[MADAM SPEAKER in the Chair]
Motion made, and Question proposed, That this House do now adjourn.— [Mr. Hanson.]
The purpose of this debate is to raise in the House some of the wide concerns about the management of the Prison Service, especially those concerns highlighted in the reports of the chief inspector of prisons. I seek a response from the Government to those concerns and to some of the ideas that I will advance.As of last Friday, the Prison Service held 64,238 prisoners in 127 directly managed establishments and in seven prisons run by private sector companies. I have chosen not to debate the issue of private prisons on this occasion, but we believe strongly, on principle, that the state should not deprive people of liberty and then hand the key to the private sector. However, that does not mean that private sector prisons cannot be managed well, and we can learn some lessons from them. I shall briefly explore that issue later. The Prison Service employs about 40,000 staff in the prisons that it manages directly and the operating costs of the service total about £1.7 billion. A service of that size must be managed as effectively as possible and must achieve its stated purposes, giving value for money. I do not believe that the Prison Service is in decline. It has made considerable achievements in recent years under particularly stressful conditions, most notably—although not exclusively—in prison security and in reducing the number of escapes. That is not surprising, as all efforts have been directed at those areas. The chief inspector pays a particularly warm tribute to the work of the former director, Richard Tilt, who was the first director appointed from within the Prison Service. He took control of the service in difficult circumstances when morale had been damaged dramatically and made significant improvements. While criticising the management of the Prison Service, I acknowledge that friends and people whom I respect work at every level of the service, from prison officers to top management. I know the dedication and commitment that they demonstrate. However, the fact remains that there are significant problems and that something is seriously wrong with the management of the service. Members of Parliament tend to know when something is wrong with organisations from the way in which individual cases are handled. I have had problems with the Prison Service over the years. While trying recently to secure the transfer of a prison officer from Scotland to England, I discovered that the England and Wales Prison Service and the Scottish Prison Service have been in dispute over transfers since 1995, and that that dispute remains unresolved. While pursuing another case involving a prison officer who I believe was wrongly dismissed and unjustly treated, I discovered that Prison Service headquarters had told a local authority inquiring about his reference that that man had never worked for the service. When such things happen, one begins to explore the situation more deeply. Those painful individual matters—the first has been resolved satisfactorily, but the second has not—cause concern, but I have many other reasons to be worried about the management of the Prison Service. Many of my greatest and most obvious concerns date back to the closing years of the previous Government. The Prison Service will never forget the years when it was run "Howard's way". His was an era when the Home Secretary interfered in all aspects of the service, but was never prepared to take responsibility for it, especially if something went wrong—as it often did. The revelations of the then outgoing Minister of State, now the shadow Secretary of State for Health, the right hon. Member for Maidstone and The Weald (Miss Widdecombe), confirmed all our worst fears about the then Home Secretary's approach to the management of the service. However, the problems had begun even before that. The Woodcock report on the Whitemoor escapes stated:
The report made the further crushing observation:"There exists at all levels within the Service some confusion as to the respective roles of Ministers, the Agency Headquarters and … Prison Governors. In particular, the Enquiry has identified the difficulty of determining what is an operational matter and what is policy, leading to confusion as to where responsibility lies."
key performance indicators—"Any organisation which boasts one Statement of Purpose, one Vision, five Values, six Goals, seven Strategic Priorities and eight KPIs"—
The new Home Secretary has rightly changed the management style that he inherited from his predecessor. He has stated clearly that he takes responsibility for the service, but his style is not one of constant and detailed interference. That is very welcome. It would be easy to assume that all the deficiencies in Prison Service management have been remedied, but the chief inspector's annual report makes it clear that serious long-term problems remain. A major theme of the report is the lack of consistency within the Prison Service. Service standards and conditions identified by the chief inspector vary greatly and include variations within the same category of prison establishment. With the exception of dispersal prisons, there appears to be considerable inconsistency of standards within each category of prison. Factors such as whether a prisoner's offending behaviour will be challenged through education, work or offending behaviour programmes, how much time prisoners spend locked in their cells and whether those cells are overcrowded depend upon which prison an offender is sent to. Referring to young offender institutions, the chief inspector's report states:"without any clear correlation between them, is producing a recipe for total confusion and exasperation amongst those undertaking a most difficult and dangerous task on behalf of the general public."
The reports on Feltham and Werrington understandably caused considerable alarm. The inspector also pointed out that Prison Service management is failing to identify the problems within prisons. He stated:"We have continued to find some disgraceful examples of unacceptable treatment and conditions of children under the age of 18 and other young offenders, as well as some outstanding examples of good practice."
He continues:"Time and time again, my Inspectorate and I find ourselves reporting on matters that I believe should have been resolved by line management as a matter of course."
The chief inspector's conclusion is that the fundamental cause of those failures is that"Unless senior management is ruthless in insisting on the maintenance of standards, never tolerating anything less than what is required, while recognising and enthusing over what is good, or better, no operational organisation can hope to succeed."
There must be something wrong with the management of a national service in which such contrasting results are achieved and significant problems are not identified by line management. That would not be acceptable in any other national service, and it should not be accepted in the Prison Service. There are varying circumstances for each Prison Service establishment, but that does not justify the results, which seem to be due to a failure in the organisation of line management. The chief inspector suggests that the problem might have originated from the abolition of the Prison Commission in 1962 and the consequent Whitehall takeover of the management of prisons. He believes that from that point, the ethos has been wrong. The emphasis has been on a service to Ministers, rather than the delivery of required operational outcomes. I have always suspected that the Home Office's tendency to second-guess Prison Service decisions, or the fear that it will do so, blurs management responsibility and weakens managers. The chief inspector does not blame individual operational directors, area managers or governors, but argues that the organisational structure needs reform. He contrasts the experience of dispersal prisons with the rest of the prison service. Dispersal prisons are under a single director with financial authority, so there is much greater direction and consistency, which contrasts with the geographically organised management of the rest of the Prison Service. He concludes that there should be much greater functional management of the service. Recent changes have addressed some of those issues, but I share the chief inspector's concern that those reforms may not have gone far enough, and some aspects of them may create new problems. A positive step is the creation of a new position of director of regimes, as well as assistant directors for adult training, women prisoners and young offenders. However, the concern remains that, because there is not direct authority over all aspects in each of those areas, the necessary improvements will not be made. The failure within young offenders' institutions is an example. Despite the Home Secretary's statements on improving the juvenile secure estate, senior operational managers were found to be failing to achieve their targets. The chief inspector said that, at Werrington, operational managers were sanctioning extensive doubling up in single cells and young people were being required to share cells with strangers on their first night in prison. At Feltham, conditions were even worse than when he had inspected the establishment two years earlier. He said:"this organisation is inefficient, because it appears to be more about the management of financial resources than the oversight of operational delivery".
The chief inspector gives the shocking example of HMP Brockhill, where, he says,"That senior line management in the Prison Service should even think that such conditions and treatment are appropriate, confirmed my fear that the Assistant Director of Regimes would be powerless to influence the day to day routines that are currently not her responsibility to fund, however much she might be able to design appropriate offending behaviour programmes."
He says that Holloway remains virtually unmanageable. The chief inspector has therefore repeated his call for greater direct functional management for aspects of the Prison Service, including making one person responsible for all aspects of individual functions, with the authority to allocate resources. The priority areas are women and young offenders, with one overall director needing to be responsible for all day-to-day activities in any prison in each of those categories. The Government have so far resisted that call, and I should like to know what their latest thinking is. The chief inspector has also drawn attention to the fact that prison governors have extensive delegated powers over the budgets for their establishments, but also face a heavy bureaucratic load, which inhibits their ability to exercise leadership and remain in close contact with the prison. He says:"disgracefully, we found that 80 per cent. of the uniformed staff were male, over a year after it had been converted to a women's prison."
There have been other recent reforms of the management system. The quinquennial review of the Prison Service has confirmed its agency status, which we have supported, but there have been further changes. A new strategy board is to be chaired by a Home Office Minister, Lord Williams of Mostyn, with the director general as his deputy, but there is also a separate Prison Service management board, which is chaired by the director general. There is concern that this unusual system of two overlapping boards will again blur the lines of responsibility in the Prison Service between operational and policy matters. How will that system work? Part of the answer to improving management may be the extension of service delivery agreements within the Prison Service. We welcome that approach, which makes clear what is expected and how it is to be achieved, and that oversight of outcomes is needed. This is not, as I have said, the occasion for a debate on the ethics of the private management of prisons, about which we have concerns, but it is relevant to note private prisons' clear advantage, which we can learn from, which is that they are told precisely what is expected of them. The Prison Service has a key regulatory role for private prisons, which do not always achieve their targets, as the long list of reduced contract payments demonstrates, but there are lessons to be learned from private management and the system by which those prisons' requirements are set. In the public sector, there needs to be proper assessment of the needs of each individual prison. Funding should follow needs more effectively, and reform should be based on that concept. The biggest problem that the Prison Service faces is overcrowding. Excessive numbers not only lead to unacceptable conditions but undermine the work of the service. The focus becomes containment and security—keeping prisoners inside—instead of the more positive work that can be done. Overcrowding drains resources, reduces morale and undermines the capacity to undertake constructive work with offenders. It is understandably difficult to manage a service in which demands constantly outweigh resources. Overcrowding is a theme to which the chief inspector returns every year. Overcrowding jams up the prison system. In theory, prisoners should move through categories of prisons by completing the required parts of their sentence at each level. However, the chief inspector points out that"To bog governors down in bureaucratic detail shows a lack of awareness of the load on them, and the fact that it is inhibiting their ability to walk their prisons is bound to have an effect on the operational performance of staff, which in turn affects the delivery of the operational aim."
It is welcome that the recent rapid rise in the prison population has decreased in the past year, but at more than 64,000 prisoners, it is stabilising at an overcrowded level. That is like saying to the inhabitants of various midlands towns, "It is all right, the floods will stay at about their present level, and they won't go up much more." The prison population is at a level above the Home Office's projection for this period. According to the chief inspector, in the past year, local prisons were, on average, holding 26 per cent. more prisoners than they are resourced to hold. That category of prison is the greatest cause for anxiety because they are centres of inactivity and idleness. They have by far the highest suicide rate. Suicide is a major problem in the service. The figures for the first quarter of this year suggest that record numbers last year may be matched this year. This country has 122 prisoners for every 100,000 people, compared with 110 in Spain, 90 in France and Germany, 85 in Italy and Holland, 80 in Belgium, 65 in Denmark, 60 in Sweden, 55 in Norway and 50 in Greece. Our prison population is well over double those of Greece and Norway. In the whole of western Europe, only Portugal jails a higher proportion of its population. We are similar to ex-communist countries in our rate of imprisonment. Liberal Democrats have continually challenged the false argument that excessive use of prison sentences makes communities safer; it has the opposite effect because it maximises reoffending and consumes huge resources that could be used more effectively to protect the public. There seems to be a belief in the Home Office that the new community sentences in the Crime and Disorder Act 1998, the introduction of home detention curfews and some lessening of the "lock 'em up" rhetoric will reduce the prison population to a more reasonable level, but there is no guarantee of that. We have yet to see the results for the prison population of the Government's adoption of the previous Government's policy of mandatory sentencing. Mandatory sentencing will not only affect those convicted of offences with mandatory sentences, but will almost certainly ratchet up other sentences when comparisons begin to be made between someone who gets a defined, mandatory sentence and someone whose offence seems to the courts and the public to be worse and more violent and therefore to demand a sentence greater than that for an offence carrying a mandatory sentence. Overcrowding and excessive demands on the Prison Service have probably been directly responsible for the provisional figures for the results achieved against the key performance indicators, which were published in a parliamentary answer to me this week. Those figures demonstrate that the service has failed on five of the 11 targets. The areas where the Prison Service failed to meet the set targets were assaults, time out of cells, purposeful activity, completion of the sex offender treatment programme and cost per prisoner. Those are key areas. If we want to cut reoffending, good work now—in the provision of effective treatment for sex offenders and of constructive activity, and in cutting violence and bullying in prisons—is essential to help to protect the public in future. Time does not allow for a detailed analysis of key performance indicators, although the chief inspector demonstrates that many of them are either false or misleading. He suggests that they would be more meaningful if, for example, they measured such things as the number of prisoners who have learned to read by the time that they are released. Following the comprehensive spending review, the Government have allocated more money to the Prison Service, which is undoubtedly needed to sustain present demand. The figures that the Government use perhaps exaggerate the amount of extra money that the service will receive in real terms. Although the Home Office report refers to £49 million extra this year, £55 million next year and £56 million the following year, in real-term 1997–98 prices, we are talking about £3 million, £8 million and £7 million extra respectively. Having said that, the money is welcome in the Prison Service, and I see indications already of where it has been committed to valuable improvements. Overcrowding in recent years has led to significant cuts. The objectives of the Prison Service—rightly—are twofold: to protect the public by holding safely those whom the courts have committed, and to reduce crime by providing constructive regimes which promote law-abiding behaviour both in custody and on release. The second objective has particularly suffered from overcrowding and tight resources. Between April 1995 and the end of this new Government's first year, there was a fall in the amount of education undertaken in 72 per cent. of prison establishments. In 63 per cent. of them, there was a decline in the amount of work undertaken, and in 49 per cent. a decrease in both education and work. That trend is in exactly the wrong direction."this sensible procedure has been severely disrupted by the effects of overcrowding, the Prison Service having to operate at over capacity the whole time to ensure that every available bed-space is occupied."
Does the right hon. Gentleman agree that there is a problem not only with overstretch but because the Prison Officers Association is not allowed to operate in private prisons? Different rules and standards of employment are leading to difficulties. I do not know whether he is aware that people in charge of escorts do not recognise the POA. Market testing of training is another problem. I have two prisons in my constituency, and those are the issues that are raised with me. I do not know whether the right hon. Gentleman hears the same problems. The staff are of a good calibre, but morale needs to be lifted. The only way to do that is to stop overstretch and more prisoners entering prisons.
As I have two prisons in my constituency and a responsibility in the House that leads me to visit many others, I echo the fact that there are just such problems. I have a great deal of sympathy for prison officers, who are at the sharp end of all the problems and must deal with cuts. Such officers are very often not available in sufficient numbers to enable the provision of education. Why are evening educational activities frequently cancelled? It is not because there is no education officer; it is because there are no prison officers to accompany prisoners on such activity.The chief inspector has expressed quite strongly the need for a change in the culture of the Prison Service, involving both management and the Prison Officers Association. Such a change, away from the confrontation of the past toward a much more co-operative approach, began some time ago. Because private prisons began operation without some of that history, they have enjoyed some advantages. However, the POA would quickly point out that such staff are at some disadvantage in that they lack the association's strong support in some of the difficulties in which they may find themselves. We are in an era of significant change in how people who work in prisons work together with a common purpose. When 53 per cent. of released offenders, including 75 per cent. of young offenders and 89 per cent. of juveniles, reoffend within two years of release, it is disastrous that we should be losing work and educational activities. There is a real chance that the Government's new money will simply plug the gaps that have grown over the past four years rather than achieve a net improvement. The key performance indicators that were published this week show that the level of purposeful activity has fallen for four years in a row. The Minister should be embarrassed that the figures are as bad as that, and should recognise the need for some urgent action. The chief inspector points out that work and education are seen as the soft target for cuts. Without guidance to the contrary, one can understand why governors make such decisions; there is very little else that they can cut in the short term. That approach must be reformed. In the section on training prisons, the chief inspector makes a significant remark:
We must end the absurdity under which cuts in the very programmes that have been shown to help to reduce reoffending are regarded as efficiency gains. It is nonsense to regard taking out the very thing that can make prison do its jobs properly as an improvement in efficiency. Prisons are there to protect the public by safeguarding those whom the courts have committed, and by ensuring that, when such people return to society, they are less likely to commit further crimes. To achieve that, the Prison Service must be resourced to meet the demands that are placed on it. However, it must also be managed in a way that delivers outcomes as effectively as possible. I do not think that there could have been more compelling testimony that that is not so than that provided by the chief inspector. I hope that the Government are taking it very seriously indeed."When Governors suggest to me that their prison is the cheapest in the system, I ask them what they are not doing in order to achieve that 'distinction'. Invariably the answer is in regime activities, which means that they have idle and unemployed prisoners, the antithesis of a training prison."
I am pleased that my right hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith) has been able to secure this debate. I shall raise three issues: the self-harm of prisoners, work and active prison regimes and the relationship between prisons and the probation service.The incidence of self-harm in prison is worrying. We know that suicide in prisons is a major problem. Between 1990 and March 1997, 516 people took their lives in British prisons, which must be a major cause of concern. In addition to those who go so far as to take their own lives, a significant number carry out other acts of self-harm. In a written answer that I received yesterday, I was given some disturbing figures. Between September 1997 and October 1998—the last 12-month period for which complete statistics are available—the number of reported incidents of self-harm among male prisoners was 5,963, and among female prisoners, 1,052. The figure for female prisoners is particularly worrying. For men, the 6,000-odd incidents can be set against 60,000 prisoners, giving a ratio of approximately one incident per 10 prisoners a year. But for the 3,000 women prisoners, there is approximately one incident per three prisoners a year. That must be a major source of concern in the management of care of female prisoners. Although self-harm, by definition, is not wholly under the control of prison management, the regime must be a material factor in deciding self-harm rates. We believe that overcrowding, in particular, causes problems because it increases tension in prisons and reduces opportunities for supervision, especially of those who are vulnerable and liable to self-harm. In that respect, the dramatic increase in the number of women prisoners who harm themselves must be noted: from 1,353 at the end of 1992 to 3,189 by the end of July 1998. That is a 136 per cent. increase, compared with a 64 per cent. increase over the same period for male prisoners. Concern about that is reflected in the chief inspector's description of the situation in Holloway as "appalling". Although women prisoners who harm themselves are of particular concern, the problem extends to prisoners in general. On issues of work and active regimes, on which my right hon. Friend touched, we on the Liberal Democrat Benches believe that prison works best when prisoners work. The figures for weekly hours spent on purposeful activity are deeply worrying. As my right hon. Friend said, there has been a reduction in hours of purposeful activity in most prisons. The figures seem to show a trend of hours falling year on year. In the year 1994–95. the average number of hours spent weekly on purposeful activities was 26.2; in 1995–96, it was 25.2; in 1996–97, it was 23.8; in 1997–98, it was 23.2; and in 1998–99, it was 22.8. That last figure was set against a declared target of 24 hours. There is an incontrovertible trend in the wrong direction, which we would wish to be dramatically reversed as a key way of reducing reoffending, which must be one of the primary goals of the Prison Service. Prisoners need a purposeful regime if they are to be prepared for release. That must be a particular concern in respect of young offenders, who we hope have a useful future before them and will not return to the prison system or the criminal justice system. The chief inspector's report on the young offenders institution and remand centre at Feltham causes particular concern in this respect. After visiting Feltham on an unannounced inspection, the chief inspector said that he had to disclose to the public not only that the conditions and treatment of the 922 children and young prisoners confined in HMYOI and RC Feltham were
but that they were some of the worst things that he had seen in the prison regime and in many ways worse than when he reported on them two years previously. There was particular cause for concern in the figures that he reported on opportunities for employment at Feltham. When the children and young offenders who were held there were asked whether they had done any work that would help them to get a job on release, only 8 per cent. thought that it would help them. Twenty-five per cent. were uncertain. Six per cent. thought that it was too far in the future to say. Nine per cent. did not comment. Very worryingly, 52 per cent. thought that the work"in many instances, totally unacceptable",
That is set against the background of the chief inspector's deep concern about Feltham in general. Those youngsters have their whole life ahead of them, and we must hope that they will find their way into purposeful employment as a major way of preventing them from having any further contact with the criminal justice system."would not be helpful to them on release".
There are in my constituency a remand prison and a senior prison—Strangeways and Hindley. I remember discussing with a prison governor, who ultimately moved very high in the prison ranks, the question of what we considered to be purposeful training in the true sense. I am glad to say that half the young remand prisoners were doing purposeful training on such things as brick making, concrete work and car maintenance. They were a bit reluctant about car maintenance. There was always a problem attached—there was some temptation there.The first thing that the governor said to me was, "If I could, I would ensure that all my prison staff got involved in this type of thing, but I have to make cuts according to the scale of tenders that are coming in for particular jobs." To cut a long story short, I believe that work is the answer to 80 per cent. of our crime problems. No one commits a crime believing that they will be caught. Fully employing people in useful occupations is the best form of therapy that one can give prison detainees.
The hon. Gentleman makes a significant and important point. It is useful to hear that those running another institution feel that the cuts that they have been expected to make are causing problems. Liberal Democrats believe that investment in confronting offending behaviour and dealing with some of the social and educational issues that have led people into crime is a very good investment for the taxpayer, and produces a far better return than making a short-term cut in an annual prison budget. If the money is used in the former way, we shall save significantly in the long term because people will not re-enter the criminal justice system.The other side of the work coin must be education. It is well acknowledged that many of those who end up in the prison system have had bad educational experiences. Frequently, they are people who find work very difficult because they have not reached the first rung of the ladder—people with literacy problems, for example. Seventy-one per cent. of the people who arrived at Feltham had been assessed for their educational needs, but, when asked about opportunities for education in the prison, a majority of them said that they were not good. Only a small number felt that the opportunities that they had had were sufficient for their needs, and 81 per cent. of those who responded said that they would like there to be far more educational classes. There we have a group of youngsters who probably have deficient educational experiences, who have committed offences for which they are rightly being punished, but 81 per cent. of whom wish to enter some form of education and obviously desire to move forward. They wanted things such as NVQs in mechanics, engineering, catering and food hygiene, which would help them to find employment on leaving the institution. The desire is there, but there must be major concerns about whether those courses are being delivered in sufficient numbers. I hope that the Minister will talk about the relationship between prisons and probation services. I know that that is a key policy area for the Government. In his 1996–97 report, the chief inspector of prisons reported on the probation services in worrying terms:
I trust that the Minister will say whether she believes that the cuts in probation staff who are seconded to prisons and those working at the area of release are being reversed. The cuts have been especially difficult for probation services at a time when many of them are reporting that they are fully stretched in trying to implement national standards. They are doing their best to meet national standards, but some of the other work in relation to their own targets sometimes falls off the priority list. Some of that interface between the Prison Service and the probation service, where the Prison Service has one set of targets and the probation service has another, can suffer as a result. I hope that the Government will consider that. Local probation services have reported to me that they naturally find it very difficult to work with local offenders, who will be coming home, and who are held in distant prisons. They simply do not have the resources to send probation officers to the other end of the country to work with the prisoner before release, and they often fail to do so simply on resource grounds. I wonder whether more could be done within the management of the Prison Service to ensure that prisoners have more contact with their home probation service before they are released, so that when they are released there is already a firm foundation for the probation work that will follow. Finally, there has been a small reduction in the number of people held in prison as a result of the home detention curfew scheme. Will the Minister say something on how well she considers the Prison Service to be managing the release of people into home detention curfew? How will the scheme be assessed and reported on? It is a novel scheme and it would be useful to see how it has panned out, especially in respect of the crucial interface between Prison Service and probation service, where we are effectively transferring a responsibility; the probation services are obliged to pick up new responsibilities and set up new systems for managing the tagging schemes. I hope that the Minister can use her response to say that the Government share many of my concerns and those of my right hon. Friend the Member for Berwick-upon-Tweed. I hope that she can give us some prospect of a reversal in the worrying trends of reduction in purposeful activity and of failure to deliver the types of education, confronting offending schemes and work experience that we believe would make prison as effective as it could possibly be in reducing reoffending."Probation services have been cut. both in the number of seconded staff working in prisons, and staff to supervise prisoners on release."
This has been a useful debate on an important subject. I sometimes think that we do not debate prisons sufficiently in the House, and I welcome any opportunity to debate prisons and prison management.I listened with great interest to the detailed speech by the right hon. Member for Berwick-upon-Tweed (Mr. Beith), who made some important points. At the outset, he said that his party had a principled objection to privatised prisons. That is fair enough. However, the right hon. Gentleman was good enough to concede that many advances have been made in the Prison Service through the introduction of private prisons, and that many lessons can be learned from the way in which they have been managed. When privatised prisons were introduced under the previous Government, we heard similar objections of principle from the then Opposition. There was a long campaign of attacks on private prisons and privately managed custody services. There was a time when every escape from privatised custody services and court transfers was reported with great glee from the then Opposition Benches, but we do not hear so much about that now. There seems to have been a conversion, which we welcome. There are ever increasing examples of the extension of private management. In another part of the House we are debating a Bill that applies privatisation to immigration detention centres. Nevertheless, the right hon. Member for Berwick-upon-Tweed raised important issues of detail, which must be answered. I listened with interest to the hon. Member for Sheffield, Hallam (Mr. Allan), who rightly mentioned the case of Feltham. I visited Feltham fairly recently. The institution has a long and difficult history. We need to pay attention to the views of the chief inspector of prisons on Feltham and the rate of progress, or lack of progress, there. One of the problems is the physical structure of Feltham and the way in which the units are divided up. Another problem is the mixing of prisoners across age groups and categories–15 and 16-year-olds sometimes mix with older youths, 17 and 18-year-olds, and remanded prisoners mix with sentenced prisoners. It is better to keep the categories separate and Feltham does try to do that, but when I visited the prison it was apparent that that was not always being achieved, because of the pressures under which the system operated. I make no criticism of the prison staff, as I know that there are many caring prison staff at Feltham and at other prisons. The hon. Member for Hallam spoke about education and training opportunities for young people in prison. That is an important subject. The best management of education and training for young people that I have seen in my visits to prisons was at an institution that has, sadly, been closed by the Government. That was the military correctional facility at Colchester—the so-called boot camp. The term "boot camp" may have put an unfortunate complexion on that institution. In my experience, it had the most caring staff of all and more was being achieved with the young people at that institution, which was set up by the previous Government, than at any other institution that I have seen. Its training produced extremely good results, measured by certificates and recognition of achievement, in fields such as those mentioned during the debate—motor mechanics, brick laying and painting. The young people who went there received good instruction from trained instructors, under the watchful eye of the non-commissioned officers of the military correctional facility. There was a good record of achievement. We look forward to the results of the independent research that has been carried out by the Cambridge Institute of Criminology into the performance of the military correctional facility, particularly its record of reconvictions. If young people who have been in trouble and spent time in custody receive good training and education and later have a lower rate of reconviction, we will study the results from the military correctional facility with great interest. It is a shame that when those results become available and the good practice there comes to light, the facility will no longer be open. Its premature closure is a matter of regret to us. Prison management is a large subject. The aspect that I shall briefly explore is the management of prisons so as to ensure that the prisoners who present the greatest security risks are held in the most secure conditions and the public are given the greatest possible protection from them, and that other prisoners who do not present such a great risk to the public are not wrongly held in secure conditions. With regard to the most serious offenders—those who are serving life sentences for the gravest offences—I am worried by a written answer received yesterday by my hon. Friend the Member for West Derbyshire (Mr. McLoughlin) about a case in his constituency, which throws light on the management of prisons, particularly the temporary release of life-sentenced prisoners. I understand from the written answer that there has been a recent history of life-sentenced prisoners absconding from Sudbury prison in my hon. Friend's constituency, and that in the past two months two life-sentenced prisoners failed to return to Sudbury from temporary release. One is still unlawfully at large. The other surrendered to the police in north Wales and has been charged with murder. It may be difficult for the Minister to respond on individual cases, but I look to her for some reassurance about the policy of holding life-sentenced prisoners in relaxed conditions, and particularly temporary release for such prisoners. In the light of the information concerning Sudbury prison, and of the understandable concern of my hon. Friend the Member for West Derbyshire, we are owed an assurance from the Minister.
I agree that the cases quoted by the hon. Gentleman give rise to questions about why particular prisoners are allocated to particular prisons, especially when one hears the police say that someone who is dangerous and whom the public should not approach has absconded from an open prison. However, I hope that the hon. Gentleman will recognise that to refer to life sentences in general implies that all life-sentenced prisoners need to held securely. That is manifestly not the case, as a life sentence is often a mandatory sentence and is sometimes applied to people with a very low likelihood of absconding or reoffending.
That is right, but we must recognise that life-sentenced prisoners will include those who are the most dangerous to the public and who must be managed with the greatest care. That is the point on which I am pressing the Minister.Moving down a notch on the scale of seriousness, the issue of prisoners released on home detention curfew was touched on by the hon. Member for Hallam. The Minister knows our view on the use of tagging—home detention curfew—for the early release of prisoners. We have no problem with the use of home detention curfew as such or as a sentence in its own right. It was pioneered by the previous Government, again in the face of opposition from the present Government. Every technical problem was highlighted, and at one time as a point of principle the then Opposition disagreed with the use of tagging in any circumstances—but I shall draw a veil over that. The Minister knows our principles with regard to honesty in sentencing. The early release of these prisoners makes a mockery of the sentences handed down by the courts, at least as far as public and victims are concerned. A sentence of six months' imprisonment may mean only six weeks spent in custody. On the management of prisoners who are to be released subject to home detention curfew, I was concerned by written answers that I recently received from the Department showing the extent to which prisoners with convictions for violence have been released on home detention curfew since the new system began on 28 January. Between that date and 19 April, 617 offenders who were serving sentences for offences of violence were released on home detention curfew. Many members of the public would find that a striking figure. They and the courts have long recognised that violent offenders present the greatest danger to the public. Statutes going back to the Criminal Justice Act 1991 have recognised the need for violent offenders to receive longer sentences of imprisonment. It is thus surprising that so many of them are being released on home detention curfew. When home detention curfew was introduced, we were assured that it would be managed in such a way that there would not be quota for such prisoner releases. I do not know how that is working out in practice, but we question whether it is right that so many prisoners with convictions for violence should be released. If the Government have taken such a course in respect of early release through home detention curfew—we have made our views known on that—and instead of releasing so many violent offenders, can the system be managed in such a way that non-violent prisoners, who pose less threat to the public, are released? Many members of the public—not to mention victims who are concerned about early releases—will find it striking that violent offenders should be released in this way. I turn from those who require secure conditions and who should serve out their sentences in prison to those who may not necessarily need to be in prison at all. I listened with interest to what the hon. Member for Hallam said about women prisoners. He is right that there has been a noticeable increase in their numbers in recent times; indeed, there has been a 20 per cent. increase since the Government came to office. Sad to say, women sometimes need to go to prison—they commit serious offences, alongside men—but we wonder what lies behind such a disproportionate growth in the women's prison population, which is growing faster than the men's. We will be holding more and more women in prison, which I do not find a particularly inspiring prospect, and if there is a way of avoiding that I should like to explore it. Members of the public will recently have seen the interesting television series featuring life inside New Hall prison. People would be concerned if we had to have more and more institutions such as New Hall to hold women prisoners, so I wonder whether imprisoning more women is justified.
Does the hon. Gentleman agree that one area that we need to explore is better community sentences for women offenders so that we have non-custodial alternatives? Some probation services have reported that community sentences, and community service in particular, are often designed for men; it is a hard-labour situation. A lot of advances could be made so that courts have a genuine alternative to custody.
It would be a shame if a court imposed a custodial sentence on a woman convicted of a serious offence because there was no appropriate non-custodial sentence, even though she was a borderline case. Many members of the public would rather she received a non-custodial sentence, especially if she had a family—she would be able to keep in contact with them.I listened to the comments on Holloway made by the hon. Member for Hallam. I had not visited that prison until fairly recently, and one of the most striking experiences of an interesting visit was meeting a 16-year-old girl who was there. I asked to see the youngest prisoner, but I never expected to meet a 16-year-old girl. That meeting made me think about the public policy involved in a fresh-faced 16-year-old girl ending up in Holloway to serve a short sentence. It is sometimes said that holding younger people in local adult prisons is justified because that enables them to be nearer their families—there are more prisons than specialised institutions—but I have to report that the girl in question came from Southampton and the distance between Southampton and Holloway made it difficult for her family to visit. She told me that the thing that she looked forward to most in life was visits from her mum, and she had not been having enough of them. I could not think of any adequate justification for that and I wonder whether there might be a better alternative. The Government have recently made announcements on young people in prison; I am prepared to give them credit for that, but I have some more critical comments to make on the question of boys in men's prisons. On the management of prisons holding girls, the Government have announced in a written answer that they intend to make use of the detention and training order
That is one of those written answers that needs reading carefully, so I read it carefully to see whether there is what we might term a seamless safety net to prevent young girls from ending up in women's prisons. The more I read the answer, the more I was worried by some of the terminology, particularly the words"by placing sentenced 15 and 16-year-old girls in available non-Prison Service accommodation, when the detention and training order is in force. The first priority will be to place the youngest and most vulnerable young women outside the Prison Service. In the short term, arrangements within the Prison Service for holding 17-year-old women, and other young women for whom other accommodation is not available, will be improved by establishing discrete units for young women under the age of 21, with enhanced regimes within these."
Does that mean that young girls will still be held in prison accommodation when other accommodation is not available? Would not it be better if we simply stopped holding 15 and 16-year-old girls in women's prisons in such circumstances? I would be prepared to give the Government a plaudit if they made such an announcement, but I would be cautious about a policy that appeared to be moving towards ending the holding of sentenced 15 and 16-year-old girls in women's prisons, but did not achieve that. We have had experience of that nature with the Government's proposals for the remand of 15 and 16-year-old boys, and I now move on to that unhappy subject. As the Minister will know, Labour Members made a great song and dance in opposition about the holding of 15 and 16-year-old boys in adult prisons. It is surprising that such boys are held in adult prisons up and down the country, sometimes in the oldest prisons. They are often held in the oldest parts of those prisons and, although they are separated from the older offenders, the context and setting are very much those of an adult prison. The previous Government set an objective of ending altogether the remanding of 15 and 16-year-old boys to adult prisons. I should make it clear that such boys have been charged with an offence, but not convicted, although it is the view of a magistrates court that they need to be held in secure conditions. I am not disputing that they may need to be held securely, but the question is which secure conditions they should be held in. The previous Government set in place a plan for providing local authority secure accommodation as an alternative to holding 15 and 16-year-old boys in adult prisons. Many people agreed that local authority secure accommodation would be a much better way of holding such boys than putting them in adult prisons, and they could certainly be given much more appropriate care and education. The hon. Member for Hallam spoke about the difficulty of providing education for young people in custody, and that is all the more difficult when they are being held in adult prisons. Small numbers of such boys—one 15-year-old and a handful of 16-year-olds, for example—may be held in adult prisons scattered across the country. It is the responsibility of the prison authorities to deliver the national curriculum to under-16s, which would be difficult if there was only one person in that category in an adult prison. It would be much easier if that person was held in local authority secure accommodation with other young people. That is one reason, and there are many others, why local authority secure accommodation is so much more appropriate for such young people—certainly more appropriate than adult prisons and, I would venture, than young offender or remand institutions. Local authority secure accommodation is the best option for those young people. The previous Government set in place a programme for creating 170 places in such accommodation, to remove the need for these boys to be held in adult prisons. The last time I asked the Government about this problem, I was told that they had provided six places in local authority secure accommodation. I should be interested to know from the Minister whether there has been any advance on six since then. How many places have been created in local authority secure accommodation since 1 May 1997? This subject is of interest to me, and it was of great interest to the Labour party before the last general election. It campaigned strongly on this issue, as did the then shadow Home Secretary, the present Prime Minister, during the passage of the Criminal Justice and Public Order Bill in 1994. He highlighted the problem on the Floor of the House, and said that more local authority secure accommodation should be provided without delay. He said that 170 places were not enough, and that places were not being provided quickly enough. We should like to know how many places the Government have provided. Given that commitment by the then shadow Home Secretary to create more local authority secure accommodation, and to put into it the 15 and 16-year-olds who are being held on remand in adult prisons, I am concerned about the announcement on the direction of Government policy in this regard. The Crime and Disorder Act 1998 allowed for the continued remand of 15 and 16-year-olds in adult prisons subject to a screening for vulnerability. We were told on 8 March 1999:"other young women for whom other accommodation is not available".—[Official Report, 8 March 1999; Vol. 327, c. 29.]
Are we to take it from that that the Government's policy is to hold those 15 and 16-year-old boys in other parts of the prison estate? Is the intention to move them from adult prisons into other young offender institutions or parts of the prison estate as opposed to local authority secure accommodation? If that is now the direction of Government policy, they are short-changing us on the commitments that were given by the former shadow Home Secretary, now the Prime Minister. The Government are short-changing us on their commitment to put 15 and 16-year-old boys remanded in custody into local authority secure accommodation. We are concerned about the management of the Prison Service in this respect. I look to the Minister for an answer on that issue. Young people in trouble and in custody are of great concern to us. We should take care to ensure that the Prison Service is managed so as to provide appropriate alternatives to custody whenever possible, including local authority secure accommodation. If young people have been sentenced to custody and are held in young offender institutions or in detention under section 53 of the Children and Young Persons Act 1933, they should receive appropriate training and care. We should devote our attention to the care of young people in those circumstances. This debate on the management of the Prison Service has afforded us an opportunity to discuss some of its aspects, and it is a subject in which we shall continue to have a strong interest. We expect the commitments that have been given to be fully honoured, and we do not want to be short-changed in the way I have described."The Prison Service is finalising its plans for a distinct estate within its accommodation for 15 to 17-year-old boys remanded or sentenced to custody, with improved levels of care and regimes delivered within it."—[Official Report, 8 March 1999; Vol. 327, c. 29.]
I am grateful to the right hon. Member for Berwick-upon-Tweed (Mr. Beith) for securing this debate on the management of the Prison Service in England and Wales. I am pleased that even though there were only a few contributions, they showed that hon. Members take a close interest in this issue. It must be reassuring for people in prison to know that what is happening to them is discussed in Parliament.Attention has been drawn to the fact that there is scope to improve our prisons and their management. I shall try to respond to as many of the points raised as possible. The 1997-98 annual report of the chief inspector of prisons, Sir David Ramsbotham, has been used as a reference point. It is an important and extremely useful report. As the Home Secretary said in his speech to the Prison Reform Trust last year, which is quoted in the introduction to the report:
It is important that we consider carefully what the chief inspector has said. In an Adjournment debate, the more negative aspects tend to be highlighted, although the right hon. Member for Berwick-upon-Tweed made some positive points. In the report, the chief inspector says that when he took up the job he was advised that progress would be made only following disasters, and he quoted the various reports that had led to changes being made. What he goes on to say is interesting, however:"The inspection of prisons should continue to be both independent and rigorous".
I am pleased that the chief inspector recognises that the Government are trying to approach the management of prisons in a different way. The two key themes of the report are that our prison system needs improved direction, leadership and management; and that standards set should be met better and more consistently—that word comes through in everything that has been said this morning—across the system. I should like to address those issues before I deal with particular points. The Government are committed to ensuring proper ministerial responsibility for the Prison Service. That was an important element of the recent quinquennial review of the Prison Service and its status as an agency. My right hon. Friend the Home Secretary announced on 1 February his conclusion that the Prison Service should remain an agency of the Home Office. That followed two reports which, together with the writing of a new framework document, comprised the quinquennial review of the agency. A report on evaluation of performance had concluded that the Prison Service, in the context of a rising prison population, had achieved a remarkable turnaround in performance over the first five years of agency status. That was partly because of a clear focus on outputs and service delivery as measured in key performance indicators. A prior options report studied the organisational options for the Prison Service and concluded that agency status should be reaffirmed. It is interesting that that was virtually the unanimous view of a wide range of internal and external prison interests. The Prison Service can, in some respects, be regarded as under new management. It now has a new director general, Martin Narey, a new deputy director general, Phil Wheatley, several new directors, a new board structure with my noble Friend Lord Williams at its apex, and a more streamlined approach with a clearer focus on performance management. Much of that is tied together by a new framework document, announced by the Home Secretary and issued at the end of March, which sets out the up-to-date relationship between the Prison Service, Ministers and the core Home Office. The new framework document proposes significant changes to meet the Government's commitment to ministerial control. It integrates the aims of the Prison Service within new planning arrangements for the wider criminal justice system. That is important, because for too long the prisons have been separate and isolated. We intend to ensure that everything that goes on in prisons is directly related to what is going on in the rest of the criminal justice system. The document focuses on management, responsibility and accountability issues with greater clarity for the roles of principal players, and in particular it provides for a new Prison Service strategy board and a Prison Service management board. The Prison Service is also streamlining its structure and its approach to managing the service's performance. The 12 area managers are now managed directly by a new full-time deputy director general. There is a strong focus on performance management with 15 service delivery agreements between headquarters and establishments in place or planned from April 2000. Three-year improvement plans for particular establishments where appropriate will be rigorously managed. These arrangements build on a strong internal auditing structure through the standards audit unit, whereby operating and security standards are audited in every establishment at least once every two years. The right hon. Gentleman asked about the Prison Service management board and the Prison Service strategy board. He felt that there might be some confusion about what each would do, and asked for clarification. I assure him that this has been carefully thought out. The newly formed management board deals with immediate issues and meets regularly, addressing a wide range of day-to-day matters such as monitoring plans, deciding on priorities and expenditure, authorising projects and initiatives, approving internal communications—that is very important—and deciding what the strategy board should discuss. The membership of the management board has been broadened to reflect our wish for a more outward-looking Prison Service. It includes a new director for corporate affairs, who will be a focal point for the service's modernisation programme. Those attending the board will include a racial equality adviser, who is yet to be appointed. The Prison Service strategy board provides a forum for discussion of the strategic direction of the service. The board, chaired by my right hon. and noble Friend Lord Williams, the Minister responsible for prisons and probation, will concentrate on long-term strategy and high-level monitoring of the service's performance. Generally, the board will discuss major strategic policy matters such as personnel and industrial relations, and the extent to which the service is looking outwards and contributing to the more co-ordinated criminal justice system that the Government are trying to facilitate. The board's membership includes a Home Office director responsible for sentencing and correctional policy, and, among its non-executive directors, a current chief constable. The director general will still have delegated authority over day-to-day management of the service, and will be directly accountable to the Home Secretary for its performance. He is the Home Secretary's principal adviser on matters relating to its activity. It is always interesting to hear the hon. Member for Hertsmere (Mr. Clappison) reminding us of what we did or did not say when we were in opposition. I would like to remind the hon. Gentleman of plenty of things that the Conservatives said when they were in government—things that they said they would do, and then did not do—but I feel that, when we are debating prisons, we should be looking forward and asking how we can improve things generally. [Interruption.] That means that I am not prepared to engage in a debate about what was and was not said, even by former shadow Home Secretaries. The right hon. Member for Berwick-upon-Tweed asked why governors were allowed to cut regimes, thus making it less likely that we would cut reoffending. We are shifting the focus on to what works, and trying to develop measures of effectiveness rather than concentrating on the amount of time that is spent outside the cell. What happens when prisoners are out of their cells is extremely important, and, as the hon. Member for Sheffield, Hallam (Mr. Allan) pointed out, it is essential for the Prison Service to work closely with the probation service in that context. We are appointing a joint independent panel of experts to accredit prisons' probation programmes, developing a joint assessment tool and improving joint planning and training. As the hon. Gentleman said, a close working relationship between the Prison Service and the probation service is vital to the securing of a regime that will help to prevent prisoners from reoffending. The hon. Gentleman also asked whether the cuts in probation services would be reversed. It is true that in some prisons probation involvement has declined in recent years; we are committed to reversing that by refocusing on constructive regimes to reduce the amount of reoffending. The ambitious programme of joint work by the Prison Service and the probation service is set out in the Government's 1998 consultation paper on the future management of probation. All the Prison Service's work on resettlement and reducing reoffending must be linked with the work of the statutory and voluntary agencies. We know that improvements can be made, and we are committed to making them. The right hon. Member for Berwick-upon-Tweed asked whether we were focusing adequately on the need to reduce reoffending, given that we had failed to meet the year's key performance indicator for the treatment of sex offenders. The extra money from the comprehensive spending review is being carefully targeted to reduce reoffending. Over three years, it will allow us to double the number of offending behaviour programmes. It will help us to improve prisoners' basic skills: we have set a target of 15 per cent., exactly the target set by the chief inspector. It will also allow us to implement a comprehensive drugs strategy, and to transform the care of juveniles to meet the expectations of the new youth justice board. The hon. Member for Hallam spoke of the importance of work. People coming out of prison need to be prepared to get work, which will require the basic qualifications that many currently do not possess. We are working hard to improve that. The right hon. Member for Berwick-upon-Tweed asked whether we were considering functional management for women and juveniles. That important matter is currently being discussed. The new director general is—I think the word is "actively"—considering whether it would be right to move to functional management for women and those under 18. Obviously, any decision will have to be made after careful consultation both inside and outside the service, and I am sure that the director general will note what the right hon. Gentleman has said today; but significant improvements are already being made as new investment comes on stream. The hon. Member for Hallam asked whether we were committed to reversing the decline in the number of hours spent on purposeful activity. That decline is not acceptable, and we are committed to reversing it, but, as I have said, we are also determined that time should be used more effectively. That is not straightforward: not everything works, which is why we must focus on basic skills, employment and accommodation needs, the problem of drug misuse and running offending behaviour programmes that work. The money for the new regime, and the new director of regimes, will enable us to make progress. The right hon. Member for Berwick-upon-Tweed said that there was not as much new money, in real terms, as had been suggested. The additional £226 million over three years is a real increase in terms of 1998–99 prices. The programme for access to drugs testing and treatment is to receive £76 million; £79 million is being provided for additional regimes for engagement in constructive activity; and £51 million is being provided for the juvenile estate and regimes. All those amounts are tied to specific improvement targets: the new money will be specifically geared to the raising of standards and the reduction of reoffending. The right hon. Gentleman asked what we meant by efficiency. Of course, no sensible person would define efficiency as the meeting of targets through the reducing of regimes. The service has been set challenging targets: as the right hon. Gentleman said, it aims to save £18 million, then £36 million and then £55 million over the next three years. We have a programme that we believe can deliver those savings through, for instance, energy efficiency, new procurement procedures and contract escorts. There will be no impact on regimes. We all know from our visits to prisons that improvements could be made. Prison officers and governors need to develop methods of management that do not affect services that are vital to prisoners. On overcrowding, clearly, prisons must take all the prisoners that are sent to them by the courts. Average capacity will be increased by 2,400 places between this year and 2001. As hon. Members will know, four new prisons are to open. Overcrowding is not expected to rise over that period. We will introduce a new KPI for this year to measure doubling, so that it will not exceed 18 per cent. The figure for 1998–99 was 18.4 per cent., a slight reduction. Nevertheless, we aim to improve on it. Self-harm is a serious question for every institution. It is dealt with by the suicide awareness team. It is often inflicted by prisoners with psychiatric illness. Often, it is evidence of frustration and replicates behaviour before the person went into prison. It is especially worrying among women. We are aware of the problem. A priority for the Prison Service is to reduce self-harm by better diagnosis and identification of risk, focusing attention on counselling, treatment and advice. It needs to be constantly monitored. There has to be a balance between allowing reasonable freedom and access to things that can cause self-harm—materials, pens, cutlery and clothing—and preserving decency and dignity. That is the sort of difficult day-to-day decision that has to be taken by those working in our prisons. As hon. Members have said, we know the difficult job that prison officers have. The hon. Member for Hertsmere was worried about lifers in open prisons and those who might be being allowed out under home detention curfews. Management of lifers is undertaken with great care. The overwhelming majority of lifers will be released in due course. Releasing them safely requires us to test them out in lower-security conditions. Once lifers have shown they can be trusted, temporary release may be appropriate for some. Of course, where there is a failure, it is a matter of great concern, but the chief inspector himself acknowledged that the service's record on the safe release of lifers is very impressive. There were a number of questions on home detention curfews. It is still early days, but, as of 28 April, 2,035 offenders were subject to the HDC scheme. Since the beginning of the scheme, 4,274 offenders have been placed on HDC and only 184— 1 per cent.—have had their licences revoked. The number placed so far in curfew demonstrates that the scheme has been handled sensitively and cautiously—the approach adopted by the governors, which we have encouraged. Clearly, disparity of sentencing throughout the country is something about which we are all concerned. The right hon. Member for Berwick-upon-Tweed will know that the sentencing advisory board has been set up, which will look at why sentences are different in different parts of the country, and how we can ensure that we get a sensible balance and that the public feel that people are being sentenced appropriately. We will keep a careful watch on that. There will be regular reports on the numbers involved. What we do not want is sentencing becoming an issue only when something goes wrong. It is important that we regularly look at what is happening. Several hon. Members mentioned Feltham, about which I feel strongly myself. We accept that there are fundamental problems at Feltham. I found the report that was published on 26 March pretty horrifying. It is particularly horrifying that so many things seem not to have happened following the previous recommendations after the full inspection in 1996. Clearly, that is not acceptable, but there are some good things happening at Feltham. The Prison Service obviously shares many of the chief inspector's concerns about Feltham. Again, the opportunity exists to tackle some of the underlying problems there so that managers and staff can work together to create a prison of which they and the service can be proud. A task force has been set up to remedy the shortcomings; it is led by a senior governor. It has chartered a plan for improvement, which will be implemented over the next six months. There are serious issues to be tackled—some 39 issues for immediate action. The remainder are being taken forward by headquarters. In addition, 10 new officers started training in April. The problems have been due mainly to population pressures. We are aware of the problem. I would hate the hon. Member for Hallam to come back in a year's time with conditions still the same at Feltham. That would be a real indictment of our attempt to change what is happening there. I am aware that I have perhaps not raised a number of other points. Hon. Members will be written to if anything has not been raised."That may or may not be so, but my optimism, and gut feeling that the Prison Service has been presented with another window of opportunity, is, this time, not based on a particular disaster, but on a situation that has been created by the very deliberate programme embarked upon by the Government in general and the Home Secretary in particular, which I hope that I have interpreted correctly."
I am grateful for what the hon. Lady said earlier. On the question that I raised about Sudbury, will she write to my hon. Friend the Member for West Derbyshire (Mr. McLoughlin) about that matter, saying as much as possible, because I know that my hon. Friend is worried about what has taken place there?
Of course we will. We will write to the hon. Gentleman and give him a full report of what is happening.We have spent a useful hour and a half this morning during which we have aired a number of concerns and issues. I do not wish to underestimate their importance, or skate over failures, but the recent security record of the service has been good. There has been a 74 per cent. reduction in the rate of escapes and a 23.5 per cent. reduction in assaults. The service came out well from the recent review. Ministers have taken responsibility for the service within a framework that allows the director general the necessary scope and freedoms to run what is a large and unique organisation. We are investing around £226 million of additional money to help to develop constructive regimes that help prisoners to avoid returning to crime following their release. Together, those changes should help to address the concerns that have been raised by Sir David Ramsbotham. Vivien Stern, former head of the National Association for the Care and Resettlement of Offenders, recently praised the Prison Service of England and Wales for its culture of knowing the difference between right and wrong, for its willingness to admit its mistakes and to strive to put things right, and for the courage and independence of prison governors in fighting for improvements in conditions. No one denies that there are difficulties and challenges to overcome, but the Government believe that the Prison Service and the arrangements for its higher management are broadly in good health as the millennium approaches. We know that hon. Members will continue to voice their views and to press for those improvements. We will continue to respond.
I am pleased to have secured the debate. I look forward to Members' contributions and to the Minister's response on a complex and often controversial subject.I know from my many conversations with Members on both sides of the House that many in the Chamber today have had first-hand experience of myalgic encephalomyelitis—or ME as it is more commonly known—either as sufferers or through the suffering of relatives or close friends. I am especially pleased that the debate is taking place today as it is national ME awareness day. Many Members will know that I have been active in reforming the all-party group on ME. I was pleased to be elected as its chair. One of the crucial tasks of those who campaign on the issue is to raise awareness of ME and its effects among the general public. One of the stated aims of all-party group is to raise awareness of the issues at Westminster. I am pleased that, to date, it has a membership of 134, as well as a number from another place. My main focus since entering the House has been on the needs of my constituents, so Members will not surprised to hear that it was through meeting an extraordinary young woman in Great Yarmouth that I became involved in the ME campaign. My first experience of the hardship caused by ME came some years ago, when I met Tanya Harrison, who lives in Great Yarmouth. She is 23, and has had ME for at least the past 13 years. She experienced a gradual and continual deterioration in her health until she became so severely ill that she was referred, and subsequently admitted, to Great Yarmouth's James Paget hospital. After months of intensive treatment, varying diagnoses and consultations with specialists, Tanya was eventually diagnosed as suffering from severe and chronic ME. For the subsequent seven years, she has been bedridden for most of the time and has continued to experience additional symptoms. At the beginning of last year, at the age of 22, she developed osteoporosis of the hips and osteopaenia of the spine—yet another consequence of living with severe and chronic ME. Despite all the setbacks in her life, Tanya's determination has shone through and she grasps with admirable zeal every opportunity to highlight the plight of fellow ME sufferers. To that end, she launched the blue ribbon for awareness of ME campaign in April 1995. Her efforts culminated in the meeting in the Grand Committee Room on 14 May 1998, at which an international line-up of experts on ME addressed an audience of sufferers, along with many Members of Parliament. I am pleased to see that some hon. Members—including the Minister—are wearing the blue ribbon today. What exactly is the disease? The literal definition of myalgic encephalomyelitis is inflammation of the brain and spinal cord, but that definition does not have the universal support of the medical establishment, because it almost implies brain pathology, which has not yet been clearly established for the condition. Post-viral fatigue syndrome, or post-infectious fatigue syndrome are other terms used when ME-like symptoms appear after viral infection. From those terms, the hybrid definition of chronic fatigue syndrome, or CFS, has appeared. The term encompasses all the previously mentioned syndromes and has been used increasingly over recent years because of its neutrality: it does not imply a specific cause and accepts that there may be a variety of causes, some physiological, some psychiatric and some involving an amalgam of factors. The difficulty that the medical profession has with a common definition is an appropriate microcosm of the whole ME debate. That is all very disconcerting for the sufferer, whose main concerns are, "What is wrong with me?" and "What can I, or my doctor, do to make me better?" The confusion and fragmentation of approach are well summed up by the title of a book written in 1991 by David Bell: "The Disease of a Thousand Names". Perhaps more alarming still is the significant weight of evidence to suggest that inappropriate treatments have been prescribed, as exemplified in a letter that appeared in the British Medical Journal of October 1997, from Dr. Alan Franklin, medical adviser on ME to several of the country's leading ME organisations. The letter, which seems to sum up the feelings of many sufferers, says:
Indeed, in the 1980s, ME attracted the most derogatory of labels, "yuppie flu", even though there is no evidence to suggest that it is more prevalent in one social class or grouping than another. We hope that such thinking can be consigned to history. I am optimistic that our debate today will make a contribution, however small, to a more considered approach to the disease, which is estimated to affect between 5,000 and 10,000 sufferers per 500,000 people in the United Kingdom, according to controversial figures produced by the royal colleges of medicine. Unfortunately, it is difficult to escape the impression that the disease has split the medical and scientific communities into two major factions: those who believe that the root cause is psychological and those who support an organic causation. Medicine and science do not always provide clear-cut answers, and that was reflected in the observations in the report of the national task force on CFS/ME, which was produced in 1994. On causation, the report says:"Unfortunately, some doctors have trivialised this illness; ridiculed patients and their supporters and subjected a few of them, including children, to oppressive, perhaps even abusive forms of treatment."
The report goes on:"The distinction between physical illness and psychological illness is becoming progressively more blurred. For instance, many psychiatric diseases, including depression, have been shown to have demonstrable physiological and neuro-chemical disturbances. In addition we are gaining an understanding of the influence of psychosocial factors on the development and cause of physical diseases."
"However we live in a society which is used to thinking of illnesses as physical or psychological and which harbours differing attitudes towards these. For example, a number of patients with CFS are denied financial benefits on the grounds that these illnesses have been perceived as psychological."
I have apologised to my hon. Friend for the fact that I will be unable to attend the whole of this debate.I was very sceptical about ME until 1992, when I suddenly discovered that I had it. I was told by the doctor in the House and by my consultant in general medicine at Monklands hospital, Dr. Harrower, that in my case, as with about 80 or 90 per cent. of ME sufferers, the condition would probably go after about two years, and indeed it went after 20 months. I am very grateful for the remarkable sensitivity that John Smith showed at the time, when I was in the shadow Cabinet. I am sure that my hon. Friend will agree that not all employers are so enlightened. My hon. Friend has done us a great service by bringing the issue to the House. It has an impact on the Department of Health, the Department for Education and Employment and the Department of Social Security. By bringing the issue into the public domain, he has done a great service to a cause that calls for much more research, much more understanding and a more positive approach from people who, like me, were once sceptical.
I thank my right hon. Friend very much indeed. I am sure that he deems himself fortunate to have recovered from ME; many are not so fortunate.The report continues:
"Since our understanding and management of diseases must take place within such a society, the debate about whether CFS is physical or psychological cannot be totally ignored. This debate has been based on three erroneous premises:
1. 'Because a physical illness exists therefore no psychological illness exists, or vice versa.' This either/or approach is wrong. Both types of illness may co-exist within the same person.
2. 'Because there is no evidence available to confirm a physical cause for an illness therefore the illness must have a psychological cause.' It may be psychological. Alternatively, it may be physical, and the absence of evidence to confirm this may be the result of limitations of current medical knowledge. For example, consumption was believed to be a psychological disorder before the discovery of the tubercle bacillus.
The national task force report goes on to say:3. 'Because an illness has a psychological origin it is not disabling or not real.' This is not true."
On most aspects, the task force report is open minded, objective and balanced, and it appears to provide a good basis for advancing the cause in an all-embracing fashion. It certainly does not rule out an organic root to the problem of ME and it is honest in admitting the limits of current medical knowledge. Anyone reading the document would be surprised to learn that the medical research establishment in the UK is not acting on one important element of the findings: the need for research into the organic causation of ME. The report is unambiguous about the need for a balanced and all-inclusive research programme, including both psychiatric and non-psychiatric disciplines. Unfortunately, the report from the Royal Colleges of Physicians, Psychiatrists and General Practitioners, on which so much emphasis has been placed, does not seem to give much, if any, support to research into organic causation. It recommends research into the neurobiological aspects of CFS; randomised controlled trials of treatment, especially in primary care; and management of CFS in children. The report, which came out in October 1996, was commissioned by the previous Government's chief medical officer and compiled by a panel of 16 experts that was top-heavy with psychiatrists or physicians believed by many to be biased towards a psychiatric diagnosis of ME. Unsurprisingly, great emphasis is given to several studies indicating psychiatric disorder in CFS patients and the report concludes that about half the patients fulfilled the criteria for affective disorder and a further quarter had other psychiatric illnesses, primarily anxiety and sleep disorders. How many of us in the Chamber today can say we have not suffered from anxiety and sleep disorders at some time in our lives, especially during elections? Does that mean that we are suffering from a psychiatric disorder? I shall not ask you, Mr. Deputy Speaker, to rule on that question. The expert committee rejects, for lack of evidence, any major role for a viral cause of CFS or for structural or functional abnormalities in muscle or the brain. Many of the report's findings have been criticised by ME charities and associations, leading medical experts and medical journals. In a statement to The Lancet, Dr. Charles Shepherd, medical director of the ME Association, said:"Whatever the origin of the disease, or the views of their doctors, people with chronic fatigue syndromes are disabled. They need and deserve help and support".
That view was echoed by the lead author of a major physiological study, Durval Costa of University college, London, who told The Lancet:"the committee was rigged, with dissenting voices excluded".
Furthermore, in its editorial appraisal, entitled "Frustrating survey of chronic fatigue", The Lancet concluded:"The committee was too quick to reject his work because members had 'technical difficulty' with understanding whole-volume, single-photon emission tomography, the technique he used in his research."
There are numerous problems arising from the adoption of the findings of the royal colleges' report, but for the sake of brevity I shall concentrate on a few areas of particular concern, including the consequences for research into the disorder. Since the release of the report in October 1996, the Department of Health and the Medical Research Council have not financed any research into the physical causes of ME. That has dismayed many doctors and scientists who believe that more research is required in the areas of virology, muscle dysfunction, energy production, and abnormalities in the immune system and several other neurological aspects. Perhaps of even greater concern is the potential physical and psychological damage to patients, especially children, who are receiving the wrong treatment. In her appraisal of the royal colleges' report, Dr Terry Hedrick, who is an internationally respected expert in the evaluation of research and methodology, said:"We believe that the report was haphazardly set-up, biased, inconclusive, and is of little help to patients or their physicians."
Dr Hedrick is not alone in believing that psychiatrists are not always the best people to be treating ME patients and there is little doubt that her views have the backing of most of the support groups and many thousands of patients who believe that they are receiving inappropriate treatment. However, busy GPs can hardly be blamed for recommending a particular course of treatment, if they are doing so on what they believe to be sound advice from a prestigious body of experts. Although there are certain cardinal features for doctors to look for, diagnosis of ME can be difficult, as it is what some practitioners call a hidden illness. Indeed, there are a number of cases of erroneous diagnosis, which on occasions have been quite serious. Recent examples of incorrect diagnosis, which have appeared in medical journals, show that ME has been confused with cancers in some patients. Unfortunately, a significant minority of GPs still refuse to accept that ME exists as a clinical entity, and consequently treats those patients in an unsympathetic or, in some cases, hostile manner. Furthermore, insurance companies could use the report as evidence for placing time limits on financial support, which could lead sufferers into severe financial difficulties at a time when they are at their most vulnerable. Government policy on welfare benefits could also be influenced by such reports. What impact did the report have on the perception of the illness by people at the Benefits Agency making decisions on sufferers' welfare payments? Sadly, employers do not always look favourably on employees who are diagnosed as suffering from psychological disorders and are very often likely to view physical illness with greater sympathy."Several clinicians I spoke with expressed concern about the child with CFS who unsuccessfully participates in a poorly developed program of cognitive behavioural therapy, or CBT, and/or graduated exercise and feels like a failure because he or she is not able to resume normal activities within a few weeks or months. We need to remember that unproven treatments, whether pharmacological or psychological, are capable of having negative side-effects".
There are numerous cases of people being hounded out of work by unsympathetic employers. I wish to cite the example in my constituency of Andrea Morgan. She was hounded out of work, and eventually won compensation at an industrial tribunal against the London borough of Hillingdon. She also suffered two years of hounding by benefits officers and having to undergo numerous medical tests to demonstrate that she was suffering from the disease. There is not only a lack of sympathy, but an active programme of employers hounding people out of work if they have the illness.
I thank my hon. Friend—and I am sure that most hon. Members could probably tell similar stories from their constituencies. The stress that people experience when they fear that they will lose their jobs or may be forced to fight for their rights to benefit adds to the debilitating effect of ME.There is little room for doubt that in a patient in whom the primary cause for ME is a psychiatric condition, benefit can be derived from the various courses of treatment recommended by the royal colleges. However, that has to be set against the negative consequences that I outlined earlier in my speech. If the balance is heavily tilted in favour of psychiatric causation, the objectivity of any diagnosis, and hence the exact definition of a patient's disorder, becomes more questionable. Not only does that have consequences for the patient: it makes accurate epidemiological studies much less valid, as such studies are likely to be based on bogus information. The progress made in AIDS treatment should act as an example of what can be achieved by robust, correctly targeted and well-funded medical research. Although the miracle cure is not yet on the market, drugs have been developed that are already available and producing encouraging results. Indeed, the American Food and Drug Administration has recently approved final-phase clinical trials for the world's first AIDS vaccine. However, Members with long memories will recall the early problems that the medical profession had with diagnosis, and that it was only through concerted medical research that a method of detecting the HIV virus in the blood was developed. While I accept that the two diseases may be different in the way they are transmitted and in various other respects, some useful lessons could be learned in comparing the approach of the medical research establishments to the two syndromes. The pro-psychology bias of the UK's research effort has already been brought to the attention of the House in an early-day motion, submitted during ME awareness week last year, which stated:
In an answer to a parliamentary question asked on 27 April 1998, the Department of Health's funding of four research projects was revealed: two on the management of ME, one on cognitive behavioural therapy and a fourth on the neuropsychological pathogenesis of CFS. Those projects represent a total Government spending of £285,467 but not a penny of that money was allocated to finding a physical explanation for ME. I am sure many hon. Members feel, as I do, that there is a need for the balance of our research effort to be adjusted, and I hope that the Minister will respond to that imbalance. I should like to see the Government encouraging a number of other initiatives that would take the issue forward and enhance the knowledge base of the medical establishment. First, there is an obvious need for an exhaustive and extensive epidemiological study of ME to discover just how widespread the disease has become and unlock more of the vital information that medics require if they are to diagnose and treat the disease successfully."That between 1996 and 1998 no resources were allocated by the Department of Health or the Medical Research Council to investigate the physical cause of ME."
One of my constituents, Mrs. Baxter, who is a member of the Tendring ME support group, has written to me about a young man in Clacton who has to travel some 80 miles to London for treatment from a specialist consultant. Does my hon. Friend agree that that is an unreasonable distance to have to travel? The other point that has emerged from my support group in Tendring is that some of the research is into managing the illness, instead of treatment or a cure for the illness. Does my hon. Friend agree?
My hon. Friend makes a good point. Probably one of the greatest problems for ME sufferers depends on where they live. If they live in an area where doctors understand the problems of ME sufferers, they are fortunate indeed. Having to travel to London, as my hon. Friend's constituent does, adds to the stress. I also agree that insufficient funding has been made available for research into ME.Such a study would need to address the duration of the illness, identify vulnerable age groups and examine the life styles of sufferers. It would also have to consider the variability of the disease according to gender, assess environmental factors, and gather a great deal of other invaluable data. A number of epidemiological studies and surveys have already been undertaken, but they have been on a small scale. Perhaps the most cited study is the "Case History Research on ME", or the Chrome survey, set up in July 1995. Its purpose is to identify as many severely disabled ME sufferers as possible and to monitor and update, on an annual basis, the course of their illness over a 10-year period. That survey might provide a useful starting point for the broad-based study for which many medics, researchers and ME sufferers have called. Secondly, great benefit could be gained from co-ordinating the data from all the information that has been gathered and creating a national database. For researchers and doctors to gain the maximum benefit from epidemiological data, a well-funded and expertly run information unit or centre would be an invaluable asset. An information centre would act not just as a data gatherer, but could also give advice on best practice. In addition, it could support GPs in a number of different ways, such as by providing detailed information to aid accurate diagnosis. The close monitoring of treatments could also provide a useful function for the unit, as at present exercise regimes are often too harsh, or in some cases totally inappropriate. Using the information collated, it should be possible to produce a management manual for all those involved in the treatment of ME patients. Perhaps such an initiative could be funded by a partnership of private and public funds. That would seem a logical step, as both the private sector and public services are victims of a disease that leads to the loss of millions of working days every year. Indeed, with so many children and young people such as Tanya growing up with the disease, and possibly never able to work, the work force of the future will be denied many talented people. That, in turn, will undoubtedly have implications for the economy. Thirdly, I believe that there is some resonance between this debate and last year's debate on cancer, instigated by my hon. Friend the Member for Norwich, North (Dr. Gibson). That debate called for the creation of a national cancer institute to act as an umbrella organisation for clinicians, researchers, carers, voluntary organisations and other interested parties sharing the common cause of treating and curing cancer. The disease ME could lend itself to that approach equally well. There is always room for healthy competition in any sphere of life, but it is important that we pool our knowledge for the overall good. Nowhere can that be more important than in the pursuit of cures and treatments to the major diseases that threaten the quality of our lives—and life itself. As with AIDS and cancer, there is unlikely to be one single research project that produces a miracle cure to ME. Answers will emerge through the slow and painstaking research of many thousands of people working on the numerous different facets of the disease. There is a definite need for a fresh look at the way in which the medical profession approaches ME, and I hope that my hon. Friend the Minister will leave the debate with that point in her thoughts. With that in mind, I very much welcome the remarks made last year by the Government's chief medical officer, Sir Kenneth Calman, when he said that the disorder
and affecting many people. That statement, together with the news that the Government have set up a working group to look at the disease, represents the best news for ME sufferers in many years and has been broadly welcomed. My only concern is that the working group should contain a broad cross-section of thinking and have an open mind on all aspects of the disease. If it does, we may have reached the turning point in the ME debate that Tanya, and the thousands like her, have been seeking for so many years."is a real entity, distressing, debilitating",
I congratulate the hon. Member for Great Yarmouth (Mr. Wright) on his initiative in seeking this debate, especially as today is the ME awareness day. I am a member of the all-party group that the hon. Gentleman has done so much to bring back to life. He is to be congratulated also on his efforts to raise awareness in the House about ME, and I hope that today's debate will go some way towards raising that awareness further.My interest in ME began not all that long ago. At the Sutton carers centre in my constituency, I was invited to meet a group of parents whose children suffer from ME. It proved a very useful lesson. I was asked a series of questions about the way in which various public services cut the parents out when it came to dealing with their children. To be honest, I had no adequate answers to the questions that were put to me. I started to make inquires about ME and about how Governments—Labour and Conservative—had dealt with it over a period of years. I tabled a series of parliamentary questions last year, culminating in the early-day motion to which the hon. Member for Great Yarmouth referred. Moreover, as part of that awareness-raising exercise, I attended the meeting organised last year by the hon. Member for Great Yarmouth. I had the good fortune then to meet Mr. Graham Baker, the co-ordinator of the local support group in my constituency. Last Saturday, I was pleased to attend an event in my constituency that was part of the launch of the awareness week now taking place across the country. Despite the weather, that event succeeded in getting the message across to more people. There is no doubt that ME is the subject of too much misinformation, prejudice and ignorance. Anything that can be done to change that will go a long way towards helping sufferers. The hon. Member for Great Yarmouth ended his speech with a quotation from Sir Kenneth Caiman, the chief medical officer. He said:
I want to deal with three matters in this speech, which stem from my correspondence and the reading that I have done. They are the definition of ME, the overwhelming need for research, and the way in which different public services have different approaches and agendas when dealing with ME sufferers and their carers. First, there is the question of definition. The material that I read made it clear that the sensitivities involved with ME are a minefield. For example, is the disease to be called ME, or chronic fatigue syndrome? Different terms can cause great offence to sufferers. There is no doubt that the use of words can provoke strong feelings. In 1992, the World Health Organisation listed ME as a neurological brain disorder, but many people have expressed concern—outrage, even—at the 1996 report from the Royal College of Physicians. That attempted to define ME out of existence by lumping it in with a more generic term, chronic fatigue syndrome. As the hon. Member for Great Yarmouth rightly noted, The Lancet was critical of the report, on the ground that it was too ready to dismiss viral causes of CFS in favour of structural and functional abnormalities in muscle or brain. In its editorial, The Lancet concluded that the report from the Royal College of Physicians was biased and inconclusive. That report has fuelled the debate and, in some ways, caused further misconception. As a consequence, severe ME sufferers especially have been offered inappropriate treatments. They include cognitive behaviour therapy, which may be suitable for other categories of chronic fatigue syndrome, and graded exercise. The latter, again, may be appropriate in some cases, but, in others, can give rise to serious concern. As I studied the question of definition, I began to realise how difficult the problem is. Even so, the national task force on CFS/ME concluded last year that, perhaps as a result of some the misconceptions and misunderstandings in the medical profession and of the pursuit of psychological rather than neurological explanations, the overall cost to the United Kingdom of the mismanagement of ME patients came to about £1 billion a year. The same task force also identified an urgent need for training and the raising of awareness in the medical profession. It would be useful to know what role the working group is playing in that. The fact that the group was set up by the chief medical officer last year is welcome, but there is understandable cynicism among some of those who suffer ME and some carers about what the group will achieve. Can the Minister tell us something about the timetable and progress of the group, and when it might produce some tangible results for Members and for ME sufferers? The group must lay the ground for new research into ME so that we may better understand its causes, prevalence and treatment. It is disappointing that neither the Department of Health nor the Medical Research Council has spent anything on identifying the physical or organic causes of ME. We must look to Australia or the United States of America to see any lead being given by Governments. A couple of years ago, the United States Government voted $11.8 million for ME research, and classed it as a priority one illness for research. Several Members, including me, have tabled written questions on ME, and the Government have been reluctant to commit themselves to such research. I have some sympathy with the reason for their reluctance—the problem of definition and the lack of agreement among medical professionals. What role will the working group have in breaking that definitional logjam? In particular, what role will it play in commissioning future research? There would be some sense of purpose and direction if we could hear what progress is being made, if not on securing consensus, at least on deciding what definition will apply for an epidemiological survey. On the matter of public services and benefits, I have received a vast number of e-mails over the past few days from people who suffer ME. They are concerned about how the benefits system discriminates against them, and how advice to medical officers and adjudication officers is out of date, ill-informed and inadequate. All too often, poorly informed adjudication officers take appalling decisions which disadvantage many of our constituents, leading them to the trauma of the appeal process before they can receive the living allowance, incapacity benefit and other benefits to which they are entitled and which go some way towards meeting their needs. The hon. Member for Hayes and Harlington (Mr. McDonnell) spoke persuasively on the way in which the system works. All too often, people find themselves being labelled by the benefits system as malingerers. I did not choose that word: it was used in letters to me by sufferers of ME. That attitude is hardly surprising, given the advice offered in the "Handbook for Medical Service Doctors". It states:"ME is a reality. It affects large numbers of people and poses a significant challenge to the medical profession."
The handbook continues in similar vein, giving adjudication officers almost no guidance and containing nothing that would allow them to help people suffering from impairment. As a consequence, our benefits system is disabling those people still further. That problem goes further than the benefits system, reaching into education, social services and other areas. We need to know the roles of the working group, the Minister and the Department of Health in co-ordinating an approach that will ensure that the Government are consistent in their attitude towards ME. Consistency is needed in advice to education authorities, social services departments and so on. As the hon. Member for Great Yarmouth rightly said, the national task force, which reported in 1994 and 1998, provided a good basis for progress. It would be useful to hear from the Minister what will be done to deal swiftly with the recommendations of the 1998 report. Clarity is required in definitions of ME. Research is needed to determine the organic or physical causes, and we need more sympathetic and co-ordinated approaches across health, social care, education and all parts of the public service."There is no firm evidence to suggest that CFS is a physical disease. If you do not complete a mental health assessment, you must explain your reasons for not doing so."
I congratulate my hon. Friend the Member for Great Yarmouth (Mr. Wright). It is still my family's delight to go to Great Yarmouth to sample fish and chip suppers in the market. They are much to be preferred to Delia Smith's boiled eggs and stuffed canaries.Myalgic encephalomyelitis first came to my attention in the 1980s, when the phrase "yuppie flu" came attached. Coming from Norfolk and Norwich, I had no idea what yuppies were, and it is only since I came to London to work that I have seen yuppies going home on the No. 11 bus from Sloane square down the Kings road, Chelsea. I do not see much flu among them, but they certainly have other habits. There has been much scepticism about whether ME exists. It is claimed that it is non-specific in its symptoms. It has no specific physical signs, and no consistent blood, pathological or radiological abnormalities are associated with it. It seems to be confined to some populations and not others, although that point is disputed. Published evidence from randomised trials suggests that intervention with cognitive therapy and similar psychiatric intervention significantly affect its outcome. There has been a tendency in the medical profession, which is still persistent, to dismiss ME. With their usual delicacy, members of the profession tend to tell patients to pull themselves together. They associate ME with patients whom they often see as being not quite the ticket. Their delicacy manifests itself similarly in other aspects of medical assessment such as the all-work test for welfare benefits. Again, people are told to pull themselves together, and a job will come easily to them. On the other hand, a large and growing lobby believes strongly in the physical existence of the disease, and that lobby is supported by research. Various treatments have been espoused by sufferers. The existence of the condition is recognised by the British Medical Journal, and the Royal College of Physicians has given the disease cautious recognition, despite dubbing it chronic fatigue syndrome and alluding to its obscure cause and nature. Despite the often polarised arguments about the subject, I have no doubt that the many of my constituents who suffer are desperately ill and feel let down by modern medicine. The name ME has been dubbed inappropriate by some, as the disease is sometimes not myalgic and there is often little evidence of encephalitis or myelitis. Argument still rages over whether it is physiological or psychological, with a psychiatric component. I have conducted a web search country by country on ME, and there are many more hits from the United States than from anywhere else. However, the number for the USA is only double that from the United Kingdom, and the figures need to be adjusted for web use and population. Britain has far more hits than Australia and Canada, and there is little evidence of ME in continental Europe, including France, Italy and Germany. There is nothing from Africa, Asia or south America. This provides an illustration of how seriously the problem is taken across the world. A recent survey of senior house officers in my local hospital, the Norfolk and Norwich, asked whether they had come across ME in their experiences around the world. A Malaysian said that it did not exist as far as he knew, and a Romanian said the same. The German SHO was certain that it did not exist in Germany. We shall publish that survey soon in the British Medical Journal. Those SHOs may be right to say that ME does not exist, but it is very real to the sufferers whom I meet in my surgeries and in clinics. ME is a prime case for the evidence-based medical approach of which we have heard so much in the House over the past couple of years. Evidence-based medicine is a conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. That approach would lead to evidence-based health care and to clinical practice based on the best available evidence, using strategies derived from clinical epidemiology and medical information. ME requires exactly such a thorough approach. There is no diagnostic test for ME and no known cause. There may be several causes, which is not unknown in medicine. There may even be one cause that manifests itself as several symptoms. There are interesting overlapping symptoms with Gulf war syndrome and glandular fever, which makes it difficult for general practitioners to diagnose. Much more research is needed on such stress-related illnesses. As the human genome project comes on stream in the next few years, a diagnostic procedure at DNA level may unravel some of the conflicting syndromes and stress-related illnesses. There may be a common factor through which we can categorise them together. The patients are definitely suffering and, sadly, there is no coherent approach to understanding the causes—be they viruses, hormones, chemicals or whatever—or developing a better diagnosis. The contrast with cancer research is amazing.
Does my hon. Friend agree that the greatest battle for ME sufferers is getting people to believe that they truly suffer from the symptoms and the disabilities that they feel that they have? The medical profession is unsympathetic. I have come across ME since the 1980s in my work in social services and as chair of social services. The debate about psychological against physiological causes means that it is little wonder that people with ME suffer stress and depression, because they make no headway in getting recognition of their situation. Does my hon. Friend agree that more sympathy and understanding are required from the medical profession?
I agree, but the hardest thing for GPs or medically trained people is to admit that they do not know. It is a comedown that they cannot handle. It is a training problem, which is why the Government are right to consider training medical people in a way that is more socially active, more interactive with the patient and less dismissive. It is a major problem.It is difficult to estimate the prevalence of ME. The best studies have been done in the United States in four large cities where it is estimated that about eight in 100,000 people aged 18 or more have ME and are under medical care. A more recent study in Seattle, where they do these things in a big way, shows a figure of 265 people per 100,000. The figures vary dramatically where the problem is taken seriously. It is estimated that 500,000 or more people in the United States suffer from the condition. It affects all racial and ethnic groups and both genders, although there is some evidence that it is more prevalent among young women. There is a paucity of study with adolescents. All my constituents who have seen me on this are adolescents, mostly women. It is important that the unique problems of chronically ill adolescents, such as family problems, social and health interactions, education and social interaction with peers, should be considered part of their care. That is too radical for the medical fraternity to handle. The dissemination of information to parents, families and school authorities is essential. The National Institutes of Health in Washington, DC has started to consider the issue, but it is the only place that I know that takes that approach, and the problem of ME, seriously. The question whether ME is contagious is often raised. Original studies in Nevada and Florida suggested that there were ME clusters, but subsequent results have not substantiated that. That does not mean that we can rule out the possibility of an infectious agent associated with the condition that reflects the development of the illness. Important questions remain to be answered on the possible reactivation of latent viruses, such as herpes viruses, in people's bodies and the possible role of infectious agents in some cases. That cannot be ruled out yet. If we are to develop political and medical approaches to ME, we need to understand its clinical course. That would help to facilitate communication between physicians, doctors and patients, to evaluate new treatments and to address insurance and disability issues. The clinical course varies between patients. Recovery rates are unknown. There can be wholesale recovery, whatever that means—for instance, does it mean going back to work? Most often, people suffer periodic lapses. The disease is usually cyclical. Some people grow worse and never completely recover. There is a spectrum of problems. We must do more to treat ME seriously, and to ensure that the medical profession does. We must eliminate the scepticism associated with the illness. There is an unmet need for ME treatment and a dearth of resources for patients and research. Suspicion of its authenticity remains. I hope that the Minister will confirm that the Government accept the validity of the disease and ensure that sufferers will not be prejudiced in welfare benefit reforms.
I congratulate my hon. Friend the Member for Great Yarmouth (Mr. Wright) on introducing the debate. I am glad to speak because I am aware of the experience of constituents suffering from ME who have approached me. I first raised the issue in the House about eight years ago, since when more and more men and women have approached me about the serious problems that they encounter. They are such that we must bring them to the attention of the House.People have problems in following employment. Some have left employment through sickness, but they are denied their pension rights because the illness has not been established. Superannuation funds, particularly public ones, will not accept that they had to cease work because of ill health. I have a case involving a young woman who worked for a national bank. The stress of her employment led her to develop ME, as has been certified by her medical practitioner and a specialist. She went before the all-work test panel and was successful in that it has been accepted that she suffers from ME, but the superannuation fund will not pay her the sickness pension to which she is entitled. I hope that this debate will mean that some of the people who are responsible for denying benefit to many of our constituents will realise that any benefit of the doubt should be given to ME sufferers. The payment of social benefits is a further problem. People have explained to me that on some days they feel good, but they then go downhill. Adjudication officers and others from the Benefits Agency cannot accept that such people have days where they feel good and then days when they feel that they cannot put one foot in front of the other. The Minister must take note of our concerns. I listened carefully to my hon. Friend the Member for Great Yarmouth because of his knowledge and technical expertise. Voluminous information has been presented today that should help to create a situation whereby people certified as suffering from ME will have no problem in having the illness identified or in getting benefits paid. I urge my right hon. Friend the Minister to take serious note of what we are saying in the Chamber today. I ask that other Departments, such as the Department of Social Security and the Department for Education and Employment, should also take note of what we are saying on behalf of the many people whom we represent. Many forms of hardship are created for many ME sufferers: they are unable to continue their employment; they are unable to receive the appropriate benefits; and they feel that they are socially excluded from their communities, because other people do not understand that they suffer from the stress of employment. The constituent who visited me recently made it clear that she would have preferred to continue her employment. When her ME was certified, she was advised, like my right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke), that it could clear up within two years. She hoped, therefore, that she would be able to return to work. Sadly, that did not happen. However, because she could not return to work within two years, she has been informed that the superannuation fund cannot consider her claim as she should have made it earlier. That person was doing her level best to return to work, but, because her condition deteriorated, she was unable to do so. Her condition is still not recognised by those people who decide whether pensions or benefits payments should be made to her.
One of my constituents, Mrs. Baxter, who is involved with a support group, has written to me about a similar case. She was a teacher. She has not been able to teach for the past 11 years, but she really tries to work because she loves her job. Her case offers a prime example. Some weeks, she can work for one hour, or possibly two, but she then has no further energy to cope with more work. Such people want to work, but are unable to because of this disease.
I am sure that the cases mentioned by my hon. Friend and me can be mirrored a hundred times in each of our constituencies. We all know of people who do not want to remain on benefit; they want to return to work, but find it impossible because of their physical and mental condition.I realise that other Members want to take part in the debate. I wanted only to make those points on behalf of my constituents. We need to record such serious matters in the House and my right hon. Friend the Minister should take them seriously. I put it to her that the time has now come for us to give serious consideration to identifying and accepting ME. More research must be carried out so that we can prevent the disease, but, in the meantime, ME sufferers should not be denied recognition of their illness, or the benefits to which they are entitled. We talk about reducing social exclusion; this is one way in which we could start to do so. I appeal to my right hon. Friend the Minister to go back to her colleagues and consider the serious issues that have been presented to the House today, and to ensure that the people whom we represent receive the fairness and justice to which they are entitled.
I congratulate my hon. Friend the Member for Great Yarmouth (Mr. Wright) on initiating the debate and on affording us the opportunity to discuss this important subject. I also congratulate him and his colleagues on the all-party group on the tremendously good work that they are doing.I have a slight feeling of deja vu, because, as my hon. Friend the Member for Great Yarmouth will be aware, I was the founder chairman of the all-party group on ME. I started it when I was a newly elected Member of Parliament in 1987. I want to share with the House the experiences that were brought to my attention. Myalgic encephalomyelitis is not an easy word to say, but at that time 1 had never heard of myalgic encephalomyelitis at all. I heard some insulting expressions, such as "yuppie flu", but was not too sure what that meant; it seemed to be a rude description that people used for something that they knew nothing about. In late 1987, there was a message on the answering machine in my constituency office from a constituent who was obviously distressed. I realised that that lady was ill and needed my help, but the tape on the machine ran out during her call and she did not leave her name or her telephone number. I could only hope that she would call back. Ten days later, I received a letter from her; that was when I was introduced to myalgic encephalomyelitis. It is a horror. I do not want to go over the ground that has been gone over so excellently this morning, but will make some points based on my experience. My constituent was involved with the charity organisation, the ME action campaign—that is how I got to know Clare Francis, who was herself a sufferer from the disease. My hon. Friend the Member for Normanton (Mr. O'Brien) will remember that Brynmor John—formerly the Member of Parliament for Pontypridd—suffered from ME. He helped me to prepare one of the two private Member's Bills on ME, which I presented during the early part of my parliamentary career. That is where my feeling of deja vu comes in, because that took place 11 years ago. My ten-minute Bill asked for research into diagnostic tests, because the disease could not be diagnosed and still cannot be diagnosed. It proposed that there should be an epidemiological study—epidemiological is another difficult word which I learned to pronounce. I shall never forget that, while I was preparing some press releases before the presentation of my Bill—on 23 February 1988—the BBC in Northern Ireland asked me to do a live telephone interview for their morning programme. I was telephoned at my flat, and I explained the purpose of my Bill. The press releases went out and I presented my Bill to the House. A few days later, I received a phone call at the House from a woman in Northern Ireland who had heard my radio interview. She had been in the process of committing suicide because although she knew that she was ill, no one would listen her. She was trying to commit suicide when she heard an interview with a Member of Parliament—someone she had never heard of—who was talking about myalgic encephalomyelitis and what we were trying to do about it. She told me that hearing that interview had given her some hope and had stopped her from committing suicide on that morning. A tragic aspect that we have not discussed is the high incidence of suicide among ME sufferers. The woman did not leave her name or telephone number, but that experience has stayed with me because, although I was delighted that she rescued herself that time, little has been done to help ME sufferers since 1988 and I do not know what has happened to her since. An estimated 150,000 people suffer from ME, and I suspect that the true incidence is significantly greater. My hon. Friend the Member for Norwich, North (Dr. Gibson) was right to mention stress in relation to ME, but the impact of stress more commonly arises from misdiagnosis or from people denying that someone is ill—saying there is nothing wrong. Clare Francis was told, "There is something wrong with your sex life—give yourself a shake, woman, there's nothing wrong with you." Such remarks come from snobbery or ignorance on the part of the medical profession. As has been said, doctors do not like to say that they do not know and, sooner than say that, they will say that there is nothing wrong or that something they do know about is wrong. Most of the GPs working in the national health service are excellent providers of health care, but there are a few who, if they cannot tell a patient to stop smoking, stop drinking or go on a diet, will send that person to a psychiatrist. That is part of the problem: if doctors cannot understand the illness, they say that it is psychosomatic, with the result that 16 per cent. of the NHS budget is spent on psychosomatic illnesses. That is a fantastic sum of money, and I have to ask how much of that expenditure arises from misdiagnosis or from people being referred to psychiatrists or psychologists because doctors do not understand or do not want to understand their condition. Having said that, I do not want to be unfair to the medical profession, for, thanks to certain doctors, an increasing number of GPs now recognise ME as an illness. There is a light at the end of the tunnel for ME sufferers, but only we in Parliament can bring that light closer. I ask the Minister to tell her advisers, some of whom will be sympathetic and others less so, to press on and to commission proper research and epidemiological studies so as to help ME sufferers. She should invite Treasury Ministers' support by directing their attention to ME and the financial costs relating to misdiagnosis, because they might be able to save money. Let us get proper diagnostic tests and research to help the many sufferers from ME. Because we lack hard information, there are many opinions as to what causes ME and what its nature is. My lay experience suggests that ME is an environmental illness, and that stress is not a cause but a result of the illness. Those of us who have met people who suffer badly from ME and are disabled by it will know that they often have multiple allergies, but that aspect has not yet been properly explored. I always ask ME sufferers who write to me or come to my surgeries whether they have had any allergy tests; invariably, the answer is no. Some of the doctors who understand the illness direct patients to get allergy tests, but the link should be explored in greater depth. Some years ago, I heard the immune system and the impact of stress on it described as the pail under the dripping tap. People who are healthy and fit can cope with a little stress in their life, but the impact of stress on someone who is ill can take that person over the edge—the pail overflows. ME sufferers' pails are brimming with their illness and related experiences, but often the thing that pushes them over the top is for them to go to a doctor and ask for help, only to be told that there is nothing wrong with them. We show deference to our doctors—when we send for a doctor in the middle of the night because we are ill, the first thing that we do when he arrives is apologise for being ill and for disturbing him. When a doctor says that there is nothing wrong, but the person concerned knows that there is something wrong, it can cause great problems. If the doctor tells a family that the illness suffered by their son, daughter, wife or husband is all in his or her own mind, however much the family loves that person, they will trust the doctor—the professional—in the belief that he must know what he is talking about. However, the truth is that, all too often, the doctor does not know, and such misdiagnoses cause stresses within the family that add to the burden on the patient of the stress caused by ME. I ask the Minister to keep an open mind and to listen to what we have said today. This Government, more than any other, have to offer the helping hand to ME sufferers. Let us have proper research, let us go out and look for a proper diagnostic test, let us commission that epidemiological study, and let us give the tens of thousands of sufferers of ME the help that they need.
I, too, congratulate my hon. Friend the Member for Great Yarmouth (Mr. Wright) on having secured this important debate. I shall focus on the group of ME sufferers whom the hon. Member for Sutton and Cheam (Mr. Burstow) cites as the reason for his becoming interested in the subject—children, who are isolated from support systems. I should also like to amplify the remarks made by my hon. Friend the Member for Norwich, North (Dr. Gibson) about the paucity of research into young people who suffer from ME.A study conducted in 1997 estimated that as many as 25,000 children suffer from ME. There is no identifiable cause of the condition, but, according to the 1994 national task force report on ME, one of the most common triggers appears to be viral infection. If so, it is hardly surprising that so many children suffer from ME, as I should imagine that their immune systems are less robust than those of adults. The same study described children's symptoms as severe shaking, difficulty in swallowing and mental confusion. That would be frightening to anyone, but doubly so to children. It is obvious that the schooling of children with such symptoms will be affected. Therefore, it is not surprising that the 1997 study to which I referred identified ME as the most common cause of long-term absence from school. That is enormously worrying. The Government place great emphasis on, and have targeted significant resources at, children's learning. We recognise that the acquisition of good skills equips children for life. The education system has always been quite good at supporting off-site learning for children with medical problems so long as those problems have a clear label and are specifically identified. Resources are triggered by medical diagnosis. If that diagnosis cannot be made, children are denied vital teaching, learning and medical support, and untold damage is done to them now and in the future. Early intervention and diagnosis triggers those resources and leads to a much speedier recovery. I refer the House to dyslexia and its history. At one time, dyslexia was not recognised by many sceptical professionals. Diagnosis did not occur and support was poor and haphazard—or, in many cases, non-existent. That is no longer the case: diagnosis is now speedy, resources are available and our children are far better served as a result. We can apply to ME the lessons we have learned from the dyslexia experience. I am delighted that the Department of Health chief medical officer has described ME as a "real entity". However, there is still a lack of research into ME, a lack of understanding about its causes, a lack of skill in diagnosis, a disparity of services, patient mismanagement, a lack of appropriate medical training and a degree of prejudice—although that is diminishing. I am interested to hear how the Minister will respond to the issues that we have flagged today. How are the Government addressing them and what are their plans for the future?
I shall not detain the House for long as we want to hear the Minister's response to the debate. All hon. Members are forced to admit that this is pretty mysterious territory, and we join in condemning those who are tempted to mock ME because it cannot be readily diagnosed or explained. I infer from the excellent contributions this morning that the medical establishment is too often inclined to take the view that what it cannot explain, it will not recognise. That prejudice must be overcome.Conservative Members fully support ME awareness day—although I must confess that it is slightly disorienting to see so many Labour Members sporting blue ribbons on their lapels. Perhaps there is a deeper message about new Labour—although it does not apply to the hon. Members for Norwich, North (Dr. Gibson) or for Clydesdale (Mr. Hood). Several points have emerged upon which I shall dwell briefly. We clearly need uniform ME diagnosis criteria. It appears that those criteria will be difficult to establish, but we must try to achieve that goal. There is a shortage of medical expertise in diagnosing ME and a shortage of consultants who can accept referrals for the condition. In treating ME, the national health service must adapt and learn to accept that a multi-disciplinary approach is necessary. Carers can also play an important role. Perhaps the Minister can comment on that point, which is not addressed in the Government's carers strategy. The main theme that has emerged from this morning's debate is the need for research. Everyone is struggling for information and both those who suffer from the illness and those who treat it are calling for more research. That would also appear to be Labour Members' main plea. I also sense that ME sufferers face an absolute minefield when claiming benefit. Will the Minister outline what criteria she thinks should apply to those who qualify for benefit so that there may be clear guidelines—if that is possible—and no argument about whether people are genuine sufferers? Many hon. Members have pleaded this morning for more research into ME. Sympathy for ME sufferers binds hon. Members on both sides of the House. It is all very well our being terribly sympathetic and wearing blue ribbons, but we must ask whether the Government intend to do anything about it. Our concern will not add up to a row of beans if the Government do not act. As a significant number of Labour Members are calling for more research into ME, will the Minister announce today what the Government's policy in this area is and will be?
I begin by expressing my gratitude to my hon. Friend the Member for Great Yarmouth (Mr. Wright) for introducing this important debate. I pay tribute to him both for his contribution today and for his tireless work on behalf of ME sufferers through the all-party group. I also pay tribute to my many hon. Friends and other hon. Members who have spoken in the debate to highlight, through the painful experiences of their constituents, the need for action and the need to do much more for ME sufferers. That task will not be easy, and I shall set out where we are in relation to Government action and where we need to go.I recognise the important work of the ME Association, made possible by grant aid and the Department of Health's section 64 programme. This is a major area of health policy which is changing and progressing—although perhaps not as quickly as we should like. We are engaged in a process of discovery and will apply our conclusions to the provision of support for ME sufferers through the national health service. I want to pick up the point about carers and ME sufferers. Many hon. Members have paid tribute to their constituents who suffer from ME and who have taught them about the seriousness of the condition. It is essential that we convey our willingness to learn about, and to act upon, the experience of ME sufferers. We know very little about the causes of ME and we are groping to establish a proper framework for treatment. Therefore, we owe a debt of gratitude to those ME sufferers who are prepared to share their experiences with us. In the absence of a clear understanding about causes, we can make at least some progress by learning more about the condition and by applying the painful lessons of what it is like to live with ME. Uncertainty about causation means that, certainly departmentally, the condition is referred to by two names: chronic fatigue syndrome, or CFS; and myalgic encephalomyelitis, or ME. As we have heard this morning, CFS/ME is a distressing, debilitating and disabling condition, possibly initiated by viral infection. It is complex and difficult, and poses a challenge to medicine and the NHS. I accept that medicine is not always sufficiently humble when presented with a challenge, the origins of which it does not fully understand. Despite a great deal of commitment from professionals and voluntary organisations, enormous gaps remain in our knowledge about the cause, diagnosis and treatment for some conditions, of which CFS/ME is a prime example. That is why the previous chief medical officer, with strong ministerial support, set up a working group to take the first steps towards improving the quality of understanding, support and care for patients with this distressing and debilitating condition. Although we do not understand its causes, we know that the condition is real for those who suffer from it and for their families. I hope that we can make a fresh start in our work on CFS/ME. Tanya Harrison, to whom my hon. Friend the Member for Great Yarmouth referred, is a member of the chief medical officer's working group. I turn now to what we know about the incidence and prevalence of CFS/ME. It affects many people and their families in Britain and elsewhere. Information about actual numbers of people with the condition is hard to establish because of the problems in producing a precise definition of the illness. It is thought that as many as one or two people in every thousand may have the illness, with numbers peaking in the 20 to 40 age group. We know that the condition is more prevalent among women and that, as my hon. Friend the Member for Erewash (Liz Blackman) made clear, it can, distressingly, affect children as young as five. More recently, we have become aware that CFS/ME is becoming increasingly common among school-age children. For that reason, we have established, as part of the CMO's working group, a sub-group that will specifically examine children's needs. Representatives of the Department for Education and Employment and social services will sit on that sub-group. Differences in age and sex distribution, social conditions and, possibly, genetic composition probably also affect the frequency of CFS/ME. There is probably under-reporting of the illness in some social groups. Defining the condition is fraught with difficulties. A definition of CFS/ME has been the subject of much debate, inside and outside the medical profession. It is more often defined by what it is not than by what it is. Those difficulties are compounded by the way in which the condition has been given different names. Terminology is important, but we need to move beyond the rather doctrinaire debate about names to tackle the yawning gap in our understanding about causation, provide better care and support and concentrate on treatment and rehabilitation. If the exact cause of the condition were known, as well as the method of acquiring it and its pathophysiology, I am sure that there would be less focus on what the illness is called. There is a great deal of debate about the causes of CFS/ME. As hon. Members have said this morning, some doctors believe that the cause is primarily psychological, but others are equally vociferous in saying that there is an entirely organic basis to the illness. No one has yet been able to provide conclusive evidence to support either view, although research is now increasingly concentrated on the organic aspects of the illness. As one of my hon. Friends said, there is a great deal of research in the United States on the organic origins of CFS/ME and the physiological changes that it creates. We hope to learn from research in this country, but fortunately such learning knows no international boundaries.
I apologise for intervening because I do not want to take up the Minister's time, but, in the remaining minutes of the debate, will she announce positive action that the Government will take in response to the requests of her hon. Friends?
The hon. Gentleman should contain his impatience because I shall certainly set out what action the Government will take.The Department of Health funds research through different sources, and has recently funded research on CFS/ME at the university of Manchester on "The role of noradrenaline in the neuropsychological pathogenesis of the chronic fatigue syndrome." We look forward to the results of that research being made available. I underline the fact that the Medical Research Council is always willing to consider new ideas for research and will judge applications on their scientific merits. Everything that we have heard this morning demonstrates that there is a need to prod scientists with an interest and competence in the condition to consider submitting proposals so that we can close some of the gaps in our knowledge. Important research is being carried out in related areas, including the study of molecules and cells, and genetics and infections and immunity, which will inform our understanding of the causes of CFS/ME. The Department of Health has been funding, through its own research and development programme, a research project called "Should GPs manage chronic fatigue syndrome? A controlled trial", which has recently reported. Unfortunately, its results were inconclusive. In addition, the NHS standing group on health technology has recently identified the latest series of priority areas for which it anticipates commissioning primary research or systematic reviews. One of the topics identified is management strategies for chronic fatigue syndrome. In all cases, priorities for our research budgets reflect analysis of the burden of disease, potential benefits and broader Government priorities. I hope that the message will go out to those with an interest in pursuing research on CFS/ME. The difficulties of defining a cause for CFS/ME mean that there is no single diagnostic test for the condition. Diagnosis hinges largely on the elimination of other possible conditions through a series of specific tests. Treatment to relieve the wide variety of symptoms that patients can experience is, therefore, a matter for individual doctors to decide in consultation with their patients. That causes problems of inconsistency and creates difficulties in developing the evidence-based protocol that we want increasingly to be applied in the NHS. Treatment is largely focused on the relief of symptoms rather than on curing the condition, which should clearly be the aim. The working group is due to report in summer 2000. There is wide representation in the group so that we can look beyond the medical issues to consider management, care and support for carers. The group includes representatives of carers and voluntary groups. We shall, on the basis of the chief medical officer's report, issue practical advice to the NHS to improve support and, in turn, the quality of life of people who suffer from this awful and debilitating condition.
A63 (Melton Junction)
Before I begin what I promise the Minister will be a very brief speech on this matter, I should like to put on record, and communicate through him, my gratitude to the Deputy Prime Minister, who, despite the pressure on his time, has afforded me a meeting and paid a great deal of attention to this essentially local issue. I hope that the Minister will pass on that compliment.I shall first describe the nature and location of the road and the junction. The House will know that the ports of Liverpool and Hull are joined by the M62—part of the great motorway network covering the country. The last 25 miles, or thereabouts, of the road into Hull is not motorway but dual carriageway—the A63, which, apart from some long, sweeping curves, is a very fast road in every respect. At the Melton junction on this fast road, there is a set of traffic lights which, due to the road's sweeping curves, are virtually invisible to on-coming traffic until a few hundred metres away. They are the only lights between Liverpool and Hull. Indeed, in terms of the motorway network, they are the only lights between London and Hull, Bristol and Hull or Birmingham and Hull, for that matter. Because the lights are almost invisible until traffic is nearly upon them, reacting to them is very difficult, particularly if, for any reason, there is a tailback. Psychologically, the road is a motorway, but physically it is virtually a country road, with crossings, very complex five-phase traffic lights and, just a little further along from the junction, a right turning into a village road. That is not at all what one would expect of a road on which traffic travels at such speed. As a result, there have been many accidents over the past five years. There were fatal vehicle accidents in 1994 and 1996, and a double fatality in March this year. A pedestrian was killed near the lights, and a further double fatality occurred at the Colby Park crossing, just a short distance from the junction. It is only by the grace of God that there was not yet another fatality when a small girl on a bicycle was narrowly missed by three cars and hit by a fourth. She was badly hurt, but, thank God, survived. In the past decade, there have been 40 accidents involving injury, in which almost 60 people have been hurt. Of course, many other accidents have not been reported because they involve only damage, not injury. This is the worst traffic blackspot in the Humberside police area. Indeed, it is the worst within a 50-mile radius of the Deputy Prime Minister's constituency and, of course, mine, as we are near neighbours. Why? Police statistics tell us a great deal. The problem is not weather-driven: 90 per cent. of accidents have occurred when there has been perfectly good visibility. Nor, despite what I said earlier, is the problem due to people not knowing the road. Some 70 per cent. of accidents occur on the westbound carriageway that leaves Hull. Almost by definition, therefore, drivers are local or have been through the junction before. In addition, in the majority of accidents where there has been some identifiable driver error—a blameworthy component, as it were—the blameworthy driver is local. It is therefore not just a case of people being surprised by road conditions. The problem is the design of Melton junction and the associated Colby Park crossing further up the road. The crossing is appropriate to an earlier era. It is appropriate to a low-speed, low-intensity road, not—psychologically—a motorway that carries 40,000 vehicles a day. I shall be blunt: I do not think that my constituents should face the fatal consequences of 1950s road design as we enter a new century. Nor do my constituents think they should. The matter is one of enormous local concern. A large campaign to solve the problem has attracted the support of many local individuals and businesses, all local parish councils, the local authority, the local police force and our much-respected local newspaper the Hull Daily Mail. What can we do? Clearly, a new road junction is needed. We need a junction that is capable of dealing with traffic growth of at least 4 per cent. per annum, as well as with increases as a result of local development. I shall return to that. Meanwhile, it is immediately necessary somehow to tackle the cause of the accidents: the speed of the traffic going through the junction. Until we have a new junction, I want the speed limit on a one-mile stretch either side of the Melton junction to be cut to 50 mph. To enforce that, I want traffic cameras and active policing, and I want to ensure that everybody understands that exceeding the speed limit will lead to certain conviction. I want the Minister to tell me today that the Government intend to issue orders to achieve that end, and that they will ensure that resources are available. Given the sort of problems thrown up by traffic cameras, a solution is not as simple as it looks. I shall listen with interest to the Minister's response. I stress that it is important that such action is taken virtually immediately. More important in the longer term, there must be a new junction. There is a grade-separated junction in the road expenditure plans of the Department and the Highways Agency, which is rather inaccurately described as a private finance initiative project—the Minister may want to tell us about that—but the projections for it seem to assume, as do Highways Agency responses to local developers and the council, a completion date of 2006. In other words, the junction will be completed in seven years' time. How many lives that will cost I do not know. I know that it will be too many. One death is too many; if we do not act, there will be more. The Minister knows that I have been a member of the Cabinet and have served in Departments. I do not therefore subscribe to the Whitehall economics of death, if I may put it quite so starkly—the idea that one can value loss of life in economic terms. Every death is a tragedy and a mortal loss to the wives, husbands, children, mothers, fathers and loved ones of those who die. I do not want there to be one more death on the road. I want the new junction to be built as soon as is physically possible. East Riding of Yorkshire unitary council and the local developer involved believe that, with reasonable good fortune, the project could be completed by 2002 or 2003 and that, even if there were a public inquiry, it should be achievable before 2004. Indeed, so confident is the council of that timetable that one of its officers told me that it is willing to act as the agency for completing the project. In order to achieve it, the necessary funding must be available, obviously. In addition, however, there must be the political will to give the project its proper priority and, if I may be blunt, the Highways Agency must get its finger out and get on with it. I am not interested in scoring political points. I know that the Deputy Prime Minister drives through the junction regularly, and he has made it clear to me that he understands the problem only too well and wants it to be solved—for which, as I have said, I am grateful. So this is not a political battle. If anything, it is a battle with bureaucracy. We all know the problem: capable and well-meaning civil servants and Government agencies face competing demands from all over the country for money, time and scarce resources. The understandable human response is to deal with such demands in turn, carefully and at a steady pace. I am afraid that Whitehall has a tendency to gold-plate and to be over-cautious in its approach. That, in turn, slows things down even more. Such an approach is no doubt entirely rational, but, in the meantime, this stretch of road is killing people. It is doing so with inexorable regularity and, as traffic flows inevitably increase, the problem will inevitably get worse. The project therefore needs to be given high priority and needs to be approached with a sense of urgency and a determination to complete by 2002–03, not 2006. I ask the Minister to ensure that his colleagues devote every effort to achieving that target. I shall conclude my speech so that the Minister may have his say and respond positively. In summary, in the immediate term, I want a new 50 mph speed limit. I want it to be strictly policed, with speed cameras and full enforcement. I want a new junction, to be as fast as possible within the law. That is what I ask of the Government, and that is what I ask the Minister to comment on today. I know that that involves numerous agencies, national and local, government and quasi-independent, public and private; and I know from ministerial experience that that often involves knocking heads together to get people to agree. If it would advance my constituents' cause, I should be happy to convene a meeting of all the relevant parties to hammer out a solution to the problem once and for all, and I should be delighted to invite the Deputy Prime Minister to chair it. I can think of no one better on the Labour Benches to knock heads together—he has a reputation for it. Whatever it takes, I will support. In the first years of the new millennium, the people of Yorkshire deserve better than a dangerous 1950s road on a major route. I hope and trust that the Government will do all in their power to help me get them a better road and a safer future.
I congratulate the right hon. Member for Haltemprice and Howden (Mr. Davis) on securing the debate. I well understand his arguments and the strength of feeling in the locality about the junction. Although I am not familiar with the junction, I do, as the right hon. Gentleman well knows, work very closely with a colleague who is extremely familiar with it.The right hon. Gentleman mentioned his meeting with my right hon. Friend the Deputy Prime Minister and Lord Whitty, the Minister for Roads and Road Safety, yesterday evening to discuss the issue. I thank him on their behalf for the very constructive approach that he took in the meeting and the important and significant suggestions that he made, some of which he has mentioned today. I shall pass on his kind comments of appreciation for the interest that the Deputy Prime Minister has taken in the subject. I can assure the right hon. Gentleman that we take road safety issues very seriously indeed. That concern is not an add-on to our transport policy but an integral part of everything that we do. It may be appropriate to put the matter into the national context before I discuss the specific subject to which the right hon. Gentleman has drawn my attention. We are fortunate in having one of the best all-round road safety records in the world. Much of that is due to the high standard of road engineering and to significant advances in vehicle design and standards. Although major road improvement schemes contribute to our safety record, our attention to detail also contributes to it. Some of the most cost-effective measures for reducing casualties are fairly modest road improvements. In the past two years alone, more than £100 million has been allocated—as part of the annual, long-term local capital expenditure round—to small-scale engineering measures specifically designed to reduce accidents and casualties. But however good our roads are, and however safe our vehicles, we must recognise that human error is one of the major contributory factors. In fact, it is a key factor in about 95 per cent. of road accidents. This is at least as much a question of attitude as of lack of driving skill. The Department of the Environment, Transport and the Regions is working on a long-term road safety strategy, with targets for reducing casualties by 2010. It is taking a little longer than we had expected because we are also carrying out the speed policy review promised in last year's White Paper "A New Deal for Transport: Better for Everyone". It will obviously be sensible to synchronise the new road safety strategy and the speed review. The right hon. Gentleman's comments about the junction amply show the relevance of linking the two issues. Excessive or inappropriate speed is a factor in a third of road casualties, and persuading drivers to keep to a safe speed is likely to be our biggest challenge in the next decade. Our current aim is to publish the strategy in the autumn. It will cover a range of road safety issues, including driver training; child safety; pedestrians and cyclists; impairment through drink, drugs or fatigue; vehicle standards; enforcement of penalties; and, of course, speed. The strategy will set a target for reducing the number of people killed or seriously injured. As previously announced, the target will be no less demanding than the 1987 target of a one-third reduction in all casualties by 2000. We are also considering a target to prevent any increase in casualties, including relatively minor injuries. We also recognise the need to ensure that safety is at the heart of our developing integrated transport policy. We have agreed exactly that approach with the Highways Agency, which looks after the motorways and trunk roads for which Ministers are directly responsible. The agency's business plan for 1999–2000 contains proposals to invest £78 million in improving road safety on the trunk road network. The guidance that we have issued to local authorities for putting together their local transport plans says that we expect them to consider road safety issues in all relevant policies, including social policies and measures to encourage walking and cycling. We shall be looking to local authorities to establish a strategic approach to their road safety problems, and to work in partnership with others to develop local solutions to local problems. For example, it can take many years to deliver expensive engineering work. In the meantime, there is scope for local authorities, the Highways Agency and other partners—such as the police—to introduce short-term measures to minimise accidents until the long-term answer can be delivered. These new arrangements for local transport plans offer the flexibility to tackle problems with imagination and to develop alternative solutions. We run highly successful advertising campaigns and road safety initiatives such as the drink drive campaign, the campaign to persuade everyone to wear seat belts in the back of the car as well as in the front, and the campaign to rehabilitate drink drivers and to get reoffending rates down. All those national initiatives will help road safety generally, not excluding on the A63 at Melton, but I recognise that the accident record there is a cause for special concern, as the right hon. Gentleman highlighted in his speech. For the three years prior to 1997, the accident record near the traffic-signal-controlled junction at Melton increased from nine personal injury accidents in 1994 to 15 in 1996. There was an encouraging drop in accidents in 1997, after some low-cost improvements had been undertaken—mainly to the road surface—but that trend was reversed in 1998. Although we do not have full details of the accident record in 1999 to date, I am fully aware of the fatal accident in March that the right hon. Gentleman mentioned, and I know about the two damage-only accidents in the area on 30 April, which would not feature in the statistics usually kept by the Department. The need for a significant improvement at Melton has long been recognised. A scheme for a two-level junction was introduced into the roads programme in 1987. That scheme has had a chequered history, with significant local debate about its layout and its impact in the intervening period. A preferred route was announced as long ago as September 1991. Progress was then stalled as a result of decisions in 1994 to seek a lower-cost solution. Alternatives at that stage again attracted local opposition. Those were overcome by 1995, and a different preferred solution was published. Further progress was suspended on that scheme following the review of the roads programme in 1995. On coming to office, the Labour Government had to undertake a full and comprehensive review of the roads programme that we inherited, to assess its affordability and its contribution to the integrated transport policies that we intend to develop. That detailed and comprehensive assessment was undertaken during 1997 and the early part of 1998. The right hon. Gentleman will be aware that the integrated transport White Paper, "A New Deal for Transport: Better for Everyone", was published in July 1998 and was immediately followed by our report on our review of the roads programme, "A New Deal for Trunk Roads in England". I am very pleased that, in that reassessment, we were able to recognise the importance of the scheme at Melton. However, because of the lack of progress with the scheme prior to 1997, it was not sufficiently developed to be available to be included in our targeted programme of improvements for schemes for which we had secured funding. However, recognising its importance, we included it in a very restricted list of only seven exceptionally important schemes in the whole of England. All those schemes must have road-based solutions, and we intend to make progress with them as swiftly as possible. I shall return to timing issues in a moment. Schemes will be progressed through their preparatory stages so that if, after full appraisal and statutory procedure, they are endorsed, they can be taken forward without delay. On 10 December last year, Lord Whitty announced the timing of the schemes included in our programme. It was announced that the next step for the Melton interchange is the publication of draft orders in 2000-01. Those orders will cover matters such as the positions of slip roads, alterations to side roads and, possibly, the compulsory acquisition of land. People will have the right to comment or object, and, as the right hon. Gentleman knows, a public inquiry may be necessary. I have already said that we will take the scheme forward as quickly as possible, subject to the views of the regional planning conference at the appropriate time. I hope that it will be possible to complete the project, assuming that it receives the necessary approvals, well before the 2006 date mentioned by the right hon. Gentleman. Were a public inquiry to be necessary following public objections, that would impact on the time scale, so he will understand why I cannot give a more precise indication. However, I can assure him that we intend to proceed urgently with the project, even though we cannot deliver it immediately, for the reasons that I have outlined. In the meantime, we shall not ignore the serious problems at the site. The Highways Agency and the police will continue to work to identify small-scale measures that can be introduced quickly to improve safety at the junction. I have already mentioned that work undertaken in 1997 had an immediate effect on the safety record, albeit only for a short time. That work improved the skid resistance of the approaches to the junction, and other measures were introduced to raise driver awareness. It is extremely disappointing that the effectiveness of those measures seems to have been so short-lived. The Highways Agency has taken immediate steps to address the deterioration since then and the consequences of the recent fatal accident in March, which highlighted the continuing problem. The agency has increased the length of time at which all signals at the junction show a red light, giving more time for traffic to clear the junction before other streams of traffic receive a green light. This measure could increase the length of queues at the junction, but, in similar situations elsewhere, it has improved safety and reduced the type of accidents that occur at Melton. The right hon. Gentleman commented that traffic accidents were not related to climatic conditions. That is also my understanding, which is why the wider measures are necessary. He highlighted the problem of speed. I am pleased to confirm that we agree with him that a 50 mph speed limit would improve the situation on the main road approaches to the junction. The Highways Agency will take the necessary steps to introduce this measure. The local police have already undertaken to enforce the limit through the use of speed cameras. I hope the right hon. Gentleman agrees that that could make a significant difference in the short term, although it is accepted that a longer-term solution is necessary.
I take the opportunity to thank the Minister for those two announcements. I know that, for reasons that he touched on, he cannot be as explicit as I would like on the timetable for the longer-term measures. However, his announcements today may well save my constituents' lives, and for that I express my gratitude to him and his Department.
I am extremely grateful for the right hon. Gentleman's comments. We are all deeply concerned about the situation at the junction. The Deputy Prime Minister made his concerns known yesterday evening, and we are determined to do all that we can in the short term. The measure that we propose could make a real difference.Moreover, some small extensions of the right-turning lanes in the central reserve will be provided to give additional room for waiting traffic, as problems can be caused if traffic backs up while waiting to turn right off the main road. Further signing measures will be introduced to emphasise the presence of the signal-controlled junction and the likelihood of stationary traffic, to give advance warning to approaching vehicles. The Highways Agency will continue to review the traffic conditions at the junction with the police and the local authority, and will introduce further measures if those will be of benefit in the period pending the provision of the grade-separated junction. The right hon. Gentleman spoke about the importance of cutting through red tape and knocking heads together. He paid a great tribute to the Deputy Prime Minister, saying that he could not think of anyone in Government more capable of doing that. I am happy to confirm that my right hon. Friend proposes to meet the right hon. Gentleman and other interested parties to consider the various issues on site at Melton as soon as that can be arranged. In summary, we acknowledge the safety concerns there and recognise the importance of taking forward a scheme to provide the long-term solution as swiftly as possible. In the meantime, we will do all that we can to improve the safety record at the site and to prevent a repetition of the tragic accidents that have occurred in recent years, which occasioned the right hon. Gentleman's speech and this debate.
I am pleased to have the opportunity to raise in the House the subject of body piercing. Many of us recognise that body piercing is a fashion and perhaps makes a generational point. There may be those who consider it a trivial matter, but I hope to make it clear that the repercussions of body piercing can be serious.My attention was first drawn to the matter by my local newspaper, the South Shields Gazette, which is proud to be the oldest provincial daily newspaper in the country. It celebrates its 150th year of publication this year. It is a campaigning newspaper, and body piercing has been the subject of one of its campaigns. My original concern related to the body piercing of minors. I was aware that under the Tattooing of Minors Act 1969 it was illegal to tattoo young people, but that apparently does not apply to body piercing. The matter was drawn to my attention by the case of a constituent whose daughter, aged 13, had returned home with her nipples pierced. To put it mildly, my constituent was not pleased when he found out. I started to pursue the matter and found that apart, perhaps, from recourse to the common law and to assault, there was probably little that could be done in that case. I originally thought that the problem of body piercing could be overcome by extending the provisions of the Tattooing of Minors Act 1969, but that would not solve the problem. The matter is not so simple. One immediately thinks of the practice of ear piercing, which has gone on for centuries in this country. It would be draconian for legislation to ban ear piercing for people under 18. I generally take the view that the fewer restrictions and regulations we impose, the better, so I am not keen to overregulate society. However, there is a case for us to examine the need for the regulation of body piercing. The more I have investigated the problem, the clearer it has become that it does not affect only young people. What people decide to do with their body is entirely a matter for them, but the House has a responsibility to protect minors. We also have some responsibility to guarantee to our citizens that if they decide to have their bodies pierced, they can do so in safe and hygienic conditions. That is certainly not the case at present. The Sunday People picked up on a series of parliamentary questions that I tabled on 20 April. It held random tests in various parts of the country, sending young people to body piercing establishments to see whether the practitioners would carry through a body piercing. I am sad to report that body piercing is widely available in Bristol, the west midlands and Merseyside—and on Tyneside as well—to young people aged 13 or 14.
Or younger, as the hon. Gentleman says, but in this case the young people were 13 or 14-year-olds.The general problem is not as acute in London because, under the London Local Authorities Act 1991, the local authorities in London can act in a more stringent manner than local authorities outwith the capital. The SundayPeople discovered that none of the young people it sent out in London—minors who were under 16—were able to have their bodies pierced. Perhaps there is a lesson in that. Outside London there is a major problem, as certain environmental health officers, medical practitioners and health authorities have recognised. Foremost among those, I must pay tribute to the Bury and Rochdale environmental health departments, which got together and wondered what they could do to address this problem. They also had meetings with the respective health authorities. At the end of last year, they decided to survey the general practitioners in their areas to discover the extent of the problem, and the results are revealing. Over three weeks, the departments surveyed 209 GPs in the Bury and Rochdale areas and 113 replied, saying that they had had to treat patients as a result of inadequate and unsuccessful body piercing. Treatment varied according to the type of piercing and cases involving the navel were the most difficult to treat. The GPs reported 191 cases involving infection of the navel and, although I suspect that there will have been many more, 167 cases involving ear piercing. There were 57 cases involving nose piercing, 23 involving nipple piercing and 17 involving tongue piercing. Although I emphasise and admit that only one survey has been carried out, I have no reason to think that the situation in other parts of the country would be substantially different from that pertaining in Rochdale and in Bury. The figures for the two authorities were almost identical; there was some variation, but not much. We have evidence that a problem exists—not only a problem with minors, but a problem with the way in which body piercing is undertaken. There is a lack of action, and local authorities lack the powers to try to ensure that they can provide some protection to their citizens who decide, quite legitimately and quite understandably, to have their bodies pierced. To support the need for action, I cite the excellent work of Professor Norman Noah, one of the foremost experts in the world on the issues affecting body piercing. He works in the communicable disease surveillance centre of the Public Health Laboratory Service, which is based at Colindale avenue in London. Over the years, he has done a great deal of work on tattooing and on body piercing. He has drawn up the guidelines for a number of professional tattooing and body piercing organisations and believes that, if those guidelines could be extended and were adhered to, we could probably overcome some of the more routine problems. I have mentioned the effect of piercing on parts of people's bodies, but it has been put to me that we cannot ignore viral infections such as AIDS—acquired immune deficiency syndrome—which could be spread by body piercing. It does not take a great deal of imagination to realise that a needle could be used, perhaps innocently, on someone who is HIV positive and then on someone else, transmitting the disease. There are major problems and Professor Noah identifies five. The first is body piercing of minors. Although I am open to listening to other opinions, I take the view that body piercing other than ear piercing—although it should perhaps not be illegal for under-16s—should not be undertaken without parental consent. Other Members of the House may want to pursue that debate at some other time. It would be tidiest if we transferred the regulations on tattooing across to body piercing, but my instinct is that that would probably be too draconian. Secondly, Professor Noah raises the valid issue of the use of local anaesthetic by non-medical personnel. Clearly one can imagine that that could cause all sorts of difficulties. The third problem, which was highlighted by the survey in Rochdale and in Bury, is the incidence and the effect of local infections and other complications arising from body piercing. The fourth problem, which is a more complicated socio-medical issue, is the incidence of side effects of body piercing, such as scar tissue resulting from nipple piercing and the effect that that could have subsequently on breast feeding. Body piercers have said that such piercing has no effect whatever, but I suspect that we do not know sufficient to be so categoric about that. The final issue is the training of body piercers themselves. There are professional associations—professional may not be the right term, but I concede that point—connected with body piercing. They have all told me that they would welcome guidance and some regulation. They are concerned that there are cowboys out there who are quite prepared to charge £20, £30 or £40 to pierce the body of any person without any regard for the outcome. The training and the qualifications of body piercers must be examined to find a way forward. I concede that we are perhaps at an early stage of the debate. I tabled a number of parliamentary questions to the Home Office Minister responsible for overall regulation on 20 April and he conceded that the previous Government had been concerned about body piercing and had established a working party, conducted a survey and concluded that there was a need for legislation. I know that this Government take a similar view, but, equally, I know that a great deal of other legislation is vying for time in the House. We may have to wait some time before we can expect legislation to be discussed on the Floor of the House or elsewhere, so we must take some action. I suggest that the work conducted in Rochdale and in Bury should be extended to other parts of the country to discover whether the problem is as serious as the survey suggested. If the problems are as acute and serious as that, we should consider taking action even outside the realms of formal regulations. I know that the Department of Health is aware of Professor Noah's research. Could it study his work to find ways of extending, on a voluntary basis to begin with, the code of practice that he devised? That could be done with the agreement of the Department of Health, and after consultation with local authorities and the professional associations of body piercers. It would be a positive way forward while we are waiting for legislation. There is a great willingness to do that. We could also consult the local environmental health authorities on the extent of the problem and on ways of making progress on this matter. This issue is of concern to Labour Members, and I know that Opposition Members have some sympathy with my arguments. The Minister is aware of the problem, and I know that she and Ministers at the Home Office want to make some progress. I hope that this short debate is only the first step, because if we make some real progress, we can allow our citizens to follow the fashion of body piercing and at the same time guarantee that if young people—it is mainly young people who have this done—go to a body piercing establishment they can expect the highest standards of hygiene, and that the body piercing will be performed as safely as possible.
I congratulate my right hon. Friend the Member for South Shields (Dr. Clark) on his success in securing the debate, and on the energy that he has expended in recent weeks to raise the profile of concern about the possible risks of body piercing. I am grateful to have the opportunity to set out the Government's position on the regulation of body piercing, which, as my right hon. Friend has rightly explained, spans the Department of Health and the Home Office, as the Home Secretary has important enforcement and legislative responsibilities.The key issue is the need to address the possible health risks of body piercing, and to assess the effectiveness and adequacy of the measures in place to minimise those risks. We shall examine the points made by my right hon. Friend about the consent for and the safety of the body piercing of children. These issues must be considered against the background of the increasing fashion for body piercing in recent years. We show our age when we say that we can barely understand the appeal of body piercing. Parents are concerned, and I am anxious that body piercing should be performed in a safe and hygienic manner, so that young people, who are most at risk if it goes wrong, get the protection to which they are entitled. I shall begin by considering the possible health risks and the measures in place to minimise them. If carried out incorrectly and unhygienically, cosmetic body piercing can cause a variety of problems. They are usually local and trivial, and arise from wound infections. However, body piercing can also result in the transmission of serious blood-borne viral infections, such as hepatitis B. There may also be other non-infectious complications directly resulting from the procedure, such as swelling around the piercing and allergic reactions to jewellery metal and antiseptics. It is essential, therefore, that we have the right measures in place to ensure public protection from such risks. It may be helpful if I explain briefly the legislative framework that is already in place to regulate these businesses, and how that facilitates the promotion of safe and hygienic practice with the express aim of minimising the health risks. Local authorities have powers under specific and general legislation to regulate cosmetic body piercing businesses. In London, local authorities may regulate these businesses by licensing and inspection, or by registration, byelaws and inspection, depending on which legislation they have adopted. The majority of London local authorities use licensing powers. Under the licensing provisions, local authorities in London may set conditions under which a licence is granted to body piercing businesses. The freedom to set conditions is an important leverage. The licence conditions may cover matters such as the cleanliness and hygiene of the premises and equipment, and the safety of equipment. Local authorities may refuse to grant, renew or transfer a licence, or they may revoke a licence, if they are not satisfied that the business will provide a safe and hygienic service. Local authorities outside London do not have specific powers to regulate cosmetic body piercing businesses. That is because when the legislation governing skin piercing businesses outside London was introduced in 1982, cosmetic body piercing was not included as it was not widely known about or practised. I suspect that some people could hardly believe that such practices took place. However, many, perhaps most, cosmetic body piercing businesses also carry out tattooing or ear piercing, which local authorities outside London have powers to regulate by registration and byelaws. Local authorities will, therefore, have the opportunity to work with businesses offering cosmetic body piercing to promote safe and hygienic practices, which will be to the benefit of all customers, including those who go for body piercing. In addition, local authorities are able to use general enforcement powers under health and safety at work legislation. That allows them to use improvement and prohibition notices, and ultimately to prosecute cosmetic body piercing businesses, if they judge that there is a risk to customers' health and safety. Following a consultation exercise under the previous Government in 1996, we concluded that primary legislation should be introduced to give local authorities outside London specific powers to regulate cosmetic body piercing businesses, when parliamentary time allows—a point made by my right hon. Friend. We are aware that there is support from local authorities and businesses themselves for legislation to control cosmetic body piercing outside London, and our decision on the consultation results is a clear indication of our continuing commitment to protect the public from potential risks. There is heavy pressure on parliamentary time from a wide range of Government priorities. It is not possible, at this point, to be more precise about when such legislation might be introduced. However, as I have already explained, that does not mean that we have left cosmetic body piercing businesses outside London completely unregulated. Local authorities outside London are able to inspect, advise and, if necessary, use enforcement powers for cosmetic body piercing businesses through a combination of existing specific legislation and health and safety at work legislation. The legislative framework enables local authorities to play a key role in ensuring quality and driving up standards. Local authorities can also be effective in promoting good practice by building constructive partnerships with body piercing businesses and organisations. I am aware that local authorities and body piercing organisations are seeking to promote safe and hygienic practices through good-practice guidelines, training courses and conferences. For example, local authorities in Oxford, Brighton, Norwich, Tameside and south Somerset have produced, or are producing, guidelines for body piercers, or the public, on cosmetic body piercing. Moreover, last September Doncaster metropolitan borough council held a conference on body piercing for local authorities, body piercers and the medical profession. The European Professional Piercers Association and the Association of Professional Piercers produce guidelines on safe and hygienic body-piercing techniques. Government can also play a role. The Public Health Laboratory Service has issued guidelines on skin piercing, which give detailed advice on matters such as infection control, surface anaesthesia and after-care, and the Medical Devices Agency has issued guidelines on sterilising equipment. All those measures should help to drive up standards, and, most important, to protect the public. I know that my right hon. Friend is particularly concerned about the body piercing of young children without parental consent, both in regard to whether it is appropriate and because of the possible health risks. As he will know, Government policy on the age of consent is the responsibility of my right hon. Friend the Home Secretary; but let me explain the position as it relates to skin piercing. Only the tattooing of minors is controlled by specific legislation—the Tattooing of Minors Act 1969. Currently, there are no plans to introduce legislation to make the body piercing of minors a criminal offence, but, without a valid consent, the piercing of one person's body by another person could be held to be an assault. In English law, the age of majority is 18, but, in the case of most forms of skin piercing other than tattooing, the question of what is a valid consent is governed by common law, which means that whether an offence has been committed depends on the circumstances of each case. The degree of competence that can be exercised by children will depend in each case on the relative maturity of the child concerned, as well as on his or her age. If a person under 18 is capable of understanding the nature of the act that is performed, he or she is capable of giving a valid consent to it unless statute provides otherwise. Some types of body piercing, however, are not necessarily subject to those provisions. For example, children under 16 may not consent to what would be an indecent assault. Whether an indecent assault had taken place would depend on the facts of the individual case. Neither the Government nor the Crown Prosecution Service know of any prosecutions arising from body-piercing incidents. As for the issue of the age of consent, I hope that I can give my right hon. Friend some reassurance by telling him that I understand it to be recommended good practice in the industry for body piercing not to be carried out on children without parental consent. The European Professional Piercers Association says that it should not be carried out on anyone under 16 without parental consent, and the Association of Professional Piercers suggests a minimum age of 18 without such consent. I have also heard of individual businesses taking a similar line on the cosmetic body piercing of children. One body piercing business that responded to the 1996 consultation exercise said that it turned down business amounting to between £120 and £150 each week in refusing to pierce the bodies of children who did not have parental consent. As far as I can tell, and given the advice that is available, the industry appears generally to treat the piercing of children's bodies in a responsible way, and—as it should—to err on the side of caution. Nevertheless, parents feel concerned when their children have body piercing done without their consent, and they are right to feel concern. I have therefore asked officials to monitor reports of problems arising from the piercing of children, and the extent of public concern. If there is evidence of widespread concern and a widespread failure to adhere to the good practice set out in the recommendations for self-regulation, we will not hesitate to consider the need for further controls.
I am grateful for the information that my right hon. Friend has just given, which constitutes a considerable step forward; but would it be possible for her to extend the good work that has already been done—the voluntary work, and the establishment of a code of practice—to ensure that the professional associations have an interchange with local authorities outside London, and best practice can be observed?My hon. Friend will have noted the evidence from Bury and Rochdale health authority. Could she use her good offices to ensure that other health authorities conduct similar surveys to measure the extent of the problems?
I should be happy to implement my right hon. Friend's proposals for the strengthening of public protection through the mechanism of self-regulation. I shall explore the options that he has suggested, as well as investigating the case for further dissemination of Professor Noah's guidelines, which, as my right hon. Friend pointed out, provide a standard for good practice.The Government's primary concern is for cosmetic body piercing to be done in a safe and hygienic manner, so that the public are protected from possible risks to their health. I have described the legislative controls that currently exist and those that are planned, as well as measures taken by local authorities and the industry to protect those who choose to have their bodies pierced. Our strong preference is for good practice to be spread by means of self-regulation, and we intend to work with the industry to secure that objective. Let me also signal our intention to take further steps if there is evidence of abuse or negligence that puts the health of the public at risk.
Opening the rural health forum conference on 26 October last year, the Secretary of State for Health said that the Government had looked at the special needs of each area, including the particular features of rural areas, and that the major factor in addition to low density of population and correspondingly fewer services was the distance to travel. There is now less public transport in rural areas, and there has been a tendency for care and treatment delivered by both health and social services departments to be concentrated on particular centres. That has made the position much worse. Moreover, those who are least likely to have their own transport are likely to be those with the greatest health needs: the less well off, the elderly, women and children.That makes the case for retaining the full range of services at Kidderminster very eloquently. The Secretary of State's words could scarcely be improved on: they reflect the sentiments of my constituents, and people living in other parts of the country—particularly those in Worcestershire—who are served by this fine hospital. In the same opening address to the conference, the Secretary of State pointed out some of the effects of the changes and developments in the national health service and in medicine generally:
Again, he got it absolutely right, but unfortunately his words have not been translated into deeds. Members do not have to take my word for that. I draw the House's attention to the headlines that appeared in the Shropshire Star last Friday:"There are still major pressures for concentration of services and the needs of local communities must be represented to the Royal Colleges involved in these proposals. Short-term considerations now should not leave us with having to rebuild small hospitals in a few years time when the new technology takes effect."
"Poll backing for NHS fight.
People living in the area that is served by Kidderminster district general hospital are so incensed about what the Government are doing with the hospital that 15 people stood for election at last Thursday's district council elections on a "Save Kidderminster hospital" ticket. Of those 15, 11 were elected, six of them knocking out Labour councillors on Wyre Forest district council. What is interesting is that, after those results were announced, the Secretary of State was interviewed on television. I did not see him myself, but I am reliably informed that he said that the council elections would make no difference. What arrogance to say that the expression through the ballot box of an enormous number of people's concern for the future of the hospital that serves their area will make no difference, notwithstanding the fact that six Labour councillors were voted out in Wyre Forest district. One can perhaps look forward to the next general election. It looks likely that the strength of feeling on the issue will mean that there will be a change of Member of Parliament as well. I see the hon. Member for Wyre Forest (Mr. Lock) in the Chamber. I gave him notice of the debate, so that, if I say anything about him, he will not be unprepared. I remind him of what he was telling the electorate of Wyre Forest before the general election. He was saying that it was a question simply of money and that the future of Kidderminster district general hospital could be assured if money were forthcoming.Hospital campaigners get vote of confidence with elections triumph."
Will the hon. Gentleman give way?
No, I will not give way to the hon. Gentleman. He knows that, when I wanted to intervene on him on the question of Kidderminster district general hospital in a similar debate in June, he would not give way, so I will not give way to him. If he wants to intervene on the Minister, I am sure that the Minister will be more understanding.Under the Conservative Government, in the 10 years from 1987 to 1997, £25 million of capital was spent on Kidderminster district general hospital: £20 million on a building programme; £5 million on equipment. Those of my colleagues who know the area—I am pleased to see my hon. Friend the Member for Bromsgrove (Miss Kirkbride) in the Chamber—will know that Kidderminster is a fine hospital. It enjoys a fine reputation. It is successful on every count. It is popular. It has conducted its affairs within its budget. In 1997, it attracted a charter mark for excellence, yet the Government want to downgrade it and to remove its accident and emergency facilities. I remind the Minister that hospital admissions via the accident and emergency department at Kidderminster have increased every year for the past five years. If he looks at the statistics relating to 1998, he will find that the number of admissions via Kidderminster's A and E department increased in each quarter of that year. I was speaking about money. I was explaining that the Conservative Government had spent an enormous amount on Kidderminster district general hospital. In a speech in the House on 15 March, the Secretary of State was bragging at column 708 about the fact that, under the new Labour Government, £1 million had been spent on the accident and emergency department at Portsmouth. He clearly thinks that £1 million is a lot of money. By anyone's standards, it is, but the point is that the Conservative Government spent £25 million on Kidderminster hospital and now the Labour Government are prepared to see it downgraded, the accident and emergency department closed and many of the services removed to Worcester. I remind the House of what else the new Labour Government have said in terms of finance. On 16 February, the Prime Minister announced that £30 million from the NHS modernisation fund would be spent on improving England's accident and emergency services. Not to be outdone, the following month the Secretary of State for Health announced an additional £100 million, again to modernise A and E departments. What is going on? How can it possibly be right that the Government are prepared to close a modern A and E department, on which £25 million has recently been spent, at the same time as they boast about modernising 50 A and E departments in other hospitals in other parts of the country? While I am talking about the hypocrisy of what the Government are proposing, let me remind the House that, today, in the Worcester and Kidderminster hospitals combined, there are more than 800 beds. In three years' time, when the Government's plan is fully implemented, there will be fewer than 600 beds; but the House does not need me to remind it that, for the whole of the current Administration and indeed in the run-up to the last general election, the Labour party was saying that the health service would be improved, and that there would be better facilities and better services for all our constituents. I am sorry, but the Government would have a job to sell that idea now in south Shropshire and Wyre Forest. We have a saying in the country: "If you want to meet a fool in the country, you have to take him with you." The people will not be fooled by all the words of the Secretary of State and Government generally when they see for themselves that the hospital that they love, the hospital that has served their area so well for so long—incidentally, the hospital to which so many of my constituents have contributed through their generosity to the league of friends, which has provided so much additional equipment—is being downgraded, with many of its services transferred to other hospitals. How can they possibly believe all the words and fine sentiments that the Government keep propounding?
My hon. Friend makes a relevant point: what is wrong with the people of Worcestershire; why have the Government broken their promises to them? When discussing the electoral consequences of those broken promises, will he bear in mind the fantastic results that we achieved in the local elections in Bromsgrove, which were the result partly of the closure of Kidderminster hospital, which serves a third of my constituency, and partly of the closure of the accident and emergency department at the Alexandra hospital in Redditch, which is also to be downgraded to a local emergency centre? The people of Worcestershire, and of Bromsgrove in particular, are most concerned about that.
My hon. Friend is a doughty fighter for her constituents and has been a staunch ally in the fight to preserve Kidderminster hospital. That must be an object lesson to the hon. Member for Wyre Forest, who should have fought harder for his constituents; his party might then have done much better in the local elections.
Will the hon. Gentleman give way?
No. The hon. Gentleman has heard what I have to say on the subject. Had he been generous in giving way to me in earlier debates, of course I would have given way, because I like debate; I like to be able to answer his arguments, but he has had time enough in previous debates.The pressure to keep Kidderminster hospital going on the present basis comes not only from me and my constituents or my hon. Friend the Member for Bromsgrove and her constituents but from right inside the constituency of the hon. Member for Wyre Forest. The Kidderminster and district community health council continues to be totally opposed to the plans, but it is getting nowhere with the Government, who appear impervious to local opinion. It might interest the Minister to know that a formidable action group fighting for the retention of Kidderminster district general hospital is to go to the High Court at the end of this month to seek permission for judicial review. That is how strongly my constituents and others feel about the issue. One does not seek judicial review lightly. That is the action of an enormous number of people in desperation at the Government's insouciance in the face of their representations. I invite the Minister to comment on the fact that, whereas Worcestershire health authority says that the downgrading of Kidderminster hospital will save £4 million a year, the finance director of Kidderminster hospital trust, who should know something about it because he is employed at the hospital, says that the savings will be at best only £300,000 a year. Which of the figures is correct? My constituents want to know, because one of the figures must, obviously, be wrong. Major decisions are being made on the strength of the figures provided, and it behoves the Minister to tell the House exactly what figures are being used in the considerations. Worcestershire health authority has a preponderance of representatives from the south and east of Worcestershire, who have clearly voted against the minority of representatives from the north-west of the county, where the Kidderminster hospital is. My constituents feel very sore about the fact that the future of our area is being decided by people from an entirely different part of the country, who have a vested interest in the new hospital that is proposed for Worcester. We have seen the arrogance of a Secretary of State who is totally dismissive of public opinion and the hypocrisy of the new Labour Government, who say one thing and do something entirely different. He says that he has considered the special needs of every area; that he recognises the problems of low population density; and that the distance to travel is an important factor—but he does absolutely nothing about it. My constituents look to the Government to review the decision and allow the district general hospital at Kidderminster to continue with a full range of services.
I congratulate the hon. Member for Ludlow (Mr. Gill) on securing time to debate a subject that I know is important both to him and some of his constituents and to the people of Kidderminster and all who value the services provided by Kidderminster district general hospital. It is customary on these occasions to congratulate both Opposition and Government Members on their thoughtful and positive remarks; sadly, on this occasion I will not be able to do that.I would like to state clearly from the outset that the Government see a very clear and positive future for Kidderminster hospital in the context of our decision on Worcestershire health authority's strategic review of services. That view has been echoed by the health authority. In the months since the ministerial decision last December, we have made strenuous efforts, with the assistance of my hon. Friend the Member for Wyre Forest (Mr. Lock), to explain that the solution that we have arrived at for Kidderminster is not a closure but a positive change reflecting the needs of a modern health service. I am sad to say that both the hon. Members who have spoken in this debate have given the false impression that we are closing the hospital. The hon. Member for Bromsgrove (Miss Kirkbride) made that allegation, which is untrue. Such misleading statements do nothing whatever—[Interruption.]
Order. I would like to think that we could continue this debate without sedentary interventions from any part of the House.
Thank you very much, Mr. Deputy Speaker.Both hon. Members have misled their constituents about the Government's intentions. We have no plans whatever to close Kidderminster hospital.
I am very grateful to my hon. Friend for giving way, in stark contrast to the behaviour of the hon. Member for Ludlow (Mr. Gill). I welcome the cast iron, on the record assurance that Kidderminster hospital will not close. May I also have an assurance that 24-hour emergency services, led by a consultant, will remain at Kidderminster, and that the driving force behind the changes, as recognised by the "Save Kidderminster Hospital" campaign's own experts, is strictly medical, and not party political? Will my hon. Friend come to Kidderminster to repeat those assurances and to discuss issues surrounding the implementation of these difficult decisions?
I can give my hon. Friend all the assurances that he seeks, and I will be happy to go to Kidderminster to explain the situation to his constituents.The change is not a ruling from on high, but is based on expert clinical advice, sound financial judgment and a spirit of compromise and listening to local views. Let me explain briefly the background to the strategic review in Worcestershire and what it set out to achieve. The Government's White Paper on the future of the national health service emphasised the need for health services to be able to respond effectively to change. The NHS is moving towards modernisation of services provided by hospitals that may serve relatively small local populations. Current and future medical developments require a complex, modern and comprehensive model of health care. The health service is responding to demands from doctors and other health professionals for the skills and experience that come from greater specialisation. This approach, known as centres of excellence, is aimed at providing patients with the very best that medical science and technology can offer, delivered in well-equipped hospitals with appropriate staffing levels. That was very much the backdrop for Worcestershire's strategic review—the need to secure clinical services that are safe for patients, of high quality, and sustainable in the long term. Some have suggested, wrongly, that the review was driven by the need for financial cuts in the face of increasing deficits. It is the responsibility of every public organisation to balance its books, and Worcestershire health authority is no exception. On its formation in April 1996, under the previous Administration, the health authority inherited from North Worcestershire health authority an accumulated deficit of £3.8 million. The health authority has worked hard to contain that position, but overspends by GP fundholders and local costs pressures, especially at Kidderminster health care trust, have worsened the situation. The duplication of services at each 'of the acute trusts in Worcester has made the delivery of efficiency savings a difficult task in the county, and one certainly cannot sustain a pattern of services that will bankrupt a health authority. However, money was merely one factor in the decision, not a driver. In reaching the decision, our primary consideration has always been the need to ensure access to clinically safe and viable services for the whole county of Worcestershire and its catchment area beyond the county, including the 12,000 south Shropshire people in the constituency of the hon. Member for Ludlow, who are currently served by Kidderminster general hospital. I am conscious of his concerns about increased travel times and I will, therefore, ask Worcestershire health authority to investigate the possibility of providing regular services to take visitors from Kidderminster to the Worcester royal infirmary during visiting hours. The decision on Worcestershire was based on a very complex process of option evaluation and consultation. Locally, the health authority has been discussing the future of its health services with stakeholders since 1995. That culminated in early 1998 in the consultation document "Investing In Excellence", which evaluated seven options for change. During the extended consultation exercise, the health authority held 13 public meetings and received more than 1,500 written responses. Those were carefully evaluated by the health authority, and, following the formal objection of the local community health council, were fully and properly reviewed by Ministers. In arriving at our decision, Ministers took the advice of clinical professionals, both nationally and locally, and we took seriously the issue of local access to services, which I know is very important in rural areas such as north Worcestershire. In short, everything was done to consult properly and fully with the public and local health professionals. We were satisfied that it was not possible to sustain three centres for emergency medicine and surgery in Worcestershire and that the accident and emergency service should be countywide. Some saw that, erroneously, as the end of all A and E services at Kidderminster. Nothing could be further from the truth. Even now, the health authority is actively involving the local community in implementing the decision. Through the newly formed primary care groups, it has established local reference groups—including users and carers, patient groups and local authorities—to act as a proper sounding board as implementation proceeds. The fact is that, after three years of uncertainty, the service in Worcestershire can now move forward, with a critical, continuing and important role for Kidderminster. So that we can be clear, let me remind the hon. Member for Ludlow of exactly what was decided by the Government last December. Kidderminster will continue to have a consultant-led emergency service. Major trauma cases will no longer go to Kidderminster and the emphasis there will be on care provided by nurses, backed up by an effective telemedicine link to the countywide A and E service. However, the designated consultant, the post that my hon. Friend the Member for Wyre Forest did so much to secure, will be responsible for training and clinical standards at the new emergency centre at Kidderminster, and will spend a substantial proportion of his or her time at the hospital. Our current best estimate is that nearly half the patients who currently use Kidderminster's A and E department will continue to use Kidderminster's emergency centre, but that figure does not take into account the expected advances in telemedicine before the changes at Kidderminster are implemented. Furthermore, all out-patient appointments will continue to be provided at Kidderminster hospital. That represents a much improved out-patient service because specialties currently only available at Worcester royal infirmary will now be available in Kidderminster. We expect Kidderminster hospital to be a leading light nationally in the development of telemedicine. We have doubled investment in equipment to reflect that desire, enabling local clinicians working at the hospital to treat as many patients there as possible. Further announcements about additional investment will be made in the near future. There are already some exciting local models of closer working between acute hospitals and primary care, for example, in east Worcestershire and south Shropshire, which includes the constituency of the hon. Member for Ludlow. With the continuing development of primary care groups, I expect the number of those initiatives to increase. I hope that the extra 35 GP-designated beds at Kidderminster hospital—another improvement that my hon. Friend the Member for Wyre Forest did much to secure—will be taken up by local GPs. We also expect around 70 per cent. of elective cases to continue to be treated at Kidderminster hospital, along with most out-patient services. Furthermore, we expect Kidderminster to keep its one-stop clinics, specialist follow-up clinics, diagnostic testing and out-patient based treatments. Its rehabilitation facilities and cancer resource centre will continue to be developed and improved over the next few years. Indeed, the rehabilitation facilities will be used by patients returning from major surgery in Worcester. In all those areas, services will continue to be provided at Kidderminster hospital. I pay a special tribute to my hon. Friend the Member for Wyre Forest. As a direct result of his strong and effective representations, the health authority's plans for Kidderminster hospital were amended to ensure the provision of safe local services, including, for example, a consultant-led emergency centre at the hospital; the doubling of the amount being spent on refurbishing and improving the hospital, including an extra £750,000 which the hon. Member for Ludlow conveniently forgot to mention; and making provision for 35 GP-designated beds at the hospital. Unlike the hon. Member for Ludlow, my hon. Friend the Member for Wyre Forest has done an excellent job on behalf of local people. That is the framework that we have laid down for the health authority. Although the changes will by no means be introduced overnight, it has already begun work on the detailed implementation. Since the announcement on Worcestershire, the Government have signed up to the brand new £116 million private finance initiative hospital at Worcester, which was promised by the previous Administration but not delivered. If the hon. Member for Ludlow believes that his party's record of expenditure on the NHS was so magnificent, he might wish to offer an explanation of why the Conservatives suffered their worst ever election defeat in 1997. The truth is that people do not trust the Conservatives on the NHS. My right hon. Friend the Secretary of State began the commissioning work for the new hospital on 19 March. The new facilities at Worcester have been planned to take account of the changes at Kidderminster hospital. There will be sufficient capacity in 2002, when the hospital is opened, to accommodate the anticipated number of emergency and elective patients. The new hospital will enable services to be configured in a way that is clinically and financially acceptable. In the interim, there will be moves towards implementation of some of the service changes agreed on—for example, the development of the ambulatory care centre in Kidderminster. As part of the consultation, the issue of trust reconfiguration was raised and those consultations are proceeding. I assure the hon. Member for Ludlow that Ministers will be vigilant in ensuring that the health authority is mindful of its responsibilities to consider the implications of its proposals for out-of-county patients and will work with neighbouring health authorities, including Shropshire, to ensure continuity and equity of access to services. There are often strong feelings expressed when local institutions of any sort need to undergo change. I understand those concerns, but we have to make a balanced and soundly based clinical judgment about how best we can provide a safe and sustainable local health service in the long term. The Government believe strongly that we have made the right decisions about the future of Kidderminster hospital, on behalf of the population that it serves. I hope now that we can begin to look forward to the opportunities to develop the service at Kidderminster and to discussing the changes in a realistic and sensible manner. Sadly, the hon. Member for Ludlow has not contributed today to that serious debate.
It is interesting that the Opposition like to dish it out, but they cannot take it back. That says something about the modern Conservative party.The health authority has a difficult task ahead of it, but a task to which it is fully committed within the boundaries the Government has laid down. Kidderminster hospital has a secure future and it can be a pioneer for modern health services. That is particularly true of telemedicine. The decisions that we have taken are the right ones for the future development of the NHS in Worcestershire.
It being Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.