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Commons Chamber

Volume 449: debated on Tuesday 18 July 2006

House of Commons

Tuesday 18 July 2006

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Hospital Travel Costs

1. What assistance is available for cancer patients to help with travel costs to and from hospital. (85839)

The hospital travel costs scheme provides financial assistance to NHS patients, including cancer patients, who do not have a medical need for ambulance transport but who require assistance in meeting the costs of travel to and from care.

Does my hon. Friend accept that cancer patients, at a sensitive time in their lives, must travel to hospital an average of 50 times in the course of their no doubt excellent treatment, at places such as Clatterbridge centre for oncology? In doing so, they incur costs of hundreds of pounds in travel and in the lottery of car parking charges. Will the Department move forward with consulting on better awareness of the hospital travel costs scheme and increasing its uptake?

My hon. Friend makes an extremely important point; he has a distinguished cancer treatment centre in his constituency. As a fellow north-west MP, I know that my constituents must travel some considerable distance to Christie’s, while others in the Merseyside region travel to his constituency. I therefore accept that people can face extra financial worries at a time of stress and anxiety due to their illness. First, further work is needed to ensure that the scheme’s scope is not too rigid and focused on hospital settings as opposed to primary care, where more could be done. Secondly, and more importantly, we need to get better information to people who may be eligible to benefit from the scheme. Many patients may be able to get significant support for their travel costs.

The Minister will be aware that the cumulative cost of car parking, not just for cancer patients but for other regular visitors to hospital, can be substantial. At this point, the normal ministerial reply is that that is a local issue—but is the Department of Health at all responsible? Does it feel that it has any national role at all in the health service, or will it just allow local trusts to charge what they like?

Normally, Liberal Democrats are the first to jump up and cry foul about micro-management and targets coming from the centre. Again, dare I say, they want to have it both ways. As far as I am concerned, car parking is a big issue for the public—[Interruption.] If the hon. Gentleman will hear me out, I shall go on to say that it is perhaps a bigger issue for the public than the managers of some NHS trusts accept. In a world in which patients have more choice, many of them will make an important point of this issue, and many trusts will be required to think harder about it. Essentially, however, it is a local decision depending on the availability of space on trust land and the proximity of the trust to the town centre.

I do not expect my hon. Friend to comment yet on the publication this morning of the Health Committee’s report on NHS charges. However, we are deeply concerned about patients’ knowledge of the hospital travel costs scheme. Can he ensure that that is improved? Can he also consider setting national guidelines for hospital car park charges, especially for patients, as the situation is a bit of a mess at the moment?

I woke up this morning to reports of the findings of my right hon. Friend’s Committee, and I detected his forthright Yorkshire tones in some of the language used to describe the situation. He is right to say that more effort needs to be made to ensure that patients, particularly those on low incomes, are given access to information about their eligibility to claim for their transport costs, either in whole or in part. How people receive that money back from hospital trusts, whether after or before their treatment, is also an issue. My right hon. Friend is also right to say that car parking is a big issue for patients. Many trusts are making exceptions for car parking, particularly for cancer patients. Others that are not doing that should look at those who are, and see whether they can provide better support to patients at a difficult time in their lives.

According to the 19th report of the Public Accounts Committee, more than three quarters of NHS patients were not given information on financial benefits that could be used, for example, to help to pay their car parking fees. As it was stated in evidence to the Committee that progress was hoped for by the end of 2005 on delivery of disability living allowance and attendance allowance to cancer patients, what progress has been made?

The health White Paper published earlier this year made a specific commitment to consult on the hospital travel costs scheme: first, on whether the scope needs to be increased so that patients not under the care of a consultant but another health service practitioner can benefit; and secondly, working with Macmillan, which has done excellent work in this area, on exactly how patients are given information about whether they are eligible to benefit. It is not as easy as sticking a poster up on a wall; we must see how we can get relevant information to patients who may be able to benefit. That is a fair and legitimate point, and we will take that forward in consultation this autumn.


2. What recent discussions she has had with representatives of the Roman Catholic Church on Government policy on abortion. (85840)

When I met Cardinal Murphy-O’Connor and his colleagues recently, we discussed several issues, including whether the 24-week time limit on abortion should be reduced. The Government have no plans to change the law on abortion.

Has my right hon. Friend had consultations with any other parties, such as members of the medical profession?

Members of the medical profession, particularly the Royal College of Obstetricians and Gynaecologists and the British Medical Association, have recently made clear that they do not believe the evidence supports any need to change the time limits specified in the present law on abortion.

Does the Secretary of State accept that if a decision is to be made, it must be made on the basis of the best advice and evidence available to Members? Will she seriously consider Cardinal Murphy-O’Connor’s suggestion that a Joint Committee of the two Houses be set up to hear the evidence so that a rational and sensible decision can be made?

That is, of course, a matter for individual Select Committees and for the House, not for the Government. However, I stress that when the law was revised in the late 1980s, the medical profession believed that the age at which a foetus was considered viable should be reduced from 28 weeks’ gestation to 24. There was a clear medical consensus on that, based on evidence. There is no such consensus or similar evidence today.

Does my right hon. Friend agree that safe and legal abortion is crucial to the mental and physical well-being of women in this country, given that no contraceptive method is 100 per cent. safe? Does she acknowledge that fewer than 0.1 per cent. of late terminations take place at 24 weeks, and that the reason for those terminations is usually concern for the health and welfare of the mother and child or the death or divorce of a partner in marriage?

I agree with my hon. Friend. Many Members on both sides of the House fought to ensure that the law would allow women to choose a safe and legal abortion should they need to do so. Speaking for myself, I believe that that is right, and that it would be a tragedy for many women if it were reversed. My hon. Friend is also right about late abortions: according to the most recent figures that we have, 137 abortions in the last year took place at 24 weeks’ gestation or above.

I am sure the Secretary of State agrees that improved education and access to contraception would help to reduce the abortion rate. Why are many primary care trusts cutting the number of community clinics as part of their strategy to reduce deficits? Will the Secretary of State ensure that clinics do not close, so that a vital service remains available and doctors and nurses can retain their skills?

The hon. Lady is absolutely right: of course it is better for women not to find themselves with unwanted pregnancies. That is why we have substantially increased investment not just in contraception services but in targeted measures to reduce the number of teenage pregnancies. I know the hon. Lady will welcome the fact that the number of pregnancies among those under 18 has been falling, and is now at its lowest since the mid-1980s. However, as was recently announced by the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), primary care trusts are considering how to redesign their sexual health services, including contraception services, to ensure that they are as effective and available as possible.


The Department does not collect waiting times for hearing aid fittings. We aim to deliver audiology diagnostic tests within 13 weeks by March 2007, and within six weeks by December 2008.

I am sure that the Minister has spoken to many people who now have digital hearing aids, who will have told him how tremendously their quality of life and that of their families has improved. Why are hearing aids not subject to the waiting time targets that apply to other health care provision?

We want to maintain a situation in which most patients are referred directly by GPs to audiology departments, not consultants, and we do not want to create a position that would distort that practice. However, there are genuine challenges and problems with waiting times in certain parts of the country, which is why the Department will be working with stakeholders such as the Royal National Institute for Deaf People to produce an action plan to improve waiting times across the country, rather than have the unacceptable standards that apply in some parts of the country.

This happens all the time. One tables a perfectly straightforward question, and the Minister answers another. Is not the answer to my question, as it appears on the Order Paper, “None”?

May I suggest that if the hon. Gentleman forwarded his questions by e-mail he might get a more satisfactory response? He should note that the £125 million invested in the programme for modernising hearing aid services has been warmly welcomed by people who have benefited tremendously from digital hearing aids, as my hon. Friend the Member for Bishop Auckland (Helen Goodman) said. I also have to say that Conservative Members did not vote for that £125 million expenditure on the modernisation programme.

Does the Minister acknowledge that, in addition to the long waiting lists for fitting—more than a year in my primary care trust area—and additional waits for diagnostic tests, there is a large legacy problem of analogue hearing aids that need to be replaced by digital aids in the course of time? What would be a realistic time frame for clearing the large backlog of commitments, which in so many cases are long awaited?

I entirely agree that that issue must be taken seriously. It must form an inherent part of the action plan that we take forward, which will include a number of issues as well as that one. Other issues are increasing demand, inadequate capacity, work force skills and competencies, and the fact that we do not yet have sufficient focus on modern technology. Our action plan will address the remaining obstacles and ensure that people all over the country have access to the quality treatment that they deserve.

In my constituency, residents are waiting 15 months after their tests before they receive their hearing aids. Given that there is an 18-week target, that is clearly unacceptable. I wonder whether it would be possible to seek a reciprocal agreement with European countries. I am told that in Denmark hearing aids are cheaper and arrive more quickly. Some people are going over there to get their hearing aids, to avoid the waiting lists here. In Luxembourg, too, it is possible to—

Thank you, Mr. Speaker. At one point I thought that we were having a discussion on the Eurovision song contest—[Hon. Members: “No!”]—not that anyone in the House is going to admit to watching that. The hon. Lady raises a serious issue, and if, as we develop the action plan, I can learn from international best practice, particularly where there are successes and achievements of better waiting times, I shall attempt to do so and incorporate it into this country’s approach to the problem.

Like me, 10 per cent. of British adults—5 million people—suffer from chronic tinnitus, and 1 per cent.—500,000 people—suffer so badly that it impacts severely on their quality of life. Will the Minister confirm whether audiology services for tinnitus, which are not necessarily linked with digital hearing aids, but often provide advice about therapeutic treatment to tackle the problem, are adequately catered for by the NHS? Many advances have been made in other areas of audiology, but this remains somewhat of a Cinderella service.

I would be delighted to give my hon. Friend an assurance that part of the action plan will be to look into the problem of tinnitus. I know that it can be a horrendous condition that adversely affects people’s quality of life and undermines their daily functioning. We should take it extremely seriously, and I confirm my commitment to my hon. Friend that as part of our action plan, we will look specifically into the advice and support that tinnitus sufferers receive.

What advice can the Minister give to my constituent, Mr. Sapsford, who has been waiting for five months for an audiology test? He has been told that he is not a priority because he is not over 90 years old, he is not receiving a war pension and he is not blind. My local trust cannot cope with the level of demand with the current level of staff. If the Secretary of State would consider allowing our trust to recover its budget deficit over the next two or three years, instead of in the current year, it might not have to make those cuts in essential services to patients.

During my responses today, I have frankly acknowledged the difficulties and challenges in certain parts of the country, including the hon. Lady’s constituency, but I hope that she will be equally honest with her constituents and tell them that time and again when we have debated the amount of resources that we should invest in the NHS, the party that she represents in this House has voted against that investment—so the situation could be considerably worse.

This is an important issue for people throughout the UK. What is the Minister doing to establish best practice between the UK Government and devolved Administrations? Does he agree that it is strange to hear oppositionist tones from the Liberal Democrats on this subject when in Scotland, they are in government?

Frankly, I am not surprised to hear that the Liberal Democrats are saying one thing in Scotland and something entirely different in England. In my experience in my constituency, they say one thing in one ward and something else in a neighbouring ward.

The Minister’s admission that there are difficulties in this area is to be welcomed, because many—including the 33,000 patients who have to wait longer than a year for an audiology test—would otherwise have considered his written statement today on audiology services complacent. Does he accept that the Government’s decision to exclude direct referrals from the 18-week time target, while including referrals made through ear, nose and throat consultants, raises the spectre of a two-tier NHS, in which the articulate and better-off will be able to ask to be referred through an ENT consultant in order to receive a hearing aid within 18 weeks, while those who do not know how the system works will have to wait far longer for their hearing aid? Does the Minister believe that that represents equitable access for all, including the 56 per cent. of patients in his local strategic health authority who have to wait longer than 26 weeks?

The whole purpose of the action plan is to ensure that we have equitable access and that the best practice in some areas—for example, the Pennine Acute Hospitals NHS Trust, my local trust, which has zero waiting time for such services—is replicated all over the country. We need to ensure that we do not have a two-tier system. However, including direct referrals in the 18-week target would have led to a perverse incentive that we do not want to encourage. We want to continue the situation in which the vast majority of people go directly from their GP to audiology departments. Anyway, we want to see more such treatment provided in the community rather than in hospital in the future. Acknowledging the existence of challenges and issues and committing ourselves to producing an action plan is a responsible way to tackle that serious issue.

Overseas Nurses

The NHS has a long history of welcoming nurses from overseas. We have also increased the number of nurses that we train in Britain by more than 60 per cent. since 1997. Those nurses should, of course, have the opportunity to progress in their careers. The Government recently changed the work permit arrangements so that in future, junior nurses from overseas can be appointed only if there is no suitable candidate from the UK or the rest of Europe.

I am grateful to the Secretary of State for that response. Given that many nurses are approaching retirement age, what assurance can the Secretary of State give that British-trained nurses alone will be able to replace them?

Vacancies are at their lowest level ever, and we are employing more than 85,000 more nurses than we were in 1997. That substantial increase has meant that newly qualified nurses have found it difficult to get jobs. The advantage of the managed migration policy is that where shortages arise—and there are shortages in specialist jobs in the NHS—they can be included in the shortage category so that employers can obtain work permits for nurses from abroad without having to show that there is no suitable domestic candidate. That is a flexible system that can respond to changes in our own labour market. Given the present situation of newly qualified staff, it is clearly right that we should take junior nursing jobs out of the shortage category.

I welcome the initiative by my right hon. Friend. Does she agree that there is no such thing as an ethical recruitment strategy from overseas, from developing countries? Countries simply recruited from underdeveloped countries to fill the gap, and they lost out in the end.

I am grateful to my hon. Friend for supporting the action that we have taken, but I do not agree about whether it is possible to have an ethical recruitment policy. On that particular issue, we have led the way—not only by making it very clear that the NHS itself and staffing agencies that work for the NHS are not allowed to recruit directly from developing countries that desperately need their own staff, but by entering into agreements with countries such as the Philippines or India whereby they train more nurses than they can possibly employ, and—certainly before we made this change—by being willing to employ those staff here. I also refer my hon. Friend to the excellent work of my right hon. Friend the Secretary of State for International Development and the investment that we are putting in—for instance in Malawi and other parts of Africa—to help countries to train the health care workers that they so desperately need to care for their own population.

Is not what the Secretary of State euphemistically refers to as managed migration a panic reaction by the Government to the sharp rises in the number of unemployed newly qualified nurses? What steps are the Government taking to ensure that those numbers do not go on rising, and that we are not ploughing resources into training nurses and offering them the prospect of work, but no jobs at the end of the training?

The right hon. Gentleman is quite right: as I said a moment ago, there are real difficulties this year for many newly qualified nurses and indeed others, including physiotherapists, in getting jobs. We have therefore been working with NHS employers, and the chief nursing officer at the Department recently issued guidelines that will make it much clearer that, for instance, the director of nursing within each trust should be working with colleagues right across the local health community—with other NHS organisations—to ensure that vacancies are created and filled wherever possible by newly qualified staff; that private agency temporary staff are reduced; and that in their place, where necessary, newly qualified staff are taken into NHS banks, where they can be offered part-time or full-time work in order to progress their training.

There are a number of practical steps being taken in different parts of the country and we will go on ensuring that that happens in order to support our own newly qualified nurses. I am not sure whether the right hon. Gentleman supports or opposes the action that we sensibly took, as the problem became clear, to ensure that we do not continue to recruit junior nurses from outside the United Kingdom and the rest of Europe. I think that that is the right step to take, and I would be interested to know whether he and his party support it.

What dispensations are available to NHS employees who are identified for redundancy or have been made redundant, with regard to recruitment and employment in independent treatment centres in organisations such as Southport and Ormskirk hospital in my constituency?

There are still several thousand vacancies across the NHS, and we have already taken steps to ensure that wherever possible, vacancies are ring-fenced for staff who are facing redeployment or even redundancy in their current positions. There is already a policy, which goes back a couple of years, of ensuring that staff who have been made redundant from NHS employment can, despite the additionality rule, seek immediate employment in an independent sector treatment centre that is also working for NHS patients.

A midwife who lives in my constituency and works at Bedford hospital arrived in this country seven years ago, trained as a nurse, became a midwife and has now been told, as part of the consultation process at Bedford hospital, that she is likely to lose her job. Nearby Lister hospital has made an announcement of 500 redundancies. My constituent has been told that her chance of securing another job as a midwife anywhere in the region is zero. Does the Secretary of State feel that my constituent, who is now applying for a job in Waitrose, has been let down by the Government, along with all the other nurses who came to this country seven years ago to train?

The hon. Lady’s constituent and many other staff are facing an extremely difficult situation at the moment, as are some of the newly qualified staff to whom I referred. I assume that her constituent has already secured settlement, as she has clearly been making a valuable contribution to the NHS here for the past seven years. However, the fact remains that every hospital that is in financial difficulties, or that simply wishes to make itself more effective, is doing everything possible to avoid compulsory redundancies. When those are unavoidable—as in some cases they are—hospitals are also putting in place every support possible to ensure that staff, who have sometimes given years of service to the NHS, are supported to get other jobs in the health service.

Will the Secretary of State admit that we have gone from a period of expansion to one of contraction for the nursing work force? Some 5,500 extra nurses were recruited the year before last, but 5,500 nursing posts are now to be lost in our hospital sector. It is not just nurses leaving education who cannot find a job, because, as my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) made clear, nurses in employment are losing their jobs. In the context of overseas recruitment, will the Secretary of State admit that? Is that not the reason why the shortages criterion has been removed not just from junior nursing posts, but from the whole of bands 5 and 6, which means that most nursing posts are affected?

We have indeed removed bands 5 and 6, which cover the jobs for which newly qualified nurses apply, from the shortage applications. I am glad that the hon. Gentleman recognises the enormous increase in the staffing of the NHS. There are more than 200,000 additional staff and more than 85,000 extra nurses—and that was made possible by the additional investment that he and the rest of the Conservative party voted against.

The hon. Gentleman talks specifically about nurses and other staff in hospitals. The reality is that as hospitals become more effective and the NHS takes advantage of changing medical practice—for example, by employing more nurses in the community and reducing the number of emergency admissions—there will need to be fewer acute beds and thus fewer staff in some of our hospitals. He really has to decide whether he believes that the NHS should use the best medical practice to give the best care to patients and get the best value from the increased investment that we have made, or whether, along with voting against the increased investment, he is also giving up on any pretence of using that investment to the best effect for patients.

It is a complete fiction that more nursing posts in the community are being created. In the last year for which we have figures, there were 500 fewer district nurse posts and 800 fewer health visitor posts. If the Secretary of State knows what is going on, she must have based her policy on a new set of work force supply and demand figures. Two years ago, the Department of Health’s work force projection said that we would be short of 40,000 nurses by the end of the decade, and that we would need to recruit 12,000 overseas nurses a year. What is the Secretary of State’s current projection?

The work force projections that the Department of Health undertakes are all based on local projections of need developed by individual hospitals and other parts of the NHS. It is already clear that when the assessments of requirements for training places were made some years ago, several hospitals overestimated their requirements. A minority of hospitals were, even at that point, overspending their budgets at the expense of other parts of the NHS, yet also taking on new staff and commissioning new training places—and now they cannot find jobs for all the nurses who have been trained. That situation is extremely unsatisfactory and unfair to the staff involved.

We still have not heard whether the hon. Gentleman thinks that we have done the right thing. The great advantage of the managed migration policy and the new system for shortage occupations is that when we see a problem emerging, as we did earlier this year, we can take action to ensure that newly qualified nurses from abroad do not continue to seek employment here. If the situation changes in future years, we can alter that. The fact is that we have substantially increased the number of training places, by over 60 per cent., so we have no shortage of nurses at the moment.

Hospital Cleanliness

7. Pursuant to the answer of 20 June 2006, Official Report, column 1792W, on hospital cleanliness (west midlands), what systems have been recently introduced to improve hospital cleanliness in the west midlands. (85845)

The former strategic health authorities which have been merged to form NHS West Midlands established their own steering groups. The membership of these groups was wide-ranging and their remits included hospital cleaning as well as infection control. Relevant action plans are now being taken forward as a result of the input from these groups.

I thank the Minister for his answer, but will he come to Dudley again to visit our new £180 million hospital, where he can see for himself a revolutionary microfibre cleaning system that is helping to combat infections? I recently met Sue Macmillan, who showed me how the system reduces infection and improves cleanliness. We can never achieve 100 per cent. perfection, but is that not a great example of the way in which extra investment, together with new facilities and ways of working, has delivered improvements for patients?

I recently made an unannounced visit to Dudley, where I saw my hon. Friend’s hospital for myself. It is, indeed, impressive, and the microfibre cleaning system used there is being evaluated by the Department to see whether or not it can make a broader contribution. Will he pass on my thanks to Sue and her team for the excellent job that they are doing? Cleaners across the NHS do a fantastic job but I am sure that, like me, the hon. Gentleman remembers the billboards at the last election that said, “How hard is it to clean a hospital?” It was a denigrating attack on the people who keep our hospitals clean, and I am sure that it was approved by the right hon. Member for Witney (Mr. Cameron). However, I am happy to pay tribute to Sue and her team, and I am sure that my hon. Friend would wish to pay tribute to many other cleaners across the NHS.

May I put on record my thanks to both public and private sector cleaners? The trouble is, however, that often they are cleaning wards that are full of litter from the Government’s bureaucracy and red tape. To be serious, is the Minister confident that MRSA, VRSA and ESBL superbugs have left the Princess Royal hospital in Shropshire? If he cannot tell the House that they have done so, why has the only isolation unit in Shropshire at the Princess Royal hospital been closed?

The latest figures for 2005 for west midlands hospital trusts rated more than 30 sites either good or excellent—none was unacceptable—for hospital cleanliness. There is therefore a good record in the hon. Gentleman’s region. However, on the question of whether we are satisfied, no, we are not complacent about the issue. It is crucial that trusts, from the chief executive down, put hospital cleanliness and control of hospital-acquired infection at the top of their list of priorities, because patients expect to be treated in a clean and safe environment. I give the hon. Gentleman a categoric assurance that that is what trusts should do, but he should take pride in the trusts in his region and constituency, because they are doing a good job.

Assaults (Mental Health Wards)

8. What recent estimate she has made of the number of assaults on patients and health care staff within in-patient mental health wards. (85846)

10. How many sexual assaults took place in in-patient mental health wards in 2005-06; and if she will make a statement. (85848)

Data from the counter-fraud security management service show 43,097 incidents of physical assault against staff working in mental health and learning disability settings in 2004-05. A report published today by the National Patient Safety Agency—a copy has been placed in the Library and I have asked for further copies to be distributed to Opposition Members—shows 558 reports of physical abuse of patients, including 122 reports of incidents relating to sexual safety between November 2003 and September 2005.

I thank the Minister for her response and for providing me with a copy of the report a few hours ago, but it is remarkable that that was prompted by Health questions, rather than previous freedom of information requests from Mind, the charity. The NPSA report is detailed, and it deserves close examination, as it recognises the important work of health professionals. However, many people are concerned about the safety of patients and the need to protect them against assault in mental health units. The report shows that there were 562 cases of patient abuse by a third party in a mental health setting, and from my reading of the graph, there were a number of cases of severe harm and, indeed, death. Can the Minister confirm that, and say what steps are being taken to minimise the risk of people in need of urgent medical treatment suffering even more trauma as a result of the actions of third parties while they are in the care of the national health service?

I certainly share the hon. Gentleman’s concern about some of the issues raised in the report. We should bear in mind the fact that about 1 million people are treated in specialist mental health services every year, but of course we take many of those allegations very seriously. In the report, in collaboration with NPSA, the Department has looked at examples of best practice which implement the guidance set out by the Department to ensure high levels of patient safety. These matters are ongoing and we will continue to examine the issues raised by the report, so that if anything else needs to be done to ensure patient safety, we will do it.

My concern is for those who are facing mental health challenges, who are perhaps the most vulnerable members of our society. In 1996 the Prime Minister made a clear commitment to the ending of mixed-sex wards. Ten years later, people have a right to know why patients are still suffering abuse at the hands of the Government—people who come to the national health service in their hour of need are found to have been abused. My question to the Minister is simple and can be answered yes or no. Will she now make the commitment to ending the use of mixed wards for mental health in-patients, and will she do it today?

Let us be clear: 99 per cent. of mental in-patient wards meet the requirements that have been laid down by the Department. Those requirements are that there should be separate sleeping accommodation and separate toilets and bathrooms. We also recommend that trusts could consider whether it is appropriate for wards to be completely male-only or female-only. Those issues are often debated, and the hon. Gentleman should recognise that. In some circumstances it is right that there are areas where males and females can go. That, in a sense, makes it a normal setting. There are also those who prefer that in some instances there should be completely separate wards. We have told trusts that where it is appropriate, they should consider such matters. As I said, there is 99 per cent. compliance in mental in-patient wards. We are working with the remaining 1 per cent. to ensure 100 per cent. compliance.

I share the concerns about the delay in the publication of the report, which I understand was available last November, but I commend the Government for collecting the information. We already knew from a report from the Healthcare Commission last May about the high levels of violence in mental health and learning disability units, which it attributed to the high level of staff vacancies, the lack of experienced staff in in-patient units, the overcrowding and the lack of a therapeutic and structured care system in wards. That was last May. Have things got better since then, and if not, why not? Will the Minister take urgent action to address these very difficult issues?

We are continually seeing improvements in mental health services, particularly with some of the community teams that have been set up so that there is less need for the in-patient care scenario. We have seen the development of those teams over the past five years, accompanied by massively increased investment—about £1.7 billion extra has gone into mental health services. I recently announced £140 million in capital investment to improve in-patient services for people with mental health problems.

Taken together, all these things mean that services are improving. That is not to say that we do not take reports such as this extremely seriously, or that we are not doing everything that we can to ensure that the existing guidance accords patient safety the highest priority.

Will my hon. Friend confirm the percentage of female patients subjected to such assaults, if that is known? Does she think that we have been rather more robust in ensuring the safety of our hospital accident and emergency ward employees—we have taken up the cudgels in that regard—and could we not show the same verve and enthusiasm in respect of our patients?

We have been very clear about the importance of patient safety, and particularly about making sure that there is proper protection for women. We have a follow-up strategy for some of the allegations made in the report, which is to look in more detail at some of the incidents that have taken place and to ensure that proper local investigations have been undertaken. We can then look at some of the details that my hon. Friend talks about.

On accident and emergency departments, my hon. Friend the Member for Don Valley (Caroline Flint), the Minister with responsibility for public health, issued a consultation recently that was particularly concerned with visitors to accident and emergency departments. However, it was decided not to issue the same kind of consultation regarding mental health patients, for obvious reasons.

Having had a Bill on this subject talked out by the Government as long ago as December 1997, may I ask the Minister what level of compensation—if any—the Government typically pay to a woman mental health in-patient after she has been raped in an in-patient unit as a result of the Government’s broken promises to eliminate mixed-sex wards?

Let me be absolutely clear: the rapes referred to in this report are allegations of rape, and we have been making sure that they are investigated at local level. If rapes had taken place and there was a police investigation, that course would obviously be followed.

Does the Minister share my concern that mental health services are more at risk of reductions in expenditure, where they have to be made, than some other areas of health provision? As she is aware from figures that I gave her yesterday, the strategic health authority in my local area budgeted for a deficit, and it is making my local mental health services pay for that deficit to a degree that has led a local authority officer to suggest that those services are not safe. What action is my hon. Friend taking to ensure—

Order. I must say to the hon. Lady that her question is far too long. Can the Minister try to answer?

We have made it absolutely clear that mental health services should not be asked to pay more than any other trust in a given area; disproportionate sums should not be taken from mental health services. If my hon. Friend has any evidence of more demands being made on mental health than on other areas, I would be more than happy to look into that.

No one who has visited a mental health hospital remotely believes the Minister’s assertion that 99 per cent. of them offer only single-sex wards: a flimsy curtain across a ward does not constitute a single-sex ward. In 2004, the Mind “wardwatch” campaign estimated that in reality, a quarter of mental health wards were still mixed, and we know that the situation has got worse, as many have had to revert to mixed-sex wards owing to deficit pressures. Only after a freedom of information request by Mind was today’s National Patient Safety Agency report published, revealing those 122 reports. There are allegations that those were only the cases that were reported. There was no mention of the cases that went completely unreported.

Is it not a disgrace that the Government sought to suppress the report eight months ago? Why did they do so? How many people have suffered subsequently because of the Government’s complacency and delay? What urgent action are they taking to improve conditions for vulnerable mentally ill patients in future?

Can I be—[Hon. Members: “Absolutely clear?”] Yes, I want to be absolutely clear about what happened to the report. It came to the Department on 16 January. Between that date and 23 May officials worked on the report with the National Patient Safety Agency, examining specific issues, including, for example, whether the allegations of rape had been the subject of a local investigation. It was important that we did not publish information without—particularly with allegations of rape—considering whether there had been a local investigation. That would have put some vulnerable people in an extremely awkward position. We did not want to do that.

We wanted to work on some of the other data analysis to ensure that that material was accurate and that the NHS could learn lessons from it. At the end of May the report came to Ministers, who signed it off on 5 June. Between then and now we have been examining a follow-up strategy, which has now been agreed. This is the response to the question that the hon. Gentleman asked. What are we intending to do with the information—

Hospitals (Surrey)

NHS organisations in Surrey recognise that health services must change and adapt to meet the challenges of the 21st century. The local NHS is therefore looking at how it organises, delivers and uses health care, as part of the creating an NHS fit for the future programme. Any proposals that emerge from the review will be subject to a full public consultation later this year, probably in the autumn.

I thank the Minister for her answer. She will be aware that the Prime Minister visited Frimley Park hospital in my constituency only last month to congratulate the workers of Surrey NHS on the superb service that they deliver. However, only last week primary care trust representatives told me and colleagues from Surrey that there would have to be cuts in all five of our district general hospitals, and that one of those hospitals might have to close. Can we have a guarantee from the Minister that hospitals will not close in Surrey as a result of the Minister’s mismanagement of NHS funding?

I am sure that there are some excellent examples of service in Surrey. The hon. Gentleman is coming to see me next Tuesday, I understand, to talk through some of his concerns. I cannot promise what he asks. It is important that we ensure that hospitals are fit for service. For example, I know that in north Surrey there has already been the relocation from acute to community settings of dermatology services and vascular surgery services. In north Surrey there is a fall service that provides out-of-hospital support for older people, particularly, who fall, with therapists and ambulance services that work together to prevent hospital admissions.

There are different approaches, which I saw in Doncaster on Friday. There are community matrons. Ken and Bill, two of my constituents, each had half a dozen visits to hospital last year. This year, they have not attended hospital. That is the sort of service that we want. We want hospitals that work for the community and services that we hope can keep people out of hospital and enable them to enjoy better health for much longer.

What message does the Minister have for residents of Guildford and south-west Surrey, who met last Thursday to be told that, because of a deficit, the loss of accident and emergency services at the Royal Surrey county hospital is a real possibility? Rather than insulting local NHS managers by saying that the deficit is the result of their incompetence, does the Minister not accept that the root cause of the deficit is her Government’s changes to the funding formula, which systematically discriminates against rural areas with many older people?

However much money the hon. Gentleman’s part of the country has had, it has been overspending for many years. There has been an 11 per cent. rise in admissions to A and E, but up to 80 per cent. of visits are non-urgent or inappropriate. Services will be reviewed to try to find better ways to provide the emergency care that some people need while allowing four out of five patients currently visiting A and E to be treated better and safely in alternative settings.

GP Lists

12. What the average size was of general practitioner practice lists in (a) England and (b) the Northamptonshire Heartlands primary care trust area in each of the last three years. (85850)

For the years 2003 to 2005, the average practice list sizes at 30 September each year were 5,968, 6,149 and 6,250 respectively. For Northampton Heartlands primary care trust the equivalent figures were 8,162, 8,214 and 8,132.

Local GPs in north Northamptonshire should be thanked for doing their best with practitioner lists way above the national average. But with 52,100 new houses set to be built in the area in the next 15 years, will the Minister meet his opposite number in the Department for Communities and Local Government to ensure that practitioner lists do not rise further within the foreseeable future?

There is considerable variation throughout the country in the number of GPs per 100,000 of the population, ranging from 41 in some of the more deprived parts of the country to 83. The number of GPs in the hon. Gentleman’s constituency is less than the national average, but nevertheless it is somewhere around the middle. I pay tribute to GPs in his constituency for providing an excellent service. There are 5,000 more GPs today than there were in 1997, and almost everywhere patients can now see a GP within two working days.

Is my hon. Friend aware that general practices sometimes strike mental health out-patients off their lists because they can become verbally or physically abusive? One can understand that reaction, but sometimes such patients are then allocated another practice 30 or 40 miles away, which is no use to them at all and will not help them to recover their mental health. Will my hon. Friend look into that system to see if we cannot serve such people better, rather than just striking them from a list and sending them miles away?

My hon. Friend rightly draws our attention to some difficult situations. Obviously, GP practices have to take into account considerations such as the safety of staff and the general relationships within their practices. It is the PCT’s responsibility to ensure that everybody has a GP, and it is right that that GP should be as close to the patient’s home as possible. If my hon. Friend has examples where that has not happened, I should be grateful if he would bring them to my attention, but we believe that that is the right policy to have.

Given the increase in the average size of GP lists, how does the Department’s recent invitation through the Official Journal of the European Union—surprisingly drafted in almost exactly the same terms as the one that he embarrassingly had to withdraw just the other day—for private sector bodies to bid for and take over PCT commissioning services and to provide health care services, help to address the problem?

The hon. Gentleman is completely confusing two issues. We are talking here about GP services in communities, not PCT commissioning. He referred to the increase in list sizes, but if he had been listening he would know that the figures that I gave show that in 2005 list sizes were lower than in 2003. The hon. Gentleman is a north-west MP and he has far more doctors per 100,000 than I do in my constituency, which is under-doctored, so I make no apology for bringing in private sector companies that are willing to provide a high-quality, open-hours GP service to parts of the country that have traditionally had poorer access to such services. If he has a problem with that, he should say so.

Mental Health Bill

On 23 March 2006, the Government announced their intention to produce a Bill to amend the Mental Health Act 1983. This Bill will be introduced as soon as parliamentary time allows.

Will the definition of mental disorder remain the same as in the 1983 Act, or will the Secretary of State use the definition that was in the two draft Bills, which would widen the group of people who could be compelled to be treated against their will?

We will take the opportunity offered by the new Bill to replace the definition in the 1983 Act. We will introduce a new and simplified definition of mental disorder, which in turn will be linked to the new supervised community treatment.

Skin Cancer

We are concerned about the number of people being diagnosed with skin cancer, which kills more than 2,000 people each year in England and Wales. SunSmart, the national skin cancer prevention campaign, has been funded by the UK Health Departments. This summer, it is focusing on men and outdoor workers.

I thank my hon. Friend for her response. I welcome the Cancer Research UK SunSmart campaign, which is highlighting the high incidence of cancer among males. There has been a 31 per cent. increase in incidences of cancer in the past decade, and on average 1,000 out of every 1,777 cases of cancer involve males. I urge the health service to promote that message and do the best that it can to raise awareness.

I thank my hon. Friend for that point, which I could not have made better myself. On Monday next week, I am meeting my hon. Friend the Member for Swansea, East (Mrs. James) to discuss how we can control the unsupervised use of tanning beds and coin-operated machines, the use of which by under-16s has caused concern.

G8 Summit

With permission, Mr. Speaker, I want to make a statement about the G8 summit, which took place between 15 and 17 July in St. Petersburg. I pay tribute to President Putin’s chairmanship and the Russian Government’s handling of the summit.

The whole summit was understandably overshadowed by the tragic and terrible events in Israel, Palestine and Lebanon. For days, we have seen the innocent killed by terrorism as a deliberate act by Hezbollah, civilians killed in the course of military retaliation by Israel, and the disintegration of our hopes for stability in this, the most fraught area of dispute in the world.

More than 1,600 rockets and mortars have fallen on northern Israel in an arc from Haifa to Tiberias, deliberately targeting civilians. In Lebanon, more than 230 people have been killed, the vast majority of them civilians. Houses, roads, essential infrastructure, factories and Lebanese army facilities have been damaged. Once again, we urge that account is taken of the humanitarian situation and that military action by Israel is proportionate. We grieve for the innocent Israelis and innocent Lebanese civilians who are dead, for their families that mourn and for their countries that are caught up in the spiral of escalating confrontation.

There are more than 10,000 registered British nationals in Lebanon, and there are probably many more, including a significant number of dual Lebanese-British nationals. We are working as hard and as quickly as we can to ensure that we can evacuate all those who want to leave. Teams of consular, military and medical officials have been deployed to Beirut, Cyprus and Damascus. We evacuated 63 of the most vulnerable British nationals from Beirut by air yesterday, but the safest way to evacuate large numbers of civilians is by sea. We have six ships in the region or heading for the region—the York and the Gloucester are now offshore, and the Illustrious, Bulwark, St. Albans and RFA Victoria Fort are heading there. The first evacuation by ship is taking place today, and further evacuations will follow. The advice to British nationals is to stay put and remain in contact with the British embassy.

We should be in no doubt about the immediate cause of this situation. It started with the kidnap of an Israeli soldier in Gaza and then action by Israel targeting Hamas on the Palestinian side. Then, without provocation, Hezbollah crossed the blue line established by United Nations resolutions, killed eight Israeli soldiers and kidnapped two more. Israel then again retaliated with air strikes against targets in Beirut. This situation therefore began with acts of extremism by militant groups that were, as the G8 said unanimously, without any justification and were, of course, designed to provoke the very response that followed.

In the communiqué issued by the G8, we refer to and condemn the activities of the extremist groups and, more elliptically, as we say, “those that support them”. For most of us at the G8, we can be less elliptical. Hezbollah is supported by Iran and Syria: by the former in weapons, which incidentally are very similar, if not identical, to those used against British troops in Basra, by the latter, in many different ways; and by both of them financially.

What is at stake therefore could not be more stark. On the one side, there is Lebanon, a remarkable democratic achievement from the days when Lebanon was a by-word for instability and conflict. I have once again given Prime Minister Siniora my solidarity and support in the immense difficulties he now faces. There are also of course those in Israel and in Palestine desperate to see progress towards the only solution that will ever work there, namely, two states—Israel and Palestine, both democratic, both independent and both at peace. But on the other side are those who want no compromise and who cannot see that terrorism is not the route to a solution, but a malign, fundamental obstacle to it. They persist in terrorism, knowing that its impact there is the same the world over—to divide, to create hatred and to drive out negotiation. That is the purpose of it.

So what can be done? I know that many wanted the G8 to call for an immediate ceasefire by Israel. Of course, we all want all violence to stop, and to stop immediately, but we recognise that the only realistic way to achieve such a ceasefire is to address the underlying reasons why this violence has broken out.

In respect of Lebanon, the G8 proposed rapid work on inserting an international security presence in southern Lebanon to stabilise the situation, to ensure that the terrorism from the Lebanese side ends and, most importantly, to provide conditions in which the Lebanese armed forces can take control and assist them in doing so. Meanwhile, the United Nations Secretary-General’s special envoys are in the region and will report to the Security Council later this week. We welcome these and other efforts to calm the situation.

We also encouraged dialogue between the Lebanese and Israeli Governments, and we pledged at the G8 further economic support to Lebanon. And, of course, we demanded the return of the kidnapped Israeli soldiers. Only in that way can United Nations Security resolutions 1559 and 1680 in respect of Lebanon be implemented.

On Gaza, we made it clear that our goal was an immediate end to the violence, and again we put forward the measures necessary—release of the Israeli soldiers and of the Palestinian Ministers and parliamentarians; an end to attacks on Israel; resumption of security co-operation between Israel and Palestine; restarting political contacts between Israeli and Palestinian officials; and an end to Israeli military operations and the withdrawal of Israeli forces.

However, let us be plain. We can and must stabilise the existing situation in Lebanon and in Gaza. We must then use such stabilisation to help Lebanon rebuild and eventually to re-begin negotiations between Israel and Palestine. But at root, we need to recognise the fundamental nature of the struggle in this region, which has far-reaching consequence—consequences far beyond that region and consequences even in countries such as our own. All over the middle east, there are those who want to modernise their nations and who believe, as we do, in democracy and liberty and tolerance, but ranged against them are extremists who believe the opposite—who believe in fundamentalist states and are at war not against Israel’s actions, but against its existence. In virtually every country of the region, including on the streets of Baghdad, such a struggle is being played out. When this current crisis abates, that is the issue to which we must return, in the way that the G8 outlined two years ago but has not so far put fully into effect.

Let me turn to the other issues that were raised at the G8. On Africa, we made modest but important progress in taking forward the commitments of last year, including: scaling up action on HIV/AIDS through replenishing the global fund in 2006 and 2007; new initiatives on vaccines for malaria and pneumococcus; and fully funding the education fast-track initiative. We agreed to review progress on Africa again at the G8 summit in 2007. I have asked the International Development Secretary to set out the key milestones for the coming 12 months in his next report to Parliament. Those will include, for us, supporting 10 African countries, developing long-term education plans and getting the debts cancelled for five more African countries. Kofi Annan will also convene the Africa progress panel to monitor progress on the commitments given.

I also discussed Sudan with several G8 leaders and Kofi Annan. We agreed that the situation in Darfur continues to be unacceptable and that we need a quick deployment of the UN force.

On trade, at the final session it was at last agreed by all to empower their negotiators to go further. The cost of the failure of that trade round for the world’s poor, global growth and multilateralism would be high. Presidents Bush, Barroso, Lula and Mbeki, Chancellor Merkel and Prime Minister Singh of India all agreed to show flexibility. Pascal Lamy has been tasked immediately with convening trade negotiators to turn that clear commitment into action, which must deliver real cuts in agricultural tariffs and subsidies and progress on non-agricultural market access. I do not minimise the substantial obstacles that remain, but at least the renewed commitment from the United States, the European Union and the G20 countries was immensely welcome. We also agreed a strong package for poor countries, including $4 billion a year aid for trade and action on rules of origin. We remain fully committed to ensuring that, in any event, it would be utterly wrong for there to be no agreement in this round on a full development package for the poorest nations.

There was also a fascinating debate on energy—of direct relevance to this country—at the summit. There was virtual consensus, in fact, on the following matters: first, energy prices will continue to rise, with a predicted increase of about 50 per cent. in energy demand by 2030. Secondly, climate change is now universally accepted as happening, including by the United States, and there is therefore an urgent necessity to make future economic growth sustainable. Thirdly, countries will need to have balanced energy policies, in which clean coal technology, carbon sequestration, renewables and nuclear power have to play a part. Our energy review was therefore absolutely in line with that consensus.

On nuclear, it was interesting to note the statement by China that it intends to develop nuclear power, by India that it regarded it as indispensable, and by many of the main oil producers, including Kazakhstan, that they would balance their reliance on their oil and gas with nuclear. That was also the conclusion of the J8—the young people from around the world who debated the issue.

The G8 also agreed on the need to accelerate discussions on an inclusive dialogue for a post-2012 climate change framework and, importantly, that that framework should include the United States, China and India. The G8 supported the need for a goal to stabilise greenhouse gas concentrations. The Gleneagles dialogue meeting in Mexico will be the next step in taking that work forward. Finally, we agreed several other texts, which have been placed in the Library.

The summit was held in circumstances that none of us could have foreseen. It was obviously dominated by the middle east. However, its conclusions on Africa, trade and energy will, I hope, stand the test of time. I commend the conclusions to the House.

I thank the Prime Minister for his statement. It is a deeply troubling time. The citizens of Israel and Lebanon are suffering, many British citizens are caught up in the conflict and there is a real danger that the conflict will escalate. Everyone has been watching as the world’s most powerful leaders met in St. Petersburg while a vital region descended into war. They want and expect concerted action.

The Prime Minister spoke in his statement about creating the conditions for implementing a ceasefire. He is right that they must include the release of Israeli hostages, the end of rocket attacks on Israel and a future for Lebanon without armed militias. Is not it the case that we will achieve lasting peace only by addressing the underlying causes of the crisis? I have some questions about the immediate crisis and the longer-term issues, and wider questions about progress on the Gleneagles agenda.

The Prime Minister spoke about the differing emphasis in the G8 and the varying degrees of ellipticality, if I may put it like that. Despite that, will there be an intense, co-ordinated and powerful effort to bring about a resolution to the crisis in the coming days? We know that the Prime Minister is considering visiting the middle east. What part will he play in the process and how will it fit in with the role of other countries? He mentioned a UN force to act as a security presence. Can he tell us what its mandate would be, which countries have, so far, shown willingness to contribute and, given John Bolton’s remarks, does it have the full support of the United States?

Stability requires the Lebanese Government to exercise full control over their country and to disband the militias. Does not that mean that United Nations Security Council resolution 1559 needs to be implemented in full? As the Prime Minister said, it is now clear for all to see that the involvement of Iran and Syria in Hamas and Hezbollah is deeply destructive and needs to be addressed.

The whole House will be concerned about the safety of British citizens in the middle east. The Minister for the Middle East, the hon. Member for Pontypridd (Dr. Howells), said yesterday that this was potentially the biggest British evacuation since Dunkirk. What clear advice is being given to British citizens? Will the Prime Minister tell us what arrangements have been put in place to ensure that the Ministry of Defence and the Foreign Office work together as one in a co-ordinated way? The Prime Minister mentioned the warships that have been sent to the eastern Mediterranean. Is he confident that there is sufficient capacity to evacuate everyone for whom we are responsible and to accommodate them in Cyprus?

Tackling the long-term causes will involve restarting the road map, tackling Iran’s nuclear ambitions and ending Syrian involvement in Lebanon. The US has offered to have direct talks with Iran, should enrichment activity be fully suspended. Does the Prime Minister agree that there is no longer any excuse for Iranian intransigence? With these significant developments in this strategically vital part of the world, and with so many British citizens—constituents of ours—caught up in the crisis, does the Prime Minister agree that we need a full-scale foreign affairs debate before Parliament rises for the summer recess?

On Gleneagles, I welcome what the Prime Minister said about the progress that has been made over the past year. On the target for HIV treatments by 2010, it is vital that interim targets be set, as we suggested. Were those targets backed specifically by the G8? A successful trade round will do more than anything to alleviate poverty. The Prime Minister said that, at the end of the G8, leaders were empowered to show flexibility. Should we be concerned that the list of leaders that he read out did not include President Chirac of France?

Time is running out. Is not this one of those moments that represents a genuine test for the G8, for the short and long term? There is a vital need for a trade deal, and today, as hundreds of innocent civilians are dying in Israel and Lebanon and thousands of British citizens remain trapped in the conflict, is there not an urgent need for concerted action to deal with the crisis?

I agree in essence with what the right hon. Gentleman has said. Let me just respond to some of the points that he raised. First, there will of course be an intense effort at Thursday’s meeting of the United Nations Security Council to talk about this issue. The question of a stabilisation force or a security presence will be debated there. That proposal was supported by all the G8 countries. Of course, it will take time to build up such a force, and we will need the circumstances to be conducive to its going into southern Lebanon. I have said constantly over the past few days that even if we manage to stabilise the existing situation and to calm it down, there will still be a risk of a recrudescence of what has happened recently unless a force is put in there. If we are able to stabilise the situation, it will be important that we put in place mechanisms that will allow Lebanon to take more control of its own future.

That leads me to the important point that the United Nations Security Council resolution 1559 in respect of Lebanon was passed 20 months ago. People sometimes forget that. It called for the disbanding of all the militias in southern Lebanon and for an end to all the support being given to them. It also called for the Lebanese forces to be able to take control of the whole country. So it is not as though we have never been able to predict the possibility of such circumstances arising. It is therefore important to recognise that we will have to ensure that that resolution is implemented. It will be very difficult to do that, however, given the state of the Lebanese Government and the Lebanese nation at the present time.

That leads me on to the next point, which has to do with Iran and Syria as they effectively support Hezbollah, financially and with weapons. That is why we will of course keep up the diplomatic pressure on Iran to comply with its international obligations, and we urge Syria to take the action that it could take in relation to Hezbollah if it wanted to do so.

We believe that by the end of the week, as the Minister of State at the Ministry of Defence said, we can evacuate about 5,000 British citizens and dual nationals. The first ship is docking today; another ship will take even more people tomorrow, and we are making progress on that as rapidly as possible.

We did agree again with the G8 targets on Africa and, yes, I did choose reasonably carefully those people I listed as being in favour of flexibility at the World Trade Organisation. It is important to recognise that each of the main actors has to determine their position by reference to somebody else: President Bush makes reference to Congress; the G20 nations meet as a collective; Brazil and India cannot simply take the decision on their own; and, of course, the European Union has its own procedures and has to agree a position. What was good was the virtually unanimous view around the table that we need to make progress at the WTO, and a very strong statement from the UN Secretary-General to that effect. It was very much as a result of what was said by us and other countries that Pascal Lamy was able to attend the summit. I hope that the talks will make progress. If they do not, it will be a very great failure, and the right hon. Gentleman is right to imply that such a failure is the last thing we need at this moment. We need to show multilateral institutions succeeding, and it is for that reason, among many others, that I hope that the WTO talks succeed.

It is clear that there was much constructive work done at the G8 in relation to Africa, the Doha round and energy, but it was inevitable, as today has already demonstrated, that the concentration would be on the middle east. We can agree that the recent events constitute a threat to the stability of the whole region. We can also agree that we will be able to rely on the professionalism of our armed forces to effect the necessary evacuation of British citizens. However, will the Government, on Thursday in New York, press for the Security Council to call for an unconditional and immediate ceasefire? How will it be possible to insert an international force unless there is a ceasefire? Such a force could hardly fight its way in.

We must all accept that the indiscriminate firing of rockets and missiles into Israel by Hezbollah is unacceptable, but so too is the targeted and systematic destruction of the infrastructure of Lebanon. What would happen if the Lebanese Government, already weakened, were to fall? What, indeed, will happen if the prediction of the Israeli Chief of Staff—that Lebanon will go back to what it was 20 years ago—comes about? Who will fill the vacuum that will be caused as a result? How will that be in the interests of long-term stability and peace in the region?

We must all accept that Israel has a moral and a legal right to live in peace within recognised and secure borders, but does the Prime Minister accept that that right does not legitimise action that is disproportionate and amounts to collective punishment, both in Lebanon and in Gaza?

I agree that we want a ceasefire and an end to hostilities, but that will happen only if it happens on all sides. As I said in my statement, it is important that action by Israel is proportionate, but we have to understand how this began and the underlying reasons for its beginning. Those reasons are that there are groups that have decided to take these steps at this moment. They are completely disregarding the welfare of Lebanon and, indeed, of Palestinians in Gaza. They have decided to take action that means that Israel will, of course, defend itself because, as the right hon. and learned Gentleman rightly says, it has a moral and legal right to do so.

The only way that we are going to get a solution—because whatever our nuances, we are all essentially in the same place—is, first, to put in place a strategy to calm the situation, and secondly, to deal with those deep underlying causes. That is why it is important to discuss the stabilisation force. It cannot, of course, fight its way in, but if we end up with the conditions negotiated for a cessation of hostilities, we at least need to consider having some sort of buffer force between Lebanon and Israel to allow us to create a situation in which the same problem does not break out again.

In the end, it depends on what one believes about why this happened. One can take two views. One can take the view that it was a spontaneous occurrence as a result of what was happening in Gaza. Alternatively, one can take the view, as I am afraid I do, that it was not spontaneous, but was a deliberate act of strategy to ensure that the conflict was widened. If one takes the latter view, that means that those who began the conflict in Lebanon will not give up easily. Israel will defend itself, and it is therefore important for the international community to find the means of enforcing a cessation of hostilities on both sides. We can rest assured that unless the Israeli soldiers are released and the rockets—1,500 of which have come over to the Israeli side—are stopped, Israel will carry on defending itself. A cessation of hostilities is needed on both sides, and measures need to be taken to try to prevent this from happening again while we work on the underlying problems in that region, which, increasingly in my view, are directly connected in an arc from Iran right across the middle east.

My right hon. Friend the Prime Minister referred to the need for an international security presence. He knows that there has been an international presence in Lebanon for many years. Can he clarify the implication of the current proposal? Will any force be under the United Nations? Will it be under chapter VI or chapter VII? How will it be deployed, and under what rules of engagement? Can he also emphasise what is being done to ensure that the conflict is not widened, which is a great danger? He has referred to Syria and Iran and their support for Hezbollah. What is being done by the G8 to ensure that Syria does not get involved and that the conflagration does not widen throughout the whole region?

As my hon. Friend rightly implies, we must put every pressure on Syria. In a sense, the most important point is that the conflict has already been widened—that was the purpose of the incursion into northern Israel. It is therefore important to ensure that we now back off the situation. He is right that the United Nations interim force in Lebanon, which is about 1,600 to 1,800 strong, has been there for many years. If we put in a stabilisation force, it must be of a different order of magnitude, with a proper chapter VII resolution and with serious rules of engagement. Those matters will be discussed over the days and no doubt weeks to come, and if there is a better idea I would like to hear it. However, I do not see how we get this stopped and remove the danger of it starting again unless some objective measure is taken, by way of force, to prevent Hezbollah beginning such action again when those behind it decide that it is strategically advantageous to do so.

The Prime Minister failed to respond to the Leader of the Opposition’s request for an urgent debate on the middle east. Will he now confirm that that debate will take place, because our constituents will not understand if the House rises next week without such a debate?

The only reason why I did not do so is that, obviously, that discussion should take place between the usual channels. I hear what the right hon. Gentleman says, however, and I understand its importance.

Does my right hon. Friend agree that the most ominous aspect of the current crisis is Iranian and Syrian support for the terrorist organisations, Hezbollah and Hamas, which are both pledged to destroy Israel? Does he agree that it is proportionate for Israel to defend itself against unwarranted aggression from organisations that pledge that country’s destruction?

Of course it is important for Israel to defend itself, and I am sure my hon. Friend agrees that it should do so in a proportionate way that minimises the dangers of civilian casualties. She is, however, right to say that the root of the problem is support for groups that do not want a peaceful solution to the problems of the region. The tragedy of the situation is that Lebanon has made so much progress over the past few years, and now that progress is being put at risk—but it is being put at risk as a result of a deliberate strategy to destabilise the country.

During his rather charmingly self-depreciative luncheon conversation with President Bush at St. Petersburg about Syria and sweaters, did the Prime Minister—after he had switched off the microphone—make any attempt to explain to the President that one of the root causes of the spread of chaos in the middle east has been the failure, over 40 years, of successive American Administrations to persuade Israel to accept United Nations resolution 242, which requires it to return to its legal frontiers of 1967? That failure has caused an inevitable degree of bitterness, which has led to the creation and sustaining of various guerrilla militias which are now increasingly regarded as part of an Islamic jihad.

If it were merely that the cause of all this was the failure to abide by resolution 242, which we support—but there must be a better explanation for the rejection of the agreement that President Clinton reached with the Israeli Prime Minister at the time, Prime Minister Barak, and the offer that was made to the Palestinian Authority then. There must be a better explanation for what happened with the road map, which provides a perfectly sensible way through this. We had to battle very hard to get America and Israel to agree to the road map, but the defaulting in respect of that was not on the Israeli side. There must be a better explanation as to why it cannot now be agreed on the Palestinian side that if there is to be a two-state solution, that means recognising Israel’s right to exist.

I do not say that mistakes have not been made in relation to this, through America, through ourselves, and through others over the years, but I think that the issue is now far more fundamental. The fact is that America would take this forward and deliver a two-state solution for the Palestinian people—I am sure of that—if we could secure the simple acceptance that only through non-violent, democratic negotiation can such a solution be found.

Of course Israel has the right to self-defence against terrorism, but surely what is going on now in Lebanon and Gaza goes far beyond any legitimate self-defence. Must not the world community make it clear that if it is unacceptable, as it obviously is, for Hezbollah and Hamas to fire rockets at civilian targets in Israel, it is also unacceptable for Israel to target civilians and civilian infrastructure in Lebanon? The world must say that clearly, or it will encourage those in Israel and those on the other side of the conflict who want to provoke further action leading to further military conflict on a wider scale throughout the region.

I understand my hon. Friend’s concern that the reaction of Israel has been disproportionate. It is a difficult situation. We can imagine how it would be in our own democracy if we were faced with such a situation—if our own citizens were being killed through hostile action. Hundreds of thousands of Israelis are now in shelter, having been evacuated from their homes, and their soldiers have been killed in such a brutal way.

I do not want to repeat myself, but there is only one way in which we can change the situation. People can go this way or that in terms of whom they wish to condemn, but, as I know my hon. Friend would accept, this began with an unprovoked attack by Hezbollah on Israel, and I do not think that one can really be surprised at the response.

May I switch the subject to what was a backdrop to the G8 summit—the position of President Putin and his attitude to the use of energy almost as a weapon of diplomacy? Did the Prime Minister have time to talk to President Putin about what is going on in Russia, and about what Russia’s ambitions are in the “near area”, as he calls it? That is particularly relevant, given that the need for this country to invest in nuclear power is partly due to our need for a sense of assurance about our sources of energy, because of the threat that Russia may one day use our need for energy against us.

We did discuss that, and the Russians gave a clear assurance that they would abide by the charter on energy that we drew up and promulgated at the summit. I expressed my view, as I always do, that the only way to make progress in Russia or elsewhere is by adherence to democratic principles. To be fair, the Russian President made it very clear that he understands people’s anxieties about security of supply, which was the reason why he felt it right to adopt and agree to the charter that we all signed. The hon. Gentleman is right that one of the reasons why it is so important to have a balanced energy policy is to ensure that we are not too reliant on any one source.

Does my right hon. Friend agree that the ongoing escalation of violence over the last eight years has continued because of the targeted nature of the Israeli response to the extreme groups within Gaza, Palestine and Lebanon, which deliberately attempts to inflame the situation? The unprecedented response of the Israelis, involving the killing of children and civilians and the targeting of infrastructure, is an attempt to weaken the forces of the Palestinian Authority and the Lebanese army and there is no way that that will support their cause. I support the idea of having an international stabilisation force, not just in Lebanon, but in Gaza and Palestine, in order to cessate the forces that are continually launching attacks on Israel and to secure the necessary protection.

Order. We must have just one supplementary question; otherwise, it is unfair to other hon. Members.

I would simply say that I entirely understand my hon. Friend’s concern, but the trouble is that, in the end, the purpose of terrorism is to provoke retaliation, which then provokes further bloodshed and misery. That is why we have to go back to the root cause of the terrorism.

Would the Prime Minister accept that I strongly believe that it would be a great mistake to try to beef up UNIFIL? Such an international force would have to be very substantial if it were to command the ground; otherwise it would be basebound, in fear of its life against Hezbollah suicide bombers—they saw off MNF-II in 1983 and would do it again. I agree with the Prime Minister’s analysis, but I urge him to acknowledge that what matters most is to get the two-state talks going again and fully to engage the United States of America and the European Union together towards that end. After all, it was the Americans and the French who saw off the Syrians. This is not a lost cause and I urge the Prime Minister to proceed with all possible speed.

Essentially, I agree with what the hon. Gentleman is saying. I agree in respect of UNIFIL that it would have to be a completely different type of force, but its purpose would be to provide security for the time that it takes for the Lebanese forces to come down. After all, that was what was supposed to happen with resolution 1559: the militias were supposed to be cleared out and the Lebanese forces were supposed to come in. The truth is that that has never happened.

May I associate myself with my right hon. Friend’s remarks on the middle east crisis, which clearly overshadowed the summit, and particularly on the need for a proportionate response? I also thank him for his positive response to the statement from the G8 plus 5 group of legislators organised by GLOBE UK, the Global Legislators’ Organisation for a Balanced Environment. I congratulate the Prime Minister on his success in including some of those objectives, such as the need to stabilise greenhouse gas emissions and the need for an inclusive framework, but can he assure me that the other G8 leaders recognise the other aspect of the statement—the urgency of the need to tackle climate change and the question whether Germany will continue that process under its presidency?

I thank my hon. Friend for his work in that area. Had it not been for the fact that the middle east so much overshadowed the summit, I would have spent quite a long time on the energy conclusions, which are—as he says—interesting and positive. There is an agreement to take the G8 plus 5 dialogue forward. There is also an agreement to ensure that we have a framework that stabilises greenhouse gas emissions and the US has also signed up to that. Round the table, it was interesting that every single person accepted the urgency of the issue and the need to develop the right framework very quickly to make progress, so that the private sector in particular, but also countries, are incentivised to develop the science and technology necessary to deal with it. Again, I thank my hon. Friend for his input into that.

The Prime Minister very fairly said that progress on Africa was modest. With regard to the G8 sanctioning initiatives to fight HIV/AIDS in Africa, when shall we have practical decisions and not just declarations on the Global Fund to Fight AIDS, Tuberculosis and Malaria and the urgently needed programmes to bring education to the 100 million poor children in Africa?

Actually, substantial sums of money have been pledged to the global health fund—hundreds of millions, if not several billion dollars. In respect of malaria, a plan is in place and the funding is being built up for it. Education is an important part of the discussion and this country has pledged £8.5 billion over the next 10 years for education in the poorest parts of the world in Africa. Although there is a lot more to do on education, there was a very strong recommitment to the funding and the principles of action that were set out at Gleneagles last year.

Could my right hon. Friend say a little more about his talks on the security of energy supply? He predicts an increase in energy demand of 50 per cent. by 2030, but given that we need to ensure, in our national interests, that we have security of supply, does he think that our energy review has paid sufficient attention to how much energy we will need to produce in our own country?

That is a very good point. Although we have pushed this to its furthest extent on renewables, energy efficiency and replacing nuclear power stations, my hon. Friend is right in that we will go from virtual self-sufficiency in oil and gas to 80 to 90 per cent. dependency on imports. A third of our generating capacity will close in the next 15 or 20 years and energy prices are set to rise. But that is the most that we believe we can achieve in this energy review at present. In years to come, people will have to look at how they can drive the process even faster forward.

May I return the Prime Minister to what, in conversation with President Bush, he referred to as “the trade thingy” and, in particular, the serious situation facing the Doha trade liberalisation round? As we do not have our own trade policy in this country, will he talk urgently to Commissioner Mandelson, who does control our trade policy, and ask him to face down the forces of protectionism in Europe and table a more generous offer? The price of failure will not be paid by us or other member states, but by the poorest people in the poorest countries in the world.

At the risk of shocking us both, I agree with the right hon. Gentleman on that. I would point out only that the statement made by Commissioner Mandelson was very strong on that point. If a whole series of fresh offers are laid on the table, there will definitely be a battle in many different parts of the world over whether they can be implemented. It is worth pointing out that everything that is on the table at the moment is conditional on everything else being agreed. But if people even did what they have offered now, this trade round would be two or three times more effective than the last trade round. The trouble is that until everything is agreed, nothing is agreed. That is the purpose of the more generous offers.

As deadly violence again convulses the middle east, is the lesson for that region that peoples will find stability not in being secure against each other, but in being secure with each other, including against terrorism? The Prime Minister has been less elliptical about Syria and Iran: can he also be less elliptical about the proportionality of Israel’s offensive response? Can he also be less elliptical about the prospects for trade justice? Does the statement that

“we remain fully committed to ensuring that in any event it would be utterly wrong for there not to be a full development package for the poorest”

mean that there will definitely be such a package? If so, of what order and in what time scale?

I accept the implied rebuke of my syntax. The answer is that I think—it has to be agreed—that there will be, in any event, an agreement on a development package. We have a far better chance of getting a development package if there is an overall agreement on the trade round. My hon. Friend, from the process in which he is engaged, will find it interesting to think that 10 years ago, it looked as though the Palestinian peace process was in better shape than that in Northern Ireland. The lesson of the last 10 years is that, unless people are put into a process that ensures continual dialogue, the danger is that the extremes take over, because there is a political vacuum there.

Accepting entirely the good sense of the G8 statement on the middle east and both what the Prime Minister said today and what the Minister for the Middle East so admirably said yesterday, will the Prime Minister tell the House precisely what the United Kingdom and the United States are doing to bring home this message in Tehran, in Damascus and, on the subject of disproportionality, in Jerusalem?

We are doing absolutely everything that we can in the contacts that we have had with the Israeli Government—myself with the Prime Minister—and obviously with the other Governments in the region. In respect of Iran, as well, it is partly, I would say, as a result of the efforts of this country that we can put before Iran, and in a sense flush out a response, a very sensible and generous offer by the international community—plus the offer by the United States of America, for the first time in 20 years, that it would talk directly to the Iranians. All that has come about in part because of the efforts of this country. My belief is that the only ultimate security in that region is the spread of democracy and liberty. When that happens, we will find that, as I am sure would happen if the Iranians were given a proper free election, there would be perfectly sensible people who would govern their country and who would want to live in peace with their neighbours.

When it comes to the middle east, does not the international community also need to examine its own conscience somewhat? We rightly required Israel to withdraw from southern Lebanon, but then we failed to provide the policing resources to make sure that there was a secure border there. We failed to stand up as an international community to Israeli land grabs and we failed to make sure that Iran and Syria stopped supplying Hezbollah. We failed to provide an honest broker in the international community. Is it not time that we put the United Nations fairly and squarely in the driving seat, rather than messing around with other organisations, and is it not time to make sure that we get a proper policing force not only into southern Lebanon, but into Gaza?

What my hon. Friend says is very fair and very right. I was just looking at resolution 1559, passed almost two years ago in September 2004, which said that the UN was:

“Gravely concerned at the continued presence of armed militias in Lebanon”.

It called for

“the disbanding and disarmament of all Lebanese and non-Lebanese militias”,

and supported

“the extension of the control of the Government of Lebanon over all Lebanese territory”.

That was after the withdrawal in the year 2000. He is absolutely right: the fact is that we did not commit significant enough resources to make sure that that was implemented.

Returning to energy, what confidence can we have in the ability of political leaders to predict that energy prices will continue to rise for the next 25 years, and to base their policies on that, when exactly the same prediction made 25 years ago in response to the last energy shock proved to be comprehensively wrong?

I think that what we can say with certainty is that there is no certainty for the future. However—[Interruption.] Well, just consider what would happen if the prediction was right, which must at least be a possibility. If we actually had a 50 per cent. increase in demand by 2030, people would look askance at the policy makers today—since we need to provide for the long term—if we failed at least to take the right precautionary measures to make sure that we had a balanced energy supply. That is what I am saying. What is different between the prediction now and that of 30 years ago is that it is now certain that China and India will consume a far larger part of the world’s energy supply. What is not certain is the way in which the world might deal with that. The growth of China and India is driving the current situation, and it will continue to do so.

I welcome the comments that the Prime Minister made a few moments ago about the regime in Iran and the need for democracy there. We should bear in mind his carefully crafted and measured remarks in paragraph 6 of his statement. He drew the House’s attention to the fact that Hezbollah is getting weapons from Iran. He also said that by an amazing coincidence, the same weapons are being used against our troops in Basra. He needs to amplify that point. Does he agree that although we recognise the delicate nature of the situation and its gravity, some of us feel that we have been too soft on Iran and have not said what we mean, and meant what we say, and accused it of being the arch-exporter of terrorism?

My hon. Friend is right that there is no doubt at all that it is supporting terrorist activity around the region, which is precisely one of the reasons why people are extremely alarmed by the prospect of a nuclear Iran. I have heard several people say in the past few days that if Iran is prepared to encourage and support action that destabilises a region such as Lebanon, think how much more dangerous it would be if we had Iran with a nuclear weapon.

What action is the United Nations immediately taking to try to get parties around the table to bring this awful violence to an end in the middle east? Is its plan to exclude or include representatives of the terrorist groups in such talks?

The UN envoys are out in the region now. I am not answering questions for them, and to whom they talk is up to them, but I would imagine that they would talk to representatives of everyone there, including Hezbollah. However the parties come around the table, it is perfectly obvious that the only solution is to rewind the things that have happened, including by ensuring that the soldiers are released and the rocket attacks are stopped. Rocket and mortar attacks of more than 1,500 or 1,600 represent a substantial bombardment on any basis.

While I agree with much of what the Prime Minister says, especially about the release of the Israeli soldiers and an end to all attacks on civilians, does he understand that given the history of bloody-mindedness on both sides in the middle east and our own heavy commitments in Iraq and Afghanistan, there is no public support in this country for this country to be involved in any extended conflict with Iran and Syria?

My hon. Friend said that he agreed with much of what I said, which I shall accept gratefully. No one wants conflict with Iran or Syria. The problem is raised in a very acute way by the offer that has been made by the European Three—France, Germany and the UK—and America, Russia and China. We have put forward an offer to Iran that essentially protects its ability to develop civil nuclear power but restrains its ability to develop a nuclear weapon. The offer is on the table. It could talk to America and the whole of the relationship could be changed. The problem is that I remember being told time after time, “If only we got America to talk to us, things would be different,” but it is done, and then things are not different. At some point one must ask whether there is sincerity on Iran’s part or not. There is no plan whatever to take such action against Iran. I am willing to consider any form of diplomacy that brings about a change, but if there is not some give on the Iranian part at some point, we are left with some fairly stark choices.

Could the Prime Minister develop his answer to that question and to the question by the hon. Member for Thurrock (Andrew Mackinlay)? He said that he had spoken to many people at the G8, pointing out how dangerous, given Iran’s actions in support of Hezbollah, a nuclear Iran would be. Did he detect at the G8 summit greater resolution on the part of all his colleagues on the international stage to bring Iran to the table and force a resolution to that nuclear crisis?

I did notice that. The fact that the G8 statement was agreed, albeit in elliptical terms, made it clear that we were sure about where this began. That was an important step forward in itself. As for Iran, time and again it must be reminded of the fact that the world has no aggressive intent towards it, but if it exports aggression, it is very hard for us not to confront that reality. Underneath it is the wider issue that I have talked about, but the fact that the G8 statement was agreed and that the G8 plus 5 in effect endorsed it was significant.

I wonder whether my right hon. Friend would agree that if there is to be long-term stability in the middle east, something that must change is the position of Lebanon. That state has been enfeebled by its neighbours, Syria and Israel, for their own misguided purposes, which prevents a long-term solution. What can be done to strengthen the Government in Beirut to make sure that Lebanon can deal with the problem of Hezbollah?

The point that my right hon. Friend is making is exactly the reason for resolution 1559. The only way, in the end, in which a state makes sure that it is in charge is for it to be in charge of force within the country. The problem is that Hezbollah militias are a constant thorn in the side of Lebanon, preventing that situation from being realised, which is why the resolution was passed. This time, we must make sure that it is implemented.

The Prime Minister has made some unequivocal statements this afternoon about Syria. Is he contemplating the recall of our ambassador to London for consultation, and will he use his much improved relations with the regime in Libya to urge Colonel Gaddafi to use his influence on Hezbollah to rein in its forces?

We have no plans to recall our ambassador, but yes, we are using our relationships with all the different Arab countries to make sure that pressure is put on Syria and Iran. It was interesting to see the statements that emanated from Saudi Arabia, Jordan and other countries, including, I think, Egypt, as they were surprisingly firm in their intent towards what those two countries are doing.

There is no doubt that the present crisis started with the illegal kidnap of one Israeli soldier, but many Members on both sides of the House believe that the Israeli response, which took out electric and water supplies for tens of thousands of people in Gaza, was an act of disproportionality that led events to spiral out of control. The Palestinian Authority is not in a position readily to restore those services, so can my right hon. Friend talk to President Abbas about ways in which we could help to restore electricity and water supplies, as their absence endangers the health and lives of many thousands of people? Can we redouble our political commitment to ensure that those supplies are never destroyed again?

Of course, we put a big reconstruction effort into the Palestinian Authority. My hon. Friend is right to say that it is terrible when infrastructure is destroyed in that way. The problem in the end is that when the disengagement from Gaza took place, my idea—others had it too—was that the international community would move in behind a Palestinian Authority that was growing in effectiveness, with increasing control over its own security forces, thus creating the conditions in which private investment could be made. Indeed, a series of people were lined up, waiting to go in and invest. It is not what happened. Once the immediate situation calms, we must go back and work out with the Palestinian Authority a proper plan that allows that Authority to take charge of its own destiny. Rather as with Lebanon but on a much greater scale, there are people who are operating outside the proper control of the authority, whose purpose is often to disrupt the very progress that we want to make.

The Prime Minister said that there would be a review of progress on Africa at the G8 summit in 2007. Can we make it clear to our G8 colleagues that the test of progress in 2007 is the extent to which G8 members have delivered on the promises that they made at Gleneagles in 2005? Unless we hold to that process, the danger is that after the modest indications at this summit, Africa will slip off the agenda altogether?

Obviously that is a danger, but I do not think it will happen. Germany has made it clear that for next year’s summit Africa will be a major topic, and Germany will review the progress again. We will set out the milestones for the next year. There is sufficient strength in civic society for us to keep people up to the mark, and we intend to use all our efforts to do so.

I will be brief. Twenty years after Chernobyl, was there any discussion of the report of the nuclear safety and security group, and what conclusions did the leaders reach?

Yes, in the conclusions there is discussion about nuclear safety and what can be done in relation to it. It was agreed that we need to co-operate not just on safety, but on the decommissioning of nuclear waste and the development of the new generation of nuclear power stations.

Given that much sympathy has been expressed for the Government of Lebanon as being helpless to control Hezbollah, does the Prime Minister have any indication that the Government of Lebanon have asked for assistance from the international community to help them to do so?

I have spoken to the Prime Minister of Lebanon. I think Lebanon is looking for international help. The precise way in which that is used and the implications for its own armed forces are matters for debate. I believe the Prime Minister of Lebanon wants to do the right thing. The people around him are desperate for some stability in their country and they feel very angry that they are caught in the present situation. We should be helping them in any way we can.

I welcome the news about the education for Africa initiative. On the middle east, we learned yesterday that the intention of Israel is to create an unmanned buffer zone in southern Lebanon. Will that do anything other than bring more problems to that region? Will my right hon. Friend please make a case for not doing that?

My hon. Friend’s comments underline the need at least to debate seriously the idea of an international force there.

Members across the House will welcome the report from the Prime Minister that the G8 recognise the need for a goal to help stabilise climate change emissions. Can the Prime Minister give us some idea when he hopes that will be concluded—he mentioned that progress would go ahead in Mexico—and what type of goal he would like to see?

The goal should be a stabilisation of the world’s climate and temperature. I do not know how far the G8 plus 5 dialogue in Mexico will move us forward, but there is now agreement in principle that such a framework should be developed.

I agree with my right hon. Friend that there is neither excuse nor justification for rocket attacks, whether on Ashkelon or Haifa, but I find his comment that Israel has not defaulted on its road map obligations astonishing. Surely he is aware that long before Hamas was elected, and while Hamas was on ceasefire for the best part of a year, Israel was building a wall in Palestinian territory and expanding illegal settlements. What is that, if not defaulting on its road map obligations?

I understand exactly why my hon. Friend says that, but the whole purpose of the road map was to create a series of mutual obligations. On settlements, he is absolutely right and we have made our position clear on them all the time. In the end, settlements can be a block to the eventual resolution of this dispute. But the reason why we were not on the road map was that people kept coming in—into the territory of Israel—and killing innocent Israeli civilians. So what I say to my hon. Friend, as I would say to others, is that the only way that this situation will be unwound is by getting back to the mutual obligations that exist for both sides in the road map.

Some moments ago, the Prime Minister said, “We are doing everything we can.” Has he had a personal conversation with President Assad of Syria, and if not, why not, given that the Government are doing everything they can?

I am not sure that a personal conversation between me and President Assad will do a great deal of good, if I may respectfully say so. I think that Syria knows perfectly well what is required of it, and the only question is whether it wants to do it.

We all obviously regret all the violence that is taking place in the region. The Prime Minister conceded that the Israeli actions in Lebanon and Gaza were disproportionate; if Israel carries on destroying the airport, roads, water supplies, electricity plant and a lot of civilian infrastructure—and killing civilians fleeing for their lives—what sanctions does he think should be applied against Israel to persuade it to desist from the expansionist intentions that it seems to be pursuing?

The only way to stop what I want to see stopped—the killing of innocent civilians—is through the process that we describe in our statement. Honestly, that is the only realistic way that we will do that.

Points of Order

On a point of order, Mr. Speaker. Outside the Palace of Westminster today there is a large delegation of my constituents, who have come to demonstrate their opposition to the closure of the Hemel Hempstead hospital. The temperature outside is more than 100 degrees, and with Westminster Hall closed there are few facilities within the Palace to allow them to come in from the excessive heat. Until the new visitor centre is open, can you advise me, Mr. Speaker, on how we can accommodate visitors to the Palace, such as my constituents, which is surely what we all want to do?

Sorry, I did not pick up the hon. Gentleman’s last point; I was being advised. I believe that he was asking about visitors; did he mention the visitor centre?

Thank you, Mr. Speaker. What I am trying to say is that until the visitor centre is complete, and with Westminster Hall completely out of action, what facilities are there for our constituents when they come to Parliament to perform their democratic right of lobbying this House against things that they are not happy about?

I am afraid that we have a difficulty in that respect. The hon. Gentleman realises that the great hall of Westminster is like a building site. I visited it last week, and things are difficult for visitors at present.

The hon. Gentleman mentioned people who are demonstrating outside. They have the democratic right to come to Parliament and express their concerns to Members. The temperatures outside are exceptional; I have never experienced such temperatures in the 27 years that I have been coming to London every week—it was exceptionally warm when I was out at 8 o’clock this morning. I will ask the Serjeant at Arms to look into the possibility of at least making available water facilities—bottled water or cool water, perhaps—because it is unreasonable to expect people to stand in such heat. I will instruct the Serjeant at Arms to see what we can do, at the very least to find water for visitors.

On a point of order, Mr. Speaker. In a written statement issued today, the Minister for Housing and Planning made it clear that home condition reports—the central part of the Government’s proposed home information packs—will be withdrawn; they will no longer be made mandatory. A flagship element of the Government’s Housing Act 2004 has been scuttled by Ministers, and yet the Minister concerned has not come to the Dispatch Box to explain why she has retreated under fire. Is that not a gross discourtesy to the House?

On a point of order, Mr. Speaker. You may recall that yesterday the Minister with responsibility for the police accused me of misleading my constituents on the subject of the cost of police mergers. Can you advise me on how I might reverse that outrageous slur made in this House?

I was present then, and the Minister concerned did refer to the hon. Gentleman’s misleading his constituents outside Parliament. My problem is that I have enough to do here in Parliament, without worrying about the hon. Gentleman’s constituency. I am sure that he will find a way to put the record right. The Minister concerned is a reasonable person and he will—[Interruption.] He is very reasonable. He comes from good Donegal stock, and he will listen to what the hon. Gentleman has to say.

Food Labelling

I beg to move,

That leave be given to bring in a Bill to introduce a uniform system for the labelling of food and drinks retailed in England and Wales to show the quantity of salt, sugar and fats they contain; and for connected purposes.

The Department of Health survey for England revealed that incidents of obesity have more than trebled in the past 20 years. For adults, that represents a rise of between 14 and 16 per cent., based on body mass index calculations for obesity. The rising obesity figures for children revealed by the survey for that period are even more alarming. While there was little change between 1974 and 1984, between 1984 and 1994 the prevalence of obesity increased to 1.7 per cent. of boys and 2.6 per cent. of girls. By 2002, those figures had risen to the extent that 5.5 per cent. of boys and 7.2 per cent. of girls in England aged two to 15 years were categorised as obese.

Projecting these figures forward 15 years—assuming that incidents of obesity continue to increase steadily—it is shockingly estimated that one third of adults in England will be obese by 2020. A Royal College of Physicians report estimates that, if the rapid acceleration in childhood obesity that we have witnessed continues, incidence of obesity in children could rise above 50 per cent. by 2020.

I could go on with these statistics, but bemoaning the state that we have got ourselves into will not bring about change and reverse the damage already done. That is why I am presenting this Bill, which seeks to provide just one measure that might help consumers in Britain to make healthier choices about the foods that they buy in a market flooded with pre-packaged, mass-produced foods with long lists of complex ingredients. A single format for simplified front-of-package nutrition information—giving the amounts of salt, sugar and fat contained in the product, combined with an interpretive element such as colour coding—would certainly bring about a positive change in the way that we shop and eat. Moreover, if such a scheme is not taken up voluntarily by the food manufacturing and retail industries, the Government ought to make provision to ensure that standards are enforceable.

As the hon. Member for Lewisham, West (Jim Dowd) said in his splendid Adjournment debate last week, the Health Select Committee’s inquiry into obesity, which reported in May 2004, is indeed its “magnum opus”. The report highlighted the growing prevalence of obesity in the UK and its effect on people’s health, and the consequent impact on the health service of increasing incidence of weight-related illnesses such as heart disease and type-2 diabetes. The Committee estimated that the associated costs are between £3.3 billion and £3.7 billion a year, and this figure will continue to rise unless urgent steps are taken.

Nutrition-based advice pertaining to the calorie or fat content in foods can often be misleading. For example, a product advertised as 90 per cent. fat-free still contains 10 per cent. fat and could still be high in calories and salt. Such promotional information prevents consumers from making the informed decisions that I know the Minister with responsibility for these matters wants them to be able to make. A more transparent and yet still simplified system of nutrition labelling would allow busy shoppers to make quick and informed decisions about the foods that they buy, and enable them to make comparisons with other products and brands.

The Food Standards Agency action plan on food promotions and children’s diets and the public health White Paper “Choosing Health” endorse the voluntary scheme for giving simplified nutrition information on the front of packaged foods. More than 2,600 consumers were surveyed in June 2005 in one-to-one interviews to test responses to and the general understanding of possible nutrition information formats. The two models that emerged on top were the multiple traffic-light system and colour-coded guideline daily amounts. It appears that the success of those two formats lies in the combination of colour coding and numerical information that makes them both accessible and informative to the busy consumer. It appears that 96 per cent. of the people surveyed thought that simplified packaging would enable them to have better health choices. Ninety per cent. were able correctly to use the traffic-light format to identify the levels of sugar, fat and salt in the products. That is compared with only 69 per cent. for colour coded guideline daily amounts.

In support of those findings, in the National Consumer Council snap shot survey consumers cited front-of-pack signpost labelling as one of the top three easy methods, alongside healthier school meals, that would help people eat more healthily and would help companies to cut down on salt, sugar and fat in processed foods.

Furthermore, there is research such as that undertaken by the consumer magazine, Which?, which I applaud. It shows that a multiple traffic-light labelling format was the preferred option for the majority of consumers and the most easily accessible system for low-income people and those from minority ethnic backgrounds.

There is an inherent danger in labelling some foods as being healthy, with other foods in contrast being regarded as unhealthy. That gives a wrong impression. Recommendation 23 of the Health Select Committee’s report stated that the Government must accept that some foods that are extremely energy dense should be eaten in moderation by most people. It therefore recommends that legislation should be introduced to introduce a traffic-light system for labelling foods either red for high energy density, amber for medium energy density or green for low energy density, according to criteria devised by the FSA.

Recommendation 24 says that although several interventions for better food nutrition labelling have been made, the traffic-light system stands up to objective assessment, and if accepted widely across the industry would be a good measure of the impact of shifts in consumption across supermarkets and brands from relatively unhealthy to healthier food products.

I regret that a number of companies seem not to support that recommendation, in contrast to leading supermarkets such as Sainsbury’s and Waitrose. All Members have received a letter from Danone, Kellogg’s, Kraft, Nestlé and PepsiCo, which want to go for the guideline daily amounts information labelling. I think that they are wrong in that regard and I wonder why they are taking that stance. Their approach is in contrast to the Health Select Committee report, the Government’s recommendation and the FSA’s report. The FSA believes that a consistent approach to food labelling will make it easier for consumers to eat more healthily and encourage consumers to look for and demand healthier food products, and incentivise businesses to produce foods that are lower in salt, sugar and fat content. I regret, for instance, that Tesco has gone ahead and done its own thing, which I believe is not in the public interest. I applaud the way in which Sainsbury’s supermarkets have introduced their own multiple traffic-light scheme, or wheel of health , which works on the principle of the FSA guidelines. Those symbols are now printed on the front packaging of more than 2,100 Sainsbury products, including and expanding on the recommendation list of items included by the FSA. Research that has been undertaken by Sainsbury’s found that the wheel of health had influenced the purchasing decisions of consumers.

Regulations on food labelling standards are currently set at a European level. The proliferation of different formats of simplified nutrition labels is a concern for consumers and the food manufacturers and retail industries alike. On 12 July the European consumers organisation presented the European Commission with the conclusions of a multi-stakeholder discussion group that included representatives from national Governments, industry, retailers and academics. I certainly support those conclusions.

The FSA, supported by the National Consumers Council, Which? and the Health Committee, recommends that industry-wide adoption of the single front-of-pack signposting scheme should be voluntary, but it would be in favour of mandatory take-up should this initial approach fail. Should a voluntary scheme fail to find unanimity among retailers and manufacturers, I urge the Government to step in to ensure an end to consumer confusion over nutrition labelling. I commend the Bill to the House.

Question put and agreed to.

Bill ordered to be brought in by Mr. David Amess, Dr. Richard Taylor, Mr. Ronnie Campbell, Sandra Gidley, Dr. Howard Stoate, Bob Russell, Jim Dowd, Charlotte Atkins, David Taylor, Mike Penning, Jeremy Corbyn and Dr. Doug Naysmith.

Food Labelling

Mr. David Amess accordingly presented a Bill to introduce a uniform system for the labelling of food and drinks retailed in England and Wales to show the quantity of salt, sugar and fats they contain; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 20 October, and to be printed [Bill 216].

Health Bill (Programme) (No. 3)

Motion made, and Question put forthwith, pursuant to Standing Order No. 83A(6) (programme motions),

That the following provisions shall apply to the Health Bill for the purpose of supplementing the Orders of 29th November 2005 and 14th February 2006 (Health Bill (Programme) and Health Bill (Programme) (No. 2)):

Consideration of Lords Amendments

1. Proceedings on consideration of Lords Amendments shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement at this day’s sitting.

Subsequent stages

2. Any further Message from the Lords may be considered forthwith without any Question being put.

3. The proceedings on any further Message from the Lords shall (so far as not previously concluded) be brought to a conclusion one hour after their commencement.—[Mr. Alan Campbell.]

Question agreed to.

Orders of the Day

Health Bill

Lords amendments considered.—[Queen’s Consent, on behalf of the Crown, signified.]

Clause 3

Smoke-free premises: exemptions

Lords amendment: No. 1

I beg to move, That the House agrees with the Lords in the said amendment.

I thank their lordships, particularly my noble Friend Lord Warner, for their hard work on the Bill since it left this House. The modest changes before us now, which are the result of the constructive and collaborative approach taken in the other place, have improved the Bill, and I am therefore delighted to be able to accept all the Lords amendments today.

The legislation shifts the balance significantly in favour of smoke-free environments. Virtually all enclosed public places and workplaces will be completely smoke free by summer 2007. It will introduce new laws to enforce higher hygiene standards in the NHS and clearly strengthen clinical governance arrangements in light of the findings of the Shipman inquiry. Those are three important health manifesto commitments.

My hon. Friend refers to the summer of next year. Could she be a little more specific? An appropriate day would be 31 May, as the Minister is aware. Is that a day that finds favour with her?

I will not commit to any particular date at this stage, but we are having discussions with stakeholders about the countdown to the introduction of the legislation, and I hope to report back on the exact date in the autumn. We are working on that at the moment. As I have said previously, we felt that a date in the warmer weather might be more conducive to a ready compliance with the legislation, as and when it comes into effect.

I am in close contact with my local authority, South Gloucestershire, which is a great enthusiast for the smoking ban, but is also anxious that it will have inadequate notice of when everything will happen, so it would like a definite date as soon as possible. It also wants to know that it will have the resources to enforce the ban. Can the Minister assure us that local authorities will not be finding money out of their already very cash-strapped coffers to subsidise the enforcement of the ban?

Officials are already meeting representatives of the Local Government Association and there are others who have asked some questions about the planning for next year. We will clearly try to commit to a date as soon as possible. We are also having discussions about a range of other issues, including enforcement, and the Bill provides for the need to finance and support local enforcement. It has been incredibly encouraging to learn from both the Irish and the Scottish experience and from my recent visit to New York, that on one level little punitive enforcement has been necessary, although there will clearly be issues for those working in this area, and that will be part of our discussions in the months ahead.

I am grateful to the Minister for yesterday’s publication of the draft regulations. The trade is concerned whether it will have sufficient time to make the necessary adaptations. Will she assure the House that the definitive regulations will have a sufficient lead-in time, so that small businesses can make the necessary adaptations without suffering competitive disadvantage?

I hope to ensure that we get the regulations right. The regulations that we published yesterday are the result of considerable discussions with many different stakeholders. Obviously, issues will arise in the consultation, but we hope that the regulations give clear guidance to small and medium-sized organisations on how best to meet the requirements of the legislation.

I remind the House that the experience of how the law is enforced and how businesses have applied the legislation in Ireland and Scotland will help us in England and Wales. The latest information from Scotland indicates that sales have not gone down as a consequence of smoke-free legislation.

I have read the draft regulations, which are a fair stab at creating a workable set of regulations to move the legislation forward. The consultation will finish towards the end of the summer recess, on 2 October. Will the Minister say whether she would consider suggestions that might arise very soon after Parliament reconvenes on 9 October, if a debate were sought from Mr. Speaker? Will she give such an assurance at this stage?

Obviously, I cannot control parliamentary time, but I am happy to provide all hon. Members with an indication of how the discussions proceeded in the consultation. There is a wonderful opportunity for hon. Members and local groups and organisations to participate in both a health opportunity and the countdown to smoke-free England in 2007, which I hope will have a fun element.

This group of amendments includes all the changes to the smoke-free provisions made in the other place. Amendments Nos. 1, 5 and 10 are all minor drafting amendments. Amendment No. 1 corrects a minor drafting inaccuracy—strictly speaking, licensees do not authorise the consumption of alcohol; they authorise the sale of alcohol for consumption. Amendments Nos. 5 and 10 were introduced by Earl Howe, who felt that the clarity of the drafting could be improved. We saw no reason to object to his suggested wording in the other place, and we are equally happy to support it here.

Amendments Nos. 2, 3, 7, 8, 9 and 11 relate to exemptions in regulations for those participating as performers in a performance in which artistic integrity makes it appropriate for performers to smoke. In Committee, I provided reassurances that the Government were minded to make an exemption for artistic performances, but the detail, as with all proposed exemptions, is a matter for the regulations.

During the Bill’s passage through the other place, we realised that it would not be possible to rely on the general power in clause 3(1) to make such an exemption in all circumstances. The prohibition on making any exemptions for licensed premises in clause 3(3), which was introduced following a free vote on Report, would have prevented any exemptions for artistic performances in licensed premises. As we are aware, many theatres and other performance spaces carry out their activities under only one licence, which is likely to cover not only the whole of the premises, but alcohol sales and theatrical performances. In those circumstances, we realised that the prohibition in subsection (3) came into play—in other words, it would be unlawful to make an exemption.

We introduced amendment No. 2 in the other place in order to relax that prohibition so far as is necessary to allow certain performers to smoke during a performance in all possible venues. The amendment also ensures that the exemption can be applied only to the relevant performer or performers. Of course, the detail of the exemption will still be a matter for regulations. The consultation on the draft regulations that was launched yesterday specifically asked for views on the exemption proposed for performers, particularly concerning whether the arrangements are adequate to prevent the development of loopholes.

This morning, the all-party group on smoking and health, which I have the privilege of chairing, discussed this aspect of the regulations and sought assurances on whether the exclusion would refer to rehearsals of the performance as opposed to the performance itself. Can the Minister reassure us on that particular point?

Through amendment No. 3, we have left the door open on exempting rehearsals, as we are still yet to be persuaded. We must not forget that any exemption is for the performer, not the premises, and that the smoker will be facilitated only when it is integral to the plot or storyline. We must be clear that this exemption is not about allowing certain people to smoke freely. From a purely practical point of view, we must ask whether it would be sensible or practical to light up and stub out cigarettes each time the rehearsal of a performance stops and starts. We will seek to clarify that through the consultation. As I said, I have taken note of the experience not only of Ireland and Scotland but of New York and California, which have exemptions in these artistic areas.

The Minister kindly said that she would contact every Member in respect of this matter, so I presume that she is thinking of writing to us all. When she does so, will she include in that letter her conclusions on the issue of rehearsals following her assessment of any further representations that she may receive?

I should like to be able to give a clear indication of the Government’s point of view following the consultation, and I will seek to make that as clear as possible for Members through a letter or some other appropriate medium.

Amendments Nos. 7, 8, 9 and 11 are consequential amendments.

On amendment No. 4, there was some concern in the other place that the power in clause 4 to make additional places smoke free was rather broad and could be used to make all sorts of places smoke free even where there was no significant risk of exposure to second-hand smoke. Given that we have consistently made it clear that we will use this power only to protect people where there is a significant risk of exposure to second-hand smoke, we had no objections to amendment No. 4, which raised the threshold for its use under the Bill. The amendment means that it would only be possible to make an additional place smoke free where “in the authority’s opinion”—that of the Secretary of State in England and the National Assembly in Wales—

“there is a significant risk that, without a designation, persons present there would be exposed to significant quantities of smoke.”

That wording makes it clear that the power cannot be used in cases where exposure to second-hand smoke is unlikely or very limited.

Amendment No. 36 makes any regulations to make vehicles smoke free under clause 5 subject to the affirmative resolution procedure. That issue was raised in Committee, where I said that I would be inclined to think about it. The Government tabled the amendment following the recommendation made by the Delegated Powers and Regulatory Reform Committee, which noted that the power in clause 5 could potentially be used to make private vehicles smoke free. Although we have absolutely no intention of using the power in that way, the amendment provides further reassurance, as no regulations under the clause can now be made without the prior agreement of Parliament.

On amendment No. 12, I pay tribute to my hon. Friend the Member for Barnsley, East and Mexborough (Jeff Ennis) for championing this cause and to the right hon. Member for North-West Hampshire (Sir George Young) for doing likewise. Hon. Members may recall that clause 30 was introduced on Report in the Commons, with cross-party support. It gives the Secretary of State the power to raise the minimum age for sales of tobacco products through secondary legislation by the affirmative resolution procedure. When introduced, it specified that the age limit could be changed only to an age not lower than 16 but did not specify an upper age limit.

Concern was expressed in the other place that the clause could allow the minimum legal age for sales of tobacco products to be raised to 21. Although that has never been our intention, we were happy to table amendment No. 12, which specifies that the minimum age for sales of tobacco products cannot be higher than 18. I am sure that hon. Members know that public consultation on whether to use the power is under way.

All the amendments in the group have improved the Bill and I commend them to hon. Members.

The Minister must be approaching the last hour of consideration of the Health Bill with much relief. Its passage has occasionally been rocky, but I am happy to say that the rocks have been mostly on the Government side. We recall the present Home Secretary’s seminal contribution to the public health debate when he identified smoking as one of the few working-class pleasures, the subsequent discomfiture of the Secretary of State for Health and her handbrake turns on food and non-food pubs and private members’ clubs. However, on a consensual note, we are pleased with the Lords amendments and also pleased that the Minister is happy with them. We will not resist them.

We note yesterday’s publication of the draft regulations for smoke-free premises and vehicles, in the nick of time for today’s debate, and the incorporation of much good sense, which emerged during the Bill’s passage. Much of the latter relates to small matters, such as provision for specialist tobacconists and research and testing facilities. They may be small but they are significant for those who will be affected by the Bill, and we welcome the provision for them.

However, we remain concerned about the lack of attention paid earlier to enforcement costs, as evidenced by the invitation in the draft regulations to comment on likely costs to enforcement authorities. That has already been mentioned. To work, the Bill needs enforcement, not simply encouragement. Clearly, little provision has been made for how that might be done. That is regrettable.

The licensed trade has asked for as much notice as possible of the definitive regulations. That is fair and reasonable. I note that the consultation ends on 9 October and hope to revert to what may follow when we discuss amendment No. 37.

The British Beer and Pub Association has asked for regulations that are easy to understand and simple to apply. The draft regulations are perhaps less monstrous than many but, as ever, the detail contains the potential trip wires. I note the section on signage in the regulations and wonder how we can make such a simple matter—which surely requires little more than the international no-smoking symbol—so complicated.

Amendments Nos. 2, 3, 6, 7, 8, 9 and 11 deal with smoking and the performing arts. They could properly be called the “Howe amendments” because my noble Friend Earl Howe is largely responsible for them. I hope that they will ensure that “Carmen”, the plays of Noel Coward, Simon Gray, John Osborne and most of Ibsen do not have to be rescripted. They are welcome.

Amendment No. 4 would introduce the test of significant exposure to second-hand smoke. The Minister spoke a little about that but I believe that it is an important amendment. Without it, appropriate national authorities could ban smoking in public in almost any circumstances. I therefore welcome the amendment. It is self-evidently wrong to ban an activity if the relevant substance is not significant. With a sensible understanding of “enclosed” and “substantially enclosed”—which, we hope, will emerge from the draft regulations—the amendment should resolve, for example, the bus stop dilemma that we discussed in Standing Committee.

We should note that our understanding of “significant” may alter with time as our appreciation of the health effects of second-hand smoke evolves. Sir Richard Peto’s evidence to the House of Lords Economic Affairs Committee is germane to that.

We are indebted to my right hon. Friend the Member for North-West Hampshire (Sir George Young) and the hon. Member for Barnsley, East and Mexborough (Jeff Ennis) for amendment No. 12, which deals with raising the age for the sale of tobacco. In Committee, they were trenchant supporters of the sensible proposal to raise the age to 18. We await the outcome of the consultation on that with great interest. We cannot raise the age beyond 21 as such a move is proscribed by existing legislation, but I was reassured to hear that the Minister would not wish to do so in any case. That we might have the potential to do so is something of an historical anomaly. We are pleased that the amendment would enable us to raise the age to 18 and no further. That is clearly the correct provision for the 21st century.

Amendment No. 36 will have the effect of ensuring that regulations applying to smoke-free vehicles must be made under the affirmative resolution procedure. Given the scope for confusion implicit in clause 5, that seems very wise. We still face the conundrum of the long-distance lorry driver, for example. He might use his cab to sleep in at night, but the lorry might occasionally be used by someone else. There is an element of confusion about whether he would be able to smoke in the vehicle, and that needs to be clarified. Bringing the measure before the House under the affirmative resolution procedure will give us the opportunity to explore the issue further.

Another example that is relevant at this time of year involves farmers in their tractors. Most people would regard a tractor as a fairly well-ventilated vehicle, but under the measure, the farmer would not be able to smoke in it because of the possibility that someone else might use it subsequently. That seems to cut across the sensible notion of significance introduced in amendment No. 4, which we very much welcome. I would be interested to hear how the Minister reconciles the two approaches.

The principal amendments in this group that I want to discuss are amendment No. 2 and the related ones that deal with smoking in performances and rehearsals. I was astonished to learn that their lordships were attempting to table amendments to cover theatrical performances and rehearsals. My initial reaction was to ask why the actors could not just act. That would surely be a better response. There would be no problem with someone holding a cigarette or having a pipe in their mouth—that is not prohibited by the Bill—as long as there was no smoke coming out of them.

There was a suggestion in the other place that Churchill could no longer be depicted on stage because he would not be able to have a cigar between his fingers, which would be nonsense, or that Harold Wilson could not be shown because his pipe would be banned. That would be nonsense as well. Surely the whole point of acting is to create an illusion. We do not actually need to see smoke physically coming out of the pipes or cigars. There was also a discussion about whether non-carcinogenic herbal cigarettes could be used instead, as they produce smoke that would not be so bad for people. However, that possibility appears to have been ruled out as well.

I cannot see why we need this exemption at all. I notice that amendment No. 2 talks about “artistic integrity”. If I were to go to see a play, and I saw an actor smoking in circumstances that I did not deem necessary to the plot, could I go to the licensing authority or the relevant local authority to protest? Would that authority have a panel of people who had been trained to judge whether the artistic integrity of the play would have been impeded by the presence or absence of a cigarette? It is nonsense to set people up in bureaucratic structures to judge whether in a particular case it was, as young actresses say, necessary to the plot.

I am reassured that the Minister seems minded not to allow an exemption for rehearsals; otherwise, we could end up in the extraordinary situation in which smoking was permitted—although only by those characters for whom the integrity of the plot required it—until the moment at which the director shouted, “Cut!” At that point, all the cigarettes would quickly have to be stamped out. No one working on the set would be allowed to smoke, but they would be allowed to inhale the smoke from the actor who had just been performing. No one would be able to smoke during the break, but they would be able to breathe in the actor’s smoke once the rehearsal started again. Those working on the set would be able to breathe in smoke, but only if it was someone else’s.

One of the beauties of the legislation is that, in most cases, there is no room for doubt. It is clear cut. We are not going to talk about the distance from the bar or about rooms with ventilation. The Minister’s argument throughout was for a comprehensive ban with as few exemptions as possible so that people would know where they stood and self-enforcement would be easier. Yet here we are with this peculiar luvvies’ amendment. I wonder what is behind it.

I said a moment ago that I thought that this was a pretty fair stab at a set of regulations. Does the hon. Gentleman agree, however, that there are areas that might be further improved, not least those relating to sports stadiums and railway stations, many of which are not yet within the remit of the regulations, even though substantial numbers of people have a significant risk of being exposed to large amounts of smoke in those places?

I certainly agree that there are still some grey areas, and my point about this artistic integrity exemption is that it creates more grey areas. I have stood—that shows how long ago it was—at football matches and been absolutely choked by cigarette smoke, albeit only for 90 minutes, so one would have to make a judgment about the long-term harm that it was doing to me. What we need above all is clarity. People need to know where they stand, and what is lawful and what is not. My worry about these amendments is that we are introducing new loopholes and ambiguities, and all because of something that could be perfectly well avoided by other means.

How does the hon. Gentleman reconcile his philistine attitude towards these amendments with his party’s liberal attitude to the smoking of cannabis?

No discussion on the Health Bill would be complete with the hon. Gentleman trying to bring cannabis into it. He seems to be fixated on it—I do not know whether there is anything that he would like to declare at this point.

Amendment No. 3 would allow the regulations to include rehearsals. Perhaps the Minister will regard this as a formal response to her formal consultation on the regulations: please do not include rehearsals. Whereas performances are a limited number of occurrences, allowing smoking during a long run of rehearsals would be potentially much more detrimental to the people who support the rehearsal process.

Amendment No. 12 deals with not raising beyond 18 the age of sale for cigarettes. We welcome that. Going beyond 18 would raise a much wider set of issues because there are many other things for which 18 is a trigger age, and it would not be satisfactory to try to change that by regulation.

The House is, as you can see, Mr. Deputy Speaker, gripped by this set of amendments. It is tempting to test the view of the House on them, but I do not sense that we would get very far, so I probably will not pursue the matter. However, I would be interested to hear the Minister’s comment on enforcement. Amendment No. 2 refers to “artistic integrity”. Who will judge that, and how will they be trained to do so?

In considering the exemption, which can be very tightly drawn, I had to consider what was sensible and how to act in proportion to the risk involved. Different places have approached the matter in different ways. Our exemption mirrors that in California’s smoke-free legislation, which has been held up as a shining example many times during our discussions. I also touched on the matter when I was in New York recently, as it concerns theatres there.

Hon. Members have asked who will decide what is integral to the plot or storyline. It will be for the performers and the management of the theatre or premises to satisfy themselves that smoking is an integral part of the artistic performance. Objections can be made to the enforcement authority, which will then investigate the matter and decide whether it wants to press the case. Ultimately, it is for the courts to decide whether smoking can rightly be considered an integral part of the artistic performance. We must not forget that the management of a theatre will want to be convinced that smoking is integral. They are, after all, responsible, by virtue of clause 8, for ensuring that smoking does not take place inappropriately. Other jurisdictions have found that they are able to enforce such legislation, but the consultation process will give us an opportunity to explore the matter further.

I am a little unsure as to whether the amendment would cover school plays. Would they be covered by the age rule, or would the amendment create an exemption to allow children under 16 to smoke?

In relation to that tortuous description, I shall look at the Hansard. Clearly, children under 16 are not allowed to smoke, so a potential offence would be committed in encouraging them to smoke. We have to grow up a bit about this. We must be realistic, and not forget that the few exemptions in the legislation sit alongside a real culture change in England, which is to be welcomed. Therefore, we must consider where we can have most effect, and the Bill amply provides for that.

To assist my hon. Friend, I am pretty certain that theatrical cigarettes are available that do not contain carcinogenic materials and would not be caught by the Bill in any way.