It is a great pleasure to serve under your chairmanship, Mr. Pope, and to introduce a debate on the first annual report of the first Service Complaints Commissioner. Dr. Susan Atkins was appointed in the late autumn of 2007 and assumed her full responsibility to receive and monitor complaints from 1 January 2008. During the year of her office, Dr. Atkins has made herself available for discussion and dialogue with Members of Parliament, attending meetings of the all-party group on Army deaths and appearing formally before the Select Committee on Defence.

The commissioner describes the process of establishing an office that should remain independent of the Ministry of Defence, while gaining trust and building confidence in the positive role of independent oversight. Dr. Atkins has shown considerable energy in bringing together a team of newly recruited staff and developing a mechanism for handling complaints that is sufficiently robust and demonstrably fair.

As chair of the all-party group, I hear the anger of families who have lost loved ones, not only at Deepcut barracks but at barracks throughout the UK and overseas. Those families have experienced the inability of the armed services to deal with sudden death and the failure of all the systems that should be in place to guarantee an effective investigation.

When the father of Cheryl James, who died from gunshot wounds at Deepcut barracks, heard that I was introducing the debate, he said that

“the only real question is why Sir Nicholas Blake QC told families he would support our call for a public inquiry if the Government did not appoint a truly independent Armed Forces Ombudsman with the power to investigate complaints: They didn’t and he didn’t.”

Families feel very bitter, angry and let down because they have not had answers to the questions that they need answered about the deaths of their loved ones.

It is interesting that the hon. Lady has been talking about Deepcut. Could she explain how she thinks that the independent complaints commissioner could become involved in an event in which, tragically, the servicemen involved are dead? In other words, does part of her remit say that she could look into not only things that are going wrong today in the armed services, but things to do with the ways in which servicemen, tragically, have been killed or have died?

The hon. Gentleman raises a very important point and I will come to it, because I want to explore the existing role and remit of the Service Complaints Commissioner and where I think it could and should be extended. The commissioner herself, in her inquiry, makes it clear that this is her first year and first report and that she will be considering in future years whether her position should be extended. I have one or two ideas on that.

Dr. Atkins sets out the role and responsibilities of the commissioner defined by the Armed Forces Act 2006. She describes the role as twofold:

“firstly, to provide a rigorous and independent oversight of how the Service Complaints System is working and to report annually to ministers and Parliament…secondly, to provide an alternative point of contact for Service men or women who do not feel they can raise a complaint with their chain of command without her oversight.”

The commissioner may also receive representations submitted on behalf of a serviceman or woman, whether from friends, family members or anyone else with legitimate concerns. The 2006 Act specifically refers to cases being raised by a Member of Parliament.

The commissioner’s role is not that of an independent ombudsman, and I regret that the Government did not feel able to accept the considered conclusions of both the Defence Committee and the Deepcut review conducted by Nicholas Blake, QC. In my view, the services have suffered from the absence of independent oversight and require a system of institutionalised checks and balances equivalent to those established to assist the police service and the Prison Service. The modern approach would be to welcome an independent ombudsman or commissioner with powers to initiate inquiries and conduct investigations where he or she regards it as appropriate to do so. Without acceptance of such a policy change, the oversight system is structurally flawed. As a result, confidence in the armed services is undermined and will continue to be an issue of public concern.

I think that protection of the lives of service personnel would also benefit from the establishment of an office that is equivalent to that of Her Majesty’s inspectorate of prisons and police and is responsible for offering external advice on shortcomings and possible improvements in efficiency and effectiveness. I also believe that the services should, wherever possible, establish lay visitor panels to carry out inspections of military facilities, particularly training camps.

However, in Dr. Atkins we have a Service Complaints Commissioner who has expressed her determination to see the complaints system working effectively and fairly. That objective has merit, regardless of the outcome of the wider debate. Dr. Atkins has approached her job with an open mind, and I respect the way in which she has produced the report and liaised with Members of Parliament, families and service personnel.

Having said that, I am genuinely mystified by Dr. Atkins’s conviction that she has no legal authority to handle the complaint of a relative or next of kin that relates to the circumstances of a death in the armed services or how such a death was handled. Outside the field of combat, the civilian police should have primacy in the investigation of the death, but that does not absolve the military of all responsibilities that arise from the duty of care. Failure to address the concerns of a bereaved family cannot be justified on the ground that the subject of the complaint is no longer a member of the armed services. That was not discussed in the passage of the Bill that became the 2006 Act and does not seem to assist the purpose of the legislation.

Does my right hon. Friend the Minister agree with me that there should be no barrier to the commissioner’s receiving a complaint regarding a death, the circumstances of that death, its effective investigation or measures taken to draw lessons in the public interest?

I am grateful to the hon. Lady for giving way again. I understand the point that she is making, which is interesting, but does she not think that if the commissioner were allowed to go down the track that she is advocating, there would potentially be a conflict with the role either of the coroner or of the military? One thinks, for example, of the Chinook crash on the Mull of Kintyre or the Hercules XV179 crash. Would the commissioner be authorised to investigate those cases that have perfectly properly been looked into by other authorities?

The hon. Gentleman makes an interesting point. However, on many occasions I have raised questions in the House about how families obtain answers to the questions about how their loved one died and on every occasion I have been told by Ministers from the MOD that they obtain their answers through the inquest system, but sadly the way in which the inquest system works has not given those families the answers that they deserve.

I am not casting any aspersions on coroners. I am on record as praising the coroners of Wiltshire and Oxfordshire, who have built up a great expertise in dealing with Army deaths. However, the coroner system, because of the way in which it has been set up, is an inquisitorial system that has limits. The hon. Gentleman and I have debated this issue in the past. Families usually do not have legal representation in a coroner’s court where the MOD does, so they feel at a disadvantage from the start. In the case of many of the families who come to me—I am referring to the Deepcut and Beyond families group—their loved ones died several years ago. When I speak to them, they often tell me about the most appalling circumstances at inquests where the coroner’s court met for 15 minutes and dealt with the issue, so they have not had answers.

I am not saying that the hon. Gentleman has not made an important point. He has, and the issue needs to be clarified.

Since December 2008, the Service Complaints Commissioner has had a role in the notification of unexplained deaths, so the Government have recognised the issue. What I am looking for at this first stage of the debate on Dr. Atkins’s role and responsibilities is for us to examine the complexities of such issues and consider how her role can be better used, without, of course, trespassing on any criminal investigation, the operation of the coroners’ courts or any other court proceedings that might come into effect following the death of someone in the armed services.

My hon. Friend is going into these issues in great detail, but she has just told the Chamber that the MOD usually has legal representation whereas the families do not. That is not so. The MOD usually does not have legal representation and is not represented legally in the majority of cases at coroners’ courts.

I hear what the Minister says. The families that come to the all-party group—they are part of the Deepcut and Beyond families group—tell me of their experiences. In their experience, the inquest can, as I outlined, be a very brief affair, although that tended to be more the case some years ago. More recently, the MOD has been represented by an array of barristers, while the family has not been. When families have sought legal aid funding, they have found themselves in a difficult position because they have been means-tested, as anyone else in the legal aid system would be. They feel disadvantaged, and we need to equalise that situation. Where there is an unexplained death, and there may be article 2 implications under the Human Rights Act 1998, the MOD needs to look seriously at the support that the families receive, to ensure that they feel that the inquest system gives them answers. Increasingly, coroners are giving narrative verdicts, which lay a duty on the MOD to provide answers.

The hon. Lady’s description matches the experience of my constituents Jim and Yvonne Collinson—they lost their son James at Deepcut—at their public inquest just a couple of years ago. However, families are being failed not just by the inquest system, but by the Ministry of Defence’s own boards of inquiry. Ten years after their son’s death, Jim and Yvonne Collinson are still waiting for the board of inquiry into what happened to him. That is incredible, given that boards of inquiry are established to look at precedents to see whether lessons can be learned. I do not know whether the hon. Lady has a view on the issue, but is it something that the Service Complaints Commissioner could also look at?

I agree that there are serious delays with some boards of inquiry. There is also concern about how evidence that is given to a board of inquiry can then be used in a coroner’s inquest. Above all, however, we have to put the families at the centre of this. They need answers about what has happened to their loved ones. As the Service Complaints Commissioner makes clear in her report—I shall go on to speak about this—she wants lessons to be learned so that they can be used to improve the delivery of the duty of care to our service personnel, as well as the efficiency and effectiveness of our armed services. This should be a win-win situation.

The hon. Lady mentioned the difficulties and limitations of the inquest system as it stands. She will be aware that Des and Doreen James, whose daughter Cheryl was, I believe, murdered at Deepcut barracks, were told before the inquest even took place that she committed suicide. Is the hon. Lady aware that there was a perfunctory inquest, which Des and Doreen James were able to attend only part of, and which simply confirmed the Army’s claims? Is she also aware that people such as Des and Doreen James have had their faith in the state entirely shattered, not least because, in the 14 years since Cheryl’s death, they have been unable to have the police inquiry into the previous police inquiry released so that they can find out what went wrong?

Before the hon. Gentleman arrived, I quoted his constituent Des James. Out of courtesy to the hon. Gentleman, I will repeat what I said. The father of Cheryl James made the important point about today’s debate that

“the only real question is why Sir Nicholas Blake QC told families he would support our call for a public inquiry if the Government did not appoint a truly independent Armed Forces Ombudsman with the powers to investigate complaints: They didn’t and he didn’t.”

Mr. James is understandably angry about that. One thing that I want to come out of the appointment of the Service Complaints Commissioner is that families feel that they can approach her and that she has a responsibility to look into unexplained deaths. As I mentioned, the MOD has recognised that she should have a role, but it relates to the notification of unexplained deaths. I urge the Minister to ensure that Dr. Atkins is kept in touch with the progress of Royal Military Police and civilian police investigations, the service inquiry and the coroner’s inquest.

I take the point made by the hon. Member for North Wiltshire (Mr. Gray) about respective responsibilities, and I am urging not that the commissioner become involved in the investigation process, but that she be kept informed. We can then learn from experience what role, if any, she should have. Again, however, my touchstone is making sure that the families get answers to their questions.

Will my hon. Friend accept that the original reason why the Defence Committee recommended an ombudsman was not so much to make things easier for a subsequent inquest and inquiry, but to prevent bullying and deaths? As Dr. Atkins says, one problem with the present system is the lack of confidence in it. It is vital that service personnel and their families can confidently make complaints and take up issues, not so that we can resolve problems after someone has died, but so that we can prevent bullying and deaths.

My hon. Friend makes exactly the right point. I will talk later about the importance of a culture change in our armed forces. Families that have lost loved ones in non-combat circumstances want answers about what happened to them, but they also want lessons to be learned—they want our armed services to respond differently and to prevent incidents wherever possible. Clearly, some accidents will not be preventable, but there are ways in which our armed services can deliver better on their duty of care to individuals.

I hope that nothing that the hon. Lady says will be taken as a vote of no confidence in the advent of the coronial service’s involvement in proceedings into the deaths of servicemen, and I am thinking particularly of deaths outwith the United Kingdom. The coronial service has done the armed forces community a great service in the way in which it has proceeded in recent years, and I am thinking particularly, in a partisan way, of the coroner who sits in Trowbridge. I have to say that I share the concerns that have been expressed about the confusion that the system advocated by the hon. Lady may introduce into the investigation of serious complaints about the treatment of people in the armed forces.

I fear that the hon. Gentleman misunderstands what I have said. I am on record in this place as praising the efforts of our coroners. I am making it clear that the coronial system and inquests have failed some families in the past. Within the operation of the existing system, in spite of the good work of many coroners, many families who seek proper answers about why their family members died still do not get them. The point that I am making is that when we debated the 2006 Act and considered the role of the proposed ombudsman or Service Complaints Commissioner, there were comments about how important it was that the office should have a role in listening to complaints from families about deaths of loved ones. I was therefore surprised and taken aback when Dr. Atkins came to the first of two meetings of the all-party group on Army deaths that she attended, and made it clear that she had no role in the system. Since then the position has changed and Dr. Atkins is notified of deaths.

I am being very careful about what I am saying and do not propose anything that would trespass on the proper responsibility of either the coroner’s court or the police or, indeed, of the board of inquiry, in making investigations. I am, however, saying that the families who come to me highlight serious concerns about all of those. The hon. Member for Perth and North Perthshire (Pete Wishart) spoke in an intervention about serious delays in a board of inquiry. There is concern that some individuals who have given evidence to boards of inquiry cannot be questioned when a coroner’s inquest is called on the same death.

I welcome some of the proposals in the Coroners and Justice Bill, such as the charter for bereaved families, which will be an excellent move forward, and the change in rule 43 of the coroner’s rules, enabling the coroner to send a narrative verdict to the appropriate Department, which must respond within 56 days. Things are moving ahead.

The point that I am making now, in my consideration of the responsibilities of the Service Complaints Commissioner, is about her new role of being notified of unexplained deaths: what is the purpose of notifying her, and can that purpose be taken further? It seems that she is simply notified, full stop; but will families have an opportunity to contact her, as they can about complaints that concern living members of the armed forces? In answer to the point made by the hon. Member for Westbury (Dr. Murrison), I am not suggesting a new process; I am drawing attention to the fact that whereas previously the commissioner had no role in relation to deaths, she now has a role and is notified of them. I am asking what seems a perfectly sensible question: can and should that role be expanded, and if so, how can it be expanded without trespassing on the perfectly proper current arrangements for investigation?

I congratulate my hon. Friend on the strong leadership that she gives with respect to the tragic events affecting the Deepcut and Beyond families. Surely the point of Dr. Atkins’s appointment is to bring transparency and clarity into the process. Perhaps something could be done together with Daniel’s Trust, which is an organisation set up by Lynn Farr and Norma Langford, a constituent of mine, the death of whose son in Belize was said to be suicide, although his parents claim that that would have been totally out of character. Surely that is what we should aim for: to improve the situation and to support families who have tragically lost sons and daughters.

I have met my hon. Friend’s constituent and she and Lynn Farr do sterling work through Daniel’s Trust. I shall refer to them later, and they are an excellent example of an organisation that members of the armed forces trust. They go to Daniel’s Trust to complain or express concern, when they will not go through the chain of command. That highlights issues that the Service Complaints Commissioner raises about the gap between the number of complaints that are raised with other organisations and those that come to her through a formal process.

I want to move on to take further what the commissioner says in her report. She provides a clear and comprehensive account of her responsibilities and the work undertaken so far. She accepts the need for greater awareness of her role and describes the difficulties of establishing a baseline of good and bad practice against which she can measure future progress. Dr. Atkins talks of narrowing the gap between perceptions of harassment and bullying and the number of complaints perceived. The commissioner has made a start in pushing for an audit of the service complaints system, but available information about the number of complaints received reflects more accurately the findings of the recruit training survey of 2006-07 that 31 per cent. of trainees believed that if they submitted a complaint it would not be dealt with fairly. Dr. Atkins’s first-year experience shows a real need for the Service Complaints Commissioner’s role to include helping to improve the service complaints system and giving servicemen and women and their families confidence that they will be treated properly.

Does not the way the Service Complaints Commissioner system is set up focus predominantly on individual redress—not, especially, on organisational improvement? The commissioner makes that clear in her report. Does my hon. Friend think that it is possible under the existing legislation for those two aims to be at the heart of what the commissioner is doing, avoiding a sole focus on individual cases, important though those are? How can the commissioner stand back and draw general conclusions and suggest general improvements for the organisation?

My hon. Friend anticipates the conclusion of my speech, because I shall make exactly that point, and agree with what the commissioner says in her summary of her conclusions.

Dr. Atkins reports that a 2005 survey found that 42 per cent. of servicewomen felt there was a problem with sexual harassment. More than two thirds of women interviewed reported experiencing adverse sexual behaviour ranging from unwelcome comments to criminal assault in the previous year; 15 per cent. reported having a “particularly upsetting experience”. On 21 February 2008, in response to a question at column 859W, the Ministry of Defence reported that only 32 complaints of sexual harassment and eight of sexual discrimination in the armed forces had been received in 2006-07. That is startling evidence that under-reporting is rife. I agree with the commissioner that robust reporting systems should be available to support the complaints process. It is difficult to make decisions about management procedures and future policy without reliable statistical evidence. That should be available from unit level to the highest echelons of the services.

Dr. Atkins draws eight main conclusions and bases her 17 recommendations on them. The Service Complaints Commissioner regards timeliness of handling and communicating complaints as a critical aspect of provision but finds current performance “generally poor”. She makes recommendations on timetable target-setting, use of specialist equality investigation teams and measures to ensure effective communication with the complainant and the person who is complained about.

I should like the Minister to address a point about allegations of bullying. When soldiers are being bullied or perceive that they are at risk they frequently need protection, and that must be prompt. The findings of the Surrey police so-called fifth report into incidents at Deepcut barracks between 1995 and 2002 provide a wealth of information about the internal service culture on the camp at the time. It is well known that the police investigation of the conduct of training instructor Leslie Skinner led to a successful prosecution. However, Surrey police say that not one of the 13 alleged victims had felt confident enough to access any of the welfare services, confidential information lines, faith-based counsellors or senior officers that should have been able to provide redress.

In my capacity as chair of the all-party group on army deaths, I have been told by concerned parents and groups such as Daniel’s Trust that recruits who are being bullied or who fear that they are at risk of bullying believe that they have no option but to escape immediate risk by going AWOL. What steps will the Minister take to assure recruits who feel under threat of bullying that their safety can be guaranteed and that action can be taken without delay?

The Service Complaints Commissioner states:

“There is a need for more ownership and proactive management of complaints at the heart of command”.

I wish to make two points about that. First, I want to see a culture change in the armed services, and Parliament has a critical role to play in that.

The commissioner finds that too few servicemen and women have the confidence to speak out when treated badly. All service personnel should feel able to voice their concerns if they are victim to bullying, discrimination or harassment. There should be an open and honest environment for everyone. Complainants should not be seen as troublemakers. They should be supported, not shunned. Many feel that making a complaint will impact negatively on their career, and there is evidence that some wait until they leave the services before making a complaint.

The enlightened employer should encourage feedback and protect whistleblowers who act in the public interest. The environment that pertains in the armed services clearly presents a greater challenge for the exercise of that responsibility, but I invite the Minister to join me in asserting that the greater risk of maintaining a culture of silence and complicity requires that solutions are found.

The second point is this: the commissioner should be given greater assistance in developing a flexible approach to what should be regarded as a complaint. Why should the evidence given and the allegations made by the BBC about bullying at Catterick not be given the formal status of a complaint requiring investigation? The commissioner is required to receive communications from a Member of Parliament on behalf of service personnel. Does such a communication constitute a formal complaint? If not, why not? Dr. Atkins refers in her report to receiving letters from Members of Parliament. Will the Minister assure me that he is routinely informed of serious incidents, and that commanding officers are required to ensure that a death in barracks is reported to the commissioner within 24 hours?

Dr. Atkins concludes that the focus of the service complaints system, which is to provide individual redress, must be broadened to take account of the need to address failure and to learn from it. If mistakes are identified, the system should provide a means by which they can be addressed. Complainants need to be secure in the knowledge that they will be treated seriously and well, and that complaints should result in organisational improvement. There should be evidence to show that once complaints are proved, changes are made. That is similar to the direction taken by the Government in their proposals for coroner law reform. The commissioner makes specific recommendations, but I wonder whether the Minister, when responding to the debate, will find a form of words to endorse the dual purpose approach that she advocates.

The Service Complaints Commissioner reports her wish to promote greater awareness of the existence and role of her office. I understand the difficulty of achieving a satisfactory level of recognition in the first year; the Irish ombudsman found a similar time lag. Although that guarantee of awareness will ultimately show the commissioner's effectiveness in meeting her objectives, I believe we all have a role to play. The Minister should draw up a plan to promote awareness and to ensure that we have parliamentary time to discuss it.

In my role as chair of the all-party group on army deaths, I am keenly aware of the work of bereaved families in trying to prevent the children of others falling victim to the same fate. If those families have confidence in the role of the commissioner, they will willingly promote her services. I bring to the attention of the House an initiative taken by Debra Williams, whose son Gavin was beasted to death at Lucknow barracks in 2006. Debra used her son’s story to urge others to work together to prevent future loss of life. Her website—stopbeastingsinthearmy.com—provides information and advice for families who think that their children may be at risk. It is important to find a way to give victims a voice in the process of creating greater awareness. The commissioner is already in touch with a number of such groups, but MPs and the Government could provide more help.

The commissioner concludes that there is inconsistency of practice on the handling of complaints across and within the services. She also believes that the lack of expertise in handling complaints is a common cause of failings. Can the Minister confirm that resources will be made available to monitor the system effectively, and to identify priority areas for improvement? Will he agree to review guidance to deal with the confusion caused by the different procedures required for equality and diversity complaints, and complaints about other matters?

When complaints about bullying and harassment arise in the public domain, the response of the MOD press office is sometimes too defensive. The standard approach of affirming the policy of zero tolerance towards bullying is well meaning but sometimes empty. The implication is that the existence of the policy has eradicated the problem. It would be better if the position was restated as a tri-service commitment to work towards the elimination of bullying and harassment, while ensuring that the Service Complaints Commissioner has been notified.

The commissioner argues that a system of complaints works best if the complaint is about a matter within the scope of command of the armed services, and recommends that the service secretariats should review the handling of complaints that arise outside the scope of the chain of command. Her report concludes that the complaints system is geared to work at the top levels and not at the lowest appropriate level, and it makes specific recommendations in order to address that imbalance. Finally, Dr. Atkins finds that the complaints system is accessible in theory but beset by barriers in practice. That is also the prime concern of bereaved families and those who contact anti-bullying organisations.

The Royal British Legion has been at the forefront of the campaign to give new meaning and substance to the military covenant. I believe that an open and transparent system for investigating complaints, and for making effective redress and institutional response to identified failure, must be at the heart of the Government’s support for service personnel.

This is the Service Complaints Commissioner’s first report, and she is clearly describing work in progress. In that first year, Dr. Atkins was contacted by 193 people, and I have no doubt that more will come forward this year. Her conclusions and recommendations mark out a method that will establish a workable baseline from which future progress can be gauged and accurately assessed. The commissioner’s proposals are carefully constructed as a coherent framework, and I urge the Government to respond to the block of recommendations as a whole.

This will not be our last debate on accountability and oversight of the armed services. Failure to address these issues will undermine the ability of Her Majesty’s armed services to deliver the effective and efficient service that we need. Oversight is an aspect of good governance that we must get right. We have a responsibility to continue the debate, to learn from experience and take the process forward. I place on the record my thanks to the Service Complaints Commissioner, who has done an excellent job in the role that Parliament gave her. I am sure that we will discuss the nature of that role at greater length as she produces many more reports.

I congratulate the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble). This is the second time in two days that I have followed her when speaking in this Chamber, but yesterday I named her constituency incorrectly, so I am pleased to have the chance to get it right today. She has introduced an extremely important debate and did so extremely well. I agree with much of what she had to say.

I wonder about the process by which the Service Complaints Commissioner’s report was brought to the notice of Parliament. As I understand it—I am ready to be corrected—there is at present no formal way for the commissioner to report to Parliament. I wonder whether it might not be sensible for the report to be more readily available—for example, through the Vote Office, which I think was not the case this year. I obtained my copy by downloading it from the internet. In future years, it might be sensible to have in place a formal method by which the commissioner can make her report known to Parliament.

Like the hon. Lady, I congratulate the commissioner on her excellent work in an undoubtedly difficult first year. She has had to get herself and her services known around the armed services, and has no doubt had to handle some very needy and difficult cases among the 190-odd that she has heard so far. I am certain that, on occasions, servicemen and women who might be nervous of their chain of command, or who might be victims of bullying, harassment or discrimination, have no other way to raise their concerns with the authorities. It is useful to have a means by which they can.

There have been a number of cases in my constituency. In two recent ones, bullying was alleged and the individuals involved went AWOL. I am glad to say that, the families officer from the 9th Supply Regiment in Hullavington handled the situation extremely well, visited the soldiers in a secret location and reported back. That case is under investigation, but was handled extremely sensitively—as far as I am aware—by the regiment. However, at another time, it might not have been, so it would be useful to have the commissioner in the background, as a back-stop for soldiers. I therefore congratulate her on the difficult work that she has done. I am grateful that she is there.

I enter two caveats on that point. First, there is a very narrow dividing line between applying the sort of difficult, rigid discipline necessary to make armed servicemen in battle do things that you and I, Mr. Pope, would not willingly do. I suspect that most of us here have visited theatres of war. We ask these young men and women to do things that we here would not do in any circumstances. That requires an especially firm form of discipline that must be inculcated into new regimental recruits in a particular way. There is a very narrow dividing line between finding ways to inculcate such discipline and bullying and harassment, and occasionally people step over that line.

Beasting has been mentioned. Most in the armed services would acknowledge that beasting is not a very good way of instilling discipline, and I would be very surprised if it is used very widely, but a company sergeant major being rough with new recruits—not physically, but in a command sort of a way—is a traditional part of the Army way of life. It is not necessarily a bad thing in itself. Being nice to recruits will not necessarily do them any good. The importance of the commissioner’s role is in judging when that dividing line has been overstepped.

I am on the record as saying in earlier debates on this matter that the training that our armed services receive is different from that received by someone in civilian life doing a civilian job. Dr. Atkins, when she gave evidence to the Select Committee on her first report, also recognised that point, saying that there is a difference between training in the armed services and training to work in Sainsbury’s. I agree with her. She also said that we need a fair complaints system, because otherwise there would just be a moaning system, and we cannot have that. If people have a complaint, it needs to be looked at.

The hon. Lady makes my point very much better than I did, and she is, of course, absolutely right.

The second caveat is this: the armed services have always had an extremely good complaints system. In my experience of the armed services—as chairman of the all-party group on the Army, a former Territorial Army soldier and an MP with quite a large number of servicemen in my constituency—by and large, the regiment, or RAF Lyneham, which is also in my constituency, go out of their way to address problems as they arise. They do not want these things to happen, and when an allegation of bullying or harassment is made, the families officer in particular goes out of their way to discover the truth. One must also bear in mind that an allegation of bullying or harassment is not necessarily the same thing as bullying or harassment. Very often, an allegation might not hold up under scrutiny. None the less, I accept the commissioner’s role, which is a particularly useful one, and I can think of quite a number of constituency cases in which I was glad to have her in the background.

I had a slight difficulty, however, with one part of the hon. Lady’s contribution. She suggested that the role laid down in the 2006 Act for the commissioner to scrutinise the armed services complaints procedure—that is really what it says in the Act—should be extended to a generalised investigation of the circumstances surrounding an otherwise unexplained death of an armed serviceman. Like us all, the hon. Lady is very concerned about the circumstances surrounding the very unfortunate deaths at Deepcut. That was a more or less unique set of circumstances. The original Select Committee report that led to the establishment of the commissioner was particularly concerned about Deepcut.

Leaving Deepcut to one side, however, should we accept the principle that the role of the commissioner is to investigate all armed services deaths where no other explanation is known? In a number of cases, that might be sensible—when a person dies from beasting, in the example that the hon. Lady gave, or when there is an unexplained death in barracks. Such cases might well be worthy of further investigation by the commissioner if there is suspicion of improper behaviour by the armed services, but I believe—I am ready to be corrected—that by far the largest number of armed services deaths are caused by road traffic accidents. In such cases I presume that the commissioner would have no role—unless the equipment or vehicle was defective, I suppose.

That argument could be developed further. I mentioned earlier the tragic deaths of 10 servicemen in a Hercules XV179 in Baghdad in 2004 or 2005. A High Court case is pending. The families are suing the Ministry of Defence, because it did not fit foam suppressant in the wing tank of the Hercules aircraft. That is a matter for the High Court, and we cannot discuss it here. The coroner reviewed the case very carefully and came out heavily against the MOD. However, the notion that the commissioner might act on behalf of those families would seem to cut across the High Court, which is considering the matter, and the coroner, who produced an extremely critical report and said that the MOD was badly at fault. There was a similar case involving a Nimrod. For a third authority—a lady with no particular back-up or support—to throw her twopence worth into such an extremely complicated and difficult inquiry would be plain wrong.

Establishing an independent ombudsman to do precisely what the coroner ought to be doing, merely because the hon. Lady has a number of complaints about the way in which the coronial system works, would seem to be a diversion of effort. The Coroners and Justice Bill is being considered in the other place, where I hope the point about barristers at inquests will be taken into account. There is something to be said for that. Surely, however, if there is something wrong with the way in which families are handled in the coronial system—I made this point during Second Reading and the Committee stage of the Bill—that is an argument for improving the coronial system. The notion of introducing a third organisation—the commissioner—to make up for perceived deficiencies in the coronial system or regimental chain of command seems administratively complicated.

The hon. Gentleman apparently fails to understand that the coroner is not a detective. The coroner establishes the cause of death, but that does not mean that the coroner’s report can identify why that cause of death occurred. Does he not understand that those of us who believe that young recruits were murdered at Deepcut Army barracks do not expect the coroner to be able to prove that point? That was explained by Nicholas Blake QC, when he called for either the full disclosure of the Devon and Cornwall police report into the Surrey police handling of those death, or a full independent public inquiry. Does the hon. Gentleman disagree with Nicholas Blake?

I have difficulty with the hon. Gentleman’s intervention on two fronts. First, he is quite wrong: the coroner’s job is indeed to establish the cause of death. That is precisely what the coroner is required to do under law. However, let us imagine that he is not doing his job. The hon. Gentleman seems to suggest that the complaints commissioner should become what he describes as a “detective”, but the 2006 Act did not establish the complaints commissioner as a detective to look into the facts. The hon. Gentleman does not like not only what the coroner did, but what the police did—he says that they had looked into the matter and also got it wrong. He seems to be proposing that the Service Complaints Commissioner should say, “You, Mr. Coroner, are no good. I did not like your conclusion. You, the police service, are no good either. I now set myself up as a new kind of detective. I will look into the complex series of reasons behind the deaths, and I want my voice to be heard above both of yours.” [Interruption.] The hon. Gentleman waves his hands in the air in a charming way as only he does, but I said a moment ago that we should put Deepcut to one side. We are not discussing Deepcut, but whether or not the commissioner can do a useful job today in investigating complaints by servicemen who are alive. By talking about whether or not the commissioner should be an alternative coroner, we have diverted the debate away from its extremely important subject.

Will the hon. Gentleman give way?

If the hon. Lady will forgive me, I will finish my point first. We are a bit short on time.

In the report, which I have read only lightly, the commissioner does not ask for the ability to set herself up as an alternative coroner. Her job, and the job clearly laid down in the 2006 Act, is to scrutinise the way in which the complaints system within the armed services is working. In other words, if the complaints system is not working well, it is her job to scrutinise that. If we, in this debate or in other discussions, were led to a sort of generalised belief that somehow neither the coronial system nor the chain of command system were working and that we had to set up an alternative to both, we would be doing the complaints commission system itself a disservice.

The hon. Gentleman misinterprets what I said. I thought that I had clarified my point in answer to his hon. Friend the Member for Westbury (Dr. Murrison). I am not asking for the commissioner to be a separate investigating body. I am pointing out deficiencies in the existing system, some of which are being addressed through the Coroners and Justice Bill. Questions relating to boards of inquiry and their link to the coroners’ system have not been properly addressed. The Government have already said that the complaints commissioner should be notified of a death; I am simply asking that she be kept informed of the progress of the investigation of that death. Surely the hon. Gentleman agrees with me that if a pattern is emerging across a series of deaths of which the commissioner and the armed forces should be aware, she should report on that. Not all road traffic accidents are the same: some might have a cause of which she and the Army should be aware and on which they should act.

I have obviously touched a raw nerve. I was not answering the hon. Lady’s intervention, but that of the hon. Member for Pembroke—

For Montgomeryshire.

I knew it was a place in Wales. The hon. Lady is absolutely right that we are not asking here for extra powers for the commissioner. Plainly, we are not. We are not seeking to find some way to investigate deaths. The commissioner’s main job must be to investigate the complaints of living servicemen—that is plainly laid out in the 2006 Act—about harassment, discrimination and bullying. That is the problem we face. We need to know whether or not there is an endemic problem of that sort in the armed services today.

In that context, I congratulate the hon. Lady on calling this important debate. I congratulate and thank the commissioner for her outstanding work in her first year of operation. I enjoin the Government to encourage her in what she is doing and to find a way to allow her to report directly to Parliament—perhaps through MOD Ministers or something of the sort—in future years, and not to be tempted by calls for the widening of her powers.

Before I call the hon. Member for Montgomeryshire (Lembit Öpik), may I remind hon. Members that it is customary for us to begin the winding-up speeches at half-past 10?

I accept and acknowledge your guidance, Mr. Pope.

I am standing here because, for about seven years, I have been trying to clarify why Cheryl James, the daughter of my constituents Des and Doreen James, died at Deepcut barracks. I am left in little doubt that she was murdered and that there has been a systemic cover-up of her murder and probably the murder of three other recruits at that Army camp.

My frustration with the situation arises from the fact that, at every turn, it seems that the Army and, to an extent, the police have been quite happy to conspire to cover up the circumstances of those deaths. My direct response to the hon. Member for North Wiltshire (Mr. Gray) is that no coroner would be able to get to the heart of the matter as an independent and effective Service Complaints Commissioner could. He fails to understand that a coroner is not able to exercise the authority to establish whether systemic bullying, or nefarious practices that lead directly to the death of recruits, are going on at an Army barracks. The coroner is simply required to establish the cause of death, and not why the victim suffered those causes. It is for that reason that we need to examine the reach of the powers of the Service Complaints Commissioner, as the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) has said.

I am astounded that, after all these years, we still have not got full disclosure of the facts pertaining to the Deepcut deaths. The only reason that we have made any progress at all is that we have persisted in trying to expose the murders. I remember the day I was attempting to force the Government to respond to an urgent question regarding the deaths at Deepcut when, lo and behold, the MOD Minister, the right hon. Member for East Kilbride, Strathaven and Lesmahagow (Mr. Ingram), decided to make a statement to launch the Nicholas Blake inquiry. Naively I thought that the inquiry would be objective and would lead to progress, but, sadly, it seems to have been as big a sham as the rest of the process. That is why it is necessary that we look closely at the powers of the Service Complaints Commissioner and decide whether those powers are sufficient to get to the heart of cases such as those at Deepcut. In my last exchange with the Minister, he brushed me off by saying that it was not necessary or appropriate for him to respond in detail to the question that I asked on the Floor of the House. He implied that I was a conspiracy theorist. Well, I am a conspiracy theorist because I believe that there has been a conspiracy to cover up four deaths at Deepcut Army barracks. [Interruption.]

The Minister for the Armed Forces is clearly entertained by this, but I can tell him that the parents are not. Des James is one of the most reasonable and circumspect individuals whom I have had the honour to represent. I am sorry to tell the Minister that Des James has no faith in the state’s ability to investigate itself when individuals are murdered within state structures. Mr. James recently saw a play at the Tricycle theatre that covered those very points. When the Minister’s predecessor was invited to attend the play, he sent a message to Des James that said:

“I have no wish to see the play because I believe it will not be balanced and will reflect an all too painful analysis.”

In another e-mail, he said that he believed the play would be

“strong on polemic and weak on objective analysis.”

I did not say that.

I can show the Minister the text that was sent to Des James. Is that the sympathy that we can expect from the Government? How on earth is there any consistency between the alleged empathy with the plight of parents who have lost their offspring within the military system that the Minister expresses and comments such as those are sent directly to one of the parents of a deceased child?

I have two specific requests to make. Will the Minister tell me whether he is certain that the four who died at Deepcut Army barracks were not murdered? Will he tell us on the record that they were not murdered? Secondly, why on earth is it that, so much time after the Nicholas Blake inquiry, we still have not had an independent public inquiry into those deaths? The Minister will recall that Nicholas Blake said that if the Devon and Cornwall police report into Surrey police’s handling of the deaths at Deepcut Army barracks was not made public, we should have a full, independent public inquiry. That is on the record, but the report has not been published, nor have we had the inquiry. When will the Minister ensure that one or other of those takes place?

I have tried time and again to use the Freedom of Information Act 2000 to have the Devon and Cornwall police report released, but it has not been released. It is in the public interest to get to the heart of why the four recruits died at Deepcut. Unless the Minister is willing to make progress today, the matter will go to the courts. That will lead to yet another embarrassing series of revelations, when the Government and the Minister could simply put right something that has been very wrong for 14 years.

I congratulate the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) on the way in which she introduced the debate. As she said, this is the first occasion on which we have such a report to debate and the first opportunity to make a judgment on how the new system is performing. She tangled with some difficult and emotive issues in an even-handed and level-headed way and I agreed with a number of the points that she made.

The new commissioner has made herself available to Members of the House and everybody else with whom she interacts. She has been very open and I commend her on it. I met her to discuss her work and it is clear that she is setting about her role within the terms laid down by Parliament with determination. She has a clear vision of where she is going. I am impressed by her general approach and encouraged by some of the things that she told me. She said that in some instances, initially, she found some resistance to her involvement in inquiries, and some scepticism and suspicion of her role. However, she said that even in the short time in which she has been in post, there has been a thawing of some of the hostility towards her and a willingness on the part of the armed forces to interact with her, which is welcome.

None the less, at this stage, she is only beginning to scratch the surface of the problems, based on the surveys to which the hon. Member for Blackpool, North and Fleetwood referred when she introduced the debate. The experience, impressions and belief of armed service personnel is that the problem is more widespread than the scale of the cases with which the commissioner is dealing would imply. I am not suggesting that all cases ought to end up with the commissioner; it is hoped that the chain of command will be capable of dealing with the lion’s share. However, I believe that there is a bigger problem than she has yet begun to tangle with. It is her first year of operation. The 193 cases that she has considered do not constitute a large number, but I expect that when we debate such things in future, the number will have increased.

For the first time probably, the debate gives us the opportunity to consider whether we believe that the system that has been created has given adequate power and independence to the commissioner. My party colleagues and I wanted the commissioner to have a stronger role and preferred the proposal for an ombudsman, which the Defence Committee and others suggested. Nothing so far has given me occasion to change my view that we need an official with greater powers than we have given to the commissioner. I noted with interest some of the proposals that the hon. Member for Blackpool, North and Fleetwood made, particularly her suggestion that the role should be vaguely analogous to that of Her Majesty’s chief inspector of prisons and that there should be a role for lay visitors. Both proposals are interesting. We must give it time, but I believe that we have not given adequate powers to the commissioner.

The hon. Member for North Wiltshire (Mr. Gray) made an excellent speech in the defence procurement debate on Monday afternoon and I found myself heckling him, in a sympathetic fashion, from a sedentary position. I am rather less in agreement with what he said in this debate. He started off by correctly reminding us that young personnel new to the armed services must learn to accept military discipline. They are going to be put into theatres of war, where complete military discipline is essential to their survival and the successful prosecution of their objectives. It would therefore be no great kindness to young recruits to treat them with kid gloves or to avoid the need for them to accept those harsh realities from the outset. However, precisely because it is their duty to obey the chain of command virtually unquestioningly, it is all the more important that there is a separate, independent avenue to go down if they have a genuine grievance that they do not feel able to raise with the chain of command.

I fundamentally disagree with some of the points that the hon. Gentleman made. In particular, I do not agree that allowing a commissioner to have a power of investigation—at the moment, all she can do is monitor the investigations that the armed forces carry out—would somehow cut across what other people do. The role of the police is to examine whether the law has been broken and whether there has been any criminality. That is all—their role does not go beyond that. The coroner’s role is to establish the cause of death. Coroners have slightly more latitude than the police to go beyond that. They often look at some of the background, and they may make recommendations, as the hon. Member for Blackpool, North and Fleetwood said, based on what comes to their attention in the course of their inquiries. However, even the coroner’s role is limited. Many aggrieved service personnel and their families want more investigation into the nooks and crannies, beyond that which the police or the coroner have a duty to undertake.

I disagree with the hon. Member for North Wiltshire that court action would cut across any investigatory powers given to the commissioner. I would compare the situation with what happens when there is a death or maiming in a hospital. In that case, the police are called in to investigate potential criminality and the coroner looks at the cause of death, but an aggrieved patient or their family might wish to take the matter either to court or to the health service ombudsman. Many ombudsmen exercise their powers only as long as court proceedings are not taking place, but it is perfectly common for them to go over the same ground that the police or a coroner might go over to learn more and to determine whether there has been any systematic failure, as the hon. Member for Blackpool, North and Fleetwood said. I am not persuaded that we will not need to come back in future and extend further powers to the commissioner to create something more akin to an ombudsman.

We ask an awful lot of our armed services personnel. The bullying and harassment about which we have heard a lot this morning are undoubtedly unacceptable. I am quite convinced that there are the beginnings of a shift in culture, but there is further to go. Nevertheless, armed forces personnel may wish to raise matters other than bullying and harassment. They might want to raise the inadequacy of their kit, for example, on which one coroner has commented. I should have thought it preferable for people to make complaints before the event rather than looking at things in retrospect.

The hon. Member for North Wiltshire said that many people die in road traffic accidents. Some years ago, a constituent of mine was maimed by a collision with a vehicle while on physical training. To this day, he blames the Army for what happened, but he has never had the opportunity to have his case looked at. That was a question not of faulty equipment, but of faulty procedure. There is a lot more to come. The commissioner’s reports in future years will give us further opportunity to judge whether we have given the office adequate powers. I am not convinced that we have done so and I believe that we will have to return to the matter in future to extend the commissioner’s role or something akin to it.

May I start by declaring my interests in the Register? I congratulate the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) on securing this debate and on the excellent way in which she presented it. The debate has been excellent, but slightly odd in that the meat of the Service Complaints Commissioner’s first report has been set to one side as we have debated wider issues relating to Deepcut. However, Deepcut is important, as it underpins the creation of the post.

It seems to me that the investigation of Deepcut is not the function of the Service Complaints Commissioner as the post is constituted. However, the prevention of a future Deepcut most certainly is. I welcome the creation of the post, as it will give a level of transparency to our armed forces and assist in changing some unhelpful elements of the culture. Somebody mentioned beasting earlier. I have not been beasted in my service career, but I was training to be a diver in Portsmouth at the time—many here will remember it—when an Army soldier died while being beasted on the mud at Portsmouth. Around that time, we started to wonder whether some aspects of the training of young people in our armed forces were appropriate.

Since that time, I have been concerned about how professionally those people are managed. Professionalism comes in many guises. It involves the way in which we conduct ourselves on operations, of course, but it also involves things such as how people are trained and how they are looked after and stewarded during the training period. There is no question in my mind but that beasting, although it was certainly part of the service culture at the time, was not what might be called professional, if for no other reason than that it causes mortality and morbidity from time to time. That is in nobody’s interests, let alone those of the organisation concerned. Such things need to be addressed, and I believe that the Service Complaints Commissioner might be part of a preventive strategy to ensure that they are less likely to happen.

Several hon. Members referred to the Service Complaints Commissioner as independent. We must accept that hers is a sort of independence—a semi-detached oversight—as she reports to Ministers and her budget comes from the Ministry of Defence, so we need to be slightly careful about the status that we accord to that office. It is important that we have such people to examine organisations that could be called total or closed, or that have the attributes of such organisations. The armed forces certainly have those attributes, as a number of hon. Members have mentioned.

According to the hon. Member for North Devon (Nick Harvey), the Service Complaints Commissioner had some concerns about how she was initially received. I must say that it does not come across that way in her report, although I can understand why an organisation such as the armed forces might resist somebody like Dr. Atkins: an inquisitorial new appointment meant to shine light on darkness. However, the more thoughtful elements of the chain of command will probably welcome the Service Complaints Commissioner. That is certainly what I am hearing from those to whom I talk in the armed forces.

The Service Complaints Commissioner makes suggestions about how her role might be expanded, but they are pretty subtle. Although the hon. Member for Blackpool, North and Fleetwood eloquently described how the role might be developed over the years, that does not really come across in Dr. Atkins’s first report. We will have to see how it evolves as the years go by, but it would be premature at this stage—she has been doing the job for little more than 12 months—to suggest that it should be radically overhauled. That would be a little unfair. At this stage, the balance that has been struck is about right. I would like to see how the office copes during the next few years and its subsequent reports. We will have to keep it under review, of course—we keep everything under review in this place, do we not?—but it seems to be a pretty good starter for 10. I look forward to the commissioner’s contribution as the months and years roll by.

Having been ever so nice, I think that it would be wrong of me not to raise one or two slight concerns. The report talks throughout of accountability. The Service Complaints Commissioner says that she accounts publicly to Ministers and Parliament; she says it on page 82 and again on page 15, and it is a thread throughout the whole publication. We could debate how she might be held to account, but it is important that we use language judiciously. I am not aware of any meaningful accounting to Parliament. We are indebted to the hon. Member for Blackpool, North and Fleetwood for securing this debate; otherwise, we would not have had a formal opportunity to discuss the report at all. Some might think that I am being a bit pedantic in making the distinction, but it is important that we consider it.

The commissioner found that knowledge of her role was poor. She is being a little harsh on herself. In the evidence that she gives in the annexe, which touches on the most recent service continuous attitude survey, we find that knowledge of how to complain overall is pretty poor within the armed forces. It is not specifically about her role; it is simply that people do not know where to go. Still, a key index for the current year is that she will improve recognition of her office, and I look forward to seeing her achieve that target and reading her report on it in a year’s time.

The commissioner mentions timeliness in the investigation of complaints, which is important. On a grander scale, we can consider the delayed inquiry into Iraq as evidence why we should conduct any inquiry or investigation in a timely fashion. As the months and years go by, unfortunately, memories fade and evidence is destroyed. I endorse wholeheartedly and with great feeling her concerns about the lack of timeliness in the investigation of some complaints within the armed forces.

Dr. Atkins points out that the complaints should be sorted out at as low a level as possible. It is a pity that she has had to say that, as it is just good management practice to ensure that complaints, concerns and worries are sorted out quickly and at as low a level as possible. I would have thought that that was axiomatic. I hope that the armed forces will consider how current procedures lead to the escalation and formalisation of complaints, which is off-putting to many people, particularly those of relatively junior ranks.

To be rather prosaic in the context of many of the remarks made today, the financial position is given briefly in annexe 4. It appears to be fairly summary. It would be nice, for future years, to have an account of superannuation, for example, in the breakdown of costs. We must be accountable for all money these days—at least, the Minister must—and it seems odd that things such as salaries should be cited but superannuation should not. Maybe we need to give that a bit of thought.

In conclusion, I think that the commissioner will be of particular use to families. I know from my experience that they often find it extremely difficult to approach the chain of command and the usual channels. They feel that such an approach might have an adverse impact on their careers, and there are significant grounds for supposing so. I hope that Dr. Atkins will be able to provide an alternative conduit for many of those concerns and that, as a result, the satisfaction of service families—on whom we rely as well as servicemen themselves—will be enhanced and improved. Service families constitute one area where this particular officer will have a particular part to play.

I congratulate my hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble) on securing this debate. I am grateful for her long-standing interest and engagement in this issue. She has put a lot of effort into these matters over a long period. I am grateful for the many contributions that have been made to this interesting debate. I will respond to as many of the points as I can in the time that I have.

The operational effectiveness of the armed forces depends on mutual trust and respect. It is crucial that our people have confidence in the system that investigates their complaints. That must be prompt and fair, while complementing the command structure that is fundamental to carrying out successful military operations. The Service Complaints Commissioner, Dr. Susan Atkins, provides valuable independent oversight of our system. She is a key component of that system.

The Ministry of Defence and the services are wholly committed to the welfare of our people. We welcome the commissioner’s first annual report on the fairness, effectiveness and efficiency of the complaints system. It commends the three services on their commitment to tackling all forms of unacceptable behaviour and on ensuring that servicemen and women are treated well. Dr. Atkins has reported that the complaints system is well designed and is working, but there is scope for improvement. I acknowledge and accept that. It is her job to help us to improve the system, but not her job alone. It must be taken seriously by all three services and by the MOD, which is considering the commissioner’s report in detail. We expect to provide a formal response in the summer.

We are building a good working relationship with the commissioner. The MOD and the services are committed to raising awareness of Dr. Atkins’ role among all servicemen and women. The commissioner will issue 40,000 leaflets to armed forces personnel all over the world with the full support of the chain of command. Furthermore, the commissioner continues to visit our people regularly and has the opportunity freely to talk to all ranks.

Widening the commissioner’s power has been advocated today. The Government committed themselves to the establishment of a Service Complaints Commissioner in their response to the Deepcut review published in June 2006. Provisions had already been proposed in the Armed Forces Bill for an independent external reviewer who would examine the fairness, effectiveness and efficiency of the service complaints system and report to Ministers annually.

A big difference between those who advocate an ombudsman and those of us who support the current role is that we do not want the chain of command to be circumvented. We are committed to the chain of command doing the job that we require it to do. Rather than circumvent that, which a different system of complaints such as an ombudsman might do, we want the Service Complaints Commissioner to work with the chain of command and to help it to improve the system and to change the culture that has existed in the armed forces.

My hon. Friend the Member for Blackpool, North and Fleetwood asked about the culture, but acknowledged that she was complaining about the culture that existed in Deepcut 10 years ago. It has been acknowledged that that culture was unacceptable and a lot has been done to try to change it over the years. We have set up the complaints commissioner and taken attitude surveys which show that people are still reluctant to complain to try to change the culture and force those issues out so that we can amend a system that has been unsatisfactory in the past.

I acknowledge that a lot has changed since the Deepcut inquiry. However, the Service Complaints Commissioner’s report highlights huge differences between different commanding officers and senior officers. She points to poor and good examples. Surely when the armed services look at the report they should ensure that all commanding officers behave according to the good practice that she has highlighted and that poor practice is done away with.

Precisely. That is why the commissioner said what she said in her first report. We will respond to that and hon. Members will see how that goes. That is the point that the commissioner was making. My hon. Friend the Member for North-West Leicestershire (David Taylor), who is no longer in the Chamber, said that the commissioner should be given the opportunity to raise wider issues, not just individual cases. She has done so: some wider issues are contained in her first report. As she gets more experience of the system and receives more feedback on it, more detailed issues will come out in subsequent reports, which we will have to respond to. I do not disagree with my hon. Friend at all.

The hon. Member for North Wiltshire (Mr. Gray) complained that he could not get a copy of the report. I do not know why. There was a written ministerial statement on 4 March and copies were made available in the Vote Office in the normal way. We also made it available on the internet, which is how he obtained it. I do not recognise the problem that he raises.

The hon. Member for Montgomeryshire (Lembit Öpik) has made very serious allegations without providing a shred of evidence to support them. He is basically saying that two police forces and the MOD all conspired to cover up these murders and that Sir Nicholas Blake conducted a sham inquiry. The only thing, it seems, that gets to the bottom of these issues is a play. Perhaps the next time we have an inquiry into very serious matters such as the deaths of young Army trainees, we ought to invite a playwright to conduct it. That seems to be the thrust of what the hon. Gentleman proposes. He has made allegations about things that I am supposed to have said. I will check up on that. If I am wrong I will apologise to him, but if he is wrong he will apologise to me.

rose—

I will not give way to the hon. Gentleman. If he is wrong, he will apologise to me—let me make that point to him.

rose—

No, I will not give way to the hon. Gentleman. He made an allegation. I will check the record and come back to him. If he is wrong, he will withdraw the allegation.

On a point of order, Mr. Pope. I am not blaming the current Minister. I want to make it absolutely clear—I was referring to one of his predecessors. I will speak to the Minister after the debate to clarify exactly who I meant.

That is not a matter for their Chair, but it is on the record.

I am not sure that that is what the record will show when we go into it.

The hon. Member for Westbury (Dr. Murrison) suggested that the Service Complaints Commissioner should be able to provide a conduit for complaints from families. She can do that, and has already done so. It is an important part of her role that she provides an alternative conduit for people to raise complaints, whether they are members of the services or their families. If people do not wish to go through the chain of command, they have another way to feed their complaints in.

The hon. Gentleman said that he was not concerned about the number of complaints because in any organisation they should be dealt with quickly and promptly at a low level. I absolutely agree with him that that is the ideal. However, there is no evidence that that is being done effectively in every part of the armed forces. The Service Complaints Commissioner said that she wants that to happen systematically across the board, but that it is not yet happening. I think that she is probably right. There is a major problem with complaints not being dealt with quickly at a low level that we need to put right. In the time available to me, I have been unable to respond to many issues that have been raised. I will write to hon. Members to try to fill in the gaps on the more substantial points, which are perfectly worthy and deserve a response.

I am very grateful for this opportunity to discuss extended schools and related issues again. In the past couple of years, the Minister has been more than generous with her time, as I have debated extended schools and have corresponded and discussed with her the delivery of that incredibly important programme. She has sometimes expressed concerns about my approach, so, for the avoidance of doubt, I want to put on record yet again that I come at the subject from the perspective of someone who believes that, along with the Sure Start and children’s centre programmes for the under-fives, the extended school approach is one of the most important things that we can do for our children. However, I remain concerned that aspects of delivery, including reliance on co-funding from sources outside her Department, upon which her programme depends, still need further work.

I am aware that extended schools and the whole early years programmes have their detractors—the usual sources, who will use any stick that they can to beat the Government, particularly on the grounds that the measures we are putting in place for children and young people are being taken primarily, sometimes even exclusively, to drive parents into the workplace. Not only do I think that there is nothing wrong with having an early years programme and an extended schools programme that allow parents who choose to work to do so, safe in the knowledge that their children will be looked after, but I have always been convinced that the Government’s approach to those agendas is founded in something bigger and even more important than that perfectly worthy objective. We have to enrich the lives of our children, particularly those whose opportunities are narrowest.

As someone who represents an inner-city constituency that includes not only some of the wealthiest parts of the country, but many areas that are amongst the poorest, I am reminded daily of the challenge that we face with our young people, who are, overwhelmingly, growing up in flats. The great majority of young people are growing up without access to their own garden space and in families who are poor, workless, or in work but in poverty—as we all know, half of all families in poverty are also in employment. Young people are growing up on the edges of central London with incredibly rich and diverse cultural opportunities nearby, but they simply never access them. Among my son’s classmates are children who have never been to the theatre, never been to the country and never had any opportunities to access what those of us with even relatively modest incomes can take for granted. Their lives are blighted as a consequence. The alienation of young people, which sometimes leaves them in the group that we call NEETs—those not in education, employment or training—or caught up in crime and antisocial behaviour, is underpinned by an inability to move in the adult world of interaction that is taken for granted by those of us who have had those opportunities, and by a lack of confidence that is brought about by that inability. They are surrounded by the riches of one of the greatest cities in the world, but they do not access those riches.

The underlying philosophy of extended schools includes not just homework clubs, catch-up clubs and extra educational opportunities, but, as the Government’s own document spells out, music, drama, arts, sport, trips and cultural visits. One of the most important things that we can do for our young people is extend the curriculum and bring it to life by giving the opportunities that make it concrete and broaden the educational experience by making it more practical. That will give people the confidence they need to be able to move in the sophisticated world that some of them have been denied—in many cases, because their parents are not able to do so, perhaps because they have massive barriers of their own such as being drug and alcohol users. Some have been in prison, have mental health problems or are new to this country and do not speak the language. Some, tragically, are simply indifferent and do not provide their children with those experiences even though they could. For such children, it is absolutely marvellous that we have the extended school programme.

I know that the Minister will say that the investment in extended schools is significant and increasing. I acknowledge and welcome that. I am also particularly pleased with the extended schools disadvantage subsidy, which goes some way towards meeting my concerns, because it will direct additional resources into the neighbourhoods, schools and populations that need it most. Perhaps the Minister will say more about that in her reply.

We now know the extent to which the number of schools offering the full core offer is increasing—we have the figures. The Minister is well aware of my concern that my borough, Westminster, has been trailing badly in delivering the offer. A few months ago, when I was doing some work that resulted in an excellent article in The Guardian on the subject, only half of all schools were offering the full core offer. Given how much we need, that causes me real heartache. There has been significant improvement in my borough recently as well, and I put that down to a dynamic new appointment. I put on record my admiration for Peter Turner, who has taken the programme by the scruff of the neck. Previously, we lacked that sort of senior management buy-in and the ability to deliver the programme, but there have been real improvements in delivering the service in my area.

That is the good news, and there is plenty of it, but I asked for this opportunity to discuss the programme again because I am still very anxious about a few aspects. First and foremost, although it is early days and the disadvantaged children’s subsidy is yet to kick in—it was piloted last year and there will be an extended pilot this year—the Government’s own research confirms that children from more deprived backgrounds are less likely than the average to use the activities and child care services available in the extended schools programme. It worrying that a programme that was designed explicitly to reach out to and lift children with the narrowest opportunities is not delivering as well to them as to the average. That is not, as slick headlines would have it, a damning indictment of the whole programme, but it gives us cause to ask what is not being done that needs to be done.

Last year’s child care and early years survey, conducted by the National Centre for Social Research, found that fewer than one in five older children were using out-of-school services at all. That figure was unchanged since 2004. I am sure that there will have been some improvement since then, but that is a cause of concern. In the extended schools survey that was conducted for the Department for MORI, published in January, only 6 per cent. of the parents surveyed said that their children had attended an activity during the school holidays, whereas the demand for holiday schemes expressed in that survey was 60 per cent. There are therefore two problems: the relatively low and stable participation in the whole out-of-school programme for older children in particular, and the gap in holiday play schemes. Given that the Daycare Trust’s research, which it produces every summer, on the cost of holiday schemes found that last year alone the cost of holiday programmes jumped by 10 per cent., MORI’s finding of a relatively low level of participation is worrying.

As an enthusiastic advocate for the programme, I agree with everything that my hon. Friend says about its advantages and the importance of ensuring that it reaches the most disadvantaged. Incidentally, I commend the excellent work being done in Oxfordshire. Does she agree that one of the problems is that too many parents themselves feel alienated from an educational environment, partly because of their own experience? One way of tackling that is to have more intensive outreach work in the community, such as home visiting. We should also build on the excellent multi-agency work being done to ensure that people have every opportunity to take advantage of the facilities available.

I totally agree; my right hon. Friend is spot on. His comments chime with my next point, which is that the MORI research also found that the people most likely to participate in the programmes were those in two-parent families and those with younger children. That is very welcome. The people less likely to participate were the parents of children in special schools—that is a great worry—and those with secondary-age children, especially parents of children in years 7, 8 and 9. Those are the years in which children make the transfer from primary to secondary education, and it is when they most need that level of intensive support.

Secondary school transfer is already a real cause of concern. The alienation to which my right hon. Friend refers is, in most cases, inadvertently compounded by secondary school transfer. The relationship between parents and schools and between children and schools is worse in secondary schools than in primary schools. That is often connected with secondary transfer. It is worrying that fewer services are available to those groups and participation is lower. It shows that there is a demand for exactly the work he describes. Intensive outreach to parents is, in a sense, parallel with the work of children centres and Sure Start. We know well that some schools are involved with that work, but not all are.

Worryingly, the MORI findings also show—it is not picked out in the executive summary—that the group that found it most difficult to fund out-of-school activities were families with no parents in work. That brings me to the heart of the dilemma: the question of co-payment and sustainability, of which my right hon. Friend the Minister is well aware. From the research, we know that one of the reasons participation is not as great as it should be is that, according to the children and parents surveyed, the activities on offer are not always what children want. That brings us back to the menu. What is the menu of activities that can engage children, especially those who need it most? We need to give them not just catch-up classes, but enjoyable activities. Those activities should deal with the problem of alienation mentioned by my right hon. Friend the Member for Oxford, East.

The other issue is, of course, payment. Lone parents, parents of children in special education and parents who are not in employment find it most difficult to deal with the payments. Obviously, some schools—the disadvantage subsidy will help with this—provide cross-subsidies. The dilemma is that the schools with the smallest proportion of parents able to pay the charges are the schools that need the service most but are least able to draw upon co-payment. There are schools in my constituency that have large numbers of children on free school dinner entitlements and parents in low-paid work. The argument is that such schools would benefit the most from that rich menu of activities, but unfortunately they are less likely to be able to generate an income that makes such services sustainable.

My right hon. Friend the Minister is aware that I am concerned about the replies I get from her Department that say, “Well, this is, of course, what the child care element of the working tax credit should do.” However, hardly anybody gets the child care element of the working tax credit. There is no evidence—if she can point me to the evidence, I will apologise and back off from this line of argument—that parents of older, school-aged children are claiming the child care element of the working tax credit to pay for out-of-school activities and holiday schemes. It is precisely because they do not do so that we have this dilemma.

Although 80 per cent. of schools are ticking the box to say that they provide the full core offer—next year, the Government intend to have all schools ticking the box that says that they do so—if we look at the Department’s guidance for schools, it states in the small print that if a school has decided that there is neither the need nor the demand for the services, it can still tick the box to say that it is providing the full core offer. Slightly weirdly, therefore, it is entirely possible for a school to say that it is providing a full core offer when it is actually not providing a single service. That problem might well come back to bite the Government and it is something about which we need to be concerned. I do not think that many schools will play that game, but it is a concern because what we understand by the full core offer is a school that is providing a full menu of the four categories of activity set out in the guidance.

As I have said, further attention needs to be paid to those on low incomes, those with free school dinner entitlements and those who are out of work. Of course, we also need to recession-proof the measures to help all those who are in low-paid work, many of whom do not receive the child care element of the tax credit. How will we ensure that the full delivery that we are promising is there on the ground? How will we ensure that we are delivering sustainable and affordable services, particularly for the children who need them most?

As I have said, I am aware that the disadvantage subsidy will be a real help in that sense, but I am not convinced that the deep pockets of disadvantage, particularly in our expensive inner cities, will benefit from a Government approach that delivers the support that is needed—that reaches out and genuinely offers a programme of activities that will enrich and improve the lives of our young people.

I welcome the fact that my hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck) has secured another debate on this subject. I have no problem with the number of times that she raises the issue because she and my right hon. Friend the Member for Oxford, East (Mr. Smith) have demonstrated today that they are fully supportive of what the Government are trying to do in this regard. She has also shown that she understands completely why it is important to have extended services that are part of a range of changes in what is available for children and families in communities.

My hon. Friend the Member for Regent's Park and Kensington, North is right to say that it is not just, or even primarily, about enabling parents to work—although that is an important opportunity that we need to provide for parents of children in poverty. The matter is much more fundamental that that; it is about enabling children to have experiences that are not just nice, but essential for their development if they are to reach their potential. That is why the best public schools build in a vast array of enriching activities and opportunities for children to challenge themselves. If that is good enough for the best schools in the country, it is good enough for all our children. That is precisely what the Government are trying to do and why we have made an historic investment in supporting children from the nursery all the way through school.

We have tried to transform the landscape of family support over the past 10 years, so that parents no longer have to go it alone. More fundamentally—this is the core of the argument made by my hon. Friend the Member for Regent's Park and Kensington, North—the circumstances into which a child is born should not dictate where they end up in life. It is the role of important public services to help children who are born with a less favourable start to make up the difference during their early years, at school and beyond, so that they have the same opportunities to be as fulfilled as any other child.

My hon. Friend is right to say that extended services in schools are a key part of the panoply of change that we are trying to achieve, and that is why, as she recognises, we are backing the ambition with about £1 billion in investment in extended services in 2008-10. That includes extra support in the form of a subsidy for payment for the most disadvantaged children, which I shall come to in a minute.

My hon. Friend mentioned early in her contribution the pace of delivery in her own area. She commends the new director, who I am sure has played a part, but she herself, as a forensic scrutineer of what is happening in her area, has also played a significant part in the considerable improvement that we have seen in the Westminster and the Kensington and Chelsea local authorities. It was partly due to her pointing out the slow pace of delivery that the Training and Development Agency for Schools, which is our delivery partner, was able to get to grips with the problem.

The latest figures show that 86 per cent. of schools in Kensington and Chelsea and 77 per cent. of schools in Westminster now have the full core offer. There are some innovative programmes; for example, my hon. Friend may be familiar with the arts extend programme at six schools in Westminster, which has been a particular success. We want to see more of that. The programme is still in the process of delivery, and even when we reach a position in which all schools provide the full core offer, the job will not be done. There are issues about quality and access, beyond a school simply saying that it is delivering the full core offer. My hon. Friend rightly raises what I accept completely are two key challenges for us to continue to work on.

The first challenge—this is a vital part of our thinking—is to ensure that children from the most disadvantaged backgrounds in particular get some of the advantages of being in a school in which curriculum activities are enriched by a range of opportunities. In developing the sustainability of extended services, it is important that schools and parents are helped to bring in an appropriate charging regime for appropriate activities, but it is also important that that regime should not disadvantage the children who need the activities the most.

That is why we introduced the subsidy. As my hon. Friend said, it is being piloted in 18 authorities, including two in London—but not Westminster, although it will get some of that resource in the coming financial year. In preparation for this debate, I gathered some information from the pilots, which only started in September 2008. Early information from the 18 authorities is that the subsidy is beginning to transform the range of activities available, and access for the most disadvantaged children. I am told that schools are enthusiastic, and reaction from parents has been profound in some instances. They speak about the difference the programme has made; for example, a youngster is able through the subsidy to buy a Brownie uniform and attend Brownies every week, or to buy equipment to take part in an activity.

There is no division between my hon. Friend and me on this matter. I am absolutely with her, but if we do not deliver extended services to the most disadvantaged children, the scheme as a whole will fail. It is those children who stand to benefit the most, and therefore we must ensure that we enable them to access the services. The MORI survey did show a lack of holiday provision, and we are working on that. It also showed that at present a slight majority—about 60 per cent. of parents and 67 per cent. of young people—are satisfied with what is happening in their schools. That is heartening, but it is not enough. We need to ensure that those figures improve.

My hon. Friend raised a related issue which involves another distinct challenge. The extended services must be sustainable, but we also need to enable parents, particularly those who are not working, to access the activities. My hon. Friend has raised this issue with me, in respect of her local authorities in particular, on several occasions. It relates to the child tax credit and the child care element of the working tax credit.

My hon. Friend is absolutely right to say that although there has been some improvement in Westminster in the take-up of child tax credit, the improvement over the past year or so has been only half that of London authorities as a whole—9.5 per cent. in Westminster as opposed to 17.5 per cent. in London. Whereas in other authorities the increase in child tax credit take-up has led to an increase in take-up of the child care element of the working tax credit, that has not happened in Westminster. It has seen half the rate of increase in child tax credit take-up, and that has not translated into take-up of the child care element of the working tax credit. I know that that is technical, and I apologise, but my hon. Friend understands this even better than I do.

Those figures are important, because tax credits—certainly the child tax credit—are one of the main ways in which parents who are not working, as well as others, can get resources to help fund activities. I am afraid to say that, without doubt, Westminster is one of the poorest local authorities for take-up of child tax credit and the child care element of the working tax credit, and has consistently been so. In addition to what colleagues in the Treasury and my Department are doing to promote resources for parents, other local authorities, including some in London, actively promote take-up of such resources, which has made a significant difference.

Will my right hon. Friend give way?

Let me just finish this point, which relates to what my right hon. Friend the Member for Oxford, East said. Other local authorities are much more assertive in the outreach work that they do from children’s centres, schools and Jobcentre Plus. They invest a great deal in their family information services and in training people so that staff on the ground really understand child tax credits and the child care element of the working tax credit. That is how take-up of both those things has been increased in other London boroughs.

I am grateful for those statistics, some of which I did not know. Will my right hon. Friend agree to ask officials in her Department to approach Westminster to see what can be done to deal with the issue? As she rightly said, it is in danger of undermining delivery of the whole programme.

My right hon. Friend may not be able to answer this question now, but perhaps she could write to me. It is still unclear to me whether anyone knows the extent to which the child care element of the working tax credit is received by parents of older children. It is difficult to drill down for that information, but, unless we have it, Westminster and other boroughs will all be slightly in the dark about the best way forward.

On the latter point, I will write to my hon. Friend. I am not clear myself at the moment whether the Treasury can disaggregate figures on take-up according to the age of children in the family. It is a valid point, and I will investigate and write to her.

I shall also write to my hon. Friend and clarify the figures that I used for the two authorities that cover her constituency. The Government office for London has regular conversations on performance with Westminster about this matter. In addition to the work of the TDA, that is partly how delivery of the programme has improved. I shall ask the office for a report on the outcome of those discussions and ensure that she is aware of it.

I am grateful to my hon. Friend the Member for Regent's Park and Kensington, North and to my right hon. Friend the Member for Oxford, East for the points that they made about the scheme. They recognise its importance, and I very much welcome their support. Extended services are a vital part of a long-term programme to improve outcomes for all children and to ensure that we reduce the inequalities that exist for children from disadvantaged backgrounds.

Mr. Pope, may I say what a pleasure it is to serve under your chairmanship for the first time? Normally, at this time on a Wednesday afternoon we are both in the Select Committee on Foreign Affairs. A change is as good as a rest, so they say, so I am delighted to have the opportunity to speak in this important debate. I am most grateful to colleagues for turning up on the busiest day, in parliamentary terms. I imagine that we have all had a rushed lunch. I thank all hon. Members for coming.

Let us first remind ourselves of the facts. Cardiac and vascular conditions are those affecting and related to the heart and to blood vessels throughout the body. They include heart attack, stroke, diabetes and chronic kidney disease, affect the lives of more than 4 million people in England, cause 170,000 deaths each year and are responsible for about one fifth of all hospital admissions. The challenge posed by those conditions is stark: cardiac and vascular disease remains the number one cause of death and disability in the United Kingdom. The death rate for coronary heart disease and stroke in men and women is still higher in the UK than in comparable western European countries. It was primarily to address that serious challenge that the national service framework for coronary heart disease, a 10-year plan of action, was launched in 2000. In England, it certainly has delivered significant progress in the fight against coronary heart disease.

The national framework for CHD, with the additional arrhythmias chapter added in 2005, led the way as one of the first national plans developed to take a root-and-ranch approach to improving the treatment and care of people with a particular condition and to take action on prevention. Progress reports have shown the following: first, the target of reducing deaths from cardio-vascular disease in people under 75 by 40 per cent. was met five years early; secondly, the number of people suffering a heart attack who received thrombolysis within 60 minutes of a call for help increased from 24 per cent. of patients in early 2001 to almost 70 per cent. in 2007; and thirdly, the waiting times for heart surgery dropped dramatically, from more than 5,500 people waiting more than three months for heart surgery in 2000 to none in 2007. However, we must not risk failing to build on what we have achieved to date. It is vital that these achievements and those of other strategies for stroke, diabetes and kidney disease are sustained and built upon. Simply to rely on a project-based approach is not enough.

I thank the hon. Gentleman for not being party political and for giving the Government full credit for our achievements to date. Does he agree that they reflect the Government’s investment in increasing health funding from £33 billion in 1997 to more than £100 billion today, and that we need to keep that investment in place for the future to build on our successes?

I think that I agree with the hon. Gentleman. In his statement today, I think the Chancellor indicated that health spending would continue along the lines that had been built in some years previously. However, the achievement in relation to cardiac and vascular disease over the past nine years is more to do with the focus that the Government brought to bear on that wide-ranging issue. That is just as important, of course, as the money that brought it to fruition.

Although I want to be non-partisan, I fear that we need to point out some failings. Does my hon. Friend agree that it is a scandal that we do not have a national programme for screening for abdominal aortic aneurism, for example, given that the national screening committee said years ago that that should happen? We continue to lose hundreds of men over 65 for want of a simple screening procedure that would probably save more lives than breast cancer or cervical cancer screening, yet Ministers continue to drag their heels.

My hon. Friend raises an important point. The Prime Minister himself announced not long ago that a special check system was to be put in place for that problem, which causes deaths in the over-60s and over-65s in the male population in particular. I thought that pilot schemes were due to start in the south-west as early as last year, but I am not aware—the Minister will probably say—that those pilot schemes for checks are in place yet. No doubt, the Minister can throw more light on that.

In fact, we do have a strategy for aortic aneurism screening and we started that in April this year. That was the date that we announced and it has happened. We need to keep to the facts.

I think there is a draw on that one.

That is a bit generous.

April 2009 is actually here and now, is it not?

Perhaps my hon. Friend would like to reflect on the fact that the announcement was made by the Prime Minister back in January 2008 and it has taken 15 months even to get the triple-A screening pilots started.

Another fact has been added to the record.

Some risk factors for cardiovascular diseases, particularly obesity and a lack of physical activity, are increasing. On current trends, 60 per cent. of males and 50 per cent. of females will be obese by 2050. If unchecked, it is predicted that that will lead to a massive increase in type 2 diabetes, with the current trend indicating that more than 4 million people in the UK will have that condition by 2025. That will result in a large increase in the number of patients who require medication to prevent cardiac and vascular events.

The number of people requiring kidney dialysis is set to double by 2014 to more than 45,000, but growth in the prevalence of cardiovascular disease and diabetes could increase the number still further. With a population that is ageing and increasingly overweight and obese, prevalence of cardiac and vascular conditions, and their associated treatment costs, will only increase. We must therefore ensure that the health service is ready and prepared for the extra demands it will face. Investment now to prevent premature chronic illness will lead to savings in the future.

The success of the national service frameworks means that more people survive acute cardiac and vascular events. Of course, that is good news, but it means that more people are living with cardiac and vascular disease, and it is vital to plan for that. However, although the Department of Health has recognised, in its recent progress report on the national service framework for CHD, the case to build services around all cardiac and vascular disease, it remains unclear how exactly it plans to deliver that integrated approach. For that reason, the Cardio and Vascular Coalition, or CVC as I shall refer to it from now on, has published key recommendations for a new integrated approach to cardiac and vascular conditions for policy makers to consider.

The 41-strong membership of the CVC is a who’s who of organisations with an interest in cardiac and vascular disease, ranging from large representative organisations, such as the British Heart Foundation, the Stroke Association, the British Cardiovascular Society and the Royal College of General Practitioners, to smaller organisations representing rehabilitation and congenital heart disease—areas poorly served by the original NSF for coronary heart disease. Those organisations have come together to make a combined case for a renewed approach to cardiac and vascular conditions. Having one cardiac and vascular disease commonly predisposes people to another.

I congratulate the hon. Gentleman on his initiative in seeking the debate, and convey to him the thanks of many of my constituents. Many of my constituents signed the British Heart Foundation’s petition, which, as he knows, attracted 130,000 signatories. Will he share his thoughts on how a national strategy should develop, and does he welcome the way in which the Government have sought to ensure that, in an era of devolution, the four Administrations work together for an effective UK-wide strategy?

I am grateful for the hon. Gentleman’s intervention, and I agree that there should be a co-ordinated approach, which the Government have shown to date. I hope that as a result of this debate and pressure from both sides of the House—this is an all-party subject of great interest—they will look ahead and continue their good work. I shall discuss the petition later.

As I said, having one cardiac or vascular disease commonly predisposes people to another—for example, people with diabetes or kidney disease are at much greater risk of developing heart disease. The shared risk factors, related pathology and possible co-morbidities of those conditions support the development of a consistent approach to the management of cardiac and vascular conditions.

It is report, “Destination 2020: A plan for cardiac and vascular health”, the CVC urges the Government to commit to a proactive and co-ordinated approach that builds on the success of the work done so far and meets the challenges of the future. That should incorporate coronary heart disease and the other cardiac and vascular diseases—stroke, diabetes and kidney disease—when appropriate. It should address key areas requiring further progress and those that were not considered in the existing national service frameworks, including cardiac and vascular disease prevention, congenital conditions, rehabilitation, emerging needs for acute and chronic conditions and, finally, end-of-life care.

A key area where gaps remain is prevalence of disease and equality of access to services. The prevalence of coronary heart disease in men in England increases markedly with deprivation. The rate is one third higher among men in the most deprived group compared with the least deprived group. The difference is even greater in women, and those in the most deprived group have a rate of heart disease at least 50 per cent. greater than the least deprived group. It is clear that there is still inequality of access to cardiac interventions, and “Destination 2020” addresses how those inequalities in the prevalence and treatment of cardiac and vascular disease can be reduced.

Another important area of unfinished business is cardiac rehabilitation—measures to ensure sustained recovery and improvements in health and well-being following a cardiac event. Effective rehabilitation can bring about significant improvements in the lives of people who have had a heart attack or stroke, and reduce disability. Despite a target of 85 per cent. of eligible patients being offered cardiac rehab in the national service framework, a recent national audit of cardiac rehabilitation warned that only 47 per cent. of eligible patients receive that life-saving treatment. Cardiac rehab has been highlighted as a key area where further progress is needed.

Other areas that “Destination 2020” says should be addressed include planning for an increase in acute events, such as a heart attack or stroke, as a result of the risk factors that I outlined—many of the patients affected will be older and likely to have complex vascular disease requiring greater supportive care, as well as a longer hospital stay than is currently the case. The report recommends further development of child-specific services to prevent future cardiac and vascular disease, and the inclusion of children and adults with congenital heart disease in future planning—an area that is absent from the original national service framework for coronary heart disease. The CVC also calls for more long-term treatment and care services for those living with cardiac and vascular disease, to take account of anticipated increases in numbers; and, finally, better end-of-life care services for patients with cardiac and vascular disease. Those patients currently receive less specialist care than those with other conditions, most notably cancer, despite mortality and disability associated with some cardiac and vascular diseases, such as severe heart failure, exceeding that of most common cancers.

The hon. Gentleman has given a comprehensive list of areas for improvement, and I congratulate him on that. Will he join me, as chair of the all-party group on heart disease, in asking the Minister to meet the group to discuss his suggestions in detail?

That is an excellent idea. Perhaps the hon. Gentleman would like to invite the Minister to address our next meeting.

I am exceptionally willing to do that, and I thank my hon. Friend for the invitation.

One nil, I think.

“Destination 2020” outlines the aims and principles that should underpin a renewed strategic approach to tackle cardiac and vascular disease in the next decade—for example, aims such as those relating to carers, third-sector organisations, and prevention. A person with cardiac or vascular disease should be placed at the centre of service and treatments with their carers and family. The aim should be to develop true partnerships between people with long-term conditions and the professionals and volunteers who care for them, underpinned by care plans and better patient information.

Carers play a crucial role in the ongoing care, rehabilitation and recovery of patients. They should be supported to provide that assistance, but a recent survey commissioned by the CVC showed that only 5 per cent. of carers had had a formal assessment of their support needs. Third-sector organisations representing patients with cardiac and vascular conditions and those around them should be encouraged to play a greater role in ensuring that their needs are addressed in policies and services.

I welcome the way in which the hon. Gentleman has emphasised the importance of carers. As chair of the all-party group on carers, I extend to his group the opportunity of having a joint meeting on this crucial issue. Will he respond positively to that?

Zero one, I think. The answer, of course, is yes, but the chairman of my group is sitting next to the hon. Gentleman, and all he needs to do is ask him.

Prevention measures should be at the heart of future planning for cardiac and vascular conditions, as they are ultimately the most effective way of reducing illness and preventing premature deaths. Comprehensive cardiac and vascular risk assessment and prevention measures should be encouraged, with particular emphasis on further progress in smoking prevention and cessation and reducing obesity.

“Destination 2020” also recommends measures to ensure that commissioning supports the provision of the resources, services and staffing required to implement a renewed strategy aimed at tackling cardiac and vascular disease. It supports the promotion of evidence-based practice and measures to maintain and strengthen the UK as a world leader in clinical trials in cardiac and vascular diseases to be conducted by both NHS and non-NHS research bodies. The Government's welcome NHS health checks programme aims to identify many of the major risk factors for cardiac and vascular diseases, and should form part of a wider focus on prevention.

It is essential that adequate plans and resources are put in place to meet the needs of the large number of people identified by the NHS health checks programme who will require follow-up. The shift towards prevention and the checks themselves are very welcome, but some questions require clarification. I did not give the Minister sight of those questions before the debate, and she may or may not have time to answer most of them, but no doubt any unanswered questions will be dealt with in correspondence in the usual way.

indicated assent.

I thank the Minister in advance. The questions are as follows. The pace, scale and model of implementation appears to be decided by each primary care trust. Surely there is a risk that that will increase inequalities, as a result of variable implementation at local level. Will that be centrally monitored and action taken if necessary?

Accessibility to heath checks for patients is, of course, crucial. How is that best to be achieved? Will PCTs be ultimately responsible? Will the services be confined solely to GP practices, or will we set up specialist clinical centres? What will be the role of community pharmacies? There is no doubt in my mind that in community pharmacies we have a fairly universal and readily accessible professional resource that could play a key role in the health check programme. That new role seems to have been actively encouraged by parts of the NHS, but not universally. Some PCTs seem reluctant to embrace that great potential, through ignorance, professional opposition, lack of focus or simple tardiness. More centralised focus and targeting by the Department of Health may be required.

It is vital that those identified as being at risk of vascular disease or as already having a condition receive the best treatment. Does the NHS have a prediction of the numbers from both those groups that health checks will pick up? There is little point in identifying those at risk but being unable able to intervene effectively. What additional resources have been allocated for prevention interventions and the treatment of those identified as having a vascular disease? Are funds being ring-fenced for that purpose? Beyond smoking cessation, what evidence-based prevention interventions are available for PCTs to use?

How will PCTs’ success in providing the health checks be assessed and poor performance tackled? How will central Government ensure accountability for local delivery? The programme will yield huge amounts of data that will be invaluable for research and providing the evidence base better to inform commissioning in the future, but what plans are there to collect and use those data effectively?

It appears that two risk engines will be used to calculate people’s risk. Ideally, a national programme would be delivered locally using the same tools. Has the Department any plans to use one system only? It is good news that the Department is beginning to look across all cardiac and vascular conditions for the checks. If someone is identified as having multiple risk factors, are there plans in place to manage those risk factors holistically?

There is a clear groundswell of public opinion behind the calls for a renewed strategic approach to cardiac and vascular disease. The British Heart Foundation reports that the CVC’s case for a new plan has been backed by more than 135,000 people—a figure mentioned by the hon. Member for Aberavon (Dr. Francis)—who have signed the petition. That is a formidable voice, comprising 41 respected and authoritative organisations and tens of thousands of members of the public. They are asking not for a new national service framework or a replica of the current one, but for a clear vision of where we are going in the next 10 years.

This debate was inspired in part by the fact that the national service framework for coronary heart disease—a 10-year programme of action—is almost a decade old. Given changes in the health service, growing demands and changing priorities, we surely require a renewed strategic approach for the next 10 years, dealing with areas of unfinished business and ensuring a consistent approach across all cardiac and vascular conditions. That call for a renewed strategy is not unique. Such a strategy would be entirely consistent with the Department’s announcement that it intends to publish a new strategy for mental health. The national service framework for mental health, which is also a 10-year strategy, is due to end this year, and the Department accepts that it needs renewal.

I am aware that the Department recently issued an update report on the national service framework for coronary heart disease. There was much to welcome in that document, including commitments, first, to address inequalities further; secondly to work across cardiac and vascular conditions; and, thirdly, to address unfinished business, including cardiac rehabilitation. The update rightly records progress made in the fight against coronary heart disease, and there is recognition that now is the time to build on the progress achieved, yet the report leaves some questions unanswered.

When will the promised reviews of the implementation of the current national service framework and the future of cardiology be delivered and how will they be applied to improve services? What is the Department’s vision to build on progress in combating inequalities across cardiac and vascular conditions? What exactly does the Department mean by “working across conditions” when it gives the impression that it will treat heart disease, stroke, diabetes and renal disease under separate programmes?

The fundamental concern about the update document was that, of its 20-plus pages, only one was devoted to future planning—for 2010 and beyond. The report is heavy on what has been achieved, but does not acknowledge that the growing burden of people living with heart and circulatory conditions requires a renewed vision for the next generation.

The health service looks very different now from how it looked 10 years ago, when the national service framework for coronary heart disease was first developed. Without a new national strategic approach to cardiac and vascular health in England, we run the risk of progress slipping away. We need a coherent integrated plan covering cardiac and vascular disease, with the experience of the patient, through prevention to palliative care, at the centre. That plan should embrace current initiatives and address remaining gaps in services, so that we can better meet the new challenges that we face, further improve the health of the nation and reduce the incidence of cardiac and vascular disease in England to one of the lowest levels in western Europe.

The CVC has produced a vision for a new comprehensive approach to all cardiac and vascular disease. Will the Minister commit seriously to considering the CVC’s “Destination 2020” document and working with the voluntary sector to plan the next phase of the fight against cardiac and vascular disease?

It is a great pleasure to serve under your chairmanship, Mr. Pope. I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing the debate. I was very pleased that he mentioned the importance of the care of, and a proper strategy for, those who suffer from congenital heart disease. It is perhaps a testament to the Government’s success that so many babies survive with that condition. It is notable, though, that not all the recommendations in the Monro report were implemented, due partly to the fact that clinical expertise is spread rather thinly across the service. A group chaired by Dr. Patricia Hamilton is re-examining these issues and I hope that early recommendations will be made such that sufficient specialist staff can be trained. A larger number of children with congenital heart disease are surviving to adulthood, and clearly resources are needed to ensure that doctors and nurses with specialist knowledge of adults with such a condition are appropriately trained. When the Minister replies, I would be interested to hear about the approach being taken to congenital heart disease and how that policy is distinguished from the rest of the policies regarding the treatment of coronary heart disease.

This debate is about the treatment of those with cardiac and vascular disease, which many of us will have experience of in the coming years. I am particularly concerned to spend some time considering the expectations of the 380,000 residents of Croydon and what they will face in the context of proposed changes in provision for stroke victims. As the hon. Member for North-East Cambridgeshire said, early treatment is very important when a stroke strikes. It is also a great testament to improvements in the service that 70 per cent. of stroke victims are now treated within 60 minutes—and very important that is too, given that for every hour that treatment is delayed, brain cells are haemorrhaging away at a rate normally experienced over 3.6 years.

In Croydon, the Mayday hospital treats 500 cases of suspected acute stroke each year; at present, we have a nine-to-five, Monday-to-Friday capability for dealing with such cases. However, Healthcare for London proposes that such provision should be provided solely at St. George’s hospital. Healthcare for London is, in some ways, setting up an artificial choice between Mayday and St. George’s. As we heard, it is important that treatment is given within 60 minutes; even with their blue lights, and despite what the London ambulance service might say, it is extremely difficult to get to St. George’s from many parts of Croydon. It is appropriate to say that the population of south-west London would be better served by having two acute stroke units.

It is suggested that St. George’s would be the best location, but Mayday’s proposals to Healthcare for London were made in partnership with St. George’s, the latter saying that the ideal scenario would be to have a joint acute unit with two front doors—at Mayday and at St. George’s. Only under the artificial construct by which Healthcare for London pitches hospital against hospital for the right to receive one of eight acute stroke units in London does it make no sense to retain Mayday’s hyper-acute provision. After all, the unit in Croydon is performing well; indeed, it has been commended on its strong performance. Its thrombosis treatment is reaching levels provided by the very best in Europe, including in Helsinki. It seems odd to propose removing the excellent provision provided at Mayday yet at the same time to propose endowing Princess Royal university hospital in Bromley with such provision, given that the latter does not have a distinct record in stroke treatment.

I am concerned that as many as 20 per cent. of those presenting with symptoms of stroke are suffering mimic stroke. Taking such patients on the long journey to and from St. George’s could put great stress on the London ambulance service. Mayday has experienced significant difficulties in the quality of liaison—it is now becoming a main general hospital—with tertiary centres. I was grateful for the interest shown by the Secretary of State in two cases that seemed to show real difficulties in communication between the hospitals.

More than 1,000 signatures have been added to a petition on the matter. I cite two residents who expressed concern. Given the expected traffic difficulties of travelling across south-west London, Peter Mason quite rightly says:

“Less miles means more lives are saved.”

Heather Bain said:

“My mother had a stroke and the only reason she is still mobile is that Mayday was so near to our home.”

It is important to consider Croydon’s demographics. It is notable that the Healthcare for London bid consultation document cited a 60 per cent. greater incidence of strokes in the black African and black Caribbean populations, which is exacerbated by social deprivation. That is an important concern for Croydon, which has a higher than average population in that respect compared with London and England. It may not be obvious at the moment, but we have a dynamic community. It is changing greatly, and that change will be further driven by migration flows, as Croydon becomes host to the Border and Immigration Agency. That sector of the population—the BME community, and particularly the black Caribbean groups—is now ageing and is much more likely to be exposed.

St George’s hospital has explicitly stated it does not have the capacity to take all acute stroke patients. Its bid identified a maximum capacity at the prospective unit of 20 beds, with a preferred bed complement of 14. The Healthcare for London tender made under the consultation suggests that 26 beds are needed for south-west London. It would be appropriate for St. George’s and Mayday hospitals to share that provision.

Given the configurations considered in the consultation, it would be somewhat safer to have a stroke in Westminster or other parts of central London. It is partly to do with history and the quality of hospitals in the central area, but coverage in London’s periphery seems rather sparse. Although it is never the Government’s intention to discriminate against the suburbs, disjointed decisions made in different parts of the public sector have resulted in discrimination against Croydon.

I warmly congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing this important debate. He is known to be a fair-minded man, and he delivered merited praise to the Government when justified. He also presented a thoughtful analysis and an objective critique when appropriate. All in all, his contribution was delivered in a non-partisan manner, despite provocation from the Taliban tendency of the Conservative Front Bench.

The Cardio and Vascular Coalition’s excellent “Destination 2020” strategy, to which the hon. Member for North-East Cambridgeshire referred, is both timely and significant. The aim is to reduce rates of cardio and vascular disease in the United Kingdom to one of the lowest in western Europe. That is a commendable aim, and we should have no trouble in welcoming and supporting it, and taking the appropriate decisions to ensure that it is delivered. As the coalition readily acknowledges, the Government have made important progress, tackling these generally fatal diseases through the national service frameworks to which the hon. Gentleman referred. That is particularly so for coronary heart disease, kidney disease, stroke and diabetes.

Vast improvements have been made to the way in which the NHS diagnoses and treats cardiac and vascular diseases, but although everyone in Parliament should be proud of that, it is vital to recognise that it is only a stepping stone to better health outcomes throughout society. In my view, the key areas for improvement are preventing cardiac and vascular disease and the rehabilitation of patients.

The hon. Member for Croydon, Central (Mr. Pelling) gave a helpful and encouraging speech. I declare an interest as chair of the Ibstock stroke club. The hon. Gentleman was talking about specialist stroke units. We have one in Leicester general hospital, which serves getting on for 1 million people in the city and the county. A feature of its care is the rehabilitation offered as an intermediate step at community hospitals in the county, including at my community hospital at Coalville. I hope that the Minister, who is an able, approachable and articulate member of the ministerial team, will accept an invitation to visit the Coalville hospital to see the work done in the stroke rehabilitation unit. Such an offer is probably difficult to refuse.

I return to the thrust of the debate. Lord Darzi’s review of the NHS will undoubtedly lead to fundamental changes to the organisation and commissioning strategies of the national health service. I am a confessed sceptic of the personalised health budget, polyclinics and the choice mantra—I hope that the Minister has not already cancelled her ticket to Coalville. Lord Darzi’s emphasis on local commissioning has the potential to continue the Government’s record of improving standards and patient outcomes in the NHS. However, in an era in which local health authorities are commissioning rather than providing primary health care, it is vital that the Government retain a strategic view of prevention, diagnosis, treatment and rehabilitation for cardiac and vascular patients, and for all other long-term chronic conditions.

As the report “Destination 2020” spells out, and as the hon. Member for North-East Cambridgeshire said, project-based approaches on their own will not necessarily realise our ambition of reducing the number of cardiac and vascular disease patients or improving their care pathway. The Government need to spell out their strategic policy—I guess that we will hear something about that in the Minister’s reply—and the changes to the NHS proposed in the Darzi review must fit around that policy, not the other way around.

I want to focus my main comments on the third principle outlined in “Destination 2020”, which talked about the CVC’s ambitions being delivered through standards of excellence, a patient-centred approach, effective commissioning, research, addressing specific areas of need and particularly by a new focus on prevention. At this point, I should declare an interest as the chair of the all-party group on smoking and health, and that is the issue to which I now wish to turn.

The Government’s Health Bill, which is proceeding through the House, is key to a new approach to preventing the diseases that we are discussing. There are overt links between smoking and many fatal diseases, such as cancer, and deaths from coronary heart disease are about 60 per cent. higher in smokers. That means that tobacco smoking accounts for more than 30,000 deaths from cardiovascular disease in the UK every year. As a result of smoking, 100 people will die from CVD today, 14 or 15 of them in the city of London.

Smoking is a major cause of death from CVD and of the morbidity associated with it, although its prevalence is decreasing, which has made a significant contribution to decreasing CVD rates. It has been estimated that about 48 per cent. of the decline in coronary heart disease mortality in England and Wales between 1981 and 2000—a period of 20 years—was attributable to the reduction in the prevalence of smoking. Smoking rates have declined since my teens and 20s—that was 40 years ago—when about half the adult population probably smoked, although prevalence varied widely by social class and age. None the less, as the Minister well knows, more than 20 per cent. of the population still smoke, and the figure is significantly higher in deprived communities. We therefore need to maintain momentum and to continue to recognise smoking as a risk factor that can and, indeed, must be minimised. It is important to recognise that even by the most optimistic estimates of smoking cessation rates, there will still be at least 5 million smokers in the UK in 10 to 12 years’ time, when a fifth Labour Government will be coming to a very satisfactory conclusion.

Even a temporary cessation in smoking improves health outcomes. Crucially, the ability of cardiovascular patients to survive surgery and avoid post-operative complications improves significantly. I do not know whether my hon. Friend the Minister, who is a London MP, was aware of this, but the London Health Observatory reached the following conclusion in its 2006 report on the short-term benefits of pre-operative smoking cessation in London:

“If patients admitted for planned surgery were to stop smoking prior to operation 2,500-5,300… post operative complications would be avoided each year, and the NHS would make the following savings: 2,600-4,000 bed days could be saved; £0.5-£1.1 million each year across London’s PCTs could be saved”.

In addition, a sum of between £1 million and £3 million could be saved across London’s hospital trusts. Those are significant figures in financial and health terms. If they were extrapolated to the rest of the country, that would result in hundreds of thousands of bed days being freed up and hundreds of millions of pounds being saved.

The risk of CVD increases in young smokers. It has been shown that people under the age of 40 have a five times greater risk of heart attack if they smoke. The immensely successful and well-organised pressure group, Action on Smoking and Health, to which I pay tribute, recently conducted work on the issue. Its report, “Beyond Smoking Kills” found that smoking accounts for 16 per cent. of circulatory disease treatment costs for patients aged 35 and over and for more than twice that figure— 34 per cent.—in the 35 to 64 age group. Coronary heart disease caused by smoking accounts for £180 million— 20 per cent.—of all CHD treatment costs for patients aged 35 and over, and the figure rises to 41 per cent. for those under 65.

We know that prevention must start early—we often say that and we know that it is common sense—but it must start even earlier where tobacco is concerned. The best way to minimise smoking as a risk factor in CVD is to prevent children from taking it up at all. Most smokers start before the age of 18, and most will never manage to quit. Smoking is a childhood addiction, not generally an adult choice. The Health Bill, which is currently in the House of Lords, is an important part of our prevention strategy. Encouragingly, it proposes a ban on point-of-sale display and on the sale of tobacco from vending machines, as well as plain packaging for tobacco products. I hope that all three of those initiatives survive through to Third Reading in the Commons.

During the Bill’s earlier stages in the Lords, the tobacco industry used front groups—a common tactic for the industry—to promote scare stories about costs, which are not justified by the facts, and to undermine this important public health measure. Ending the display of tobacco in shops will, like the ban on tobacco advertising, help to ensure that tobacco is not seen as normal for our children and that it is not seen and bought alongside sweets and newspapers. Smoking accounts for half the difference in life expectancy between the richest and the poorest in our nation. Breaking the cycle of addiction in the poorest parts of society is the only way seriously to reduce and eventually end such health inequalities. Population-level prevention measures have been shown to work, and the proposed legislation will work across all our communities to help put tobacco out of sight and out of the reach of our children.

When the Bill comes to the Commons, I hope that there will be cross-party consensus in voting to support bans on point-of-sale display and tobacco vending machines, as well as the introduction of plain packaging. I am sure that the hon. Member for North-East Cambridgeshire will raise such issues with the leader of his party, who refreshingly confessed to his personal experience of the difficulties of giving up smoking. I hope that the Leader of the Opposition will be persuaded of the significance of the measures in the Bill and support the CVC’s vital ambition of ensuring that the Government adopt a new approach to preventing the diseases that we are discussing. Worthy as they are, however, and highly likely though they are to be effective, the proposed measures will not work in isolation and must be part of a comprehensive approach. Such an approach should be supported and linked to a CVD strategy of the type outlined in the excellent and concise report “Destination 2020”, which the Minister will have read.

I have two final points to make. First, the provision of appropriate smoking cessation services in secondary care—the hon. Member for North-East Cambridgeshire mentioned this briefly—must be a standard part of care for all those with CVD or CVD risk factors. That must be an element of our strategy. Secondly, second-hand smoke makes its own deadly contribution to CVD. We banned smoking in enclosed workplaces only in July 2007. Evidence from Scotland, which implemented the measure rather earlier, shows that smoke-free legislation does lead, has led and will lead to fewer heart attacks across the population and that second-hand smoking is often a serious risk factor for those with a pre-existing CVD condition.

The Minister has readily assented to a meeting with the all-party groups that have an interest in this issue, and I hope that we can talk to her. As I said, she is a very approachable Minister, and we have confidence that she will be able to carry forward some of the things that we say to her. Everyone on both sides of the Chamber—there is no serious political divide on this issue—wants to build on the Government’s progress to date. The Department of Health would do well to root its future cardiovascular disease strategies deeply in the work that the coalition has recorded in its very clear and concise document. We all—politicians and the general population alike—owe it a debt of gratitude for that work. I hope that the Minister will give her personal, professional and political response to the contents of what is a very useful document for framing the health policy of the next 10 to 15 years and more.

I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing the debate. It is a timely one and I welcome his commitment to the issue. We had a bit of political knockabout early in the proceedings, which I found interesting, because to try to get an idea of what all the parties are doing we had tried to find out Conservative policy on the matter, and could find only one reference:

“The Conservatives have committed to lowering the number of premature mortality from stroke and heart disease to below the EU averages by 2015.”

That is from a document called “Delivering Some of the Best Health in Europe: Outcomes Not Targets.” I suppose it is a start, but I have a slight problem with it because one is not quite sure where to aim without knowing where the rest of Europe is going. Anything that makes a comparison with a basket of other countries is almost destined to fail. It is much better to have a clear target that says, “This is where we want to be.”

It is important to be fair and acknowledge that things are much better now than in 2000, when I was elected. There has been a lot of progress in the area we are discussing. In 2000 the Government produced the national service framework for coronary heart disease, which was a 10-year plan. We do not have anything against which to monitor its progress. It was really a framework to build on; but at the time it gave a clear direction. I am sure that the Minister will give us full details—probably quoting from the progress report for 2008, which we all received fairly recently. Credit where it is due: the target for decreased numbers of deaths was met five years early and waiting times for surgery have decreased—that is partly due to increased use of statins and emergency thrombolysis.

However, in January 2008 the Prime Minister set out—I am not sure whether it could be called another example of a rushed announcement like yesterday’s on Members’ expenses—plans to extend dramatically the availability of predict-and-prevent checks. Those are meant to give people information about their health, to support lifestyle changes, and to offer early interventions, when those are deemed necessary. The checks were to be systematic ones for people in the age group 40 to 74. It was not a bad announcement, but as so often happens something seems to have gone slightly awry, because vascular screening was supposed to have been up and running this April.

Over Easter I took the opportunity to discuss the issue with a doctor from my local medical committee, who said he had received no guidance yet. It would be useful if the Minister would explain or outline the guidance that primary care trusts and commissioners will receive. I am pleased to say that those concerned have not been idle on the matter; they have been talking to the local pharmaceutical committee, which is something that does not happen everywhere. A provisional system was arrived at by which the two professions—pharmacy and the GPs—would work together so as not to duplicate effort, and to avoid treading on people’s toes. It was a quite simple idea: the surgeries would produce lists of the patients most in need of a check, rather than a blanket list of everyone in the relevant age group, some of whom would already be in a doctor’s regular care, and the people in question would be directed to a pharmacy for a vascular screening check. That seemed to me a quite grown-up way for professions to come to a practical solution, each doing the work they are best placed to carry out, without antagonising each other in the process. In health, things sometimes get a little territorial between the professions.

I was pleased that the hon. Member for North-East Cambridgeshire mentioned pharmacy. I should declare an interest as a fellow of the Royal Pharmaceutical Society. It is worth mentioning that 96 per cent. of the population live within 20 minutes of at least one pharmacy and I echo the hon. Gentleman’s comment that pharmacy is currently an under-utilised resource. In addition to vascular checks, pharmacies can help with smoking cessation—which was mentioned just now by the hon. Member for North-West Leicestershire (David Taylor)—diabetes screening and management and weight management services. They can sometimes be of most use to the groups that are harder to reach, such as men who do not go regularly to the doctor but who might live near a pharmacy and be able to pop in on a Saturday. Sometimes members of ethnic minority groups, and particularly women, may shop in the local pharmacy, but be less likely to go to the surgery. Pharmacies such as the Green Light Pharmacy in London have done a huge amount of work with diabetes in ethnic minority communities, to the extent that local consultants noticed that something was going on and worked back to trace the source of the improvement to Green Light’s work. We need to examine those examples of best practice and build on them. Even with such a stunning example of success, however, Green Light Pharmacy does not always find it easy to persuade the PCT to commission services.

I welcome the Cardio and Vascular Coalition’s document, which acknowledges what has been done and serves as a useful focus on what should happen next. No one can really argue with its list of ambitions, which include reducing the incidence of cardiac and vascular disease to among the lowest in western Europe within a generation. I have the same slight reservation I mentioned before, about the difficulty in knowing how to target where one is going, without knowing where everyone else is going as well. Hopefully movement will be in the right direction, but I should like something a little more specific. The ambitions also include the reduction of inequalities and better integration across health and social care. I cannot, either, argue with the general framework, which is about adopting the best evidence-based practice. It should be patient-centred, with a focus on prevention, and there should be effective joined-up commissioning of services. There is also the standard request for more research.

How is it all going to be achieved? If it were easy it would all have been done by now, and that is part of the problem. To start by thinking about inequalities, in its report the Select Committee on Health did a thorough job of examining the barriers that mean people do not get access to care. It is clear that there are still wide inequalities in this country, whether in the context of class, educational attainment, gender or ethnic minorities.

I was a little concerned about the idea in the document that awareness-raising campaigns are a useful tool. Those campaigns are very difficult to carry out. When politicians try to raise awareness of something that we are doing in a community it takes many different approaches and a lot of time and effort in different media to achieve the desired level. The new buzz phrase is social marketing, but I have yet to be convinced that it works. There is a lot of emphasis on TV and newspaper campaigns, but a lot of younger people today do not even watch much TV. They do not read newspapers. They get all their information from the internet, where it is much more difficult to target an awareness-raising campaign.

It would be more effective if, instead of wasting resources on advertising, they were put into the quality and outcomes framework, so that general practitioners could identify the patients most at risk. Most surgeries have extremely good database information on their patients, and some have put much time and effort into identifying at-risk patients and even more time and effort into making contact. Usually, they invite them in to see a doctor, but if they do not go, somebody will try and make contact with the patient themselves to provide help and advice. That seems to be a much better use of resource than marketing campaigns.

Another interesting aspect of the Select Committee report dealt with the better integration of patient pathways. It talked about health and social care, which was music to my ears because it is a Liberal Democrat policy. However, before moving to that, there is a problem with co-ordination between primary, secondary and tertiary care. Quite often, local commissioners are very focused on primary care but do not—many doctors have told me this—consult enough with the secondary care level to ensure that the whole approach is joined up. One of the biggest hurdles facing my local medical committee, who I met recently, is the lack of continuity between hospitals and communities. When somebody is discharged with a new medication regime, information does not always follow in a timely manner. Mistakes are quite often made upon discharge. No mechanism is in place for checking that.

There is the quite simple idea of patient-held record cards. I wondered whether that was the result of exasperation with the non-appearance of the NHS IT system, which stills seems some years away from being joined up. However, we should not knock old-fashioned card and pen. Using maternity services, pregnant women keep records of what is going on, because they come into contact with a number of different practitioners. It would be useful if patients felt more empowered and had something to which they could refer and of which they were custodians.

Prevention is the key. Much has been said about healthy lifestyles. We all know what foods we are supposed to eat, that we are not supposed to drink too much, that we are supposed to exercise and that we are not supposed to smoke. Knowing is one thing, but putting it into practice is another. I do not think that anyone has cracked that one yet. Much emphasis is placed on food and diet, but we are not actually eating that much more than we did decades ago, although we might be eating slightly differently and consuming more fat. However, we are exercising less. We need a greater focus on exercise, because what is good at fighting cardiovascular diseases has also been shown to be beneficial in preventing cancer and other diseases.

That would be a useful focal point, particularly from a preventive point of view. However, if a condition develops we must ensure that the earliest and best treatment is provided. For example, diabetes can go undetected for up to 12 years, and people will often have developed complications by the time that it is diagnosed. Indeed, the complications are often diagnosed first and then the diabetes is discovered. Again, prevention is the key message, but equally, if we get better at early diagnosis, we can save the health service a huge amount of money. It is very cost-effective.

Twenty thousand strokes could be avoided through preventive work on high blood pressure, regular heartbeats, smoking cessation and improved statin use. The Stroke Association is calling for a more co-ordinated and strategic prevention programme that brings all the varied initiatives together and recognises the commonalities of cardiac and vascular conditions. It also wants early and full implementation of the 20 quality markers in the 2007 national stroke strategy. It would be useful to know how the Government plan to evaluate its implementation. When will the Department of Health commission an evaluation process, what form will it take and when can we expect the results? I again acknowledge that progress has been made in this area, but as budgets tighten, it would be useful to have an indication of where priorities lie and which areas will be resistant to any budget restrictions. We need national leadership, and the excuse that it is up to the local PCTs to set priorities will not, in this case, suffice.

I am pleased to serve under your guidance, Mr. Pope. I, too, congratulate my hon. Friend the Member for North-East Cambridgeshire (Mr. Moss) on securing this important debate, which he introduced in an extremely articulate, comprehensive and detailed way, setting out clearly the issues that the Government need to address. Congratulations must also be offered to the Cardio and Vascular Coalition for the excellent work of its disparate groups and for the production of the report, which will enable a continued focus to be placed, quite rightly, on this area of the provision of health care services in the forthcoming months and years.

I want to give the Minister plenty of time to respond to this afternoon’s excellent debate. However, while clearly progress has been made—my hon. Friend was right to emphasise that—issues remain to be addressed. I was slightly surprised by the hon. Member for Romsey (Sandra Gidley), who was completely dismissive of any sort of European comparators. For example, the UK is significantly behind France in respect of mortality rates. Indeed, only two countries on mainland and western Europe have worse rates than us—Finland and Ireland. Although progress has been made, significantly more needs to be done.

Additionally, the prevalence of illnesses is likely to increase as the population age, as other Members have said. We need to ensure, therefore, that the requisite resources are put into this area, especially given that cardiovascular illnesses will be exacerbated by rising obesity levels and reducing levels of physical activity. The Foresight report concluded that, on current trends, by 2050, 60 per cent. of males and 50 per cent. of females will be classified as obese. Irrespective of which political party we belong to, we all have a collective and significant role to play in trying to ensure that the country’s population get the message about the importance of lifestyle changes.

I do not necessarily agree with the hon. Lady’s analysis. People understand that smoking is bad for them—the hon. Member for North-West Leicestershire (David Taylor) made a powerful case for the need to do more on that. However, I do not think that people necessarily understand that the significant lifestyle choices they make about, for example, diet, drinking too much and lying in the sunshine for too long also have very significant negative health impacts. Central Government and other bodies have a role to play in disseminating that very important information.

The initial national strategy framework pulled together for the first time all the inherently linked problems associated with cardiovascular diseases such as kidney disease. That focus in 2000, along with the additional resources funded by British taxpayers’ money, has made a difference, and we recognise the improvements made. However, in order to ensure improved delivery and patient outcomes, the Government still need to focus on specific areas on which, arguably, they have not focused sufficiently over the past decade or so.

The first area is prevention. It is clear that the Government have not done enough to raise awareness of the risk factors, causes and symptoms of cardiovascular illness. Although we welcome, for example, the recent FAST campaign on stroke awareness, we believe that both primary and secondary prevention must be more prioritised, which is why we have pledged to have a much greater focus on public health, with ring-fenced public health budgets, locally appointed directors of public health and an enhanced role for the chief medical officer’s department, with a specific focus on this area.

The second area that we need to concentrate on is health inequalities. It is well documented that the prevalence of cardio and vascular illnesses is significantly higher in areas of socio-economic deprivation. For example, women in the most deprived areas have a heart disease rate 50 per cent. greater than those in the least deprived areas. Health messages about such illnesses should be targeted at the most at-risk groups to reduce health inequalities. Excellent work is being done by primary care trusts to address some of those areas, but it is very patchy and it needs to have greater priority across the board. Moreover, things are being done in other countries that we could do in the UK to improve and reduce health inequalities.

Thirdly, significant regional variations were clearly highlighted in the Destination 2020 report. In particular, there were variations in access to cardiac care with relation to revascularisation and National Institute for Health and Clinical Excellence care. We cannot just wait for people to come to the health service; we must take health care out to people in the form of outreach. The hon. Member for Romsey was right about that. Money is often wasted on marketing when it could be used in significantly different ways. In some pockets around the country and in Scotland, such an approach is already under way.

Let me mention the NHS health checks. At the beginning of the debate, we had a party political exchange in which the hon. Member for North-West Leicestershire referred to me as part of the Taliban. That slightly surprised me because I have never been referred to in such a way before. I am sure that the hon. Gentleman will be the first to acknowledge that that exchange was started by one of his own colleagues, rather than by my hon. Friend the Member for North-East Cambridgeshire or myself. For the benefit of patients and patient outcomes, Opposition Members should pressurise the Government to deliver as fast as possible what the Prime Minister promised in January 2008.

Most people in this place would not see me as a boneheaded loyalist, but as far as the NHS is concerned, the Government’s record of the last 12 years stands in stark contrast to the 18 years that preceded it. I am referring here to investment, success and changes in outcome. That is the point that the hon. Member for North-East Cambridgeshire (Mr. Moss) brought out clearly in his positive and objective remarks.

Obviously I was not in the House in the 18 years of the previous Conservative Administration, but I say that we need to look forward. We have clearly said that the health service will be our No. 1 priority in government. We will continue to increase in real terms the investment going into the health service, but we will ensure that taxpayers’ money is used to maximum effectiveness to deliver patient outcomes. In the past 12 years, that has not happened in the way in which it should have done. We would do things differently—for example, by focusing on patient outcomes rather than on process-driven targets.

I urge the Minister to ensure that the policies that were announced in January 2008 are delivered as fast as possible. Triple A screening, for example, should be delivered across the country because it would save a significant number of lives a year. My hon. Friend the Member for Westbury (Dr. Murrison), who is no longer in his place, was right to raise the issue. He has been an assiduous and continuous advocate of rolling out the triple A screening programme. Moreover, there are issues related to peripheral arterial disease, such as the rise in amputation rates. The UK has the lowest number of PAD patients referred to vascular specialists per head of population of any major country in western Europe. Therefore, the Government must focus on that particular issue as well.

One of my final points before the Minister winds up relates to NICE guidance. Although I do not urge the Minister to pressurise or get involved with NICE—that is certainly not her role—it is essential that once NICE guidance has been issued, it should be implemented as fast as possible for the benefit of patients.

The final area that the Government should consider—we are looking at it in great detail—is information. Information should be easily accessible and communicable to the patient. Patients need the information to make choices about not just where they receive their treatment but the type of treatment they receive, so that it best suits their particular circumstances.

In conclusion, I was very pleased to read this excellent report. Many of its principles fit very comfortably with the Conservative party health policy. We have long been calling for a patient-centred national health service with a greater focus on public health, on prevention and on stronger and more effective commissioning closer to the patients. I am very pleased that the report confirms and agrees with much of what we have been saying in the past few months.

May I say what a pleasure it is to be under your chairmanship today, Mr. Pope? I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) most sincerely on his success in the ballot, which has enabled us to have this very important debate in Westminster Hall today.

Cardiac and vascular health is very important to us all. I learned that as a young nurse in the health service. I spent much of my 30 years in the health service as a cardiac nurse. Sadly, my father died in his 50s of his third myocardial infarction. With today’s treatment and expertise, he would not have died so young. As we have heard in this debate, cardiovascular conditions account for a very significant burden of disease and premature mortality. We have demonstrated our commitment to tackling such conditions by developing the national service frameworks for coronary heart disease, diabetes and renal disease and the national stroke strategy. They have been developed with active input of the NHS, the third sector, patients and carers.

I understand why hon. Members have to be elsewhere on Budget day, but I am sorry that they are not here. I should like to thank them on behalf of the Government and the Department for the work that they do with carers and with the group nationally in an all-party way. Such strategies have helped to drive the excellent progress we have seen across the NHS in cardiac and vascular services. I would particularly like to pay tribute to the role of the third sector in supporting progress in those services.

During this debate we have heard many mentions of the British Heart Foundation, which has made enormous contributions across the whole range of cardiac services. The Department of Health has enjoyed a good relationship with the BHF over the years and we have worked on many projects together. For example, the Department of Health worked with the BHF on developing its genetic information service. I should like to congratulate the British Heart Foundation on the development of such a service.

I need to tackle a few things that have come out in this debate. Perhaps we should start with screening. Triple A screening is essential. The Prime Minister announced our strategy in 2008, but those who understand how the health service works will know that one cannot make an announcement and press a button and get everyone to start such important screening. Triple A screening is very complex and any programme would need careful development, involving cardiologists and specialists.

There are important patient safety considerations, too. We must be sure that we can provide the correct treatment at the highest standard. It is essential that we put it on the record that the health service, the clinicians and others concerned with this screening have to have the right training to ensure that the right standard of safety care is always in place. The same applies to vascular screening. The next steps guidance was issued in November 2008 and was accompanied by a primary care service framework. Best practice guidance was issued in April 2009. Both guidance documents have drawn on input from not only the NHS, but PCTs, pharmacists, all the other groups that have been mentioned in the debate, and especially the learning network that has been operating since 2008.

The hon. Members for Romsey (Sandra Gidley) and for North-East Cambridgeshire mentioned targets on a few occasions in their contributions. Of course targets make a difference. I am pleased to see two—if not three—converts to targets today.

The hon. Member for Croydon, Central (Mr. Pelling) talked about congenital heart defects. We recognise that services for people with congenital heart disease need to be different from those for acquired heart disease. I will be happy to write to him with a more detailed response—I am not able to deal with it in the time available in this debate. However, on his final point on any proposed reconfiguration, I urge and encourage him to engage with his constituents. The NHS in London is currently consulting on its proposals for the future of stroke and trauma services, which is exceptionally important. I understand that he met the Secretary of State recently; such consultation should continue.

I should also like to address the call for a further strategy document. I understand where Members from within the coalition of all-party groups are coming from, but we believe that our NSFs have stood the test of time. Some elements of the guidance have been updated over the years by NICE, as we envisioned from the outset. However, the hon. Member for North-East Cambridgeshire would find the standards in the NSF and the markers of quality element of the stroke strategy hard to improve upon.

I was overwhelmed with invitations at the beginning of the debate—my hon. Friend the Member for North-West Leicestershire (David Taylor) was exceptionally complimentary. I am happy to commit to discussing the way forward. The hon. Member for North-East Cambridgeshire will also find that the Government have never said that the NSF will not run after its 10th birthday. We tend to talk in terms of those horizons, saying things like “Over the 10 years” and the like. It is a convenient round number and people can consider what will happen when the 10 years are up. I accept hon. Members’ concerns, but I think we can put them to bed.

Will the Minister explain the fundamental difference between the renewal of the mental health strategy and the renewal of the cardiac and vascular health strategy?

The hon. Gentleman makes an interesting point. Mental health is not within my portfolio, so it would be unfair to the Minister with responsibility for it if I were to comment on it. As I said, I can see why people have the 10 years figure in their heads. Our recently published 2008 progress report for the CHD NSF stated that we must continue not only to build on the success that we have realised so far, but to consider where we need to do better. There is no doubt that we need to focus relentlessly on improvement and on making quality the organising principle of the NHS.

I should now like to reflect on the successes of our NSFs and the progress that has been made on the implementation of our national stroke strategy. Our greatest achievement in cardiac services has been getting waiting times down. That has been acknowledged by hon. Members today, for which I thank them. That was achieved with a massive increase in cardiologists and other key staff and a 50 per cent. increase in capacity thanks to a £735 million capital investment programme.

The improvements in recent years could not have happened without the hard work and commitment of NHS staff. Cardiologists, cardiothoracic surgeons, cardiac nurses, technicians and rehabilitation specialists have all played their part. I have the great good fortune to meet front-line workers in the health service frequently. I visited St. Peter’s hospital in Chertsey, where I saw the angiography suite, which is a very impressive nurse-led unit, and in November last year I was able to accompany the Prime Minister on a visit to Harefield Heart Science Centre, which is led by the eminent cardiologist, Professor Sir Magdi Yacoub. I saw the energy of the young scientists in the centre. They look at stem cell research and other things to research the causes and nature of heart disease and, of course, they consider the importance of its prevention and treatment. I also visited the cardiac catheter laboratory and the walk-in emergency centre at Harefield, which is led by another eminent cardiologist, Dr. Charles Ilsley, and I witnessed a cardiac catheter angioplasty being performed at King’s college. I pay tribute to all those people.

We have tried very hard not to have a party political, partisan debate, but I should like to give the hon. Member for Boston and Skegness the opportunity to dissociate himself totally from the remarks made by Daniel Hannan, a Member of the European Parliament, to Fox News. He told those he called his “friends in America” not to go down the same route as us. He said that the NHS was “a mistake” that

“we have lived through for 60 years”

and that it

“has made people iller”.

Would the hon. Gentleman like to dissociate himself from those remarks?

I am grateful to the Minister for giving me the opportunity to do so. It is clear that we do not agree with those remarks. The NHS has just had its 60th birthday and we were keen to celebrate it. Since I have the opportunity, I, too, should like to thank and congratulate the hard-working NHS staff, who do such an excellent job every day of the year.

I hope the hon. Gentleman will ask his party leader to do as he has just done and dissociate himself from the MEP who made such scurrilous remarks about our NHS.

We are planning two pieces of work for the CHD NSF. First, we are commissioning an external review of its implementation and delivery to understand better what has gone well and, more importantly, what has not gone well and, more importantly still, why. Secondly, we will undertake an analysis of the trends in the burden of heart disease and how they, combined with changing patient and public expectations, and technological and medical advances, are likely to affect future demand and patterns of service provision. We aim to make that analysis available alongside the external review.

The CVC report offers the most helpful contribution to our thinking about future burdens. We are happy to continue to discuss the matter and to work with our third sector partners to ensure that the development of heart services continues to improve and that the momentum we have generated in the past 10 years is not lost. One direction that we are keen to pursue is a more integrated cross-vascular approach. There are close links between the risk factors for heart disease, stroke, diabetes and kidney problems. Our recently launched NHS health checks programme demonstrates our desire to pursue such an approach and our commitment to focus increasingly on prevention.

In the brief time remaining to the Minister, will she address the key points that several hon. Members made on the significant role that pharmacies could play in improving and delivering care and prevention for those with cardiovascular problems?

I mentioned that. I said that we have consulted pharmacies particularly on vascular checks. They are aware of their important role.

We can also look at healthy lifestyles and address the inequalities in health. Those words were not allowed to be used in the Department of Health prior to 1997, so I am pleased that that has changed. A wide range of the Department’s health promotion initiatives contribute to vascular health. As was mentioned in the debate, obesity is the common risk factor across the range of vascular diseases, which is why our healthy weight, healthy lives strategy is focusing on helping people to maintain a healthy weight by promoting healthier food choices and physical activity. Eat less, move more, live longer is the message.

The combination offers a really powerful mechanism for embedding quality as the organising principle of the NHS, whether it is through prevention or looking at the science of the disease. It is important because it affects us all, especially our constituents in more deprived areas. We have much more work to do, and I look forward to working with the coalition.

I am delighted to have the opportunity to raise this issue, and it is a particular pleasure to serve under your chairmanship, Mr. Pope.

It is customary to describe Westminster Hall debates as timely, but this debate is particularly timely, as from next Monday, motorcyclists who want to earn their licence will be subject to a new two-module test. The new test stems from the European Union’s second driving licence directive, which introduced a requirement to test emergency stops at 50 kph, or somewhere between 31 and 32 mph. I should say at the outset that it is disappointing that the Government did not seek a derogation allowing the emergency stops to be tested on roads, as they were previously. I hope that those in Europe with responsibility for the decision would look favourably on a measure that would suit us better and that, after all, involves a difference of little more than 1 mph, although perhaps the Minister can tell us differently. However, I will not dwell further on the decision in Europe. We are where we are, awaiting Monday’s looming farce.

We face more immediate concerns, although it is worth pointing out where failures have occurred. I hope that this debate will reinforce the view that the Department for Transport and the Driving Standards Agency have an important duty to ensure that people can access the test. The practicalities of the new modular test have led to the Government’s creation of a series of new facilities, to be known as multi-purpose test centres, to provide for the test. The original intention was to have 90 sites across the United Kingdom. Some 66 were planned, but when the test comes into effect on Monday, only 44 centres will be operational.

In October, when the new testing regime began, 39 testing centres were ready for action. The new testing regime was then delayed for six months, owing to the lack of facilities. Only five more centres are in place now than were then, so I do not understand why, if a delay was appropriate in October, it is not appropriate now. There has been no significant increase in the number of facilities open. I encourage the Minister—perhaps rather optimistically, at this late stage—to think again.

I should place on record the DSA’s much appreciated strenuous efforts to locate additional sites. However, even if the 66 sites were up and running for next week, serious concerns remain about the new test’s implications for some in rural areas. The map of the United Kingdom highlighting the location of the centres makes for gloomy reading. There are huge voids across mid and west Wales, parts of Scotland and the west country. However, as I am flanked by my colleagues from mid and west Wales, the Minister will appreciate that Wales is the issue of the day.

In Ceredigion, my constituency, riders face the choice of undertaking the first module in Shrewsbury or Swansea. That will lead to potential round trips of up to 140 miles, which raises significant issues of both convenience and safety. Many motorcyclists have expressed to me their fear that riders might have to negotiate treacherous conditions over long distances. It is deeply worrying that a test introduced to improve safety could have the opposite effect. The sun is shining here today, as I dare say it is in mid-Wales. It would be a pleasure to travel the roads of mid-Wales today, but that is not always the case. A few months ago, the roads were dark, wet and icy. It is worrying.

My hon. Friend is spelling out the situation in Ceredigion. In my constituency, the Harley-Davidson academy of motorcycling operates a centre where people can learn to ride motorcycles safely and with skill, but those taking phase 1 of the test will have to travel at least 50 miles to Shrewsbury, Swansea or Newport. As he says, returning from the test, particularly if they had failed it, would be an ordeal for somebody just learning how to ride their motorbike.

My hon. Friend represents a constituency that is arguably even more rural than mine. The practical difficulties facing constituents trying to take the test present a huge challenge. However, he will forgive me if most of my speech concentrates on Ceredigion.

To put the issue into context, it is not just mid and west Wales that have been affected. The original proposals have created particular difficulties for those in rural areas of Scotland, particularly some island communities. The Isle of Wight has not been included in the list of MPTCs, so riders from the island will have to travel to the mainland. Also, my hon. Friend the Member for Mid-Dorset and North Poole (Annette Brooke) has told me of her constituents’ concerns. I am sure that the search for casual testing sites is ongoing in such areas, as it is in mine. Any positive news that the Minister can give us will be most welcome.

I mention those areas—they are far from being isolated cases—to illustrate the fact that although mid-Wales is certainly among the worst affected areas, the infrastructure put in place for Monday is far from adequate. I am an optimist by nature. I do not intend to be a doom merchant, but I am worried about the operation of the test as of Monday.

I emphasise that I do not blame the DSA for the situation. I was privileged to meet some of its representatives in my constituency last Friday. It has been given a budget and been charged with using it as best it can to reach as many people as possible. It is incumbent on Government to provide the DSA with adequate resources, so that it can provide adequate testing facilities to meet the challenges of rurality and geography that some of us face.

I congratulate my hon. Friend on this debate and echo his concerns. Car driving instructors in Newtown and the surrounding area feel the same way. Does he agree that, apart from the basic stupidity, eco-unfriendliness and additional danger of the change being forced upon us, it is the Government’s responsibility to ensure that people can learn to ride bikes and pass their driving test without bearing an inordinate additional burden as punishment for the fact that they happen to live in mid-Wales or Montgomeryshire?

I am grateful to my hon. Friend for making that point. Like my hon. Friend the Member for Brecon and Radnorshire (Mr. Williams) and me, he is acutely aware of our constituents’ sensitivity to the loss of public services from rural communities.

As I mentioned, the DSA has been helpful in trying to identify casual testing sites where module 1 can take place. We are still trying to find a suitable site in my constituency. I am hopeful, not least because of the determination of the Motorcycle Action Group and of some of my constituents—particularly Rory Wilson and Ken Huntley—that we will be able to find somewhere. However, no site will be ready by Monday, which is why I still hope, optimistically, for some reassurance from the Government about the arrangements as well as about a delay.

Without those assurances, the effects of the new test will be felt immediately. The worst-case scenario is that the new test will reduce demand for module 2, causing problems for the businesses that offer that part of the test. Module 1 must be completed before module 2 can be taken, and there has already been worrying evidence of what lies ahead. Ian Plover of Rider’s Edge, which operates from the Royal Welsh showground in Builth Wells in the constituency of my hon. Friend the Member for Brecon and Radnorshire, contacted me about his concerns. When he bought the business in November 2008, it was on the understanding that there would be a casual testing site in the town of Llandrindod Wells. Unfortunately, that does not appear to be the case at the moment and, as a consequence, Rider’s Edge finds itself in some difficulty. As of last week, not a single test had been booked after the start date of the new test.

Mr. Plover made the point strongly that the DSA was helpful and did everything it could to assist him in making testing as accessible as possible, but his example demonstrates clearly what might happen when the new test is in place. A reduction in demand for the first module could cause some businesses to become unsustainable. In a few months, we might find not only that some in rural areas do not have access to module 1 at an MPTC, but that no one offers the second module locally either.

I emphasise that the facility in Llandrindod Wells was supported by the local authority and the Welsh Assembly Government. With those supporters, I do not understand why that facility could not be provided.

My hon. Friend makes an important point. I have a vast list of sites that have been explored as potential casual sites but have been rejected. Perhaps the Minister will explain why the Llandrindod site was not pursued.

If my hon. Friends will forgive me, I will now migrate to the west coast. West Wales has been hit further by the lack of an available MPTC site in Haverfordwest in Pembrokeshire. That was explained to me in some detail by the DSA last week. It fought hard to ensure that there was a site in north Pembrokeshire, which would have alleviated some of the concerns in the south of my constituency. It appealed through the planning process to get a site up and running and spent a lot of money from its budget on doing so. It was not the fault of Government, the DSA or the local community. Blame may lie elsewhere.

Losing the Haverfordwest option means that testing provision, which was already inadequate, has become more so. Haverfordwest was chosen for a reason. Presumably it was to respond to demand in west Wales and to the challenges of geography. That option has now gone. As a consequence, there will be no MPTC in Ceredigion, Carmarthenshire, Pembrokeshire or Powys. That is a vast area. Although I appreciate what the DSA has said about the lack of demand in the area, there is a significant gap in coverage. I repeat that the DSA assessed that there was a need and it located Haverfordwest as a possible site, but that option has gone.

Will the Minister say what is happening to compensate for the lack of that option in north Pembrokeshire? There will be no other MPTCs in Wales to make up for its absence. I presume that the money that had been earmarked for Haverfordwest, some of which was spent on the planning process, has gone elsewhere. Some of us feel that we are being penalised by what happened in Haverfordwest. More generally, are there plans to review the number of MPTCs in future or are these proposals set in stone? There has been a downward spiral from the 90 that were envisaged originally to the current 44. The Government hope to expand on that figure, but there has been a downward spiral.

I still believe that there is a strong case for an MPTC in my constituency. I accept that that is unlikely to happen in the near future and that we must concentrate on finding a casual site. Does the Minister foresee a time when the current network will be expanded? We know that the DSA thought it was necessary to have an MPTC in west Wales, but that will not now happen. I hope that the Minister will hold out the hope for future expansion.

It seems to me that having an MPTC is the only way that we can guarantee permanently accessible testing. Casual sites by their nature will be on loan. Although they might be guaranteed for a certain time, they cannot be guaranteed permanently. Finding a casual site is not an easy process. At least five sites in my constituency have been rejected. Three sites in Aberystwyth, one in Tregaron and one in Aberporth have been examined. We are in the process of examining another site in my community of Borth. The local county councillor, Ray Quant, has been particularly active in that. To date, we have been unsuccessful.

Although the DSA has been helpful and has responded to suggestions in this ongoing process, there has been conflicting information. In my first correspondence with the DSA, it was made clear that it would not pay for the surfacing of a test site. I was later told that it would. Other costs are involved in the testing process for things such as electrical contact points and crash barriers. However, my constituents have now been told that money will not be forthcoming. If the Minister is not able to clarify the specifics of individual sites, will he say whether there is a willingness to spend money on a new site? The assertion that we can find a site without cost implications is a fallacy.

There are deep concerns in my constituency. The Under-Secretary of State for Transport, the hon. Member for Poplar and Canning Town (Jim Fitzpatrick), indicated to me in writing that he would be prepared to meet with my constituents to discuss those concerns. I hope that that will be pursued after the debate.

The fundamental principle that must be considered in any road test is safety. We expect drivers to take tests that determine their competence to avoid unnecessary accidents and deaths on our roads. We all agree with that. However, in implementing this new test without the necessary arrangements, I fear that we are unintentionally compromising that important principle. I do not think that I have come across anyone who thinks that the new test is a bad thing—anything that encourages safer riding is welcome. However, the lack of provision for the test could lead to certain hidden safety concerns. I have mentioned the difficulties involved in travelling long distances on country roads. Concern has also been expressed that due to the greater inconvenience of the testing, some riders may opt not to take the test and to remain on provisional licences or even ride illegally.

There were not enough testing sites in October. There are still not enough testing sites. I know that efforts are being made to find new sites. I implore the Government to give assurances on the finance behind this and to help us to find sites in mid and west Wales.

I think that this is the first time that I have served under your chairmanship, Mr. Pope. So far it has been a delight.

I congratulate the hon. Member for Ceredigion (Mark Williams) on securing the debate, which builds on his contributions to the debate before the Christmas recess in which he raised many similar matters.

I believe genuinely that the goal of everybody present, the DSA and the Department for Transport is to ensure that the motorcyclists on our roads have the right qualifications and are safe and careful for themselves and others. That must be our guiding principle.

It might be helpful if I explain some of the provisions. In setting out how we have reached the present position, I will pick up some of the points that have been raised. The European Union legislation on driving licences that was agreed in 2000 set higher minimum requirements for driving tests. That was meant to ensure that the matters assessed in theory and practical tests were relevant to modern driving conditions. Those new EU standards support our domestic strategy for reducing road casualties, which we set out in 2000 in “Tomorrow’s roads: safer for everyone”.

The strategy set some challenging targets for reducing the number of road casualties. By 2010, we want to reduce by 40 per cent. the number of people killed or seriously injured on the roads in Great Britain. An even harder challenge is to reduce by 50 per cent. the number of children aged nought to 15 killed or seriously injured. We want to reduce by 10 per cent. the rate of slight casualties per 100,000 vehicle kilometres. All those figures are set against the baseline of the figures for 1994-98.

Because of the work that many people have undertaken, we are on target to meet the 40 per cent. target, and the other two targets have already been met. By 2007, the number of people killed or seriously injured was 36 per cent. below the baseline. The number for children was 53 per cent. below the baseline, and the slight casualty rate was 45 per cent. below it. All those achievements were delivered by the collective efforts of many organisations and people such as Motorcycle Action Group. We welcome those achievements.

Yesterday, we launched our consultation on a new road safety strategy for the period beyond 2010. The Department recognises that motorcycling has a role to play within the whole transport set-up, and our aim is to facilitate motorcycling as a travel choice within a safe and sustainable transport framework. To that end, we published first the Government’s motorcycling strategy, and then, in 2008, a revised and updated plan, which we are taking forward in partnership with motorcycling and other interested groups.

After all the good news that I have just laid out on our achievements, there is, sadly, a downside, on which all of our decisions have to be focused. Motorcyclists still represent a large proportion of road casualties: despite making up only about 1 per cent. of road traffic, they account for some 22 per cent. of deaths and serious injuries. We must take that seriously. The road safety strategy made improvements to driver training and testing, thereby playing an important role in producing safer drivers and riders, and it identified European developments as a factor in future changes to the driving test—for example, we believe that the changes to the practical motorcycle test will contribute to a reduction in motorcyclist casualty rates.

The EU changes of 2000 included the introduction of two higher-speed emergency manoeuvres—braking and avoidance—into the practical motorcycling test. The hon. Gentleman seemed to be saying that that has always been done on the road and is therefore nothing different, but I understand that the manoeuvres required are higher-speed emergency manoeuvres. As he pointed out, they must be conducted at speeds of no less than 50 kph and they should have been included in every practical motorcycling test in Great Britain since 29 September 2008. There were overwhelming safety objections to conducting those higher-speed emergency exercises on roads, where there may be other vehicles and pedestrians. That is why those who took a position on the safety aspects for all those involved concluded that those exercises should be done off-road. Ministers therefore asked the Driving Standards Agency to explore and assess those manoeuvres at off-road testing areas that were free from other traffic.

Proposals for the implementation of the new EU requirements were the subject of a public consultation in December 2002, which offered a range of delivery options. In the consultation, contributions were made on all of those options, and undoubted preferences were shown for off-road assessments of the special manoeuvres elements and for those assessments to take place before the general on-road riding assessment process. It was considered that that arrangement would reduce significantly the health and safety risks associated with conducting the specified manoeuvres on the public highway and would answer the cost and access concerns raised by some consultees. Separating the specified manoeuvres would result in a longer practical motorcycling test and would provide an opportunity for the candidate to cover a greater distance during the on-road part of the test.

The new test centres were to be based on the updated design that we intended to use, with appropriate facilities to conduct all the specified manoeuvres off-road, whilst offering improved accommodation and facilities for customers and staff. As well as being fully compliant with disability discrimination legislation, the new centres were to support the Government’s wider sustainability agenda. In order to maximise our investment in those centres, the DSA decided that, wherever possible, they would be multi-purpose test centres, which the hon. Gentleman mentioned. In addition to the practical motorcycling test, the centres were to deliver practical tests for learner car, lorry and bus drivers, and their off-road test facilities were to be made available for training purposes when not being used by DSA.

The results of the consultation were published in 2004, and included a stated intention that most motorcycling test candidates should be able to reach an MPTC within 45 minutes, or should be within a 20-mile radius of one, as was laid out in the response to the consultation. On that basis, the DSA estimated that 66 MPTCs would be required across Great Britain to meet demand and to enable the majority of people to attend one and to fit within those criteria. On those estimates, 83 per cent. of the population would have fallen within the criteria. The DSA would have had 38 MPTCs fully operational by 29 September 2008, and it intended to offer, in addition, motorcycling tests from nine part-time Vehicle and Operator Services Agency centres and three casual hire sites. That would have meant that 70 per cent. of the UK population would have fitted within the criteria that I have mentioned.

The hon. Gentleman said that, because there has been no change in those six months, he did not see why there should not be another six-month delay. I must respectfully point out that there has been an improvement in the position in that time, because we have been able to increase the number of centres available. Let me spell it out in this way: instead of 50 being available, there are now 66 sites that would be available. When that time was requested in September, on that basis, we agreed to that six-month delay and we informed the EU Commission accordingly. To give greater flexibility, further consultation was then undertaken about splitting the test into modules 1 and 2, which the hon. Gentleman has mentioned.

I thank the Minister for his answers to some of my points so far, but I have an eye on the clock. The situation has moved on since then and one of those important sites down in Haverfordwest has subsequently gone, and so has been taken out of the equation. He mentioned the VOSA sites, but most of those are on the other side of Offa’s dyke and so are not of particular assistance to my constituents. What compensatory news can the Minister give people in west Wales, given that the MPTC for Haverfordwest has now gone, and given that we are still exploring casual sites and that Monday’s deadline is fast approaching? My constituents would be very grateful for some specific news on west Wales.

I understand the hon. Gentleman’s concern and I shall come to where I see our way forward. As he has said, a number of sites have been considered, but it is not easy to find a route through that is suitable to meet the required standards for the new test, which is of benefit in making sure that we have good standards of training and good test sites available for those whom we want to make sure are safe drivers and motorcyclists. We have taken the opportunity, in the past six months, to increase the number of facilities available and to increase from 70-odd per cent. to 88 per cent. the percentage of the population now falling within the criteria that we laid out. However, I recognise that we have difficulties and that the situation is nowhere near ideal for his constituents and constituents in some other areas.

We have to strike a balance. Some £71 million has been invested in MPTCs, as the hon. Gentleman has recognised. He has said on his website that he hopes that Ministers will find a sensible way forward. I think that way forward is to continue to introduce sensible reforms to cycle and test provisions, because we want safer cyclists and we want them and others on the road to be better protected. We continue to work together and with county councils to take forward the various sites that have been identified, of which some have been too small and some too large.

I thank Mr. Speaker for granting me this debate, which is important to my area. I want to put on record the contribution that health service staff are making in dealing with sexual health matters in Middlesbrough, and to highlight some of the good practices that are being followed. Given that it is Budget day, I will not ask the Minister for any more money—she can put herself at ease on that subject—but I shall demonstrate what good practice is being followed and express one or two concerns that I have for the future.

Securing improvements in sexual health and well-being will continue to present a real challenge to all of those charged with that responsibility nationally, locally and regionally. Sexual health services have been required continually to adapt to changes in the communities that they serve. That was evident in the most recent Department of Health document on the issue, which was entitled “Progress and Priorities—Working for High Quality Sexual Health”.

That document shows us, for example, how the shape of HIV in this country has changed significantly, particularly in relation to increases in the diagnosis of heterosexual people infected overseas and the undiminished levels of newly acquired infections in gay men. Despite the availability of more effective drug treatments and expanded testing opportunities, too many people are still diagnosed too late. Overall, diagnoses of sexually transmitted infections have continued to increase. Other social changes also impact significantly on sexual health, such as the frequent use of alcohol and other drugs.

One subject that has not been well reported or analysed is the need for sexual health services for older people. Sexual behaviour research in that group is minimal, but recently, in a large survey of almost 8,000 people over 50, two thirds said that they were sexually active and more than one in 10 said that they did not use contraception with their current partner. They also did not know about their partner’s sexual history. The document concludes:

“Whilst progress has been encouraging in some areas, overall the picture is one of worsening sexual health”.

That is the case in Middlesbrough and Teesside, too. Middlesbrough, Redcar and Cleveland, and Hartlepool primary care trusts, as well as Stockton-On-Tees teaching PCT, have developed proposals for the improvement of local sexual health services as part of a Teesside-wide investment. That is an example of best practice in collaboration across geographical boundaries. Flowing from that, a Teesside-wide sexual health reorganisation is taking place to help to facilitate a fully integrated sexual health service.

A tendering process is under way in the area to appoint a lead provider, which will be responsible for organising the delivery of an integrated sexual health service. That will include genito-urinary medicine—GUM—contraceptive and sexual health services, and teenage pregnancy. It is intended that such a future pattern of integrated sexual health services will start to address the issues that I have mentioned. Those developments will support the changes needed to take a radical step forward in service delivery on Teesside. That vision of sexual health services sets out an ambition for everyone across Teesside to have access to comprehensive sexual health services, and to promote sexual health and well-being. Our providers say that that

“will be delivered through high quality, fully integrated care pathways, that will be both holistic and client focused”.

That is, and will be, delivered through PCT primary services at street and clinic level, and the James Cook university hospital in my constituency. The South Tees Hospitals NHS Trust GUM services are currently meeting Government targets on the number of patients seen and appointments offered. In fact, South Tees GUM services were recent finalists in the Nursing Times GUM service awards.

On HIV, approximately 300 patients attend South Tees services—the majority attend the department of infection and travel medicine. Patients are usually seen by the department of infection within 48 hours of referral. Medical, nursing, psychological, dietary and social input gives holistic care to patients with HIV.

For too long, our area has had to suffer poverty and health inequalities, and it has long been recognised that there are serious health inequalities in the Cleveland area. More than 16 per cent. of the population have health problems and that is significantly higher than the national figure of 13.1 per cent. Standardised mortality ratios are higher than national averages for all causes of death—for example, standardised mortality ratios for coronary heart disease show that, in some wards, levels of heart disease are more than 50 per cent. higher than national rates.

The same is true of sexually transmitted infections. Across the Tees area, the four primary care trusts have the highest levels of teenage pregnancy and sexually transmitted infections in the country. The evidence collected by the four PCTs shows a clear picture of an increasing trend in sexual risk-taking behaviour, with the resultant increase in sexually transmitted infections. That is often exacerbated by alcohol and drug taking.

The first priority is to deal with these infections at the sharp end, both in clinics and in hospitals, as I have mentioned. However, a longer-term view is also needed. So, alongside the need to manage the growing demand, the PCTs are acutely aware that they must have a better understanding of social causes and provide better education and prevention. The PCTs have recognised that, although they commission a range of sexual health services, there is not a comprehensive approach to the issue. They also acknowledged that strong, strategic leadership was needed to build on a vision and strategy for this delicate but crucial area of service. As a result, there should be a strong, robust, patient-and-public-involvement focus to address the needs of vulnerable groups.

The PCTs also recognised that although there are good informal service links, commissioning is gradual and service developments are generally not well co-ordinated across the Teesside area. That is expressed in a key document entitled “The Shaping of Sexual Health Services Across Teesside”, which is a patient survey conducted in October 2008. The survey ran for four weeks and closed on 26 September 2008. It asked the public to comment on issues such as their understanding of what sexual health services do, where they can go to find information and, if they had received treatment, their opinion of the service.

The survey—an online and paper questionnaire—received 591 responses from members of the public and 24 responses from inmates at the local Kirklevington Grange prison. There was high awareness—over 85 per cent. in all cases—of sexual health services provision, but respondents were not knowledgeable about where to access services, which is a concern.

The internet and GP surgeries are the main sources of information, and, for many members of the public, the GP’s surgery is the preferred location for a check-up. People expressed a strong desire to see a same-sex health professional. In addition, many respondents expressed a desire for the clinic to be located where they were not likely to be known, and in a setting not identified as a dedicated sexual health centre.

The responses were received not from those who might be called serial users of sexual health clinics: over 60 per cent. of respondents were recorded as not having had to use a sexual health service in the past two years. The majority of respondents were female, over 86 per cent. were heterosexual, less than 7 per cent. were gay or lesbian, and 3.4 per cent. were bisexual. Nearly half of respondents were 35 to 64 years old, and 95 per cent. considered themselves to be white British. In summary, the vast majority had not required sexual health services, and there was high awareness of what services were offered but not where to access them.

One aspect of the survey that caused me some concern was the location of respondents by postcode area. I will do my best to spare the Minister the ordeal of my running through a social analysis of all the postcodes in my constituency and the general area, but, in short, the distribution of replies reflected respondents from the wealthier areas of Teesside. Worryingly, some of the more affluent wards in our area seemed to have a higher number of respondents than would be the case if analysis were done on a population basis. I do not intend to accuse those responsible for the survey of producing a distorted picture, but I suspect that the findings indicate that the poorer population of inner Middlesbrough has a pattern of needs even deeper than the survey may indicate. As such, I feel that there is a need for a follow-up survey in areas such as central Middlesbrough.

However, the good news from the survey was that, despite the need to extend the service, there was an appreciation of the services provided and of the people providing them. For instance, one respondent said:

“The Doctor took time to listen to my concerns and gave me a full explanation without being patronising.”

Someone else said:

“I went to the hospital because I’d been in a sexual attack and the doctor worked with me with areas I wasn't comfortable in expressing.”

In June last year, the national support team for sexual health reviewed services on Teesside. The review reflected examples of local good practice but also made several key recommendations, including a move towards much more integration of services. The development of a service specification is an attempt not only to change service delivery but also to try to look more holistically at people’s physical, emotional and social needs. In turn, that will be used to try to implement change through positive attitudes and behaviours. I understand that this is the first such reorganisation in this field in the country.

In conclusion, I hope that the Minister will follow the progress made in the process and outcomes of the reorganisation, given that it provides one of the first standard models for England. I hope that she will keep a close eye on it, given the concerns that I have expressed. However, great progress has been made, given some of the problems and difficulties that we have experienced. I will leave it at that.

I congratulate my hon. Friend the Member for Middlesbrough, South and East Cleveland (Dr. Kumar) on securing this debate.

My hon. Friend and I would agree that there is no doubt that the issues around sexual and reproductive health in the 21st century present us with immense challenges—he touched on some of them—but that we are making some progress. The problems include rising numbers of sexually transmitted infections, waiting times for clinic appointments, the emergence of chlamydia as a major infection, the need for better contraceptive services and the need to inform all sexually active people about how to reduce their risk of infection and maintain their sexual health and that of their partner. Underpinning all those issues is the need for consistent improvement, not just in Middlesbrough but across the whole country, and bringing services up to the best possible standard.

My hon. Friend spoke about health inequalities and the importance of reaching out in particular to members of the population to whom services are still not delivering the kind of response that we would like. I concede that Middlesbrough, in common with many other parts of the country, is very much a work in progress. My hon. Friend touched on that when he discussed improving sexual health. There are stories of real innovation and improvement, which he mentioned but, as he said, the picture is still mixed. It is clear that local services must continue to strive to do better to meet the ambitious national targets that we have set them, as Middlesbrough is doing with its new sexual health strategy. I hope that it will ensure that progress is made. I assure my hon. Friend that I will keep an eye not only on Middlesbrough but on the development of sexual health services in all local health areas across the country.

It is important to focus on a few things in Middlesbrough. The town experienced a fall of nearly 24 per cent. in under-18 conceptions between 1998 and 2006, which was very good. Regrettably, it experienced a substantial rise in such conceptions between 2006 and 2007, which left it lagging behind the trajectory for reaching the 2010 targets. After reflecting on that, I, like my hon. Friend, would urge the organisations in Middlesbrough to ensure that, within the important strategy that they are developing, they examine what they need to do to bring teenage conception rates down again.

On STIs, we have data only at strategic health authority level, which show an upward trend in HIV, syphilis and gonorrhoea in recent years. I realise that some increases result from more people coming forward for testing, which is a good thing, but it is important that Middlesbrough considers other reasons for the trend within the strategy. There are, however, signs of better things to come. For example, I am encouraged that Middlesbrough’s chlamydia screening programme is starting to grow. It is still a little behind where we would like it to be from a national perspective, but it is heading in the right direction. Again, I urge local organisations to commit to faster progress over the next 12 months. My hon. Friend touched on that when he spoke about the need to ensure that there is a proper focus on all communities and on accurate information, and that there is dialogue and partnership not just with the organisations that provide the service but with local communities as well.

It is good to see that last year, Middlesbrough offered 99.9 per cent. of all patients an appointment at a sexual health clinic within 48 hours—a hair’s breadth from the national expectation of 100 per cent.—but consistently, between May 2008 and February 2009, it hit 100 per cent, which is encouraging.

My hon. Friend mentioned the visit of the sexual health national support team in June last year. The team made a number of recommendations to local trusts across Teesside, including the need for stronger strategic leadership, more patient involvement in planning new services and campaigns, better governance and integration across genito-urinary medicine, community and primary care services, and specific improvements in the way in which the chlamydia screening programme was being delivered.

I am encouraged by the fact that the four primary care trusts covering Teesside have joined forces on the new five-year strategy to improve health and well-being, which, as my hon. Friend said, has a particular focus on sexual health for children and young people. Implementation only started this year, but the plans are sensible and they need to pick up on the recommendations of the national support team, as he rightly said. Specific measures include better partnership working between general practitioners, schools and youth workers, facilitated through Children’s Trust arrangements in the area. We know from experience across the country that that is crucial in addressing teenage pregnancy.

The PCTs also launched a series of new information campaigns to get the safe sex message across to targeted groups. Let me stress that it is particularly important that these campaigns are targeted. I echo the points that my hon. Friend made in saying that the campaigns need to reach excluded young people who have been expelled from school, involved in drink and drug abuse or who have entered the criminal justice system. In many cases, young people, particularly young women who are pregnant, or those who catch STIs, have other problems in their lives and unless we reach out to them early on and deliver a joined-up solution, we are not making the difference that my hon. Friend and I would like to see.

Drawing together the sexual health strategy and looking at it over a five-year period, I hope that we will not only shut the door before the horse has bolted—that is important in the provision of these services—but that we will still ensure that there is concentration wherever necessary to make people wise after the event. In respect of the plans routinely delivering contraceptive services, I am particularly encouraged that anyone attending an abortion clinic across Teesside will receive automatic advice, support and counselling, which is a step in the right direction.

Like my hon. Friend, I have focused on the local dimensions and the work on sexual health in the Middlesbrough area, because, ultimately, it is about local services—schools, GPs, youth services and prison services—all working together in this important area. Local action, however, is not a fig leaf for inaction from Westminster. My hon. Friend said that he was not—at least, not today—asking for more money for Middlesbrough, but it is important that we consider the high profile campaigns and the work that is going on.

A significant investment is being made by the Government to improve access to contraceptive services. We have invested some £26.8 million over the last financial year to improve women’s access to contraception, particularly long-acting reversible contraception. We have allocated these substantial resources. I say to my hon. Friend and to organisations in Middlesbrough that it is important that they ensure that that money is spent speedily and efficiently to support and reinforce the important points that my hon. Friend made with regard to the five-year strategy.

A great deal of work is under way to broaden services. I mentioned the national target for everyone who needs one to receive an appointment at a sexual health clinic within 48 hours. We also expect PCTs to look at how they can deliver more choice and a wider range of services, because not everyone feels comfortable going to a GUM clinic. We therefore want more primary care and nurse-led services. I hope that we will see those sorts of things blossoming in Middlesbrough. Many GPs are now broadening their skills by delivering routine sexual health services through locally enhanced services.

Although I have already mentioned it, teenage pregnancy is a key concern, which is why we launched the teenage pregnancy strategy, following a detailed report by the social exclusion unit. My hon. Friend touched on inequality in health, leading to economic inequalities and the impact that that has on people’s quality of life and their general well-being. Although there has been dramatic progress—falls are welcome—we need to recognise that progress is not fast enough: we are behind in our stated objectives and we need to ensure that our ambitious target to halve the under-18 conception rate by 2010 is achieved. To speed up that process, I announced, with my right hon. Friend the Minister for Children, Young People and Families, additional support to help local areas further reduce their rates. That support includes £20.5 million extra funding to improve young people’s access to effective contraception, as well as additional support for parents to talk to their children about sex and relationships, so that young people are able to make those choices and feel empowered with regard to their sexual health, rather than feeling pressurised by their peers.

In October 2008, my right hon. Friend the Minister for Schools and Learners announced that personal, social and health education, which includes sex and relationships education, will become statutory in all schools. This is crucial, added to other policies, including the strategy in Middlesbrough, if we are to ensure that young people have the knowledge and skills to make safe and responsible choices about their sexual health.

We know that where local areas are following the national teenage pregnancy strategy, and where we see strong strategic leadership from PCTs and local authority chiefs, as well as effective partnership working bringing together education, health and youth services to confront the underlying causes of teenage pregnancy, the impact can be significant. We know from experiences across the country, in places such as Hackney and Liverpool, that teenage pregnancy is not inevitable and that if we deliver the services in the right way, fantastic results can be delivered.

I appreciate that Middlesbrough faces particular challenges, with pockets of severe deprivation and disadvantage across the city but, together with my hon. Friend, I urge all local organisations involved with the sexual health strategy in Middlesbrough to make a renewed commitment to the strategy and to tackle speedily the key concerns that he has raised today by ensuring that they have not only the framework and the strategy in place, but that they have ways to deliver it to individuals in the communities across his constituency to make real changes.