend the meetings of the group and to sign early-day motions—early-day motion 1069 entitled "World Lupus Day" has more than 200 signatures attached to it—but they provide support and encouragement to each other.
Lupus can be an incredibly lonely disease. If sufferers know no one else who has the disease they can feel very isolated. Because it is not as well known as other conditions, such as multiple sclerosis, other people will find their symptoms difficult to understand. Sufferers and their families may find the symptoms difficult to understand. GPs may also not understand them until a diagnosis has been made. Reading Lupus UK'sNews and Views or meeting other sufferers helps many patients and their families to understand the condition better and to realise that they are not on their own.
Because lupus is a chronic disease there is a need for close monitoring, sometimes by a patient's own GP, sometimes by consultants in specialist units. Often those will be rheumatology units or specialist lupus units such as the one at St. Thomas's hospital. There are concerns that patients are not able to receive appointments at such centres of excellence as frequently as might be ideal. I would be grateful to the Minister for any reassurance that she can give about access to specialist treatment facilities for lupus patients.
Another issue raised through the all-party group on lupus concerns the employment of specialist lupus nurses at various centres of excellence throughout the country. Currently Lupus UK funds several specialist lupus nurses who provide valuable ongoing support for patients with this unpredictable and frightening condition. The idea is that local primary care trusts should ultimately pick up the costs of these specialist nurses, but in some cases that can prove difficult. I should be extremely grateful if my hon. Friend the Minister provided me with some hope that that will be rectified.
I am pleased that so many members of the all-party group on lupus are here today to support this Adjournment debate. I know that members of Lupus UK greatly value the involvement of Members of Parliament in their fight for greater recognition of lupus.

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When the all-party group was established, a survey of all Members of Parliament was carried out to establish their knowledge of lupus. I reported the results in my previous Adjournment debate in 2001. Of the 153 MPs who replied to the survey—that response was pretty good in itself—51 were aware of constituents with the disease, five had close family members affected by it and 24 had friends who suffered from it. I hope that, by now, parliamentarians' knowledge of lupus will have increased even further through the work of that group and because of contact from constituents.
I am well aware of the effect of lupus on individuals and their families, because both my late mother, Mary, and my late husband, Alan, suffered from the disease. For all who are affected by lupus, I hope that the Minister can provide reassurance that the Government will do all that they can to ensure that the medical profession is well informed about the disease, so that diagnoses are made earlier, sufficient it funding is made available for research into the disease and patients can access specialist treatment when and where it is needed.
9.46 am
Dr. Richard Taylor: When I retired as a doctor, I did not think that I would end up in this place, and when I arrived in this place, I did not think that I would be talking about lupus, which was, if people can understand the phrase, one of my favourite illnesses when I was a doctor. A doctor looks at it in the opposite way from a patient. For a doctor, a favourite illness is one that he thinks he knows something about, he thinks he knows how to diagnose and he thinks he knows how to treat. My problem today is that, because I have given quite a lot of lectures on lupus to general practitioners, students and junior doctors in the past, I must be careful not to give a straight medical lecture, which would not be appropriate. I shall therefore say a little about the name of the disease, diagnosis, treatment, prognosis and research.
Mr. Deputy Speaker: Order. This might be an appropriate moment for me to remind hon. Members that the first of the three winding-up speeches will start 30 minutes before the debate concludes. I must therefore try to allow all other hon. Members to contribute by 10.30 am. A further three are in line to speak.
Dr. Taylor: Thank you, Mr. Deputy Speaker. I have no intention of going on for hours; I am sure that I can say what I need to in 10 minutes or so.
I accept the definition of the name "lupus" that the hon. Member for Burton (Mrs. Dean) gave. However, I visited my local safari park not long ago and looked at the wolves, and they do not actually have a rash on their faces, so I much prefer returning to the archaic mediaeval Latin, which describes lupus as an eating ulcer or cancer. That is exactly what lupus does. It clogs blood vessels, which means that bits of tissue inside and outside die. The person affected looks as if a wolf has been gnawing at them. The Bible talks about "ravening wolves", and Shakespeare talks about men returning from battle and eating like wolves, but Mrs. Gaskell got it best. She uses the phrase
"deaden the gnawing wolf within",
which is a marvellous quote to describe lupus, because lupus sufferers have a gnawing wolf within.
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Diagnosis in medicine is similar to bird watching. If we are interested in birds, we know exactly what a bird looks like and, from reading about it, its habits. Those of us who know anything about birds know that a willow warbler and a chiffchaff are identical until they open their beaks. Equally, we can look at books, but we cannot recognise various of the wading birds until we really observe them.
I was a general physician with a wide range of interests and a special interest in rheumatology. This may sound hard, but it is not meant to: one almost collects illnesses, and diagnosis becomes the most fascinating part of the job. Seeing someone whose symptoms have gone undiagnosed for years—as with lupus—and being the person who puts their finger on the problem gives one great satisfaction and makes the patient a friend for life, because one then takes them on.
It is splendid that the hon. Member for Burton secured the debate. As she said, diagnosis of lupus is difficult because it mimics other illnesses. One of the first patients whom I saw was a lady who had been diagnosed as having regular clots in her lungs, but the X-ray appearances of repeated pulmonary emboli are similar to those of repeated appearances of vasculitis in the lungs, when the lungs shrink.
I know that my lectures to local GPs had some effect because, as long ago as 1979, I received a letter from a GP about a lady who had had a series of attacks of swollen knuckles associated with a rash of both cheeks and her upper lip. He wondered whether she had systemic lupus erythematosus, and of course, she did. There are many causes of recurrent chest pain, early strokes, and epilepsy, so the only way to diagnose lupus is to be aware of it as a possibility, and do the necessary referral and tests. Oddly, some of the simple tests of acute inflammation—this is an inflammatory disease—that a GP would expect to act as screening tests do not. Lupus is one of the few inflammatory diseases that can completely fox a doctor, as normal tests would pick up some of the inflammatory diseases.
The hon. Member for Burton referred to prognosis. In 1943, all but two of a series of 30 patients were dead in three to eight months. By 1970, survival rates were much better due to treatments, and because the way in which those treatments are used is better than 30 years ago, survival rates are improving. Still, however, patients can be given a gloomy prognosis by somebody who does not know much about lupus. A lady came to me in floods of tears because her husband had been talking to her GP and had been given a fearful prognosis, which he could not keep from her. That needed correction.
On treatment, as has been said, there have been no new drugs in about 30 years, which is very disappointing. I wrote a review article on lupus as long ago as 1970, and in the introductory paragraph, I wrote:
"Since 1948 the advances in our understanding of lupus have been dramatic and exciting. One feels that the final answer must be close at hand."
Sadly, that was 34 years ago.
When I arrived in Parliament, I was staggered to find that there were so many all-party groups related to health issues; my latest list shows that there are 66. Of those, a large number refer to important health issues, but about half refer to single illnesses, where there are pressure groups of patients who feel that those illnesses

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are not getting a fair crack of the whip so far as staffing and resources are concerned. Lupus is one of those, and it is very deserving because it is controllable in most cases. If it is not picked up and controlled, it costs the NHS vast amounts in support and treatment of late complications. I hope that we shall hear from the Minister ideas about raising awareness, which should not cost too much money. Most local hospitals have a rheumatologist, who will diagnose the disease if someone is referred to them, and there are also specialist centres. I hope that Government funds will increasingly be pushed into the research into lupus, and I would like to hear some encouragement from the Minister on that.
9.55 am
Liz Blackman: First, I want to congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing the debate and pay tribute to her hard work over the years, not only in raising awareness of lupus, but in campaigning for better services. In comparison, I know little about it. I belong to an east midlands group, I am a member of the all-party group and I have constituents who have lupus. For those reasons, I intend to confine my remarks to one or two specific points about it.
Lupus is an auto-immune condition; in fact, it is a spectrum of disorders. Its symptoms can range across any medical book, in any combination. They can be mild or extremely severe and can move from one to the other in the blink of an eye. That makes diagnosis extremely challenging. Yesterday, I rang the lupus expert centre in Nottingham, and I asked a clinician whether there was any evidence that patients were rattling around less at general practitioner level before being referred to that centre. He said that there was. I asked him what he put that down to and he said that it was partly because of the work of Lupus UK in raising awareness, and because there is an excellent centre in Nottingham. Of course, communities of GPs liaise and link with a local or sub-regional centre of excellence, and naturally improve their education in that way.
Unfortunately, there are still gaps in the service and an awful lot of stories about people struggling a great deal to get a diagnosis. Nevertheless, diagnostic tests are much more available to GPs, including auto-antibody tests, and there is evidence that GPs are using them more. Therefore, there are encouraging signs, but there is a lot more to be done.
A patient who receives a diagnosis of lupus may follow various pathways. People might be lucky enough to live in an area where there is a sub-regional centre of excellence, such as Nottingham, Newcastle, Birmingham, or Leeds; St. Thomas's and the Middlesex have also been mentioned. What has happened is that a group of experts have come together and made the service excellent. They have a specific interest. Their backgrounds are in haematology, immunology, rheumatology and renal services. For some reason, a catalyst has brought them together and they have knit the service together well.
However, those sub-regional centres do not exist everywhere. There are some good local lupus facilities that can offer treatment for the aggressive presentation
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of lupus, but they do not necessarily have the same kinds of facilities as the sub-regional centres. Many patients find themselves in local hospitals where the training and expertise in management simply is not at the same level. I wondered whether the Minister would say whether there is an additional role for strategic health authorities, to ensure that those excellent services are much more coherently available across the country. I would be grateful if she examined that. Primary care trusts also have a role in terms of funding and commissioning services.
At the heart of the lupus issue, because of the nature of the condition, is patient self-management. The patients know their condition best; they know when symptoms change. However, at the heart of that is the need for investment in resources for good education for patients, so that they can see the signs, access the relevant services and make a distinction between signs that might indicate a stepping-up—a more aggressive presentation—of the disease, and signs that herald something much more common that we all get from time to time.
At Nottingham, the PCTs have gathered together and funded two specialist lupus nurses. They are invaluable: patients can access them at any time, and if those patients have an aggressive episode, they are rapidly signposted to the appropriate services. Specialist nurses for many conditions are coming through now, and I would like to see more coming through for lupus. Patient self-management is phenomenally important.
I want to move on to treatment other than self-management. One large aspect of tackling the condition is the drugs regime. As has already been said, there are far more effective drugs, and cocktails of drugs, available now than ever before. As the hon. Member for Wyre Forest (Dr. Taylor) said, many years ago a person given a lupus diagnosis thought that they had—and in many cases, they did have—a death sentence. That is no longer the case.
I am delighted that the National Institute for Clinical Excellence is evaluating prasterone for systemic lupus erythematosus. Thai is very good news. However, there is a problem with developing drugs for a condition such as lupus, because the disease is still relatively uncommon, and drug companies do not have the same motivation to develop a drug that will be used only by a relatively small number of people.
However, there is scope for international cooperation. I was delighted to hear from my hon. Friend the Member for Burton that that is happening much more actively. Of course, the global demand is much larger than demand in any specific country. Cooperation, ought to be stimulated and enhanced.
In that context, NICE has recently given the green light to a drug called rituximab, which has proved very effective in treating non-Hodgkin's lymphoma, and I gather that there is some kind of read-across to the treatment of some types of lupus. However, there would need to be clinical trials prior to any evaluation by NICE of that drug in relation to lupus. Again, we fall into the trap: who would sponsor those clinical trials to establish whether that drug would read across and be effective with lupus patients?
Finally, I ask the Minister where we are with the national service framework for long-term conditions. I know that the focus is on neurological conditions, but

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obviously there is also an intention to set high standards for generic long-term conditions. It would be good to know how that initiative is progressing, because it will offer a template to ensure that there are more joined-up services and more equity in the system.
10.4 am
David Taylor: I am grateful for the opportunity to make a short contribution to this important debate. I congratulate my hon. Friend the Member for Burton (Mrs. Dean), whose constituency almost borders mine, on securing it.
When my hon. Friend described developments in public awareness, particularly those that have occurred in this place, she characteristically understated her own contribution. Her arrival here on 1 May 1997 coincided with a significant increase in awareness among parliamentarians and those linked to Parliament.
Although it is one of the least- known conditions, lupus affects some 5 million people across the globe. There are more than 50,000 sufferers in this country, which means that each Member of Parliament has 70 to 100 lupus sufferers in his or her constituency. Lupus is more common than better-known illnesses, such as leukaemia and multiple sclerosis. However, despite its prevalence, relatively little was published on it until recent years. I was pleased to hear that the hon. Member for Wyre Forest (Dr. Taylor) was active in this area as long ago as 1970.
Little has been published about the effect of lupus on sufferers, or what can be done to relieve it, but at last lay people like us are steadily learning more about its effects and treatment. That owes much to the admirable and unstinting efforts of Lupus UK, the national registered charity to which my hon. Friend re erred earlier, which supports those with systemic and discoid lupus and assists those who are approaching the long process of diagnosis.
Treatment depends a great deal on the professionalism, skills and energy of those who work in units such as the one just a few hundred yards from here at St. Thomas's hospital, which is led by Dr. Graham Hughes. We look to volunteers, who raise so much money for the vital, pioneering research that is taking place, and we ought to put on record our admiration for the work that they do. Politicians, such as the Minister of State, Department of Health, my hon. Friend the Member for Doncaster, Central (Ms Winterton), and the all-party group, of which I am happy to be a member, need to raise the public profile of lupus and raise awareness of what is being done and what lies ahead to be tackled.
Lupus is a worldwide disease. There is international co-operation in researching its causes and tackling people's concerns. World lupus day was two weeks ago. In New York city, there was the international congress on systemic lupus erythematosus and allied diseases, where more than 100 patient and advocacy bodies were able to share information and develop or strengthen collaborative initiatives to find a ca use of and a cure for lupus. October 2004 has been designated awareness month.
What are the priorities for the lupus campaigners? The resources for medical research have yet to catch up with those for other conditions of comparable
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magnitude and severity. Much more work is needed to develop safer, more effective therapies for the disease. We have heard that no wholly new therapies have been introduced for more than three decades. That says a great deal about the Cinderella status of lupus. Existing treatments can be toxic and often, perversely, cause life-threatening health problems that may be worse than the primary disease. Much more remains to be done to resolve such chronic difficulties.
Several international studies have shown that lupus has a considerable impact on the health care system and on society, owing to its complexity and treatment. Depending on which organs are affected and the frequency and severity of disease activity, individuals with lupus may have to take multiple medications, be treated by physicians from several medical specialities and undergo numerous evaluations and procedures. Worst of all, they may be hospitalised several times a year.
Substantial progress has been made on morbidity and mortality in the past half-century. We have heard some of the figures. In the 1950s, the five-year survival rate was around 50 per cent. Nowadays, the 15-year survival rate is some 85 per cent. However, lupus still has a serious effect on the quality of life of those who suffer from it. Fewer people die from it, but the figures are still significant. For example, the Arthritis Research Campaign website records that of 361 SLE patients treated at University College's Middlesex hospital lupus clinic from 1978, 50, ranging in age from 16 to 87-years old, had died by 2002. The mean age at death was 50, which is perhaps 30 years less than normal life expectancy. ARC also deserves to be congratulated for the work that it is doing. As it points out, while the prognosis is better, close monitoring is the order of the day.
We know that lupus is caused by the inter-reaction of environmental, genetic, hormonal and other factors, but the enormous complexity of the disease makes identifying its precise cause incredibly difficult. Nevertheless, newer emerging technologies give researchers cause for optimism. The structure and function of specific antibodies are being evaluated while the study of the inter-reactions between cell populations in the immune system is assisting our understanding of how lupus develops.
The good news is that some laboratory research translates fairly speedily into new therapies in the clinic. One example is the British use of B-cell depletion to treat severe cases of the disease. However, there is much to do to extend understanding of the critical involvement of cells and molecules, such as the lymphocytes and cytokines, which are the chemical messengers that enable cells to communicate.
There is even more to do to deal with the widespread lack of recognition of lupus by health professionals, the general public and Governments. Many physicians worldwide are unaware of its symptoms and health effects, causing people with the disease to suffer for several years before being correctly diagnosed and treated. There is an unmet need, in this country and worldwide, to educate and support individuals and families affected by lupus, and to increase awareness of the symptoms and health consequences.

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We need continually to raise awareness of lupus, to collect better epidemiological data on its extent and impact, to research its complex causes and a possible cure, and to develop therapies to improve the quality of life for the thousands of sufferers in this country.
Lupus has been a Cinderella area of health care. Although I do not expect the Minister to produce the glass slipper that will transform its status, I hope that she recognises the scale of the problem and will react swiftly and appropriately to tackle the problems highlighted by the all-party group on lupus, led magnificently for seven years by my hon. Friend the Member for Burton.
10.12 am
Ross Cranston: I congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing the debate. She is a patron of Lupus UK and has done a magnificent job in leading the all-party group and making MPs more aware of the disease. I feel intimidated having heard the hon. Member for Wyre Forest (Dr. Taylor) and my hon. Friends the Members for Erewash (Liz Blackman) and for North-West Leicestershire (David Taylor), because I am not knowledgeable about the disease and do not have their expertise. As politicians, we learn a great deal about people's concerns, troubles, successes and achievements, but it is impossible to become experts on every issue, although we do of course become aware of many matters. I do not know whether we are better weather vanes for public concerns than focus groups—that is an issue of empirical research.
As MPs, we are privileged to be taken into people's lives, and that is how I found out about lupus. My hon. Friend the Member for Wolverhampton, South-East (Mr. Turner) mentioned Yvonne Norton. I first became aware of lupus because she lives in Coseley in my constituency. As my hon. Friend said, she is a wonderful woman who has done a great deal with the all-party group. In 1981, she founded the west midlands lupus group, the first regional lupus group, and she is still the chair of that group as well as being the vice-chair and trustee of Lupus UK. She is also the UK representative to the European Lupus Erythematosus Federation. Her husband, who has not been mentioned, is the treasurer of the west midlands lupus group and the ELEF.
I want to talk briefly about what the west midlands lupus group has done to raise the issue and to provide support. It has made a financial contribution of £400,000 to help to fund lupus research and patient care, in addition to funding the day-to-day running of the group. It also produces a newsletter and organises open meetings. As my hon. Friend the Member for Erewash said, the group contributes to patient self-help. It helps and supports patients. It helps sufferers come to terms with having lupus; for example, it advises on the items and adaptations that may be needed to live as near a normal life as possible with the disease. It holds open meetings, which medical speakers and others attend, and it also holds social and fund-raising events.
Since 1997, the west midlands lupus group, as part of Lupus UK, has sponsored a Lupus UK specialist nurse based at the Queen Elizabeth and City hospitals in
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Birmingham. On 1 September 2001, the Lupus UK research assistant began a three-year project based in that hospital. In 2002, funding began to part-sponsor a Wolverhampton university Lupus UK PhD student for three years. Previously, sponsorship had been provided for a research associate at that university, a specialised lupus technician at the Queen Elizabeth hospital, and a PhD student at Leicester university.
Providing self-help and funding is the first aspect of the work. The booklet produced by Lupus UK has been mentioned, but Yvonne Norton had earlier produced, with Lupus UK, "Lupus—a GP Guide to Diagnosis", which was sent free of charge to every GP practice in the country and distributed more widely. It is the only book that covers all aspects of lupus aimed specifically at GPs. As I understand it, it is now used extensively for both reference and diagnostic purposes.
I also want to refer to what happened at the Dudley guest hospital in my constituency. In October 2003, I had the privilege of being at the opening of the first UK lupus drop-in clinic with the mayor of Dudley, Rosemary Tompkinson. That idea has taken off and will, I hope, be folio Ned in other parts of the country. It was an initiative of Yvonne Norton and the west midlands lupus group, and it is a joint project with the Dudley Group of Hospitals NHS trust. It is a monthly drop-in clinic. A nurse practitioner and representatives of the group are always in attendance. Talks are held there.
The first three-month evaluation of the success of the clinic is about to be published by Treharne from the Dudley Group of Hospitals NHS trust and various colleagues from the University of Birmingham. The study demonstrates that the dedicated care that the clinic can provide is extremely useful in helping not only with the immediate symptoms but with associated disorders. The research work demonstrates that depression was the most common co-morbidity, followed by osteoarthritis and back pain. Co-morbidities are common and need to be dealt with. By providing that dedicated care through the clinic, they can be addressed more efficiently.
I hope that I have given a flavour of the work that is being done. Following the success of the Dudley lupus drop-in clinic, plans have been formulated to set up drop-in clinics in other areas covered by the west midlands lupus group. Other regional lupus groups are seeking advice on establishing similar drop-in clinics.
I began my remarks with the general, and shall finish with the general. Lupus, as my hon. Friends have explained, is under-recognised as a disease. Early recognition and diagnosis are essential, but that may be difficult because the symptoms often mimic common illnesses. It seems to me, having seen the work that Yvonne Norton does and the work of the all-party group, that there is a challenge to professionals. The hon. Member for Wyre Forest has taken a longstanding interest in the matter, and professionals are now much more open to and welcoming of patient involvement in medical diseases, as consumer involvement might be welcomed in other areas.
However, in this area, as my hon. Friend the Member for Erewash said, self-management by patients is crucial. My hon. Friend the Member for North-West Leicestershire mentioned the work of volunteers. The

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work of professionals can benefit from patient involvement, not only in providing support groups or financial support for research, but in raising the consciousness of a disease among both professionals and practitioners, and among people such as ourselves.
10.22 am
Sarah Teather: I, too, congratulate the hon. Member for Burton (Mrs. Dean) on securing the debate. I know that in her role as chair of the all-party group she has worked tirelessly to raise awareness of this distressing condition.
I also welcome world lupus day. As the hon. Member for Erewash (Liz Blackman) said, it may be instrumental in encouraging international co-operation and perhaps will result in the development of drug treatments. I pay tribute to Lupus UK for its work in supporting people with the condition and in funding research.
As has been said, lupus is a distressing condition, which may vary from very mild effects to severely disabling symptoms; in some cases it can be fatal. We have heard that prognosis has improved considerably, but there is still a long way to go. Lupus is far more common—six times more common—in people of black and ethnic minority origin than in white people. My constituency is diverse and lupus is much more common there than in many other parts of the UK. Consequently, general practitioners in my area are well attuned to picking up the condition and diagnosing it, but that is not the case in many other areas.
Our local hospital, Central Middlesex hospital, has around 400 lupus patients on its books, which is high for a hospital of its size. It has one specialist in the condition and one specialist nurse. However, I am told that it desperately needs another specialist and another specialist nurse to meet the need. In common with most specialists in the condition, the current specialist is a general rheumatologist, so he has many calls on his time.
Lupus needs intensive monitoring. It requires complex drug regimes that also require intensive monitoring because they have a very narrow therapeutic index. We heard from the hon. Member for Wyre Forest (Dr. Taylor) that if the condition not managed well, the problems can get worse, and the drain on the NHS can be enormous. It is therefore a false economy not to manage the condition well. As the hon. Member for Erewash said, specialist nurses play a vital role, as they do in many other complex and long-term conditions, because they give patients the opportunity to learn more about their condition and to manage it themselves.
Although the situation in Brent is better than in many other areas, there are some shocking cases in which people have fallen through the net Earlier this year, a gentleman came into my constituency office in exasperation. He had been referred to the lupus unit at St. Thomas's hospital, Westminster, and was originally given an appointment on 20 January 2003, which was put back once to 30 September 2003 and again to 28 September 2004. He was then told that he would probably not be able to see a specialist until 2005. Following my intervention, and with great help from the patient advice liaison service, he managed to get an earlier appointment, but it caused immense anxiety and stress.
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The problem of the lack of specialists is difficult to quantify because general rheumatologists tend to treat the condition. When I asked a parliamentary question about the number of specialists available, I was told that the information was not held centrally. I also asked about the number of patients with lupus and the only information I was given came from Lupus UK, which was out of date in respect of about 10,000 patients.
There is a problem in assessing need, which is typical of a disorder that unfortunately attracts little attention. The hon. Member for North-West Leicestershire (David Taylor) said that it was a Cinderella disorder. It is a specialised condition in the NHS. Liberal Democrats have asked whether the present voluntary consortium arrangements are adequate in dealing with specialist commissioning. The Government's review of specialist services has not addressed that problem adequately.
Another matter that puts great pressure on lupus patients is prescription charges. Ongoing problems that need many complex drugs, perhaps over a lifetime, can put a great strain on patients who may already be under pressure financially if they are unable to work or if their income decreases because they can only work part time.
David Taylor: Lupus sufferers often have to take a cocktail of drugs, which can produce adverse effects. Can the hon. Lady suggest how the privately owned pharmaceutical industry can be encouraged to invest more in research? That might allow the number and range of drugs that are prescribed to be narrowed, with a consequent reduction in the adverse effects?
Sarah Teather: As the hon. Member for Erewash said, international co-operation is the key and I hope that world lupus day will encourage specialists to work together. Groups of pharmaceutical companies will need to co-operate, perhaps with incentives from the Government to do so.
Prescription charges can place great burdens on patients. Liberal Democrats are committed to a full review of prescription charges to find a fairer system, especially with a view to considering the effect on the chronically ill, who have a particular problem in that respect.
I hope that the national service framework for long-term conditions will come on line very soon. I know from my work with Macmillan Cancer Relief before I was elected to Parliament that many patient groups are desperate to have the national service framework and have great hopes that it will lead to better management of chronic conditions.
I have been brief to allow other hon. Members time to speak and the Minister to respond. I urge the Government to obtain better data on the number of patients with the condition and the number of specialists who treat it, so that specialist numbers can be better matched to patient need, and to ensure that GPs have adequate training in treating the condition. I repeat my hope that there will soon be an NSF for lupus.
10.29 am
Tim Loughton: I, too, congratulate the hon. Member for Burton (Mrs. Dean), not just on securing the debate but on her work

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with the all-party group and on the awareness of the condition that that has encouraged. I count myself a member of the all-party group on lupus and it is a tribute to the hon. Lady that the debate is being held today. Three years ago, she secured a debate at a late hour at the end of the day, when there were fewer hon. Members present to witness it. I am glad that today many more hon. Members are participating in the debate, which is guaranteed to give the Hansard writers nightmares, as many diseases with technical spellings have been mentioned.
I echo the hon. Lady's thanks to the leading lights in Lupus UK; the determination and hard work of a few individuals has put the condition much higher up the agenda. The name of Yvonne Norton has been quoted by just about everybody, and I will be no exception. I want to praise the work of Lupus UK. It works not just to raise awareness of this little-known disease but to provide welfare facilities for members as well as books, fact sheets, videos and, as hon. Members have already mentioned, the bible to the disease, "Lupus—A GP Guide to Diagnosis", which I know that GPs in my constituency use often.
I also want to mention a personal interest: how good it is to see the progress of the Louise Coote clinic under Dr. Graham Hughes at St. Thomas's. Louise was a friend of mine, who died almost 10 years ago. She spent much of her adult life in and out of hospitals with most of the symptoms that have been mentioned today. She bore her illness with enormous courage until it eventually got the better of her. What has been satisfying is that her husband Tim and many friends have raised and continue to raise so much money to support the centre, which has the biggest register of lupus sufferers in the world. It is a centre of excellence that many people throughout the country can use, and it does some fantastic work.
We have had some interesting contributions. In opening the debate, the hon. Member for Burton gave many of the facts and figures, which I will not repeat. She mentioned the recent world lupus day, which is something of a slimmed-down version of Lupus UK's lupus awareness month two years ago. That was perhaps somewhat greedy compared with the weeks and days that most other groups have. However, the campaign has gone worldwide, which is essential. We need to use the expertise and experience of drugs companies and of those races and ethnic groups throughout the world who have a greater propensity to have the disease, to try to accelerate a cure.
The hon. Lady mentioned many of the knock-on effects—not only the physical symptoms, but some of the mental health symptoms, including depression and memory problems. Those points are often neglected, because we tend to look just at the physical manifestations. We need to ensure that special mental health assistance is available for lupus sufferers as much as for people who suffer from less technical and complicated mental health problems.
Mrs. Dean: The hon. Gentleman might like to know that there are both physical and emotional reasons why people get depression when they develop lupus. Someone can obviously become depressed because they have a chronic disease, but there are also direct physical reasons for depression and other neurological manifestations. That is because lupus can inflame the brain just as it can any other part of the body. Both living with the disease and undergoing the physical changes cause depression and other mental health symptoms.
Tim Loughton: The hon. Lady is right, but the point is that, more than many other conditions, lupus is a technical disease that involves a range of professionals and different assessments, as the hon. Member for North-West Leicestershire (David Taylor) mentioned.
As ever, we heard an interesting contribution from the hon. Member for Wyre Forest (Dr. Taylor), who is a general physician with a wide range of interests, as he described himself. In his contribution, those interests extended to twitching and to classical and literary references. I side with him on taking up the cudgels for the much-maligned wolf, and the Latin to which he referred will have had much more to do with the naming of the disease than that one part of the animal kingdom.
Both hon. Gentlemen mentioned the improving survival rates, but it is depressing that the hon. Member for Wyre Forest was able to pluck out an article that he wrote 34 years ago, And yet not much progress has been made since then in understanding and getting to the heart of the disease. The hon. Member for Erewash (Liz Blackman) described how Lupus UK has raised awareness among doctors, and I underline her point about how important patient self-management is. The hon. Member for North-West Leicestershire commented on the side effects of some of the toxic cocktails of drugs, which is another worrying aspect.
A multidisciplinary approach is required, involving many different professionals and assessments. There must be ways of simplifying the system, which currently often pushes lupus patients from pillar to post, seeing one consultant after another, filling out more and more forms and going through more and more tests. We need a more streamlined patient-centred approach to the disease than we have at present.
The hon. and learned Member for Dudley, North (Ross Cranston) referred to the pioneering work undertaken by the west midlands lupus group, especially the drop-in clinics. They bring great succour to sufferers from lupus and other diseases who would not otherwise know where to go for help. If their GP is not completely in tune with the disease, sufferers can feel lonely, as the hon. Member for Burton said when she opened the debate.
As we have heard, systemic lupus erythematosus can inflame different parts of the body and affect organs—a few parts or many—such as the heart, the brain and the kidneys. Skin and joints can also be affected. It is difficult to pin down. People suffer fatigue, flu-like illness and skin rashes. Some lupus patients have a clotting tendency, which can present itself as a thrombosis in a vein or artery. I agreed with the hon. Member for Burton when she said that we have underestimated the extent of problem. Lupus is rarely

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recorded on a death certificate. Kidney failure or similar symptoms are attributed as the cause of death, not lupus. Many more people are dying from lupus than are officially recorded as such, which is another reason why we must give more attention to the disease. Will the Minister explain what steps have been taken to secure more accurate reporting of deaths that are caused by lupus, rather than it being one of the symptoms that have brought about death?
We have heard about the numbers of people affected by lupus, such as one in 750 women in the United Kingdom, in whom it is triggered especially between the ages of 15 and 50. A recent study undertaken in Birmingham showed that, in a population of 1.2 million, 242 adults were known to have lupus and 33 new cases of lupus had been diagnosed in one year. The prevalence was 28 per 100,000 people, which is about one person in 3,500. The incidence of new cases per year was 3.8 per 100,000 people, which is about one person in 26,300 people; 90 per cent. of lupus sufferers are female, and people of West Indian origin are particularly likely to develop the disease even when they are born and live in north America or the United Kingdom. Surprisingly, people of West African origin, from which group the West Indian population is descended, are at a low risk of developing lupus, but studies have suggested that up to one in 250 women in Jamaica develop lupus.
In Birmingham, one in 500 women of Afro-Caribbean background have lupus compared with about one in 1,000 women from India and Pakistan and about one in 2,500 white European Caucasians. What special measures are the Government taking to investigate the higher instance of lupus among black and ethnic groups? What extra support can be given to such groups, who are often more reluctant to come forward to medical practitioners anyway? What special measures can be taken in future?
Worldwide, there are 5 million lupus suffers. It is more prevalent than leukaemia, muscular dystrophy or multiple sclerosis. I repeat that people underestimate the extent of the disease. Will the Minister say what further work has been undertaken on the causes of lupus? It has been suggested that an hereditary tendency might exist. The hon. Member for Burton has said that in the past, but no single gene puts people at risk of developing lupus, unlike haemophilia and cystic fibrosis. Environmental factors include exposure to ultraviolet light, various infections, possibly chemicals in the environment, factors related to stress and female hormonal activity, for example the oestrogen-containing contraceptive pill or pregnancy. Can the Minister say what research is being undertaken?
We have heard about the lack of available drugs, although mild lupus can be treated with aspirin or non-steroidal anti-inflammatory drugs. Some years ago, mention was made of clinical trials taking place in the United States on a drug called aslera, which was the first drug to have been developed in 40 years. Will the Minister give us a progress report on that drug and say whether it has reached an advanced stage?
The training of doctors is important. I have mentioned the guide produced by Lupus UK. We have heard that doctors should he trained more about lupus.
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We heard from the hon. Member for Burton that, as standard practice, dentists now hear more about diagnosing lupus. Can the Minister give a progress report on how many doctors, as standard practice, are now made aware of lupus? What is the progress on specialist lupus nurses, who can make such a big difference?
Finally, I want to echo the point about prescriptions. As the hon. Member for North-West Leicestershire said, many complicated cocktails of drugs are involved, because lupus affects various parts of the body. Dressings may also be needed if there are skin lesions. That can put an enormous financial burden on sufferers of complex lupus symptoms. Has the Minister any words of comfort about special circumstances pertaining to lupus sufferers?
Lupus is a specialist illness, but an important one. More than many others, it involves a range of different disciplines and professionals. It is often forgotten in the bigger picture: we hear much about nurses and doctors, hospitals and waiting list numbers, and not enough about long-term chronic diseases such as lupus. I hope that the Minister will give words of encouragement that the Government understand the extent of the problem and will give more practical support for the many sufferers of lupus. Without the work of Lupus UK and individuals about whom we have heard, as well as the hon. Member for Burton who secured the debate, many would still be suffering, largely in silence, and without the greater understanding of the disease than we had 30 years ago—although we still have a long way to go.
10.42 am
The Minister of State, Department of Health (Ms Rosie Winterton): May I start by adding my congratulations to my hon. Friend the Member for Burton (Mrs. Dean) on securing the debate? I know that she secured a similar debate in 2001 and has worked extremely hard to raise awareness of lupus, not least with her work as the chair of the all-party lupus group, and I am pleased to see so many hon. Members from both sides of the House supporting her. This has been a thoughtful debate, and all hon. Members have paid tribute to the hard work and dedication shown by the voluntary sector in helping people with lupus, especially Lupus UK. We are all aware of the contributions that individuals can make and are making.
My hon. Friend the Member for Wolverhampton, South-East (Mr. Turner) and my hon. and learned Friend the Member for Dudley, North (Ross Cranston) paid tribute to the work of Yvonne Norton. The hon. Member for East Worthing and Shoreham (Tim Loughton) spoke about seeing at first hand through a friend the work to raise funds and awareness done at St. Thomas's hospital.
As my hon. Friend the Member for Burton said, 10 May was world lupus day, and October is lupus awareness month. The programme of events around the country will build on the work of previous years to raise the profile of what has been highlighted today as a distressing condition. It is important to raise awareness among the medical profession and the public. Many hon. Members have referred to the problems with diagnosing lupus. The hon. Member for Wyre Forest (Dr. Taylor) gave an insightful account of GPs'

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experience in diagnosing lupus and, as he said, it is one of those conditions that mimics other diseases.
My hon. Friend the Member for Burton and my hon. and learned Friend the Member for Dudley, North raised the issue of GP awareness in particular. Many hon. Members have pointed to the fact that information has been circulated to GPs about diagnosis. My hon. Friend the Member for Erewash (Liz Blackman) spoke about how Lupus UK has also raised awareness and how it is being raised through specialist centres; my hon. and learned Friend the Member for Dudley, North also spoke about the role of specialist nurses. My hon. Friend the Member for Erewash mentioned the role of strategic health authorities in ensuring that there are such centres everywhere. My hon. Friend the Member for Burton talked about whether there would still be specialist nurses if funding from Lupus UK were to stop.
While, obviously, I hope that the funding of such nurses will continue, it is important to recognise that in shifting the balance of power we do not dictate from the centre exactly what should happen in each area. I think that the hon. Member for Brent, East (Sarah Teather) highlighted that when she discussed the prevalence of the disease in her constituency. We can assist in raising awareness. We have tried to do that in the work that we have done with Lupus UK on NHS direct. We can indicate support and help to spread best practice. However, it is up to individual local health authorities to decide how they want to utilise those resources.
As many hon. Members have indicated, the number of specialist centres is increasing. I am sure that all hon. Members will be aware that, as a Government, we do not specify the content of the GP training curriculum. That is the job of the Joint Committee on Postgraduate Training for General Practice, which is the independent authority for putting together general practice training in the UK.
David Taylor: The Minister rightly spelt out the limits of the Government's involvement in GP training. Does she hope that the various bodies that are responsible for that will reflect on the Oklahoma research published only days ago, which showed that testing for auto-antibodies can help to predict the onset of rheumatoid arthritis and lupus four years before symptoms occur? Surely, that is a helpful test and GPs should be aware of it?
Ms Winterton: Yes. As my hon. Friend said, there are increasing developments in that area, which will assist in helping diagnosis. We expect GPs to learn and to get the training and skills needed to deal with all their patients, which, obviously, includes those with lupus.
I also wanted to mention the development of specialist GPs, which, in a sense, the hon. Member for Wyre Forest drew attention to; in his own way, he developed that specialism. As hon. Members will know, we are looking through the new contract to ensure that that specialist GP training is available.
Many hon. Members mentioned the importance of ensuring that patients with conditions such as lupus can manage their illnesses more effectively. I want to refer to three strands of that: the expert patients initiative; the
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chronic disease management programme; and the national service framework for long-term conditions. Although, as many hon. Members have pointed out, lupus is not one of the headline conditions in those programmes, important lessons can be learned from them about managing chronic diseases.
In the chronic disease management programme, we are examining self-care—something that my hon. Friend the Member for Erewash mentioned. The first steps are to audit existing work being carried out to support patients in managing their conditions and to look at how future work can be devised. Again, the involvement of patients, carers and representatives will be central to that work. As the chronic disease management board considers how to take its work forward, I will make it aware of the work that is done by Lupus UK. The board will focus on two approaches to managing chronic conditions: case management and self-care support.
On the expert patients programme, as hon. Members know, people with chronic illnesses have several common requirements, including dealing with acute attacks. The effective use of medicines and treatment is incredibly important, especially in this area, because, as has been said, patients often have to take a range of drugs. They have to manage pain, fatigue and depression—something that my hon. Friend the Member for Burton has raised. We know that lupus can be managed by drug regimes, by careful monitoring of drugs and by having information available to manage the condition. Through the experts patients programme, we are considering a generic course that helps a person with any long-term illness to become more confident in dealing with their condition day to day. It has been said, in particular by my hon. and learned Friend the Member for Dudley, North, that if that can happen, it will reduce hospital admissions and vastly improve quality of life. By 2007, the expert patients programme will be in place nationwide.
The national service framework for long-term conditions is another aspect of our work to ensure that people manage lupus more effectively. To answer a question asked by several Members, that will be published towards the end of the year or early 2005.
Mrs. Dean: Is it likely that the national service framework will name some conditions? If it does, does the Minister agree that it is important that lupus should also be named? We already have the problem that the condition is little known. If multiple sclerosis were to be named in the NSF because it is a neurological condition, it would be equally important that lupus was mentioned because one of its manifestations is neurological.
Ms Winterton: The NSF will not cover non-neurological conditions, which is what lupus is considered to be at the moment. However, it will consider how to cover some of the common issues faced by people with long-term chronic conditions and disabilities. It will consider the generic issues of information for service users and carers, and community equipment. It will also help us to look at how we can assist families and carers in developing skills and expertise in understanding and managing conditions. We want that to be linked closely with the

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expert patients programme and the chronic disease management programme.
The hon. Members for East Worthing and Shoreham and for Brent, East (Sarah Teather) spoke about prescription charges. As is well known, entitlement to help with prescription charges is based on the principle that those who can afford to contribute should do so. However, a number of schemes are in place for people on low incomes, and special certificates are available for people who have to take a range of drugs. I must say to the hon. Member for East Worthing and Shoreham that, given his party's plans to reduce expenditure on the NHS, I do not think that the issue will be one that they consider.
Tim Loughton: Would the Minister like to withdraw that comment? She knows full well that we have plans to increase expenditure on the NHS. We will consider precisely those long-term chronic conditions that her Government have blatantly neglected in pursuit of artificial targets and because of the distortion of clinical priority.
Ms Winterton: There is a slight difference between what is said on record and what is clearly said off record by Conservative Members.
Mrs. Dean: Will the Minister give way?
Ms Winterton: Not just now, because I want to address the issue of research.
Many hon. Members have paid tribute to the work done by Arthritis Care and others to promote research, and I absolutely support that. The main agency through
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which the Government support medical and clinical research is the Medical Research Council, an independent body. It is a long-standing and important principle of successive Governments that they do not dictate to research councils the detail of how they should distribute resources between competing researchers and so on. However, it is important to stress that if Lupus UK has specific proposals for research, they should he submitted to the appropriate body. In 2002 the MRC spent some £5.5 million on arthritis and rheumatism research. There is an ability to ensure that research can be carried out.
Hon. Members raised the issue of new drugs and pharmaceutical company research. A new drug has been developed in the United States as a potential treatment for lupus. It is called aslera, and it is the first new drug for the treatment of lupus to be developed in some 40 years, as hon. Members said. We have asked the National Institute for Clinical Excellence to carry out an appraisal of that drug, and we expect it to report on in 2005.
If there are points that I have not addressed, I will be happy to write to hon. Members, but I should like briefly to mention data collection. It is difficult to collect data on individual conditions, because of problems associated with collecting, analysing and constantly updating them. I will bring the point about the classification of deaths to the attention of the Office of Population Censuses and Surveys.
I hope that I have made it clear that the Government take the condition extremely seriously. The work being done to raise awareness will be important not only among the medical profession but to the public, and the general programme that we have set out will ensure that greater attention is given to this distressing condition.

Child Cyclists
11 am
Mr. Eric Martlew: I am pleased to have secured the debate. I requested it because my private Member's Bill, the Protective Headgear for Young Cyclists Bill, received its Second Reading on 20 April, but, unfortunately, there was a technical problem—we did not have a quorum—so the Under-Secretary of State for Transport, my hon. Friend the Member for Plymouth, Devonport (Mr. Jamieson), did not get the opportunity to respond to my speech and those of other hon. Members. It would be inappropriate for this Minister to reply to a debate that has passed, especially as he was not the Minister in the Chamber at the time, but I intend to go over the Bill's salient points and give him the opportunity to reply to those. Children are always a vulnerable group, so I hope that the Government response will be fairly extensive.
The sad truth is that a disproportionate number of accidents involve children on cycles. Figures from the Transport Research Laboratory and the Department for Transport show starkly how vulnerable children on cycles are. The Transport Research Laboratory has found that child cyclists comprise only 6.6 per cent. of road cyclists, yet the Department for Transport's analysis of average road-cyclist deaths in a two-year period leads it to conclude that there are 133 deaths, 28 of whom, or 21 per cent., were children. Using that calculation, children are four times more likely to die in a cycle accident on the road than adults. Once a fortnight, a child dies in a cycling accident on our roads. Children are seriously injured and often disabled in our constituencies every day of the year. Each year we kill the equivalent of a primary class of children and severely injure the equivalent of a small secondary school.
I do not claim that introducing cycle helmets will necessarily reduce the number of accidents, but I am convinced that the measure will reduce the severity of the injuries involved. Many accidents involve serious head injuries. Scientific research, both at home and abroad, has proved the case for cycle helmets in protecting the head and brain against the worst effects of injury.
The report "Bicycle helmets: review of effectiveness" was produced by the Department for Transport in November 2002. It is good and I recommend it to hon. Members. It states:
"There is now a considerable amount of scientific evidence that bicycle helmets have been found to be effective at reducing head, brain and upper facial injury in bicyclists. Such health gains are apparent for all ages, though particularly for child populations".

I said that although child cyclists comprise only 6.6 per cent. of the population, 21 per cent. of those who are killed are children. The report says that cycle helmets save lives, and that is the conclusion of the supporters of my Bill, who come from a wide range of professional organisations.
If my Bill were successful—it is still tabled for discussion, although I suspect that it will not become law—it would provide a legal framework that was practical and proportionate. It would make it an offence for children under the age of 16 to ride a cycle on the road, in a public park or in a recreation area unless they are wearing protective headgear. This is not new
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ground. A similar Bill was put on the statute book in 1990. The Horses (Protective Headgear for Young Riders) Act 1990, which was introduced by Harry Greenway, the then hon. Member for Ealing, North, made it an offence for children to ride a horse on the public highway unless they were wearing protective headgear.
My Bill would not make every child cyclist or their parents into potential criminals, as some of my more excitable opponents claim. Provision for an offence is an important enforcement mechanism when there is persistent flouting of the law, but in reality I envisage that a friendly word of caution or verbal instruction to wear a helmet would be enough to ensure that people complied with the law. Recent statistics show that in 2002 there were only 92 prosecutions of people riding on the pavement and 134 of people riding without lights. Some might say that there should be more prosecutions, but in many cases the law can be enforced without taking people to court.
The Government have argued about compliancy rates, and I accept that the Department for Transport has been trying to do something about them by actively targeting young people. Last year it devoted £137,000 to an advertising campaign on the importance of wearing a helmet as part of t he safe cycling message. Perhaps the Minister will tell us whether there are plans for another campaign this year or next year.
The Department is concerned about compliance and it wants the rate of helmet wearing to increase to a critical mass before it is made compulsory. I understand the Department's motivation for holding that view, but does the Minister think that the goal will ever be reached? Surely, it should be the other way round. Rather than waiting for the practice of wearing helmets to change and then introducing an enforcement measure, could not the Government act now and introduce enforcement measures, so ensuring that the practice changes? If they do not, the Minister will continue to fall into the trap set by the opponents of helmets, such as the Touring Cycle Club, which will do everything it can to avoid helmets being made mandatory. The CTC discourages people from wearing them because it realises that if the practice reaches a critical mass, the Government might legislate.
In 2002, when 18 per cent. of cyclists were wearing helmets, the Government said that they would monitor the wearing rate and review the option for compulsory wearing from time to time. In October 2003, they used the same words, although the rate had by then increased to 25 per cent. The Minister must tell us what rate the Government would find acceptable before deciding to legislate to make it compulsory.
The Government agree that helmets are effective. They also agree on the vulnerability of child cyclists and the importance of delivering a safer cycling environment. In fact, in a response to me, the Prime Minister said:
"The issue that my hon. Friend raises is a high priority for hon. Members and the Government."—[Official Report, 31 March 2004; Vol. 419, c. 1594.]

It is a pity therefore that we cannot agree on the most effective means of delivery.
On Second Reading of my Bill, I went into detail on its opponents, but I shall not do so today. However, I am concerned about the National Cycling Strategy, a

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quango set up by the Government and given credence because it operates out of Marsham street. It sent letters to hon. Members from the Department for Transport headquarters which gave a distorted view of my Bill. which worries me. Does the Minister believe that quangos should be involved in the politics of a private Member's Bill, especially if they do not tell the truth? Is it appropriate that this particular quango should be housed in the offices of the Department for Transport?
The argument for my Bill is that attempts to encourage children to cycle should go hand in hand with measures to create a safer cycling environment. I agree with the press release put out by the Under-Secretary of State for Transport, my hon. Friend the Member for Plymouth, Devonport, which said:
"by making cycling safer, more people will take to their bikes."
That is common sense and beneficial, but does not reflect the current situation.
If the Government are concerned that making cycle helmets for children mandatory would be unpopular, they should take note of the poll of 9,000 adults carried out by the My Voice polling organisation in April. Some 80 per cent. of the those polled wanted helmets to be mandatory for children, and 70 per cent. of children agreed. Experience in other countries has led not only to recognition of the effectiveness of helmets, but to action—they have made it law.
In many countries, putting on a helmet is as common as using a safety belt in a car. Accidents and injuries have declined dramatically in countries which helmets are mandatory, including Australia, New Zealand, Spain, the Czech Republic, and parts of the United States and Canada. Since the Second Reading of my Bill, two European Union countries—Sweden and Finland—have introduced laws making it compulsory for children aged 15 and younger to wear helmets.
Another important area is child cycle training. Perhaps hon. Members can remember the old cycling proficiency test at school—it was the first examination I ever passed and I took pride in that. It also had the advantage of bringing policemen into schools, so children's first contact with the police was favourable. Throughout the '90s, the police decided that they were too busy and that cycle training was not their responsibility. Sometimes that responsibility was passed to the county council, which decided that it was not mandatory. Therefore, the number of children being trained properly declined. We would not have dreamt of letting a child out on the streets without having taken a test. It should not necessarily be compulsory, but this and previous Governments have not given the issue the priority it deserves.
The Secretary of State for Education and Skills is keen to encourage young people to cycle to school. Having seen the way some youngsters cycle, I think that they have never been made aware of the potential dangers. What provisions will there be to increase cycle training for children? I want more youngsters to go to school on bicycles. A report will be published tomorrow—although it is in the media today—on obesity and, in particular, child obesity. I want more youngsters to ride bicycles, because it is good for them, and to be taught what to do. I also want them to wear helmets so that we do not have the tragedies that we see at present.
11.15 am
The Parliamentary Under-Secretary of State for Transport (Mr. Tony McNulty): I congratulate my hon. Friend the Member for Carlisle (Mr. Martlew) on securing the debate and on all that he has said about the safety of child cyclists. I also convey to him apologies from the Under-Secretary of State for Transport, my hon. Friend the Member for Plymouth, Devonport (Mr. Jamieson), who is out of the country on Government business; otherwise, he would have responded to the debate.
The Government take the safety of children on the roads very seriously. Our road safety strategy, "Tomorrow's roads: safer for everyone", published in 2000, emphasised our aim to improve our performance on child road safety. The general target is for us to reduce deaths and serious injuries on the roads by 40 per cent. by 2010 compared with the average for the period from 1994 to 1998, but the target for children is 50 per cent. The reduction in child casualties has been outstanding. Compared to the baseline, child pedal cycle deaths and serious injuries have fallen by 47 per cent. That reduction significantly outstrips the decline in child cycling levels over the same period—something that concerns my hon. Friend—and represents a significant trend towards the target. However, we are not complacent and are taking action on a range of fronts.
The data show that, although the number of casualties is falling for child cyclists of all ages, we still have a problem with the number of young adolescent boys in particular getting hurt while cycling. We know from regular monitoring that boys are the most reluctant to wear helmets. Set against the general, rising trend, the wearing rate for boys went down from 16 per cent. in 1994 to 12 per cent. in 2002. A large proportion of those who choose not to wear helmets are young adolescents.
In the broader sense, we are doing much to improve child cyclists' safety. There are measures designed to make drivers far more aware of vulnerable road users, such as child cyclists. The highway code includes a section on road users, including cyclists, which requires drivers to take extra care. The practical driving test has been lengthened, so that drivers experience more road types and have a greater opportunity to encounter vulnerable road users. The theory test question bank contains many questions about vulnerable road users, including cyclists. Hazard perception skills are important to safe driving, and we want new drivers to develop those skills quickly. The screen-based element of the theory test includes video clips to help to test hazard perception with moving images.
We have also produced publicity for drivers. Our drink drive advert shows a motorist taking care to avoid a young cyclist. The underlying message is to give cyclists space. We have published the "Drive Safe, Cycle Safe" leaflet, in alliance with the AA and the Cyclists Touring Club. It is designed to make motorists and cyclists aware of one another.
Of course, it is important that cyclists take responsibility for their safety, and cycle training is an important part of that, although awareness among drivers is equally part of the overall safety package. About one third of children aged between nine and

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10 are trained each year at school. Research shows that trained children are significantly safer than untrained children, as my hon. Friend suggested, when knowledge and skills are tested two years after training. We strongly advise parents to encourage their children to have cycle training and not to let them out on the roads until they are competent to handle their cycles safely.
We have raised the standards of child cycle training. We assisted the Royal Society for the Prevention of Accidents financially with its "Guidelines for the management and operation of Practical Cyclist Training Schemes". My Department and the Department of Health gave a £76,000 grant to the CTC to develop a cycle training scheme for adults and teenagers, which was launched in May 2003. Driver awareness is certainly important but, as my hon. Friend suggested, the training of cyclists is very important, too.
Mr. Martlew: I am conscious that the Minister said that one third of youngsters are trained. That means that two thirds are not. How will we get to those two thirds? In addition, the CTC campaigns against wearing cycle helmets. How can the Government be involved with that organisation when it works against one of their objectives?
Mr. McNulty: I shall return to the CTC in a moment. On my hon. Friend's first question, he is right: a significant number of children are still not trained, and the job to ensure that more and more are trained remains ongoing. These are not one-off initiatives aimed at simply sorting the task out and moving on. The job on driver awareness and cyclist training is ongoing.
On publicity for child cyclists, we have published "Arrive Alive", a highway code for young road users that encourages children to act sensibly when using roads, and it includes a section on cycling. It is given to every child taking cycle training and more than 500,000 copies are issued annually. We are working with private sector organisations on a cycle smart campaign, which promotes safer cycling among children. It consists of a comic and a "Be safe and be seen" sticker. We promote the wearing of cycle helmets. Some say that helmets do not work. To try to get an independent, objective view on which could all agree, we commissioned research to assess the effectiveness of helmets. It concluded that they have been found to be effective in reducing injury for cyclists of all ages, especially children. As ever, some question that research, but as children are more likely to have low-speed accidents just falling off their bikes, I do not believe that much research is required to conclude that they will be better off wearing a helmet.
The Government helped to launch the Bicycle Helmet Initiative Trust's "Guidelines for Setting up Community Based Bicycle Helmet Programmes" in May 2002. That was the result of three years' work, with £100,000 of joint funding from the Department of Health and the Department for Transport. We also funded the Bicycle Helmet Initiative Trust to produce similar guidelines for schools, which it issued in July 2003.
We believe that helmets can work, so last year we launched publicity aimed specifically at boys in the vulnerable age group—the young adolescents. Before
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the launch, we tested different material with them to establish how they would receive it. The publicity that we ran was the material to which they were most receptive. It is called "Cycle Sense", and the campaign also covers issues such as technique, cycle maintenance and visibility. It consists of a poster, postcards and a website. We are also developing a TV filler film that we hope to launch later this year.
I agree with my hon. Friend; I, too, was very disappointed with the reaction of the CTC to that initiative. It mounted a campaign to undermine it and complained to the Advertising Standards Authority, which has since found in our favour. To an extent, I appreciate the CTC's concern to increase cycle levels, but that is an issue for the Government too, and we tailor publicity accordingly. If the reaction had been that young adolescents would he put off cycling, we would not have used the campaign. The CTC is a major cycling stakeholder and I hope that it will work with us more positively on safety in future, as it does on other cycling issues. Given the CTC's role as stakeholder, we could not simply refuse to work with it. However, I share my hon. Friend's concerns and acknowledge his complaints about its activities in the past.
I do not have the information to hand, but I will explore what my hon. Friend says about the National Cycling Strategy and its role in the run-up to 23 April and the promotion of his Bill. I will get back to him on that.
I congratulate my hon. Friend on giving the issue of cycle helmet wearing such prominence through his Protective Headgear for Young Cyclists Bill, which, as he knows, was dealt with on 23 April and remains, not in pole position, but in the frame for further discussion on 18 June.
Our position on compulsion has been that we will—to quote yet again the words quoted by my hon. Friend—review the option from time to time. However, due to the current rates of helmet wearing among children, which are relatively low, we have a concern that compulsion would affect cycling levels and cause enforcement difficulties. That has been the Government's position. The Bill has caused us to reflect; we need to think about how compulsory helmet wearing might affect the wider initiatives to increase cycling and improve health.
The supporters of helmet wearing say that provided that helmets are introduced with care, compulsion need not affect cycling levels. As my hon. Friend will know, some of the international experiences are that, with a long lead-in of promoting awareness, education and other elements, compulsion has subsequently been introduced. Opponents point to evidence from overseas where compulsion has clearly affected cycle levels. As ever in this life, the reality is mixed and the overseas experience can be read either way. We worry, however, that with helmet wearing by youngsters so low at the moment, compulsion would put many of them off cycling. If that happened it would affect cycling levels. Increasing cycling has the positive benefit of improving health. It is key to our anti-obesity strategy, especially for children, and to the further development of sustainable transport.
Our success in this area does not begin to compare with how well we are doing in moving towards the road safety targets, but I agree with my hon. Friend's

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intention: we must increase helmet wearing. We are continuing our campaigns to promote cycle helmets, ensuring that we do not do so in such a way that it presents cycling as dangerous or risky. The emphasis is on cyclists being sensible and other road-users taking care around them.
It is not simply about training, driver awareness and helmets, with or without compulsion. The whole package is designed to heighten cyclists' awareness and drivers' awareness of cyclists and the notion that cycling is good and should be encouraged, especially among young people. We want to promote cycling and the wearing of helmets. We will continue to reflect on the issue of compulsion and the level at which it should kick in. I hope that others, both inside and outside the Government, will do all they can to support us in promoting cycle helmets and improving the safety of child cyclists. I congratulate my hon. Friend on securing the debate.
Mr. Martlew: The Minister said that when we reach a critical mass the Government will consider implementing compulsion. What does he think the critical mass will be? Is there not a difference between children and adults with regard to compulsion?
Mr. McNulty: As I said, it is not as simple as just reaching a cut-off point for children or adults. It is about all those aspects: driver awareness, cyclist training more generally, and the promotion of cycling, especially among young children. There will be more focus on young adolescents through education. Depending on the effectiveness of all those policy initiatives, we will see whether compulsion should kick in. We will reflect on all those issues, because of the wider campaign and the points raised by my hon. Friend, and will review the position from time to time.
If not all those elements are successful, we may need to steer in other directions. Increased cycle helmet wearing may go alongside all those policy initiatives. We may need to reflect at every stage. One conclusion may be that things are going so slowly that we should move to compulsion. It may be at a far lower figure than we expected. If all those elements are successful, compulsion should be at the tail end, rather like the experience in New South Wales.
I wish my hon. Friend well in his campaign to increase helmet wearing by young cyclists. I know that it will not stop on 18 June. I fear that, for batter or worse, the debate on compulsion will continue I suspect that that is right and proper. We agree absolutely with his fundamental position: wearing helmets makes cycling safer. We should all, CTC included, endeavour to increase cycling wearing by young cyclists in the context of promoting cycling generally. It is an outcome that we all want to see.
Sitting suspended until Two o'clock.

Illicit Trade in Antiquities
2 pm
Mr. Richard Allan: I am pleased to have the opportunity to talk about this subject, and I want to start by setting out the terms of the debate. There are different types of debate in Westminster Hall; those in which we slam the Government for an alleged outrage, whether or not they have committed it, and those in which we plead for the Government to do something that they cannot or will not do. This is neither a slamming nor pleading debate, but a prodding one, in which I will seek to prod the Government to commit to doing what they know they should be doing and probably want to do anyway.
I slightly confused myself in coming up with the title. I was not sure whether it should be a debate on the illicit trade in antiquities or on the trade in illicit antiquities. Either way, we are talking about cultural objects that are a little or decidedly dodgy. What I really mean is the buying and selling or importing and exporting of cultural objects that have been removed from heritage sites and buildings illegally in Britain and elsewhere. The Minister may recognise that phrasing as one that we considered in the Dealing in Cultural Objects (Offences) Act 2003.
The defining principle in this debate is that prevention is better than cure. Much of the damage done in heritage terms is done at the time of removal of objects rather than in what happens to them subsequently. From a heritage point of view, the agenda is about ensuring that removal never occurs in the first place, and my remarks will address that intention.
We want to remove the incentives for objects to be removed, tackle the trade and remove the market. If we kill the market, we take away some of the incentives from people who are engaged in the trade for financial advantage. That happens in the United Kingdom with people who are colloquially known as nighthawks— people, often with metal detectors, who go on to scheduled ancient monuments, typically at night, and remove objects that they then put into the dealing chain. Far more seriously, especially in scale of activity, are the people who operate in conflict zones.
Iraq obviously springs to mind as an example because of the Baghdad museum looting that was in the news. That country should be in the minds of everyone who is interested in heritage, because looting on a far greater scale is currently happening across the range of Iraq's unprotected archaeological sites. Material at those sites is being removed in such a way that the heritage value of those sites is utterly diminished. We have seen that occur in conflict zones such as south-east Asia—Cambodia in particular—and on an enormous scale in west Africa. Countries such as Sierra Leone are having their heritage systematically removed and put on to the world market.
My remarks will be aimed mainly at preventive measures, but I am also seeking a commitment by the Minister to enhanced enforcement of the measures that are already in place. I will set it out as a shopping list at the beginning of the debate so that she has time to consider it and, I hope, respond positively. I know that other hon. Members will flesh out elements of this list.
The list has been drawn up with support from experts in the field, and I want particularly to credit Roger Bland and Michael Lewis from the portable antiquities

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scheme. They are now based at the Museums, Libraries and Archives Council, having been at the British Museum, and they have done a huge amount on the subject. I want also to thank personally David Barwell from the National Council for Metal Detecting, who came here with a colleague to make an excellent presentation about the issues from the metal detectorists' point of view, which is an important perspective.
During the passage of my private Member's Bill last year, I also learned a lot from people within the dealing trade. For example, Anthony Browne, who represented the dealers on the illicit trade advisory panel, was of enormous use to me. I have also had many letters and e-mails about the subject, and it is one that attracts considerable public attention.
My list of items for the Minister falls into three parts; preventive measures, enforcement measures and policy development. I shall try to separate them out. My priorities for the preventive measures are: legislation, which is now mostly in place; the portable antiquities scheme in the UK context, which needs funding for its essential role in securing the UK's heritage; the development of a database to assist dealers in assessing whether they should be concerned about a particular object; and guidance to assist the public, especially non-experts, who are increasingly engaged in the field, for whom the advice is a little weak. I shall flesh those four issues out in some detail.
Unusually, I shall not call for additional legislation. We often come to this Chamber to ask for more legislation, but the Government have provided that through the UNESCO treaty accession, and the Dealing in Cultural Objects (Offences) Act 2003, with which the Minister's civil servants assisted enormously last year. However, there is one specific gap in the export licensing regime, which was mentioned by the last Select Committee report, to which the Government have responded. It remains an important gap that we hope will be considered; there appears to be a conflict between agreements reached at EU level, and the ability of the UK's Department for Culture, Media and Sport to block the export of an object that should not be on the market. I hope that that gap in the legislation will be addressed, and that the Minister can offer a resolution to it.
The portable antiquities scheme has impressed all hon. Members with whom it has come into contact. The all-party parliamentary group on archaeology, in particular, has had much contact with the scheme, and has seen that it provides a tremendously valuable service in safeguarding the UK's heritage. It is important to the metal detectorists, who are carrying out, in most cases, a legal activity, so long as they are not on scheduled ancient monuments and have the landowner's permission. We want to offer metal detectorists a legal framework, and encourage them to work with finds liaison officers. That will create a virtuous circle whereby the metal detectorists become educated in how to perform their activity in an archaeological or heritage-friendly manner, and feel rewarded. Without the portable antiquities scheme we should be back to square one, and the incentive for metal detectorists to engage positively would be gone.
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The resource prepared by the scheme, www.finds.org.uk, is a superb example of what can be done. One of the criticisms made of archaeology is that all kinds of materials are dug up, but that nobody can access the output from it;the public are interested in it but have no ability to access it. However, finds.org.uk is a wonderful example of how, with quite moderate resources, a huge amount of research material can be made available to the general public. It justifies the effort put into the scheme.
I am sure that the Minister will hear more, particularly from members of the all-party archaeology group, on the subject, as it is part of the Department's comprehensive spending review bid process. However, she should be aware that there is huge political support for the scheme to be funded for the long term. We are realistic about it being inappropriate to go back to the Heritage Lottery Fund, which funded the start-up costs and which had its arm twisted a little to keep the scheme going. The fund has made it clear that it will not fund the scheme in the long term, so I think that it is a core activity for DCMS.
The second new development in which we are interested is the database, which allows somebody who wishes to deal in portable antiquities to find out whether the object with which they are presented is one that they should consider. I understand that there has been some progress with that, hut it requires cross-departmental work, which is always challenging, particularly in this case with the Home Office. However, it remains concerning that more progress has not been made. I made commitments to dealers with whom I worked last year when taking through the legislation that I would continue to press the Government on the matter, because the dealers rightly said that they need progress. They co-operated effectively in introducing the legislation, but they have asked for the tools to allow them to comply with it. We have a duty to ensure that such tools are available.
I should like to see a database that deals not only with stolen objects but can give people general warnings, such as those issued by ICOM—the International Council of Museums' red list procedure—which can issue generic warnings saying that it is aware, for example, that looting of statues is taking place in Sierra Leone. That is important if we are to use the Dealing in Cultural Objects (Offences) Act 2003, under which we must demonstrate that the dealers knew or believed that the objects were illicitly removed. In order for that knowledge or belief to be created, it is in our interest to spread the knowledge so that dealers have no reason not to be aware of specific problems. The database is important, so I hope that the Minister can indicate what progress has been made with it.
The final issue on the shopping list of preventive measures is that of guidance to assist the public. That emerged from fairly positive discussions that we had recently with eBay, the online auctioneers, which indicated a willingness to co-operate in trying to ensure that illicit material is not advertised on its site. We are trying to put together a tool kit to enable it to do so. It

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also said that it would point people towards guidance that would assist them in establishing whether an object was illegal, but as we examined that matter further, we realised that there was no definitive and authoritative set of guidance available.
The production of such guidance would require work by Government lawyers and civil servants, but would be well worth doing, particularly because many people who deal in that kind of material on eBay are not dealers in the traditional sense. If we are to require legal compliance from those people, we must offer them an easy and straightforward link to such guidance. I suggest that the Department for Culture, Media and Sport is the obvious body to provide that guidance, so that people can find out easily what their responsibilities are with regard to export licences, the Dealing in Cultural Objects (Offences) Act 2003, heritage legislation and the Treasure Act 1996. If people do not have that source of information, they can continue to plead ignorance. We should be proactive in offering them that kind of resource.
A single, definitive guide of that kind, accessible as a link on the internet to anyone who was offering material online, would also be a valuable resource for anyone who works in that area; for finds liaison officers, for example, who advise people, such as metal detectorists, on whether their material is saleable. It would be helpful for such information to be available and accessible.
The National Council for Metal Detecting has a strong view on enforcement measures. It knows that there are criminal elements—the kind of criminals who will engage in any activity that is perceived to be easy. The criminal approach is, "If I can make a fast buck, I'll do it, providing the risks of being caught and prosecuted are very low." The NCMD is clear that there should be prosecutions from time to time, to send a message out to the metal-detecting community that nighthawking is an activity that should not be engaged in.
In that context, the Crown Prosecution Service recently decided to drop the prosecution of a Mr. Robert Duquemin who was alleged to have removed a hoard of coins from a scheduled ancient monument in Wiltshire. That has caused an enormous amount of dismay because it sends out the signal that such activities are low risk. It should be made clear that, from a legal point of view, such activities are high risk and that prosecutions will take place. I hope that the Minister will examine that case, and will use her offices to press the prosecuting and law enforcement agencies to enforce heritage legislation. It would be helpful if the Department for Culture, Media and Sport sent out the message that such prosecutions are important.
There is particular concern that the heritage value of the items stolen is not properly considered when decisions about prosecutions are taken. The cash value of a hoard of Roman coins could be modest—£20 to £50—and would fall outwith the normal Crown Prosecution Service guidelines for prosecution. However, the heritage value could be far more significant, particularly if one considers the damage that might have been done to the archaeological site to recover those items, even if their intrinsic cash value is low.
Mr. Tam Dalyell: We have spent an unconscionable number of hours on relevant legislation such as the Wildlife and Countryside Act 1981. I am dismayed that more has not been made of just a few prosecution cases "pour encourager les autres".
Mr. Allan: Absolutely. One of the models that we might examine—this was suggested to me by someone in an e-mail—is wildlife legislation. In that context, people occasionally have been prosecuted for offences such as the removal of birds' eggs. Although those prosecutions are only occasional, when they hit the headlines they have a significant impact on the collectors of birds' eggs. We need the equivalent prosecutions in the heritage field; we have not had sufficient cases "pour décourager les autres". I hope that the Minister will signal the importance of the prosecution side.
I understand that if one is in the police, Customs and Excise or other law enforcement agencies, one is constantly being set targets. In the midst of that, heritage can seem like a low priority item.
Mr. Robert Key: There is another dimension to this problem. The police are perfectly keen to catch people removing archaeological finds illegally, but when such cases get to the Crown Prosecution Service, which is all about prioritising, the priority of heritage is very low. When the police get the call, therefore, they do not bother because they say it is a waste of time because the CPS will not proceed.
Mr. Allan: That was a helpful intervention. In the Wiltshire case, it was initiatives by the local police force that got the thing going, but they have felt pushed back, because, after doing all that work—they took forensic samples to prove that the soil around the coins came from the scheduled ancient monument and not another site—the case was sent back by the CPS. My suspicion is that it such cases are given low priority because of the low cash value of the items involved. CPS guidance should be clarified so that if significant heritage value is involved and somebody has committed a huge heritage crime by destroying an archaeological site, that is taken into consideration, and not the fact that the coins are worth £20 or £50. The role of the CPS is critical.
During our discussions with eBay, which have been interesting in terms of clarifying how things can and should work, the arts and antiquities squad at Scotland Yard has been helpful. The squad is willing to act as a conduit. If it is told with reasonable certainty by a competent authority that material on eBay appears to be an illegal antiquity, the squad will ask eBay to be involved in what it calls a notice and takedown procedure. It gives eBay a notice, and eBay in return agrees to take down the material of which it is notified. I hope that we make more progress on that, as it would be a helpful development.
As soon as one engages with the specialist crime squads at Scotland Yard, one realises how short of staff they are. If this is to be an area of priority for the DCMS, encouragement, support and resources for the squads that must police the legislation that we introduce would be enormously helpful. We should take any opportunity to call for additional support. I recognise that that is not directly a DCMS responsibility, but that Department sets the climate within which decisions on resources are taken.

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I now turn to policy development and monitoring the effectiveness of the measures that we are taking. I make a direct plea to appoint a successor body to the illicit trade advisory panel—ITAP. I have no doubt that the Dealing in Cultural Objects (Offences) Act 2003 was possible only because of the existence of ITAP. The panel brought together all the interested parties and created a climate in which constructive discussion could take place about how best to introduce legislation. That enabled the legislation to be introduced and proceed smoothly through Parliament. Had ITAP not existed, I have no doubt that we would have ended up in one of those awful battles, whereby the trade lobby would have resisted the archaeologists and the issue would have been seen as highly contentious and divisive. In the end, people worked together constructively.
ITAP proved its worth in Parliament and in several other recommendations that it made to Government, some of which have been taken up. ITAP was set up on an ad hoc basis in response to a Select Committee report some years ago. I urge the Minister to set up a more formal body, which brings together archaeologists, museums, dealers, metal detectorists and officials to keep the agenda fresh. There will be great disappointment if ITAP is disbanded without a successor body in place.
The Government would derive huge value for money from such a body. It is not an expensive undertaking to set it up, as the people who take part do so willingly; they want to be engaged with it. It is not a costly business, but the value to the Government would be enormous and would pass any cost-benefit analysis.
My next request relates to the internal operation of Government. We need a bit of the much-fabled joined-up government that we have been promised for the past seven years or so. When we consider archaeological matters, we look to the Department for Culture, Media and Sport as the lead agency. However, on the enforcement of the legal measures, which we are talking about today, we need to look to the Home Office and Customs and Excise. The local archaeologists work for local authorities that answer to the Office of the Deputy Prime Minister
A lot of our concerns about planning, listing and scheduling monuments are to do with the ODPM, rather than the DCMS. We highlighted that in the all-party archaeological group report and said that that kind of "joined-upness" was essential in archaeology, because even people who work in that field are saying, "Who is taking responsibility for this?" The fear is that nobody takes responsibility and this issue falls through the cracks between the Departments. This is a complex matter and an interdepartmental working group on a structure for archaeology that crosses all Departments would be a major advance.
I have set out an extensive, but not expensive, shopping list containing quite modest measures that, together, would do much to tackle the illicit trade in antiquities. I hope that the Minister will be able to indicate positive support for those measures. I think that were she to do so, she would have significant support inside and outside the House.
2.21 pm
Alan Howarth: We should all be very grateful to the hon. Member for Sheffield, Hallam (Mr. Allan) for securing this debate. I congratulate him on his speech, just as I congratulate him on the Dealing in Cultural Objects (Offences) Act 2003, which he introduced and took through the House.
I am grateful to you, Mr. Deputy Speaker, for calling me to speak. Normally, I should not be speaking, because I have a rule that I do not interfere with my ministerial successors; they have enough problems without finding me under their feet. However, I am concerned about a number of the issues that the hon. Gentleman has called to our attention. I am particularly apprehensive that the Government may be about to divest themselves of an important resource in the illicit trade advisory panel.
The subject of our debate is important by any standard. It is important if criminal activity is persisting and if we are dealing with thieving, the desecration of sites and significant problems of money laundering through international organised crime, as I think we are in some aspects of the illicit trade in antiquities. It is even more important because we are contemplating the roots of our civilisation. We can, through good archaeological and museological practice, recognise, understand, conserve and honour the origins not only of our own civilisation in the west, but also of Islamic civilisation. The illicit trade dishonours and disgraces all who participate in it, whether they are in Baghdad or St. James's.
When I had the privilege to be Minister for the Arts, I became increasingly, and intensely, concerned that as a Government we were at that stage doing too little to tackle the illicit trade and that we lacked a coherent policy on archaeology, Let me record my admiration for officials in the cultural policy unit and the heritage department of the DCMS. It is always appropriate for Members of the House to press Ministers to raise their game and do better. but there have been occasions—although certainly not today—when hon. and right hon. Members have, if I may put it this way, slagged off Departments a little too broadly. I deplore that when it occurs.
If there is one individual who sharpened my awareness of the problem of the illicit trade in antiquities, it is Lord Renfrew of Kaimsthorn. I think that everybody here today would pay tribute to his enormous authority and concern to ensure that we get public policy right.
When I was Minister, successive Governments had been falling around over the UNESCO convention for some 30 years. The re was some obfuscatory advice coming from the Lord Chancellor's Department, for example, which I did not believe had looked seriously at the issue. It was advising my Department that accession to the UNESCO convention would, in some not very clearly specified senses, be inconsistent with the proper principles of English law. I was tempted to ignore that advice but it was, in practical terms, impossible for me to do so.
I also recognised that there were some genuine difficulties with the UNESCO convention, such as the vagueness of its terminology and the possibility that, if we took it seriously and literally—it is our custom in this

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country to take rather seriously and literally the international conventions and directives to which we subscribe—we might create a fairly oppressive, bureaucratic system.
There were doubts, for example, about what the meaning of the term "inventory" might be. It was with some relief that I was advised by Ms Lyndell Prott of UNESCO that, in the world of UNESCO, an inventory does not really mean an inventory, and that it would be okay; we would be able to handle that.
Equally, there would be a requirement to supervise archaeological explorations; one can imagine the practical considerations of that. There were obvious difficulties. There was also the requirement to ensure that the trade complied with all the stipulations of the convention, and that registers were kept. All that risked creating some impractical and rather oppressive situations.
My predecessor in office, my hon. Friend the Member for Stoke-on-Trent, Central (Mr. Fisher), who I am glad to see here today, asked officials to consider whether, as a fallback position, it might be preferable to subscribe to UNIDROIT, and they had been carrying forward that work; but I came to the view that the whole process was going nowhere. We were also in considerable difficulty over export licensing, notwithstanding the extremely conscientious work of officials in the cultural property unit. However admirable their work might be, there was a problem, in that Customs and Excise did not regard the enforcement of export licences as high among its priorities.
I came to the view that we needed to form an expert panel that would advise the Government, enable us to achieve some definitions, map the extent of the problems that we needed to address, advise s about the nature and extent of them, make specific recommendations to us about policy, and—assuming that we were able to implement those policy recommendations—thereafter invigilate progress. I set up ITAP—the illicit trade advisory panel—which deals with illicit trade in cultural objects. Its terms of reference were
"to consider the nature and extent of the illicit international trade in art and antiquities, and the extent to which the UK is involved in this"
and
"to consider how most effectively, both through legislative and non legislative means, the UK can play its part in preventing and prohibiting this illicit trade, and to ad vise the Government accordingly."
That was appropriate at that stage and, I think, still expresses a current and continuing reed.
We were fortunate that some immensely distinguished individuals were willing to serve on the panel. I pay particular tribute to Professor Norman Palmer, a professor of law at University college, London, who chaired the committee, and the experts from museums, academia, the art and antiquities market and the specialist press, who became members of the panel. As the hon. Member for Sheffield, Hallam suggested, it was not particularly easy to persuade people with those diverse interests to work together, but they were willing to do so. I believe that they did so very successfully, and were enormously helpful to us all.
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At the same time, I instigated the formation of an interdepartmental official group. It was necessary then, just as it is necessary that there should be such a group now. A wide range of Departments apart from the DCMS should take a serious and responsible interest in the field of archaeology: among them the Home Office, the Department of Trade and Industry, the Ministry of Defence, the Office of the Deputy Prime Minister, and also Customs and Excise. This issue, as the hon. Member for Sheffield, Hallam said, is a classic instance of both the importance and the difficulty of achieving well co-ordinated Government policy and practice.
The hon. Member for Sheffield, Hallam was, if I may say so, incorrect historically when he said that the intention was to set up ITAP as an ad hoc body. I envisaged ITAP as being a permanent feature of the scene. It was on my initiative that we set it up. Indeed, the Select Committee was annoyed when it learned that we were setting it up because it found that the Department for Culture, Media and Sport was doing its job and, in a way, we had shot its fox. All that was rather petty. We were working on a common agenda. The problems were obvious and important, and the recommendations of the Select Committee, which tied in closely with our thinking, were an important contribution to the evolution of policy during that period.
Neither the Select Committee nor the Department itself would have been able to muster the expertise that, fortunately, we had available to us on the panel. They could not have been a substitute for the panel. The panel was essential to us. It worked very quickly and reported with 16 recommendations in December 2000. I shall say a word or two about its principal recommendations, the first of which was that we should subscribe to the UNESCO convention. The panel's recommendation gave great power to my elbow and the Department was able to persuade the Government that that was the right action to take. It was an important step forward.
It was recommended that a criminal offence of dealing in illegally removed cultural objects should be created. It was an enormous disappointment to me that the Home Office, which never ceases to churn legislation through Parliament and had two or three Bills in the next Session, was unwilling to incorporate those rather modest provisions in one of its Bills. However, thank goodness, the hon. Member for Sheffield, Hallam stepped into the breach and, with support from the Department and sufficient support from the Home Office, it has been possible for the offence to be put on the statute book.
There have been greater difficulties about export licences and export control. In its progress report in 2001, ITAP recorded what it thought it would be appropriate to do, including, importantly, that the export licensing unit should take account of any evidence of unlawful removal, including illicit excavation of an object from a third country in which the object was located before the country of its last location. That was endorsed by Baroness Blackstone, as the Minister. ITAP had recommended that there should be spot checks. We learned three and a half years later from the European Commission that there was a legal difficulty with mounting spot checks. It was

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disappointing that it took so long for the European Commission to furnish us with that advice. It demonstrates that stamina is essential in such proceedings. We continue to need to mobilise our forces—intellectual, administrative and diplomatic—to achieve the results that we want.
There have been problems in establishing the databases that were recommended in the original ITAP report. Let us remember that, even if we are successful in establishing a database of tainted items, it will not cover those items that are in the ground and may yet be dug up, looted and put on the market improperly and illicitly.
Some of the work that ITAP and the Department envisaged in the year 2000 is complete, but some policy is unclear, and implementation has proved difficult.
The combination of the Treasure Act 1996 and the portable antiquities scheme provides an excellent model. It goes with the grain of human nature because it recognises the enthusiasm of amateur archaeologists and metal detectorists and their desire to be able to keep the objects that they find. Because it recognises and, to as great an extent as is proper, accommodates their energies and enthusiasms, it is workable, in contrast to the absolute and comprehensive prohibitions that other countries in Europe and elsewhere seek to impose. However, its success depends on the services of the finds liaison officers. Without them, I dread to think what will happen in our country. We will revert to a situation in which people wander around finding things and digging things up, and archaeological finds are not recorded. That would be a tragic setback. It would be popular with archaeologists and the wider public, who care very much about archaeology and this part of our heritage, if the Government were able to find the resources to ensure the continuation of the portable antiquities scheme.
We always knew that there would be a problem, because when we managed to persuade the Heritage Lottery Fund to finance the first phase of the scheme that we have had in recent years, we knew that in the end it would depend upon a more permanent source of governmental funding. I fear that we shall still be in difficulties if that is left to local authorities on their own, unless it is made a mandatory requirement, which seems improbable. I hope that the Department will be able to find resources for a scheme of grants to allow the portable antiquities scheme to be maintained.
Internationally, we now have the archaeological catastrophe in Mesopotamia. I congratulate the DCMS and the British Museum on the energy with which they responded to the crisis as it broke. The Institute of Field Archaeologists has recently advised us, however, of how dire the situation is. Only some one third of the objects looted from the national museum in Baghdad have been recovered. The institute asked whether we could provide funds for training to match the funds that are being provided by the Americans, the French and the Germans. It also asked us to provide further support for the British Museum and the British School for Antiquities in Iraq. It would be wonderful if the Department found the resources to do those things.
Against that background, I was therefore surprised when in February the Government announced that they expected ITAP to produce its final report towards the
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end of the year and that the panel would be dismantled. I assumed that that was because the Department did not have the staff to enable it to service the panel. That is a real consideration; the Department is leanly staffed, and nobody would suggest that it is extravagantly resourced, so one has to recognise that choices need to be made. I do not know whether my right hon. Friend the Minister will be able to tell us whether the problem is that the DCMS lacks the resources both to service a continuing policy review by ITAP and its monitoring role, and to support the administrative effort of implementing and enforcing existing policy and the interdepartmental coordination that we all want to see.
I know that this is an anxious spending review for the Department and that my right hon. Friend the Minister wants to do the best that she can for museums, heritage and archaeology. I would note only that the money that it would cost to provide support for a better effort in Iraq, for the portable antiquities scheme and to sustain ITAP would be a fraction of the money that is being spent to support the coalition in Iraq. It would be so tiny as to be indiscernible in the national accounts, and yet it would make a significant contribution to the reestablishment of a peaceful and humane order in Iraq.
Policy is not complete and needs to evolve. The hon. Member for Sheffield, Hallam drew attention to the eBay issue—the problem of trading on the internet. I should have thought that invigilation was part of implementation. It is desirable to keep ITAP. Is there a problem with the Nolan rules? ITAP would have its fifth birthday in May 2005. I do not think that the Nolan rules should be regarded as the law of the Medes and Persians. I also think that I recollect not only that it is in order to renew members of the body for a second term of office but that there is specific reference to highly specialised advisory functions, where the Government cannot just fish another member of the great and the good from the public appointments unit pool. I hope that there would not be an insuperable difficulty in ensuring that ITAP continues beyond the end of this year.
Its members are prodigiously distinguished. They work pro bono. They are not expensive to support, but without them both the DCMS and the Government's interdepartmental effort will be less able to achieve what they need to do. That expert and independent help is needed. I know that my right hon. Friend the Minister for the Arts is always, in her ministerial dealings, courteous and positive. She will certainly be courteous and positive to the members of the panel and I hope that she will be able to tell us that she is willing to reconsider the decision that was announced in February.
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Mr. Robert Key: I congratulate the hon. Member for Sheffield, Hallam (Mr. Allan) on securing the debate. It is an important opportunity to discuss the subject in hand.
I am sure that we are deeply grateful to the right hon. Member for Newport, East (Alan Howarth) for recalling the wonderful things that he achieved as a Minister. I am bound to say that I was a founding Minister at the Department of National Heritage and that as I established the new Department and went from capital to capital negotiating with culture Ministers who

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had had large Departments for a century or more, it did not feel like faffing around. However, he saw it as faffing around and we were all pleased to be put right and to be put in our places.
I will simply record my thanks to Mr. David Mellor, who was my Secretary of State for some time, to Lord Brooke, who was a most distinguished Secretary of State, and to that most civilised of permanent secretaries, Sir Hayden Phillips, who gave a new opportunity to archaeology in the establishing of the Department of National Heritage which is now the Department for Culture, Media and Sport.
It would be a surprise if the Member of Parliament for Salisbury did not have something to say about this matter. More recently, the Salisbury hoard has been a subject of much debate. Anyone who has the privilege of being the Member of Parliament for the constituency that includes Stonehenge, who celebrated their 10th birthday on top of a barrow on Cranborne Chase and who is guardian of the Pitt Rivers collection in the Salisbury and South Wiltshire museum, will have something to say about it.
Mr. Allan: This may be a cheeky question to ask the hon. Gentleman. However, is he a long tunneller or a short tunneller?
Mr. Key: I would love to have been a long tunneller. We are talking about the controversy over a tunnel under Stonehenge, Mr. Deputy Speaker. At the public inquiry, the long tunnel was the one thing that united everybody—from the druids to the Department. However, the Treasury said no, and that was it. We are now in the middle of a public inquiry about the short tunnel. That, at least, was a development.
Mr. Deputy Speaker: Order. Perhaps the hon. Gentleman might point out the relevance of that to the subject of antiquities.
Mr. Key: The tunnel will go underneath one, Mr. Deputy Speaker. However, I will row return to the subject of the debate, and you are quite right to reprimand me.
This morning, I clicked on to the eBay website, typed in "artefacts" and discovered a number of items for sale. One listing read:
"Anglo-Saxon Bronze Artefacts measuring up to 37mm in length. Good luck with the bidding."
It cost £7.99. I discovered an "impressive medieval iron spur". The winning bid for it was £19.99 and its description was:
"Complete medieval iron spur as found And yet to be cleaned. It is complete with rowel and measures 150mm in length. Good luck with the bidding."
I then discovered the pages of thanks, and in relation to the medieval spur the buyer had e-mailed and written:
"Medieval Spur is superb—I wonder who originally wore it? Great eBayer thanks!"

That was just one of 239 pages of thanks that had been sent to one website that sells artefacts.
Therefore, I am grateful to the hon. Member for Sheffield, Hallam for telling us what he has been talking to eBay about. That is an issue that we must address and
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I hope that the Minister will tell us where the DCMS has reached in its discussions with eBay. It is making lots of money. I daresay that it is technically correct, but I believe that it has a moral responsibility and I hope that it will acknowledge that.
The illicit trade, including unreported treasure finds, is sometimes news. That was the case on the BBC's 6 o'clock news on 19 May. However, eBay is now the largest marketplace for antiquities in the UK. I believe that the DCMS must be more proactive on that matter.
I shall concentrate on the lack of co-ordination across Government in tackling archaeological problems such as that. The Office of the Deputy Prime Minister is responsible for local government, and some areas of local governments, notably county councils and unitary authorities, have responsibility for our heritage and for funding museums. I say in parenthesis that most of those local authorities, sadly, are cutting their budgets for museums; mine is, and I regret that very much.
The Department for Education and Skills clearly has a locus, as does the Department for Environment, Food and Rural Affairs, which is responsible for agri-environment schemes. As I know well from its activities in Salisbury, on Salisbury plain in particular, the Ministry of Defence has a great deal to be proud of in its support for archaeology and for the maintenance of the archaeological environment.
Then there is the Department for Transport. When I transferred from being Minister at the Department of National Heritage to being Minister for Roads and Traffic, I was appalled at the desecration of many archaeological sites over many years.
I hope that there can be more co-ordination. The all-party parliamentary group on archaeology, in its excellent report that I am delighted to endorse, recommended that there should be far more joined-up government and that the DCMS should establish an interdepartmental committee on archaeology at ministerial level, which would include the Office of the Deputy Prime Minister, the Department for Education and Skills and DEFRA.
The report suggested that the departmental representatives should meet and maintain a small, strong team to provide policy advice to the DCMS, at least one member of which should be an expert on archaeology seconded to the Department.
The DCMS should also ensure closer co-ordination on archaeology issues among its architecture and historic environment divisions, its museums, libraries and archives division and the cultural property unit. The Department should play an enabling role in bringing together representatives from the sponsor bodies.
Finally, we need a single, non-governmental organisation to lobby for archaeologists. The Council for British Archaeology, the Institute of Field Archaeologists and the Institute of Historic Building Conservation, and possibly other organisations, should have a review under an independent chairman to ascertain how they could better lobby for archaeology in general.

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As a lifelong advocate of archaeology, I regret to say that it is much neglected in this country. The state of archaeology is not too bad, but catalogued today have been some of the consequences of not having a tight enough grip upon that world. Resourcing is a major issue, of course; it always is. The quality of graduate entrants into archaeology is a problem too.
However, there is no doubt that planning policy guidance 16 has resulted in a phenomenal increase in funding for archaeological work, much to the advantage of the constituents of mine who work for Wessex Archaeology, the biggest and best of the contracting archaeologists, including those in the field of marine archaeology. Its headquarters are, needless to say, in Salisbury. The consequences of PPG16 have been tremendous, but there is a problem with the capacity of museums to take and store material, and that has to be addressed with resources.
Above all, the wider context of the debate should be seen in the role of archaeology in the life of our nation. There is a lack of knowledge of history, heritage and archaeology in the curriculum. The Minister knows all about that; I am glad that she is responding to the debate, because she may wish to comment. The lack of archaeology in the curriculum probably contributes to a low sense of identity, of pride of place and of social identity in our wider communities, and that is regrettable.
However, the more of these debates that we have, to raise the issue gradually up the agenda—we may be talking about small items for sale on the internet or the great issues of the archaeological damage done in Iraq and Mesopotamia—the better, because people will realise the importance of looking backwards if we are to understand how to move forwards.
Mr. Deputy Speaker: Order. Perhaps I should remind all right hon. and hon. Members that I am required to call the first of the three winding-up speeches at 3 o'clock, 30 minutes before the conclusion of the debate.
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Mr. Tam Dalyell: I thank the Minister for her optimistic answer to Question 2 on Monday on portable antiquities. I raise the question of reciprocity and incentives, a subject covered under item 12 of the brief given to us by the British Museum. I will not go into the brief in detail for the sake of time, but it is important because it raises the question of whether items that were taken, possibly as long as 150 years ago, should be repatriated. I am chairman of the court of the university of Edinburgh, and we are under intense pressure to return to Ethiopia religious artefacts of great importance that were taken by British forces in the 1860s. What does the Minister's Department think about the return of valuable objects?
There is a review of treasure trove in Scotland and it has been recommended that Scotland needs a team of finds liaison officers similar to those in England and Wales. Does the Minister agree that that would be helpful in ensuring the reporting of treasure in Scotland, and that the role could not be satisfactorily undertaken by museum development officers as the Scottish
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Executive suggested? Does she also agree that that demonstrates what a great success the portable antiquities scheme has been in England and Wales? The Government should ensure its long-term funding, and that funding should be ring-fenced to ensure continued delivery of the project's aims.
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Hugh Bayley: York is an important place for history and archaeology. It is a centre for the application of science and technology to archaeology, as carried out at the environmental archaeology unit at York university and the conservation work of York Archaeological Trust.
The Council for British Archaeology is based in York. The council's portable antiquities working group met yesterday. It is the executive arm of the standing conference on portable antiquities, which includes some 30 archaeological organisations. I agree with the hon. Member for Salisbury (Mr. Key) that there should be greater co-ordination of the voice of archaeology in Britain for lobbying purposes, but the council plays an important role as an umbrella body.
The council has asked me to raise two questions. The first relates to the replacement for the illicit trade advisory panel, which my right hon. Friend the Member for Newport, East (Alan Howarth) established when he was the Minister for the Arts. It has done important work; I pay tribute particularly to the contribution of Peter Addyman, the director of the York Archaeological Trust. It set out a detailed agenda that called for, among other things, the creation of a database for stolen cultural objects. The Under-Secretary of State for the Home Department, my hon. Friend the Member for Don Valley (Caroline Flint) told the Culture, Media and Sport Committee last November that the Home Office would provide start-up funding to establish such a database. A report was due to be published earlier this year setting out the plan for establishing a database. What progress has been made on that?
I realise that creating a full database would be costly; the estimate is about £15 million, but why cannot it be funded in the long term by the trade in cultural objects? The arts market in Britain has a turnover of some £4 to £4.5 billion a year, so one third of 1 per cent. of the turnover would pay for a database to be constructed and maintained in perpetuity. London is an important centre for the art market and it would add to its prestige and importance if it were seen to be taking a lead in supporting such a database.
The Council for British Archaeology asked me to ask the Minister about the interdepartmental body being established to oversee the enforcement of legislation. It is clear that interdepartmental co-operation is needed when one considers the respective roles of the Minister's Department and the Home Office in relation to the database. How will the interdepartmental body work and how will it obtain advice from the archaeologists—the experts in the field—on the work that it is doing? Now that the illicit trade advisory panel has been wound up, it is important that professional archaeologists have a continuing input in discussions with the Government about the implementation of their policies.
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Sir Robert Smith: I join hon. Members in congratulating my hon. Friend the Member for Sheffield, Hallam (Mr. Allan) on securing the debate and in helping him to prod the Minister and the Government on the issue. I am optimistic in that respect, as a debate in Westminster Hall last week prompted the Deputy Leader of the House of Commons to say that the debate had triggered the Government into taking action. I hope that a precedent has been established that will be followed today and that my hon. Friend will receive supportive answers to his probing questions.
My hon. Friend drew attention to the export licence regime and the need to tighten it up. The Government's reply to the Select Committee's report in paragraph 18 states:
"Since the meeting in early 2003, the Department for Culture, Media and Sport has been considering this issue in detail, undertaking research and consulting others in order to move the issue forward. In particular, the Department is exploring the position with the European Commission."
It would be helpful if the Minister updated the House on the progress of those explorations and said whether the point was being reached when there would be some concrete developments. Without an efficient export licence regime, a key barrier to the illicit trade, and a weapon in preventing it, is missing.
What my hon. Friend the Member for Sheffield, Hallam said about prevention is important; permanent damage is done to a heritage site if artefacts are removed without care and attention and traded round the world. Connections with the original heritage and the chance of our having the maximum understanding of where we come from and the cultures that went before us are lost for ever. If we can do more to tackle the illicit trade, we can do more to prevent the loss of our heritage and the despoiling of our history.
My hon. Friend praised the portable antiquities scheme. If it is to continue, we need to identify how it will be funded and I hope for positive news from the Minister on the subject. The hon. Member for Linlithgow (Mr. Dalyell) asked what was happening in Scotland, which is a matter for the Scottish Executive, but it will be interesting to know what contacts there are between the Minister's Department and the Scottish Executive to co-ordinate best practice, and about joined-up government within UK-reserved areas. When something that is seen to be successful is established here, what information is passed on to the Scottish Executive?
Mr. Dalyell: The Dealing in Cultural Objects (Offences) Act 2003, which tries to curb dealing in tainted cultural objects, is not law in Scotland, as the hon. Gentleman knows.
Sir Robert Smith: I did indeed know that. He reminds me to congratulate my hon. Friend the Member for Sheffield, Hallam on all his hard work on that Bill. As the former Minister, the right hon. Member for Newport, East (Alan Howarth), said, it was amazing that, given the conveyer belt of legislation coming out of the Home Office, it was only through a private Member's Bill that the legislation was introduced. I congratulate my hon. Friend on successfully seeing it on to the statute book.
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The other challenge is the establishment of a database. Again, that seems to be drifting, but perhaps the Minister has good news for us. At the third bullet point of paragraph 5 of the Government's response, they made the point that the second phase in the database's development was due for completion in April, and that they would produce a detailed strategy for the development of a pilot project. Now we are into May. I hope that today's debate is a chance to hear what stage that database has reached.
The hon. Member for City of York (Hugh Bayley) talked about the potential for funding that database through the private sector. The database will be dealing with several low-value artefacts, which are not necessarily part of the private sector mainstream, so for it to be successful it may require the public sector to take a lead role in its establishment. If we are to encourage organisations to behave responsibly—if we are to put public pressure on organisations such as eBay to recognise the important role that they can play—a public database that can be consulted seems an important part of making that pressure almost irresistible from the point of view of the trade.
Similarly, clear and effective guidance for the public will help people police themselves. There is a dangerous misunderstanding; any one individual may feel that they are not doing much wrong, although they may be aware at the back of their mind that what they are doing is not quite right. They do not realise that they are not the only individual involved. The sum activity of lots of individuals doing a little bit wrong can do so much collective damage over time. As I have said before, things can be irreplaceable once the damage is done, and good education and public information will help to get that message across.
As has been said, effective, high-profile prosecutions get into the media. For example, prosecutions involving birds' eggs have been effective, and most people now realise how important sensible behaviour is in that field. The dropping of prosecutions sends a dangerous signal if it is done just because of the value of an item. It is not the value alone, but the effect on heritage that is at stake. The message must be sent to the CPS that that is this House's concern.
Mr. Allan: In the run-up to this debate, I was told that all police forces have wildlife liaison officers to deal with specialist wildlife crime, but only a couple have a heritage liaison officer. There is clearly a disparity.
Sir Robert Smith: Yes, that sends out a clear signal. As the hon. Member for Salisbury said, if police are slogging away with finite resources and do not expect the CPS to take things forward, a signal is being sent there, too. In the Government's response, they reject the idea of targets for this crime by saying in the third bullet point of paragraph 8:
"We are looking to minimise the number of targets on forces to allow them more flexibility to focus on their own local problems and priorities."
If the Government genuinely want to minimise targets, the distortion will be less if this specific crime does not have targets. However, I worry that the police still have a lot of targets. Certainly, when I speak to police forces, I am told that their concern is how targets drive

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priorities. Although the police try to cover all crimes, if something is being measured, they will try to meet that Government target. If the Government do minimise all targets, however, forces will be free to concentrate on the problems in their areas, and that may remove some concern.
I have looked at the briefing notes for this debate and have heard what has been said today. Much of what has happened appears to have been galvanised by the setting up of ITAP. There is concern that with its winding up, there is no longer an external input to keep the Government's mind focused on these issues. Some of the recommendations have been implemented while others are still very much in the pipeline. It is important to maintain the ability to bring outside voices into the Government.
Clearly, joined-up government and internal co-ordination is important, but the focus of an external voice making the concerns outside clear to the Government and maintaining that dialogue has certainly proved valuable in other sectors. My constituency experience of the oil and gas industry has made a huge difference to my understanding of the Department of Trade and Industry. It might be less so in respect of the Treasury, but I support bringing the industry and the Government together in a permanent way so that feedback can always be achieved. Again, I hope that the Government will reconsider their position.
I do not regard the hon. Member for Salisbury as a faffing-about sort of person. To be fair, he deserves to defend himself from that accusation. He, too, emphasised the importance of joined-up government and cited practical examples of how we need to develop, with the internet, new means of tackling illicit trade that is carried out without people realising it. We want to put more moral pressure on eBay so that it recognises that if it wants public acceptance, it has to work effectively and have the moral authority of playing its part in not promoting an illicit trade.
The understanding of our origins is something we can do only one time round, when artefacts are found. It is crucial that we tackle the illicit trade. As my hon. Friend the Member for Sheffield, Hallam said in his opening remarks, it is a matter of prevention rather than cure. We need to prevent the crime from happening in the first place. We can play an important role. If this country can break the cycle of the trade and ensure that no illegal trade is passing through here, it will play a major part in removing the pressure that causes the crime in the first place. If the Government can stop the illicit trade, they will be taking a major step forward in protecting our heritage and that of other countries whose artefacts are traded through our nation.
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Mr. Boris Johnson: I congratulate the hon. Member for Sheffield, Hallam (Mr. Allan) on securing this important debate on a subject about which I am passionate. All hon. Members who have spoken so far have alluded to Iraq, which, of course, is very much on our minds at present. Despite all the horrifying images of present-day Iraq, matters might improve eventually in that country. If and when life returns to
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something like normality there, Iraq will need one thing, above all; tourism. People like you, Mr. Deputy Speaker, and I should go there.
I am not saying that there should be an organisation called "Simply Mesopotamia", but it would be wonderful if people were attracted by the cradle of civilisation, the ziggurats at Ur and the hanging gardens of Babylon, such as are left after the depredations of Saddam. In their present post-Saddam incarnation, fascinating they remain. That was why those of us who supported the war w ere so dismayed to see the looting of the museum in Baghdad at the moment of liberation.
I wrote a very angry piece denouncing the disappearance of the Warka vase, the squatting Arcadian king of 2500 BC and the golden bull's head harp of Ur. It later turned that some of our anger was a little overdone, because those objects were found not to have been stolen. A great many objects were finally recovered. I was in Baghdad a few days after its fall. I was standing in the grounds of the museum when people kept coming with great cardboard boxes full of cuneiform seals and returning them to the curators, who were overjoyed to recover them.
Mr. Mark Fisher: Is the hon. Gentleman aware that the all-party group heard evidence last week from the British School in Baghdad? Of the 40 most prized objects that were initially looted, only 20 have been returned.
Mr. Johnson: That is exactly the point that I was about to make. We have to take back some of the more wounding things that we said about the Pentagon and how it guarded the museum, and perhaps we have to withdraw some of the allegations, which we saw in some of the newspapers, about a conspiracy between the Pentagon and the American Council for Cultural Policy. That may have been exaggerated. However, many wonderful things were lost and there is still considerable looting. It is only right that the current policy of the people of Iraq should be retentionist in the extreme, to use the jargon. They should hang on to their patrimony.
Mr. Allan: Does the hon. Gentleman agree that one of the real disgraces is that there are ongoing police investigations, as I understand it, into dealers in the United Kingdom who are dealing in material taken from Iraq in contravention of all the sanctions and selling it to buyers in the United States? After all the publicity, that is disgraceful.
Mr. Johnson: That makes it all the more important that we should listen to everybody who has spoken so far and supported the work of ITAP, which insists that there should be a database of all these things.
We should consider the most terrible thing about the loss of antiquities of this kind; 1 do not just mean the vacant case in the museum, or the empty plinth, because people know what has been lost. If we analogise cultural assets with the human mind, people may not be able to remember the first 100 lines of "Lycidas", but they know what they cannot remember and there is a blank spot somewhere in their mental catalogue.
The most unsettling things are the "unknown unknowns", to use Donald Rumsfeld's immortal phrase in his brilliant summary of all the epistemological

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possibilities in world. The terror of Alzheimer's is not only forgetting things, but not even knowing the things that have been forgotten or lost. That is why we need the records and the database of objects—tainted items as they are called—that may have been stolen. Only if we have that do we have the hope of restitution. It would be a good thing if the database included generic descriptions of things that might have come from Iraq, because the Iraqis do not even know that they have lost many of the things that are currently being traded.
I have to make a confession. The hon. Member for Sheffield, Hallam spoke eloquently and said that we must all be careful to avoid falling into the trap. I have a slightly guilty conscience, because I have in my pocket a cultural artefact of potential cultural and historical importance, which I shall produce for the benefit of hon. Members. It is Tariq Aziz's cigar case, which I liberated from the house of the former Iraqi Foreign Minister a few days after the war. That object was at one time as close to the former Foreign M mister's bosom as Saddam Hussein himself. I do not believe that I was wrong. Had I not taken it, a hidden hand would have removed it. The important fact is that I faithfully and openly recorded the date and location of the discovery in a daily newspaper, together with it s exact provenance. If any democratic successor Government in Iraq—as I hope there will be—decides in the normal way to apply for the restitution of this cigar case I should be happy to give it to them. If they think that Tariq Aziz deserves to be reunited with it, that is fine.
I adduce that point trivially and frivolously to make a point, although I hope that it is not entirely trivial. The key element is transparency, and knowing where things come from and how they fit.
Sir Robert Smith: It is dangerous to say that looting is acceptable as long as it is transparent. People's behaviour in a war zone, especially that of legislators, should be a bit more cautious.
Mr. Johnson: I count myself as chastised by the hon. Gentleman. I think that I have preserved this artefact for the greater edification of others, and I am willing to restore it to its rightful owner if and when he is acquitted or convicted of his various crimes. That is why I approve so strongly of the portable antiquities scheme, not only in registering objects that have been discovered but in trying to invigilate the trade in them.
I salute the work of my hon. Friend the Member for Salisbury (Mr. Key) in setting up the portable antiquities scheme, under which 150,000 objects, some of them very stunning, have been notified to the public since 1997. The rich earth of this country is constantly bringing forth new treasures. Like my hon. Friend, I spent this morning looking at some of the extraordinary things that are for sale on eBay. A Celtic silver coin was going for £4, and a half-groat from the time of Henry VIII was going for only £5.50. There are some amazing bargains. It would be wonderful if the origins of these things were clearer and we could he sure that we were not being invited to buy something that was stolen.
We must face the fact that there will be a great deal more excavation in this country in the coming years. There are plans to build many more houses in south-east England. Gravel pits are being imposed in south
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Oxfordshire by regional government. During the digging up of the beautiful area around Dorchester and Sandford, who knows what things will be found? It would be very sad if that archaeological site were destroyed. It would be even sadder if the things that were discovered were lost, and disappeared into the great magnetic maw of eBay.
That is why it is vital that we keep track of them. We do not want to stop all the trade in such antiquities. Far from it; we want to encourage people to value these objects. The things on eBay are grossly under-priced and some are under-priced because they are dodgy. We should stop that. It would be great if the Minister did what she could to stop this cultural memory loss and the terrible sense not only that we have mislaid something and cannot remember where we put it, but that we are not quite sure what it is that we may have mislaid.
ITAP and the portable antiquities scheme provide important ways of stopping this haemorrhage without stopping the legitimate trade in art and antiquities. That is why I hope that the Minister will feel able to give them the support that is shared by everyone in this Chamber.
3.17 pm
The Minister for the Arts (Estelle Morris): First, I congratulate the hon. Member for Sheffield, Hallam (Mr. Allan) on securing the debate. I find myself surrounded by experts, either by training or through a constituency interest. I think that this is the most expert group of MPs that has ever met to discuss an issue, and I have an awful feeling that Members know most of the answers that I am about to give. Nevertheless, I shall try to respond to the issues raised.
I also want to take this opportunity to congratulate the hon. Member for Henley (Mr. Johnson) on his appointment to the Opposition Front Bench. I did not have the chance to do so during Question Time because he chose to major on sport, but he might return to home base at the next Question Time. I hope that he enjoys his time speaking on behalf of his party. I also hope that the hon. Gentleman does not repeat too many tricks like the one he just produced. I thought that he was about to announce that he had purchased something from the eBay site, but perhaps one possible crime in an Adjournment debate is as far as we should take things. I must say that some of the excuses he gave for having the cigar case are ones that I have heard from many people who have objects that should not be in their possession. However, I have no doubt that somebody will read the record of what was said, and in the interests of access we all ought to get a look at the case.
I turn to the serious issues in this discussion. I want to address several matters in the ten or so minutes that I have. I was going to talk about the achievements that have come out of the ITAP report since it was published because there are many of them, but I will not; I would be giving a list of things that people knew about and I would not have the time to address the important issues that have been raised. However, I want to put on the record that I think that it was an exceptionally high quality report and I congratulate the former Ministers who are responsible for that. I pay tribute to my right hon. Friend the Member for Newport, East (Alan Howarth), without whose initiative we would not be discussing the report today, to the work of Professor

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Palmer and his team, and to my officials in the DCMS who have moved forward rapidly, given the slow way government sometimes works.
I am proud of and pleased with the progress that has been made in signing the UNESCO convention and, in conjunction with the hon. Member for Sheffield, Hallam, in helping to guide the Dealing in Cultural Objects (Offences) Act 2003 through Parliament. However, as hon. Members have said, a number of matters have not yet been fully implemented, and I think that the most appropriate thing to do is to give a progress report on them.
I will start with the portable antiquities scheme. I have been hugely impressed by that scheme and I am determined to ensure that it continues. I should point out for the record that the DCMS has invested £1.5 million to ensure that it survives. It is true that the Heritage Lottery Fund cannot continue to fund it, as that is not in its nature, even for small projects. I accept that if the scheme is to continue, the DCMS core budget must pick it up.
All that I can say is that as an advocate of this sector of the DCMS's responsibilities, I have done whatever I could to ensure that the scheme is included, in big letters, in the bid. When we know how much money we have been allocated from the Treasury, I will do all that I can to ensure that the scheme continues. I cannot say anything beyond those assurances. However, any change would not be for a lack of wonderment on my part at the scheme, those who run it or the museums.
I have had the opportunity to speak to some metal detectorists, whose hobby has become far more than that; it has changed their lives. We talk about the importance of such work because it helps us understand where we have come from as a nation and race and where we might be going. It had a great effect on those men and women, who have dug up from the earth things that have helped to inform the rest of civilisation about itself, and I am great advocate of that.
In response to my hon. Friend the Member for Linlithgow (Mr. Dalyell), I dare not tread into the matters of the Scottish Parliament, but if Scottish Ministers were interested in talking about the portable antiquities scheme or anything like that, I would be more than delighted to respond.
Let us turn to the trickier issue of the stolen objects database. There is no doubt that work on it has been too slow. Having traced back what has happened, I believe that the Select Committee was right to criticise both Departments for the slow pace at which they have worked. Why that has happened is irrelevant—it has happened and the work has been slow—so I shall talk about where we are now.
I have had meetings with Home Office Ministers, and we have jointly funded the second phase of the work, which reported in April and May this year. Let me be honest; the consultants' report has not meant that we can immediately begin work on implementation. That has been the problem and is why this is a tricky area for debate. I cannot say in all honesty that, having received the report, we can now go at full speed ahead. We now have to return to some other issues, and given what the consultants have said, I have two important concerns to pick up on.
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The first question is about who pays. We envisage that the database could and should be self-financing, which would mean, as my hon. Friend the Member for City of York (Hugh Bayley) said, members of the trade paying for its use. Their willingness to do that is now less certain than before, and mention was made of the value of the goods on the database being part of the reason for that. The second question is about how helpful the database will be for enforcement through the criminal justice system.
Our plan now is to commission further work. Although the first report is completed, I cannot say that its recommendations will be acted on as soon as I had hoped even this time last week. I am more than happy to keep the all-party group and the House fully informed on that. Given how ashamed I was about previous slow progress, I will personally do what I can to ensure that progress is made as quickly as possible.
On public guidance, we have two guidance notes on the website, including information on the Treasure Act 1996. The UNESCO legislation database is also being prepared, although it is not an easy task. Some 26 pieces of legislation have already been identified, but there have been problems when nations have provided that information electronically. Six sets of information supplied by nations were not in a form that UNESCO could use. The legislation database is on its way, but more slowly than We thought.
There is better news on the export licensing regime. Hon. Members were right that the difficulties have been in the wording of the regulation to carry out spot checks on objects of non-EU origin. They were also right that we need an amendment, and we have submitted a paper to the Commission requesting an update of the legislation. That should be discussed at the next meeting of the advisory committee on cultural goods in November; I hope that that will be the way forward.
I reassure my hon. Friend the Member for City of York that the cross-Whitehall group met for the first time this week. Whether the hon. Member for Sheffield, Hallam wishes to claim that as an example of an Adjournment debate again doing great things I leave to him. However, the group is meeting now and will, I hope, go on meeting.
Everyone has mentioned ITAP. I am, coincidentally, meeting Professor Palmer tomorrow; that date was in my diary before this debate was. I have an open mind on this subject, and I have no wish to avoid doing what I can to implement the report. The reason why we suggested that the panel no longer meet was not because officials could not service it; we are a pretty lean Department, but not that lean. In fact, the reason was the one to which my right hon. Friend the Member for Newport, East—and perhaps others—referred. The panel has been in place for four years now, and a committee set up outside the Nolan regulations would not normally continue beyond that.
Mr. Fisher: Does my right hon. Friend not accept that the work of the panel should continue? If it will not meet again, it is her responsibility to establish something that will take its work forward.
Estelle Morris: Absolutely, and that may well be what I decide tomorrow, if the establishment of such a body needs to happen and I am persuaded by the arguments that I have heard. If someone is looking over one's shoulder, it is much better if their sole reason for doing so is because they are passionate, and not because they have other interests. I am very happy for a body to be established; I can see no disadvantages to that. I was nervous about allowing a committee that was outside the Nolan regulations to continue, because the advice that I was getting from officials was that that was not quite the way to do things. It was not quite proper, and there could be criticisms.
I will meet Professor Palmer tomorrow; that might be a way forward. It may be appropriate to then write to the hon. Member for Sheffield, Hallam and copy the letter to Opposition spokesmen to let them know what I decide. If the case is made, there is no disadvantage to what hon. Members propose. I am happy to take on board all the representations that have been made. Quite honestly, the establishment of such a body would give power to the Department's elbow in terms of enforcing and enacting provisions. I would sooner finish my time at the Department having implemented the ITAP report than having failed to do so, and if there is anything that I can do to assist that, I will.
On the eBay point—I refer also to the Wiltshire case and the issue of implementation—the eBay website clearly needs attention. I thank the portable antiquities scheme and the hon. Member for Sheffield, Hallam for the conversations that they have had so far. I think that the takedown route is the right way forward. We are continuing to talk to the British Museum, eBay and others.
I do not think that this has been mentioned by anyone: we think that eBay should display information on export licensing and regulations on the website, so that the person who gets to the website genuinely not knowing that they might be about to engage in illegal activity will at least have that brought to their attention. We have been talking to eBay about that.
I take the point that has been made about working across Whitehall. I am not one for setting up groups just for the sake of it. There is a real danger in Government of setting up a cross-party group so that one can say that that has been done, even if it does not actually change anything. I would rather look to the heritage protection review paper, the response to which will be published in June, to see what is said.
We have had a gallop through most of the issues raised by hon. Members. If there is any point that hon. Members feel particularly strongly about to which I have not responded, I will happily do so in a letter, but I do not think that there is anything I have left out. I finish by thanking hon. Members for pushing the DCMS, so that we can take action on this important area of national activity. I know that they will continue to do so, and I promise to work closely with them.

Breastfeeding
3.29 pm
Mrs. Annette L. Brooke: I am pleased to have finally secured this debate. It seemed appropriate to raise issues relating to breastfeeding close to breastfeeding awareness week, which was, of course, earlier this month. The Minister will be aware that two relevant early-day motions were tabled that week, both attracting more than 70 signatures. One notes that the UK has one of the lowest breastfeeding rates in Europe and also identifies some of the many health benefits from breastfeeding. The other highlights issues relating to baby food marketing. I want to make it clear at the outset that I consider it an important matter of personal choice for a mother how her infant is fed. However, the provision of facts, support and encouragement for breastfeeding, and regulation of the marketing of baby milk, all help to support an informed choice.
I acknowledge that the Government are supporting important initiatives, but there is always more to be done, given the advantages of breastfeeding and the disadvantages of not doing so. The health benefits of breastfeeding are well known and I shall quickly mention a few. The risk of gastroenteritis, respiratory, urinary and ear infections, eczema and childhood diabetes are all likely to be reduced. There is widespread concern in Parliament and across the country about childhood obesity. That has been brought to a head, I imagine, by this morning's coverage on the "Today" programme of the leaked report.
In response to a recent parliamentary question, I was told:
"In 2002, the Committee on Medical Aspects of Food and Nutrition Policy reviewed the benefits of breastfeeding in its Scientific Review of the Welfare Food Scheme and stated that breastfed babies are less likely to become overweight as children. Since then, a further review in 2003, by Dewey et al, found that most large studies show a protective effect of breastfeeding against overweight in children and adolescents." —[Official Report, 17 March 2004; Vol. 419, c. 383–4W.]
I understand that further research is being carried out. I suggest that among all the other recommendations that are likely to emerge from the Health Committee's report when the final version is published and responded to by the Government, the starting point should be the baby's start in life or perhaps even the mother's diet. I am not an expert on that, but childhood obesity requires us to go right back to the beginning.
I visited a specialist children's dentist in my constituency last week and was surprised to learn of further benefits in relation to jaw development. There are also, of course, many health benefits for the mother, including reducing the risk of pre-menopausal breast cancer and ovarian cancer, not to mention aiding weight loss after pregnancy.
Around two-thirds of women start to breastfeed their babies in the UK. However, the last five-yearly survey carried out by the Office for National Statistics showed that 21 per cent. of mothers who started breastfeeding had stopped in the first two weeks and 93 per cent. of them would have liked to have breastfed for longer. Just one in five babies are receiving breast milk by the time they are six months old, although the World Health

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Organisation recommends that babies need nothing other than breast milk for the first six months of life. It contains everything that a baby needs. There are huge variations in breastfeeding rates according to social class, age and area, so it is important to tackle the inequalities.
Excellent work is taking place in many areas to support and encourage breastfeeding. I am particularly pleased that Poole primary care trust employs a breastfeeding co-ordinator and I congratulate Mandy Grant on her work. I recently attended the inaugural meetings of two new bosom buddies groups. One of my constituents, Julie Dyball, played an important role in the latest one to be set up in Upton. Through regular weekly meetings, it provides a social environment for mothers and toddlers as well as support from other mothers and breastfeeding counsellors. How does the Minister intend to ensure that good support is available across the country? Also, what support will he give to maternity units seeking baby friendly status? I am pleased that Poole hospital is likely to apply for that.
I have wondered about how I became quite so involved with breastfeeding because, until a year ago, I simply thought that I had been there and done that way over 30 years ago. I recall that my main motivation to breastfeed was based on economic grounds, an important factor for many mothers today, but perhaps not always recognised as there tends to be a lower rate of breastfeeding in areas of deprivation.
Once I started to talk to mothers in my constituency and members of the National Childbirth Trust, I became aware of how many dimensions, and obstacles and obstructions, there were to supporting breastfeeding today. On the support aspects, clearly it is important that there should be good training for all professional workers, including nurses and health visitors, who will be in contact with a new mother. I have been impressed by the work carried out by Bournemouth university on that issue. As a consequence of securing the debate, I received representations from the Royal College of Midwives the Minister will not be surprised by that. Although the Government plan to recruit more midwives, the latest statistics from the NHS and the Royal College of Midwives annual staffing survey reveal that we are not recruiting as many as we need. That shortage has an inevitable impact on how much support midwives can offer women on acquiring skills such as breastfeeding. That is an important point, despite the nature of the lobby. The training of breastfeeding counsellors who work on a voluntary basis is also important. Schemes such as bosom buddies could not exist without voluntary support.
During my trip to learn about breastfeeding in this day and age, I was shocked when I asked local GP surgeries and local primary care trusts about breastfeeding levels in my constituency. The statistics all seemed incredibly good. I have thought about that and it seems to me that we must not be complacent. There is a danger of focusing on the percentages of women who start breastfeeding. It is important to have comparable data, across different areas, monitoring the first six months and beyond.
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Last autumn, I learned from Poole PCT that guidelines were awaited, and I discovered from the response to a parliamentary question that guidelines for PCTs on the collection of statistics on breastfeeding initiation were made available to national health service staff on 28 November 2003. Are those guidelines being followed by all PCTs? What further steps is the Minister taking to ensure that there is good data on which to make further decisions?
On the cultural aspects, it seems that we have reached a strange position in society when some people become embarrassed at a mother discreetly feeding her baby in a public place. I was travelling on a crowded tube the other day, and a baby was crying. The mother addressed the situation quickly and efficiently. Result: happy baby and less stress for the other passengers, including me. Attitudes are slowly changing, but we have a long way to go. If a mother wishes to use a quiet and private place for feeding when she is out shopping, for example, the facilities are often poor, if there is any provision at all. Living in a tourist area, I am very aware that the facilities are lacking.
There can be no quick fix for societal attitudes, but leadership at a national and local level can clearly contribute over time. Support needs to come from society as well as from health professionals, family and friends. Greater understanding and positive attitudes are needed to encourage and support breastfeeding women and to enable them to carry on for as long as they would like. Ideally, breastfeeding should be a normal part of everyday life. I could not help but notice the contrast between the UK and Ghana during a visit I made to that country last year.
We have a strong call to make to the Government on the marketing of baby food. In 1981 the United Kingdom signed up to the international code of marketing of breast milk substitutes, adopted by the World Health Assembly as a minimum requirement to protect infant and young-child feeding, and hence their health. The international code is a unique and indispensable tool to protect and promote breastfeeding, and to ensure that the marketing of breast milk substitutes, feeding bottles and teats is appropriate.
It applies to all products marketed as partial or total replacements for breast milk, such as infant formulas, cereals, juices, vegetable mixes and baby teas promoted for children under six months. The United Nations Committee on the Rights of the Child has expressed concern about low breastfeeding rates in the United Kingdom and called on the Government to implement the code fully. Clearly, all the excellent supportive work and increases in breastfeeding initiation are undermined by company promotion that violates the code but is permitted by UK law. The market for breast milk substitutes is worth more than $20 billion; it is very big business. Monitoring by the International Baby Food Action Network found a surprising amount of illegal promotion as well as code violation.
Last year—I asked rather a lot of questions on this issue last year—I asked the Secretary of State whether he would take steps to ensure that jars of baby food could be labelled to say that breastfeeding is encouraged

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for six months rather than four. The answer was comprehensive. It stated:
"Current European Commission legislation provides that weaning foods may be labelled as suitable for infants from four months of age. This is due to be reviewed in the new year in light of the World Health Assembly (WHA) Re solution 54.2 on Infant and Child Nutrition to strengthen activities and develop new approaches to protect, promote and support exclusive breastfeeding for six months."—[Official Report, 10 December 2003; Vol. 415, c. 502W.]
Can the Minister give me an update on that?
Ms Julia Drown: I congratulate the hon. Lady on initiating this important debate. She explained the benefits of encouraging breastfeeding in this country and mentions World Health Organisation recommendations. It is estimated that 1 million babies may die across the world every year because of low breastfeeding rates. It is clear that a majority of people are in favour of breastfeeding and of doing more to encourage it, and we need to do more to approach the minority who are against it. Is it not crazy that breastfeeding is sometimes not allowed in workplaces or places that people visit even though it is safe to breastfeed in them? Of course, this place is one of those places.
Mrs. Brooke: I thank the hon. Lady for her intervention and endorse her comments about the worldwide situation. We are talking about 1.5 million children a year and a child dying every 30 seconds. Those are horrifying figures. There is also a great discrepancy between countries. At a reception here just a week or two ago, we heard that Brazil has introduced a strong law, which is well implemented, and what a difference that will make. I appeal to the Minister for the UK to show leadership. We should have stronger laws and better implementation of them, which I am sure would provide a model for the rest of the world. I shall leave my comments on the workplace until the end, because that is perhaps the more controversial point.
It is now more than 20 years since the inception of the code. That leads us to ask what is happening. The early-day motion tabled by the hon. Member for Birmingham, Selly Oak (Lynne Jones) was very good and comprehensive. I shall not read it all out today, because it picks out the points that we have just covered, but it rightly says that something needs to be done.
Of course, international companies will find ways around the legislation and regulations that we have had for a long time because their profits are bound to be enormous. Just imagine the profits 11 at might be had by international companies promoting their wares in countries such as China, where 20 million babies are born each year. It is big money, which is why we need changes here.
What I found quite surprising in the work of IBFAN and, indeed, local reports is that the problem is not simply a matter of not having strong enough legislation; it is also the extent to which the code is violated. A local supermarket had a particular promotion—I cannot remember whether it involved a two-for-one offer or extra reward points—but fortunately local members of the National Childbirth Trust took swift action, reported the matter to trading standards officers and action was taken. The work of trading standards officers, who enforce the narrow UK law, is to be commended, but they need more law to work with.
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Another problem is that, in hospital or soon afterwards, many mothers receive gift packs that contain samples of complementary foods, breast milk substitutes and follow-on milks, or vouchers. Leaflets for mothers are sometimes found in clinic waiting rooms. Companies often give branded gifts to health workers, ignoring the explicit ban on direct and indirect contact with pregnant women and mothers of infants and young children. Telephone care lines and websites compete with those of the NHS and mother support groups, which are in turn promoted to mothers in leaflets, parenting magazines, direct mail and on product labels. Companies use the same brand name for a range of products. Infant formula is labelled "for use from birth" and one or more follow-on formulas are labelled
"for use with older infants".
Follow-on formula did not exist when the code was adopted and has been described by the World Health Assembly as "not necessary". Companies can widely advertise follow-on formula in the UK. It serves to promote infant formula with the same brand name and clever packaging, which tends to idealise artificial feeding. There is also a problem with complementary foods, labelled
"for use before six months of age",
which we desperately need to address.
Returning to obesity, my hon. Friend the Member for Hazel Grove (Mr. Stunell) recently tabled parliamentary questions on the link between the high-sugar content of baby foods and obesity in children, and asked what information is available on baby foods and sugar. We must highlight the facts about fat, salt, sugar and other substances contained in complementary foods.
The Minister should respond positively to IBFAN's well rehearsed call for action. It suggests three strategies: a change in Government policy, which would include the prohibition of materials on infant and child care that are produced or sponsored by companies with an interest in infant feeding; new legislation implementing the code's provisions for feeding bottles and teats, including a ban on promotion; and revised legislation that would fully introduce all the revised EU directives.
On education, in the process of preparing questions I discovered that GCSE syllabuses on child care do not even cover the international code on the marketing of breast milk. That is appalling. Through my parliamentary questions, and having pursued the matter with the Qualifications and Curriculum Authority, I have received a commitment that the syllabuses will be amended when they are revised. That action will be implemented at the earliest opportunity. So that was a success, although it has opened up how much more must be done in education.
Will the Minister liaise with his colleagues in the Department for Education and Skills, because teaching about breast feeding versus bottle feeding should ideally involve bringing a professional into the classroom? There is a lot of scope in personal, social and health education for sensibly promoting breastfeeding, which means tackling the matter from the beginning. There is much more that can be done, but, incredibly, text books do not cover the 1981 code.

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I have left the subject of the workplace until last, because I thought that that might bring some of my colleagues into the debate. There have been splendid initiatives on child care and on making it easier for mothers to return to work, but those sometimes introduce a third factor of having to give up breastfeeding. It is a tragedy when Government policies, in effect, work against each other. I am the last person in the world to want to introduce bureaucracy and put difficulties in the way of businesses, especially small businesses, but what surveys have been conducted on what would make it easier for mothers to continue to breastfeed when they return to work? I would not want to pronounce on the solutions to that, but surveys should be conducted.
We should think outside the box a little. Greater flexibility is probably needed, such as the ability to take a longer lunch hour. I would hope that larger companies provide suitable places for breastfeeding. If we are to have a holistic policy that is about the health of children, that policy must be examined from all angles and take into account the concerns of the Department of Trade and Industry, the DFES and the Department of Health. I hope that the Minister will take a lead across the Departments on those important issues, to help us to succeed in bringing our breast-feeding levels at least up to those of other European countries.
3.50 pm
The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I congratulate the hon. Member for Mid-Dorset and North Poole (Mrs. Brooke) on securing the debate and on taking an interest in a subject that, as she said, she thought she had left behind many years ago. However, she shares that interest with my hon. Friend the Member for South Swindon (Ms Drown). I am sure that this will not be the last time that we discuss the subject.
Breastfeeding provides the best possible start in life and has considerable benefits for mother and baby. As the hon. Member for Mid-Dorset and North Poole said, those benefits continue long after breastfeeding has ceased. That is why, in line with the World Health Organisation code, the Government recommend exclusive breastfeeding for the first six months of a baby's life, with continued breastfeeding along with complementary feeding after that.
The Government also recognise the positive impact on public health that will occur by increasing levels of breastfeeding. That will be particularly significant among mothers from disadvantaged groups. Indeed, two of the Government's priority areas for health improvement—cancer and coronary heart disease—could be positively affected by increasing breastfeeding levels. For example, mothers who breastfeed are less likely to develop pre-menopausal breast cancer and are more likely to lose the excess weight that they gained during pregnancy. Breastfed infants are five times less likely to be admitted to hospital with common infections, such as gastroenteritis or respiratory infections, during their first year of life. Moreover, there is emerging evidence that breastfed infants are less likely to become obese in later childhood.
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As far as reducing health inequalities is concerned, mothers from low-income groups are the least likely to initiate and to continue breastfeeding. "Tackling Health Inequalities: a Programme for Action", launched by my right hon. Friend the Secretary of State in July last year, sets out a framework with a strong focus on the prevention of health inequalities. It highlights the need to increase breastfeeding levels, especially among low-income groups.
The infant feeding survey in 2000 found that 71 per cent. of mothers initiate breastfeeding. However, there are striking differences in breastfeeding levels, related to levels of education, geographical location and age. For example, in the UK, 85 per cent. of mothers in higher occupations initiate breastfeeding compared with only 52 per cent. of mothers who have never worked. Some 78 per cent. of mothers aged 30 or over initiate breastfeeding compared to 46 per cent. of mothers aged less than 20.
That is why we have made a commitment in the NHS plan to increase support for breastfeeding and have set a target in the priorities and planning framework for 2003–06 to increase breastfeeding initiation by 2 per cent. per year, focusing in particular on women from disadvantaged groups. The Commission for Healthcare Audit and Inspection will be inspecting against an indicator to monitor progress towards meeting that breastfeeding initiation target.
In addition, a national service framework for children is being developed to set standards across the NHS, the social services for children and young people, and maternity services. Breastfeeding will be included in the development of that national service framework, which we hope to publish in July. The hon. Lady asked what the Government will do to ensure that there is consistent performance in increasing initiation rates. Those two elements—the indicator and inspections by the Commission for Healthcare Audit and Inspection, and the national service framework for children—will be particularly relevant. Further work is also being undertaken by the Health Development Agency, which has appointed two collaborating centres in maternal and child nutrition Their work will include increasing the body of evidence on what encourages breastfeeding and moving that evidence into practice.
Last year, the three-year infant feeding initiative was successfully completed. It was supported with just under £3 million from the public health development fund. The overall aim was to consider ways to increase breastfeeding rates among disadvantaged groups. As part of the initiative, 79 best-practice projects were funded. The majority were local projects looking at best practice and practice development.
The Department of Health commissioned an evaluation of the 79 projects and the findings were published in a report in December last year. The report makes clear the important contribution the projects made to understanding how women from disadvantaged backgrounds can be supported and encouraged to breastfeed. The strategies and lessons learned from the 79 projects need to be shared and disseminated to those supporting and encouraging mothers to breastfeed to assist them in delivering the priority and planning framework target. For example, some of the key findings relating to antenatal education

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and peer support programmes support other research findings, which means that midwives and health visitors have a key role to play in increasing breastfeeding rates.
I acknowledge the comments made by the hon. Lady about the recruitment of midwives. That is exactly why the Government, working with the Royal College of Midwives, have developed a six-point action plan to improve the rate of recruitment. I note what she says about lobbying from the RCM, but I assure her and the RCM that we are making significant progress. I wish I could wave a magic wand and produce all the midwives that we need, but I cannot.
We have produced a practical, user-friendly resource pack for health professionals, based on the evaluation of the projects and current research evidence, and plans for its dissemination are in place. The resource pack has drawn on the experiences of all those involved in breastfeeding. Genuine local partnerships involving health professionals, the voluntary sector and mothers enable communities to identify and prioritise local need and ensure that effective interventions and resources are targeted on the areas with the greatest need. The commitment in the NHS plan to reform the welfare food scheme will also ensure that children in low-income families have access to a healthy diet and will help to bring equality to mothers who are breastfeeding.
We consulted on proposals for reform towards the end of 2002 and published our response to the consultation setting out our intentions to introduce a new scheme in February. The healthy start scheme provides vouchers for fresh fruit and vegetables as well as liquid and infant formula milk from the beginning of pregnancy, and an additional voucher from birth for the first year will be available to all mothers. Breastfeeding mothers have long felt that they lose out and the new scheme redresses the balance. It will also increase the choice available to all mothers in the scheme. Healthy start will free the NHS and child health clinics from the obligation to supply infant formula milk to mothers on the scheme, which will enable health professionals to concentrate on what they do best: providing high-quality care, advice and support to pregnant women and their families.
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We are taking other steps to raise awareness of the issue: national breastfeeding awareness week, funded by the Government, is an annual public health campaign and is a main vehicle for raising awareness about the health benefits of breastfeeding. The hon. Lady referred to this year's campaign, which took place two weeks ago, in support of the priorities and planning framework target to encourage new mothers and mothers-to-be to "give it a go" Although the evaluations of this year's campaign have not yet been collated, the media coverage on breastfeeding was supportive and all the broadsheet press mentioned the campaign.
National breastfeeding awareness week is channelled through the NHS. Last year, health professionals distributed more than 1.25 million pieces of material produced by the Department of Health, professionals and voluntary organisations, who also helped to generate more than 550 regional press reports about breastfeeding during last year's campaign.
The Government are committed to the promotion and support of breastfeeding internationally, which brings me to the concerns that the hon. Lady expressed about the World Health Organisation's international code of marketing of breast milk substitutes. The World Health Assembly adopted the WHO code of marketing breast milk substitutes in 1981 prior to the development of what are now called follow-on infant formula milks. The WHO code, which the Government support, aims to protect and promote breastfeeding and establishes principles for ensuring the proper use of breast milk substitutes, including their marketing and distribution.
Rules on the composition, labelling and advertising of infant formula are harmonised throughout the EU by the EU directive on infant formula and follow-on infant formula. The principles of the WHO code relating to the labelling, advertising and provision of information about infant formula are incorporated—
4 pm
Sitting suspended for a Division in the House.

Paper Industry
4.15 pm
Jonathan Shaw: I am pleased to bring to the attention of the House an industry of which Britain should be proud. It makes a massive contribution to the manufacturing base, with a turnover of £3.5 billion. It directly employs some 30,000 people and indirectly employs another 250,000. My constituency has the largest concentration of paper and board manufacturing in the UK, employing about 1,000 people with 1.4 million tonnes of production. The paper industry is a good employer; it offers well-paid jobs with good industrial relations.
In Britain, we consume 12.6 million tonnes of paper and board every year. The UK market is the sixth largest in the world and the second largest in Europe. The shape of the economy can be benchmarked against the consumption of paper and board. If the economy is doing well, the newspapers get fatter; if the newspapers get thinner, there is uncertainty or a downturn in the economy. Advertising, rather than the quality of journalism, determines the weight of the satchels carried by newspaper boys and girls to our front doors every day.
The 80 mills in the UK account for 40 per cent. of domestic production. The majority of paper and board is now imported. Since I held a debate four years ago, the industry has faced many challenges. The then Minister went on to become Secretary of State, which shows that Ministers who take a close interest in the paper industry enjoy good fortune, so I am sure that the Minister is taking note. Four years ago, the strength of the pound was a primary concern for the industry, as it was for most exporting businesses. The situation improved last year. Performance in export markets is up and that is welcome. However, it has not returned to the level of 2000. Throughout the 1990s, production and consumption grew year after year, but that halted on 11 September 2001. One mill in my constituency, Aylesford Newsprint, felt the effect immediately. Despite a successful economy, there was a loss of confidence, advertising reduced and newspapers became thinner.
The purpose of the debate is to build on the paper industry's work on engaging with the Government. It must assist the Government to meet recycling levels and carbon emission levels by investing in high-quality combined heat and power plants. Those objectives are mutually beneficial not only in terms of the bottom line. The paper industry has the desire to fulfil its potential for the common good in a sustainable way.
Over the past four years, the industry has organised a new trade body—the Confederation of Paper Industries—which represents recovered paper as well as paper and tissue manufacturers and converters. The industry is developing a sustainable development programme to identify how it can improve its environmental performance. Its strategy covers the whole paper cycle, from raw material production to disposal. It also incorporates elements such as training, health and safety, staff turnover and sickness rates.
Over the past few years in particular, the industry has developed a constructive dialogue with Ministers and officials. The all-party group on paper-related
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industries, which I chair, encourages industry representatives to speak to Members of Parliament so that we can understand the needs of the industry and what the industry can do for the British economy and environment.
The paper industry is the largest recycler of paper in the UK and is the largest exporter of recovered paper. Last year, 2.2 million tonnes of paper were exported, with the majority going to Asia. Progress has been made on the materials used. In 1991, wood pulp accounted for 43 per cent. of production, but that has now reduced to 24 per cent. There has been investment by the industry and support from the Government. Most recently, £17 million from the waste and resources action programme contributed to an increase of 30 per cent. in recycling at the UPM Kymmene mill at Shotton in north Wales.
The Government set targets for local authorities, which have made a significant impact in the collection of household waste for recycling—rightly so, because doorstep collection is popular; people want to be able to make their contribution to protecting our environment. In 2001–02, 87 of the 375 local authorities did not offer a kerbside collection. That number has now fallen to just three. A health warning to attach to that might be that not all kerbside collections are as good the next. Aylesford Newsprint, working with my hon. Friend the Member for Lewisham, Deptford (Joan Ruddock), has produced an atlas— a league table—of those who are performing well and those who have much more to do.
As a consequence of that situation, the market for raw materials has stabilised, which is a crucial factor for the industry. It must have a guaranteed supply of material. Running an operation such as Aylesford Newsprint requires 500,000 tonnes a year. In the early days, when that mill was commissioned, the fluctuation of the cost of the raw material meant that considerable costs had to be built in and it penalised the company for many years. However, now there is continuity. That has not happened by accident, but by the industry working as partners with local authorities to help to develop longterm contracts at agreed prices. That is good for the industry, local authorities, the environment and Britain. That type of commercial environment can create the confidence that is needed for investment, which might increase the UK's ability to provide a greater proportion of the domestic market than it currently does. For once. our collection rate is at 54 per cent., although it is still one of the lowest in Europe.
Recycling has taken a big leap forward, and the industry and local authorities are to be congratulated on that. The next step is to examine how we collect that raw material and how we measure it. Tonnage-driven rates have caused unforeseen problems. Local authorities are driven by considerations of weight rather than of quality. Therefore, a reduction in quality inevitably happens. The quality of the raw material is vital for the paper industry to produce the quality product that consumers want. To illustrate the point, the number of councils that offer a dedicated paper and card collection dropped from 117 in 2001–02 to 55 in 2002–03.
Many materials are all lumped together, which causes significant problems. If recovered paper comes into contact with grease, food or glass, it is contaminated and cannot be used. If we are to take the next step in recycling, we must separate materials at the doorstep. It

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makes no sense to separate them after collection, particularly when one of the key materials is redundant. The message from the industry is that we have made a good start— the industry played its part in that— but we need to move away from purely considering tonnage to considering quality. There is brass in muck, but there is more brass for everyone if the muck is of a better quality.
I hope that the Minister will note that and give it some attention, particularly when he is in discussion with colleagues from the Department for Environment, Food and Rural Affairs and the Office of the Deputy Prime Minister. I know that he has met industry representatives and is aware of the significant investment of people, time and systems that has gone into implementing European legislation on pollution prevention control, which has cost the industry £4 million.
I am proud of the Government's environmental achievements. We have not done enough, by any means, and industry has to play its part. The industry appreciates that the Department of Trade and Industry has set up the regulatory impact assessment as a way of ensuring that UK industry is not unfairly affected on the European scene before environmental legislation is implemented. We are six years ahead of the game on pollution prevention control. Some of the industry complains about that, but I hope that it will mean that we will be in a more competitive position than our European competitors when they implement the PPC in the years to come.
Investment in good quality combined heat and power plants is a major plank of the Government's strategy to deliver on climate change. My hon. Friend will be aware that there are just 19 CHP plants in operation in UK paper mills. Sadly, at least five projects have been shelved. The reason for that, which he will understand, is that gas prices have doubled. They doubled in 2001, and the bill for the paper industry lone increased by £50 million. It remains high, which means that investment in CHP has riot reached the expected level.
A plant costs around £10 million. Officials from the Department of Trade and Industry, the Treasury and the Department for Environment, Food and Rural Affairs visited a CHP plant at a paper mill in Kent a few months ago and the problems were explained to them. The industry has proposed that if power companies were obliged to include CHP as a percentage of their output, in the same way that they are obliged to do for renewable energy, investment might be kick-started. Has the DTI given serious consideration to that proposal?
The industry is concerned that the Government think that the solution for reinvestment in CHP will be achieved by an increase in electricity prices. Can my hon. Friend confirm that that is not a serious solution and is not desirable? He will realise from the number of mills that I have mentioned that CHP mills are in the minority and the rest rely on electricity. With the cost at £10 million for a new plant, a huge hike in electricity prices would have a devastating effect on the paper industry, which already faces considerable challenges.
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Will my hon. Friend confirm that that is not the Government's solution? Will he also confirm that he is keen to seek new ideas and solutions to unlock the desirable CHP investment that we all want, so that we reach our climate change and Kyoto targets? Furthermore, what consideration has he given to the increased gas prices arising from the EU emissions trading scheme? There is uncertainty in the industry about how CHP will be treated in the new regime. I should be grateful if he shed some light on that matter.
I understand that the European co-generation directive provides that member states should consider heat demand as well as electrical power demand in assessing their overall energy needs. That is welcomed by industries, including the paper industry, because it makes the importance of heat more central. However, there is concern that the UK has not fully embraced that approach and remains wedded to the sole consideration of electrical demand. Again, I should be grateful if my hon. Friend commented on that.
The industry is a good employer. The industrial relations that are enjoyed between the employer and the main union, the Graphical, Paper and Media Union, are constructive and in many ways exemplify modern partnerships in the workplace. Yet despite that positive working relationship, the industry had an accident rate that was twice the level experienced by the rest of manufacturing industry, and a fatal and major accident rate that was equal to, or in excess of, the construction industry. In 1998, the industry experienced two fatalities and had an accident rate of 23.4 per 1,000 employees. Everyone agreed that things had to change.
In 1998, the paper and board industry advisory committee set out its target to reduce accidents by 50 per cent. Four years ago in this Chamber, I strongly criticised the industry for its lack of progress. However, its safety record has improved considerably. The total injury rate is 16.6 per 1,000 employees. That is a major achievement, but everyone, including the unions and employers, agrees that more needs to be done. That does not just involve the unions and the employers; there has been a tripartite approach. The Health and Safety Executive has been effective in that partnership. However, there is concern among the unions and employers that the reduction in the number of HSE employees means that it will not be able to play such a constructive role in future. Perhaps my hon. Friend could comment on those concerns.
Britain should be proud of this industry, which makes a considerable contribution to UK plc and also the UK environment. It wants to continue the current constructive dialogue to find solutions that enable the industry to go forward in a highly competitive market. In addition, it should supply far more to the domestic market so that we no longer have to import so much.
4.30 pm
The Parliamentary Under-Secretary of State for Trade and Industry (Nigel Griffiths): I congratulate my hon. Friend the Member for Chatham and Aylesford (Jonathan Shaw) on securing the debate. He has given me the opportunity to praise this industry and to acknowledge his close interest in this sector over a number of years. Indeed, I am grateful for the advice that he has given me as a Minister in his capacity as chair

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of the all-party group on paper-related industries. In fact, his is one of the best-informed contributions that I have had the pleasure of listening to as a Minister.
My hon. Friend has given the Chamber details of the contribution made to the economy and to employment by the UK paper industry. The sector, which includes pulp and paper products, employs 93,000 people in more than 2,400 companies and contributes a staggering £11 billion a year to our economy. It covers a wide range of key products from newsprint to packaging, fine papers to health care. Large companies like St. Regis, as well as smaller independents like Tullis Russell in Fife, compete with multinationals that also make a significant contribution to our economy.
Aylesford Newsprint, to which my hon. Friend referred, is a world-class facility. I am proud that the Department of Trade and Industry helped it with financial investment to ensure that it has built this fantastic capacity. It now produces 1 per cent. of the world's production of newsprint. Its newest machine, the PM14, has set five world records for newsprint production. About a third of the mill's production is exported to Europe, making a valuable contribution to our balance of trade. The company owns and operates 2,145 banks for recycling, which is a terrific contribution to the recycling aims that we all share. It has achieved Investors in People ISO 14001 and ISO 9002, which reinforces my hon. Friend's message about the respect it pays people and the fact that it sees its work force as its most valuable resource.
This year I have already had two meetings with the key sector representatives: the Confederation of Paper Industries came in with Chris Blackford of LINPAC, and Martin Gale of UPM-Kymmene, Don Coates of St. Regis and Peter Mansfield of Cheshire Recycling have all been to see me and given me high-quality briefings. We discussed the key issues affecting the industry, including recovery and recycling.
I join my hon. Friend in praising the 370 councils that now offer recycling facilities. They have worked with the Government to meet our targets, but I am alarmed at the trend towards mixing paper for recycling with metals, glass or other materials that contaminate the paper. I am pressing for this trend to be reversed. Co-mingling makes it much more difficult to recover quality paper products. Although the industry and I appreciate that the need for other vehicles to be involved in collection weighs heavily on resources and depletes our environment, I am sure that there are solutions that are cost-effective, good for the environment and good for the industry in question. I am also aware of the corrugated case and, like my hon. Friend and the industry, we want to see as much of that recovered as possible.
My hon. Friend highlighted the role of combined heat and power and emissions trading, and I was pleased also to discuss that in some detail with industry representatives. I recognise that the increase in gas prices and lowering of electricity prices in recent years has affected investment decisions in CHP. After I met industry representatives, officials from the DTI went to Aylesford Newsprint, in my hon. Friend's constituency, with colleagues from the Department for Environment,
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Food and Rural Affairs and the Treasury to learn more about the issues and, I hope, help come up with some of the solutions.
My hon. Friend rightly asked about the industry proposal for power companies to have an obligation to use CHP-generated power. A CHP obligation would be the surest way to ensure that the CHP 2010 target of 10 GW is met, but I am advised that it would be expensive relative to the carbon saved. We showed our commitment to CHP by publishing the UK CHP strategy four weeks ago on 26 April. It sets out a framework to support the growth of CHP capacity in the UK and to enable the CHP industry to meet the challenges ahead. I am keen to work with the industry to seek solutions and unlock CHP investment, and I am determined that the Government should help the paper industry to maximise its contribution to the UK economy.
My hon. Friend also mentioned industry concerns about the impact of the European Union emissions trading scheme, in particular on gas prices. As a form of low-carbon generation, CHP plants should benefit above other less efficient forms of energy generation. The impact of the scheme on CHP capacity is difficult to quantify, but modelling work has suggested that it would be in the range of 100 to 400 MW by 2010. Considerable uncertainty exists about the likely price of carbon, and the final impact on CHP will depend on decisions yet to be taken on the implementation of the EU's emissions trading scheme. We are grateful for the representations that my hon. Friend and the industry, both individually and collectively, have made to us, and they will help us reach a better-informed conclusion.
My hon. Friend also mentioned the EU co-generation directive. CHP is a highly fuel-efficient energy technology that puts to use the waste heat produced as a by-product in the electricity generation process. We have had that in the United Kingdom for a number of years, and the situation has not changed with the co-generation directive. The point that I want to emphasise is that it will not place the importance of heat more centrally than it is now.
We have heard about health and safety issues, which I know that the industry takes seriously. I am grateful for the positive steps that have been taken to set the challenging target to the industry of a 50 per cent. reduction in accidents. I understand that the industry has reduced the number of accidents by 29 per cent. in the past three years, and I pay tribute to everyone in it, including the unions and work forces, for their efforts in securing that improvement. I know that they will now redouble their efforts to reduce the accident rate further. All accidents are avoidable, and best practice is the way towards a zero accident rate. The industry and Department recognise that more work is needed, and I shall ensure that the Department works with the industry to monitor that and give every assistance possible.
I am delighted that the CPI is developing its sustainability strategy for the industry. It is consulting stakeholders for their views, including my Department and environmental groups. I am also glad and proud that the DTI part-funded an image study. It was published last year and found that the industry could work with us to highlight the positive achievements that it has made in sustainability and, in particular, managed

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forests. I represent a constituency in Scotland and I know that that is of particular interest to a wide group of hon. Members, including my hon. Friend.
The CPI recognises that there is room for improvement. It is addressing the issues so that companies in the sector have the tools to improve sustainability across the board. As with all challenging companies at the forefront of technology, it has set itself an ambitious goal to make the United Kingdom paper industry the first truly sustainable sector. It is about to publish its strategy and I am confident that if any one sector can be in the lead and make such an achievement, it is that excellent sector. We are liaising with it to ensure that we can showcase what it achieves.
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If there are points that I need to cover in more detail, I shall write to my hon. Friend. We have a close and warm dialogue on the sector and we both feel strongly about it. I have some good news for him and the Chamber. In spite of being a Minister who runs a high-tech office, has state of the art computers and electronic document management at the latest cutting edge level, my office is far from being a paperless office—something to which my staff will attest. The future of paper with a Minister like myself is very bright. I congratulate my hon. Friend again on securing the debate and on his well-informed contribution to it.
Question put and agreed to.
Adjourned accordingly at eighteen minutes to Five o'clock.