In the last 25 years, there have been eight referendums. Between 1973 and 1997, there were four—an average of one every six years. In the first year of this Labour Government, there have been a further four. It is clear that the Government believe in referendums; we all know that they plan many more. It is essential that the conduct of those referendums is above reproach, or else the suspicion will be that they are being used to direct public opinion for party political ends, rather than to determine public opinion for the public good.

There are three groups of questions which must be answered when considering referendums; why, when and how? First, why hold a referendum at all when we have a parliamentary democracy? Secondly, if the principle of referendums is accepted, when should they be held? Thirdly, if they are held, how should they be conducted?

There are those who say that it is a Government's job to govern, to make decisions and to be responsible for their effect. They argue that referendums are an abdication of that responsibility, and introduce danger and uncertainty, and that therefore they should never take place.

The alternative point of view is held by the Minister without Portfolio, who, earlier this year, said in Germany:

"It may be that the era of purely representative democracy is coming to an end."

He added that its place would be taken by

"plebiscites, focus groups, lobbies, citizens' movements and the Internet."

I do not subscribe to either of those extremist wings. I understand why the Government's thought policeman would want to bypass considered parliamentary scrutiny and control, and I deplore it. I agree that the Government alone should be held to account for the effect of their decisions, but there may be times when Parliament will want to consult the people. The question is when.

The question is not just when. If my hon. Friend is going to argue in favour of referendums, I hope that he will address the question whether we can always reduce a complex issue to a sufficiently simple question to get a legitimate answer in a referendum.

I am profoundly grateful to my right hon. Friend for his question, which leads me very nicely to my next remark.

As a believer in representative parliamentary democracy, I am clear that referendums should be used only under certain circumstances. The first is when the matter is of great significance. The next is when its effect will be profound, enduring and not subject to a change of Government. The next criteria is when the detailed facts are widely known, understood and—to answer my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth)—capable of being reduced to a clear and simple single question.

How do we achieve that? There can be no definitive answer, because it depends on the circumstances, but guidelines can be formulated. First, referendums are not a substitute for parliamentary democracy. They must be used only to advise Parliament, not to dictate to or coerce it.

Is my hon. Friend aware of the situation in Switzerland, where, because of the cantonal system, they prefer the idea of a referendum? Consequently, the most reactionary legislation—

Order. I should like to see the hon. Gentleman's handsome face.

I apologise, Madam Speaker.

Consequently, in Switzerland, the most reactionary legislation has been passed on immigration, women's suffrage and capital punishment—which my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) might welcome, but which does not lead to liberal democracy.

My hon. Friend makes a very good point. Referendums—such as proposition 13, in California—should be used only extremely sparingly, and not as a substitute for parliamentary democracy. This is the place where we can argue out the issues.

Referendums should be used only on matters of great and lasting significance, and when the consequences are appreciated and the need for change is demonstrable and coherent, and spans party political divides.

Referendums should be used only when all reasonable points of view have an equal chance of being heard. Electors affected by any decision in a referendum should be entitled to take some part in that referendum.

No referendum should occur until Parliament has considered, debated and amended the legislation that would implement the proposals that may be put before the people.

If those guidelines are not followed, referendums might be used—I believe that they are being used—to stifle debate and to bushwhack the Houses of Parliament. Therefore, to forestall any hint of such developments, the Government should, at the outset, clearly state what they consider to be the minimum threshold and participation rate of any referendum.

We should now consider whether the four recent referendums have met any of the criteria that any reasonable person would expect to be applied in a referendum. We should then go on to determine how we can ensure that, in future, conduct of referendums is not only fair but agreed to be fair. If we do not ensure such agreement, I believe that the results of referendums will be in dispute and their consequences rejected, and democracy will be held in contempt.

In last year's referendum on Scottish devolution, six out of 10 eligible Scottish electors voted. Three quarters of those who did so voted in support of a Scottish Parliament. As a Conservative and a Unionist, I regret the result, although I accept that it reflected the Scottish view at that time. However, as an honestly conducted referendum, it failed. It was pre-legislative, so the detailed facts were not known. The result is being used to coerce Parliament. Public money was used to promote the yes vote, but there was no similar funding of the no campaign.

In the Scottish referendum, English electors were disfranchised. Yet—after that referendum, and even after the start of the Scottish Parliament—the poorer English regions will continue to fund richer Scottish regions. In this place, Scotland will continue to be over-represented by Scottish Members, with greater powers but fewer responsibilities than their English counterparts.

The referendum in Wales was an even greater fiasco. The result was a flop: the votes of one quarter of the electorate were deemed by the Government to be decisive. Worse still, that pitiful result—which was achieved only with public money given to the yes campaign—was placed in doubt because of allegations about how the ballot was conducted. Although some of the allegations were made by the Secretary of State for Wales's own constituency Labour party, the right hon. Gentleman refused to clear up the mess and establish an independent inquiry. In London, the turnout for the referendum was even lower than it was in Wales.

Unless the Government plan on using referendums as a party political tool—if they do, they must say so—they must mend their ways. I have stated some guidelines that I believe should be followed. The constitution unit's commission on the conduct of referendums has made even more detailed recommendations. Today, I hope that the Minister will give us his considered response to the safeguards that both the unit and I have proposed. Above all, we need today to hear from the Government an acknowledgement that referendums are too important to be entrusted to the self-serving whims of any one political party.

The House will want to hear the Minister accept that, if the results of referendums are to be above suspicion, beyond reproach and not treated with contempt, their conduct should be determined by an independent body—comprising the brightest and the best, encompassing all political parties but dominated by no one political party, and dedicated to the impartial questioning of our political masters, the people.

I should like quickly to make a few points, as I am aware that there is little time, and many hon. Members would like to speak in this debate.

As we have no constitution in the United Kingdom, it is doubly—trebly—important that, when we undertake to change our electoral or political arrangements, we have in place proper safeguards. Generally, I am rather happy that, unlike many countries, we do not have a written constitution, which tend to be a hidebound way of approaching matters. I think that, over the years and down the centuries, our friends in the United States have come to regret their written constitution.

Nevertheless, as we do not have such a constitution, surely it is incumbent on hon. Members—even more so on the Government—to guarantee that safeguards are in place when contemplating the type of changes described by my hon. Friend the Member for Mid-Bedfordshire (Mr. Sayeed), primarily to ensure that the Government cannot change the rules that govern their own election. Ultimately, that is what we are talking about.

My hon. Friend gave as examples the referendums held in Scotland, Wales and London. However, the background threat is that the Government might eventually propose changes to the very system by which they themselves will seek to be re-elected. That is the biggest danger of all. Today, at the very least, we must receive from the Government cast-iron assurances that they would do no such thing—that, without first establishing proper safeguards, they would never embark on a course leading them to change the rules by which they offer themselves for re-election. Such safeguards are essential.

My hon. Friend also discussed the questions that should perhaps be asked in a referendum. We have some good recent examples of how the choice of questions can go badly wrong.

The example foremost in my mind—I suspect that it is foremost also in the mind of my hon. Friend the Member for Croydon, South (Mr. Ottaway), who is in the Chamber—is the question, or lack of questions, asked in the London referendum. We believe that, at the very least, the people of London were entitled to a say in whether they wanted an executive mayor in London and/or an assembly. However, the Government out-manoeuvred everyone else, and insisted on asking only one question, whereas two quite separate issues were bundled into one question—for the sake of political expediency. The example demonstrates the type of danger that we face.

Scotland, Wales and Northern Ireland have been or will be asked what they want, but England has never been asked what it wants. When will the English be asked a question in a referendum? That question has to be answered. To date, the Government have been able to decide—on the basis of political convenience—what they ask, when they ask it, and whom they ask. What we need to know is, when is the bulk of the United Kingdom's population going to be asked some questions and have an opportunity to give an answer? We might find the answers interesting, if the right questions were asked.

The only other matter I want to mention in this context is European economic and monetary union. It is obvious that the Government are going to wait until such time as they consider propitious for the answer they want before putting the questions, which illustrates all too well the point made by my hon. Friend the Member for Mid-Bedfordshire.

There is also the issue of reversibility, or, when can we return to the question? New Zealand is the most interesting example available of this issue. A few years ago, the people of New Zealand were asked the wrong question about changing their political electoral system, and they answered that they wanted something different. They got something different—a proportional system, which did not give them the Government they expected, because of back-room deals between political parties. Already, only a few years later, serious consideration is being given to asking the questions whether the change has proved satisfactory, and whether they should go back to what they had before.

That raises an important question: does a referendum answer last for ever? Surely not, but that raises the question, at what point can we legitimately return to the issue and say that, although we decided something by referendum, we now believe in the light of experience that we made a mistake, and that we should return to what we had before or move on to something else?

On the issue of getting it wrong, does my right hon. Friend not find it ironic that market research companies have found that asking simple questions with yes or no answers results in the most inaccurate response? If the Government have their way, are we not likely to see a drift away from referenda and towards focus groups; and would that not be far worse?

My hon. Friend makes a valid point. I suspect that the Government may say that the country is just one enormous focus group, and that endless referendums are an adequate way of consulting the people.

indicated dissent.

The Minister may say no—in any case, it would be interesting to hear his response to that point.

I hope that, at some stage, the Minister will give a strong indication of his view on the extent to which it would be legitimate—indeed, necessary in many cases—to return to the issue once the question had been asked, and in the light of further experience. Any of us who have been to New Zealand know well how bitterly disappointed the people are at having been misled by the question put to them and by the change in their electoral system, and how desperately they want to go back to what they had before.

On a point of order, Madam Speaker. I am most grateful for your allowing me to raise a point of order that relates to the language in which we communicate in this Chamber. Your predecessor once rebuked me for using the language of the Common Market: I said "faute de mieux", for which he immediately called me to order. The word "referendum" is being scattered about, but, although my hon. Friend the Member for Lichfield (Mr. Fabricant) used the correct plural, I have often heard colleagues refer to "referendums", which is an exceedingly ugly term.

May we have from you, Madam Speaker, a ruling, or at least an expression of preference, as to whether we continue to use the Latin word, which many would think historically appropriate in the Chamber, or whether you have no objection to the continual anglicisation of the term and the use of the word "referendums"? Were you to express a preference for the Latin form, which I hope you will, you would certainly be striking a blow for classical revivalism.

The right hon. Gentleman raises an esoteric point, albeit hardly a point of order: more a matter of taste. I notice that, in the public Bills list, the word "referendums" is used in relation to Scotland and Wales. The word "referendum" was first used in English 150 years ago, according to the Oxford English dictionary, which I have just consulted, and I imagine that, after 150 years, the House is now used to it. The plural is a matter of taste, but I have always preferred the use of the English language to any Latin form; I hope that that provides some guidance.

Coming from the right hon. Member for Kensington and Chelsea (Mr. Clark), that was a wonderfully communautaire point of order. In France, they have Government bodies that determine how the language should be used, but that is the first time I have ever heard the Speaker of the House of Commons being asked to rule on which words are appropriate to the English language. The House is indebted to the right hon. Gentleman for raising the interesting question of "referendums" versus "referenda", because the subject is a topical one, with several referendums already having been held, and more in prospect.

I take the view that, in general, in a parliamentary democracy, Parliament should decide, but there is obviously a case for saying that it is appropriate to refer major constitutional issues to the people. The risk is that one can get into a la carte choices on which decisions are appropriate to be referred to the people, and which should be left to Parliament.

It should be possible to take such decisions on an objective basis: for example, many people outside would love to have a referendum on whether capital punishment should be reintroduced, but that is a policy issue, which is most appropriately dealt with by Parliament; but there is a case for referring amendments to the constitution and to the way in which the country is governed to the people, as we have done.

The speeches so far have addressed specific concerns that I share about the current status of referenda in our constitution. The idea of having a referendum on the establishment of a Parliament in Scotland was sold as a means of entrenching the position of the Scottish Parliament, but Conservative Members have shown that they cannot wait for an opportunity to overturn the decision of the Scottish people.

I just wanted to pick up on the hon. Gentleman's use of the word "referenda". Further to the point of order raised by my right hon. Friend the Member for Kensington and Chelsea (Mr. Clark), I wanted to point out that "referendum" is the gerundive—in other words, it means "requiring to be discussed"; therefore, in English the correct plural is "referendums", not "referenda".

It is quite a long time since I failed my Latin A-level, so I shall not pursue that point.

The questions that require clarification are: what the criteria for holding a referendum should be; how a referendum should be conducted; who should decide which issues are appropriate to be referred to the people by referendum; and, above all, what the status of a referendum result is at the end of the day.

The hon. Member for Mid-Bedfordshire (Mr. Sayeed) acknowledged that we have just had a fairly dramatic and conclusive result to a referendum in Scotland, on a perfectly respectable turnout of 61 per cent. of the people, 75 per cent. of whom voted yes to the establishment of a Scottish Parliament within the United Kingdom. Politically, that should be the end of the story—the subject was debated for many years, and a conclusive decision has been given, not only in the referendum, but in the results in Scotland at successive general elections. However, constitutionally, it is still technically possible to dismiss that result, and for Parliament to legislate in a different direction altogether.

Speeches from Conservative Members—the right hon. Member for Bromley and Chislehurst (Mr. Forth) used the term "reversibility"—show that they are already questioning the validity or the binding nature of the outcome of the Scottish referendum, so I ask my hon. Friend the Minister whether it would be possible to ensure that, when legislation is enacted with the specific endorsement of a referendum, that fact is acknowledged on the face of the Act; and to ensure that any repeal of that legislation is also subject to a referendum.

It would be scandalous if, after 20 years' debate about home rule for Scotland, successive general election results endorsing the establishment of a Parliament for Scotland, and an overwhelming referendum decision to establish a Scottish Parliament, some future Government, simply on a political whim, could turn the whole thing on its head.

Does the hon. Gentleman agree that that argument would have much greater force if one had post-legislative referendums rather than pre-legislative ones? Is not part of the problem, which casts doubt on what is expressed in referendums, the way in which subsequent legislation often differs from promises made before the referendum?

That is an illustration of the sort of problem that I have in mind. If there is any doubt, anywhere, there is always somebody, usually on the Conservative Benches, who wants to nit-pick. Who better than the hon. Gentleman to fulfil that role?

Endorsement of legislation by referendum should be specifically referred to in that legislation. There should be an implicit requirement that any radical repeal of the legislation—I am not saying that it should not be possible to amend legislation—should also be subject to a referendum, so that no future Parliament can repeal an Act that is entrenched by a referendum.

I fear that Conservative Members are doing themselves no good when they call into question the validity of the result of the referendum in Scotland. A Parliament is to be established in Scotland, and we want it to be a success and to play its role in the framework of the United Kingdom. Endless nit-picking can only endanger that settlement.

I am glad of this timely opportunity to speak on the subject of referenda—the option to my taste—since, under this Government, they have once again become a familiar part of our political life We have had referenda in Scotland, Wales and Northern Ireland, which we fully supported as clear issues of constitutional significance.

The referendum on London government was less clear-cut, but, on balance, still necessary as a means of moving to regional self-government. Liberal Democrats shared many of the concerns expressed by the right hon. Member for Bromley and Chislehurst (Mr. Forth) about the question that was used. We would have preferred two questions, and believe that the Government cheated, to an extent, by using the one-question device.

People continue to be concerned about the use of referenda, mainly because the power to hold or withhold them is still in the Government's hands. There is a complete lack of rules on when or where referenda may or may not be used, although they are perfectly legitimate in an open democratic society with a strong constitutional framework. Indeed, we want it to become mandatory that constitutional change is contingent on support in a referendum. The hon. Member for Mid-Bedfordshire (Mr. Sayeed) described that as the "why" decision on holding a referendum. We would ultimately like that enshrined in a written constitution which sets out conditions for holding such a referendum.

I heard what the hon. Gentleman said about consulting the people over major constitutional change. He will know that, in Wales, the decision was taken—although only one in four people wanted it—to set up a non-tax-raising assembly. Why did his party try to amend the legislation so that, in future, the Welsh assembly could introduce tax-raising powers, without consulting the Welsh people?

The specific measure to which the hon. Gentleman refers was part of my party's open, stated position at the general election—our manifesto commitment. Colleagues in the Welsh team decided to take that forward to air the issue during the passage of the legislation. It is perfectly acceptable if they choose to do so.

Does not that precisely illustrate the point that I was trying to make about the problems of pre-legislative referendums? In, for example, the Welsh referendum, the Welsh people were offered a committee form of government as the great selling point, yet, by the time the legislation had gone through the House, a sort of cabinet government was proposed. How can the wishes of people be reflected in pre-legislative referendums?

Although I do not disagree with the hon. Gentleman's fundamental point that post-legislative referenda are preferable, there were precedents—Labour and Liberal manifesto commitments and a pre-election agreement—for the legislation that has been taken forward in this Parliament, which meant that the measures would progress quite rapidly. That was made clear at the general election.

Rather than using examples of perverse use of referenda in countries such as Switzerland, which I accept has not been helpful, we should look across the sea to the Irish example. They have a written constitution, which they have successfully amended and updated through the use of referenda. They have managed to avoid many of the European arguments that we have had in this country, because every stage of ceding power to the European Union has been accompanied by a legitimate decision of the Irish people through the use of referenda.

Is it not important that there should be a separate constitutional body to make regulations to control referenda? In the Republic, the funding for both the yes and the no campaigns is equal, whereas, in our situation, Government funding tries to manipulate the will of the electorate. Ministers make promises during the referendum campaign that are not normally fulfilled.

The hon. Gentleman must have picked up a copy of my speaking notes. I was about to say that we should have an independent electoral commission to oversee the use of referenda, particularly as we are expecting one on the fundamental issue of moving towards a more proportional voting system, with all that that entails, and—possibly—one on the single European currency, which will be hugely contentious, not least on the Opposition Benches.

We need rules that are accepted by all sides, and an independent statutory commission to oversee them. We have made clear our support for a permanent electoral commission to oversee the administration of elections. Such a body was recommended by the 1991 all-party Hansard Society commission on elections. Parliament could give an electoral commission such responsibility for referenda. The commission would organise matters such as the poll, the count and the declaration of results, as well as overseeing the wording of questions. Parliament could pass primary legislation on matters specific to particular referenda as they arise.

The commission would be a procedural body. It would not help to make the decision about the constitutional status of referenda. We should consider whether referenda are mandatory or advisory. The Government certainly have enough access to private polling and focus groups without the need to transform the people of the United Kingdom into yet another one. I very much agree with the hon. Member for Mid-Bedfordshire that referenda should not be used as focus groups. Their role needs to be clearer.

Given our present lack of a constitution, we need to consider thresholds. I am convinced that they have standing neither in constitutional theory nor in electoral practice. We would all like 100 per cent. of the electorate to vote in general elections. The precise percentage of voter turnout in a general election in no way affects the binding quality of the result. I would be interested to know at what levels hon. Members who propose participation rates and thresholds think they should be set for the House in order to give the Government legitimacy—the same principles apply.

We should like Parliament to set up an effective information campaign on a referendum, and for a decent period to be provided for it. We would suggest three weeks—as there is before a general election—to debate a referendum.

In that time, the electoral commission would ensure that both yes and no campaigns had equal access to resources. It must introduce the kind of legislation that applies to a general election, covering limits on spending and broadcasting, and the way in which literature is produced. Having advanced toward a written constitution and an electoral commission, an agreed role for referenda could be established, so that there would no longer be any need to nit-pick over thresholds or the conduct of campaigns, as we have unfortunately seen over the important constitutional referenda since the change of Government last year.

I congratulate the hon. Member for Mid-Bedfordshire (Mr. Sayeed) on raising this subject. Many points need to be clarified about the use of referendums—starting, of course, with the plural of the word. In our own referendum on the plural of the word, the House is 3:2 in favour of the use of "referendums".

I can report to the House that, during my former employment at The Guardian, a long, almost religious debate took place over many years, before the issue was finally settled in the style book in favour of "referendums". The argument was that the word "referendum" is a Latin gerundive, not a noun, but has been taken into English as a noun, so the Latin plural is not relevant.

When did The Guardian ever spell anything right?

The days when misspellings frequently appeared in The Guardian are many years in the past. My hon. Friend shows his age by remembering the days of bad proofreading, before new technology arrived. Certainly The Guardian always had an intended spelling—an ideal spelling to which it aspired and which, in the later editions, it usually achieved. Perhaps my hon. Friend, in Scotland, may have read the earlier editions, which were always riddled with literals.

There is a good argument for the use of "referendums", which is that, in Latin, the word "referendum" is simply a heading for a list to be referred. "Est referendum" means simply that something is to be referred. If there were two items, the heading would be "Sunt referenda", but if there were only one—[Interruption.] It is simply a Latin phrase.

I am sure that the hon. Gentleman will agree with me that, in Latin, the gerundive is much stronger than in the English language. Its use implies not simply something to be discussed, but something that should be discussed—that the discussion must take place.

rose—

Order. Before the hon. Gentleman responds, may I say that although this is an interesting debate about the origin of the word "referendum" and its plural forms, I should be grateful if we could now return to the substance of the debate? I also remind all hon. Members that many people still want to speak, and if others make their contributions reasonably brief, more will be able to do so.

I take the point, Mr. Deputy Speaker.

My substantive argument is that several features of referendums in this country need to be established. One is the funding of the two sides. Another is entrenchment, in the sense discussed by my hon. Friend the Member for East Lothian (Mr. Home Robertson). Surely a measure passed as the result of a referendum should be repealed only after a subsequent referendum. There is also the question of reversibility, as raised by the right hon. Member for Bromley and Chislehurst (Mr. Forth)-although the issue is not always as simple as he made it seem.

On thresholds, I agree with the hon. Member for Sheffield, Hallam (Mr. Allan) that it is nonsense to try to insist on a particular participation level for all referendums. As we saw in the London referendum, the turnout depends on the level of controversy or opposition to the proposition being put forward.

In a sense, a referendum is a safeguard for the public, enabling them to scream, "No, we don't like that." In London, the issue was, correctly, put to a referendum, because it was assumed that there would be party political controversy, or at least public controversy, on the subject, and there would be a lot of publicity and a high participation rate.

As it turned out, that did not happen. My local authority spent thousands of pounds issuing a glossy leaflet to put through every front door opposing the referendum, but one week later it announced that, as the leader of its party had said that the Conservatives would support the referendum, their opposition was of no avail, and the council tax payers of Wandsworth should forget about the glossy leaflet and support the referendum.

The promised opposition never materialised. Television crews from London Weekend scoured London looking for plausible groups to advocate a no vote, so that they could cover it on their evening newscasts. Without an opposition, the media could not cover the two sides of the debate, so they gave it no publicity. Consequently, although the turnout was reasonable, considering that the referendum was held on the same day as the local elections, it was not very high.

That does not invalidate the result. It simply means that, because it met so little opposition, the issue referred to the people of London did not spark off the kind of debate that would have produced a high turnout. The result should not be condemned on the grounds that the proposal received so little opposition. It would be nonsense to say that, because the turnout did not reach a certain level, the result should not be accepted.

The corollary of that argument would be that only on hotly controversial issues would the turnout pass the threshold. Indeed, that idea affected what happened with the Scotland Bill in the 1970s, when a threshold was inserted.

Would the hon. Gentleman say that the Welsh referendum had passed that threshold?

I am arguing against the use of thresholds. Thresholds are nonsense, because participation will depend on the degree to which people disagree with the proposition. Often, something put to the people in a referendum sparks little controversy and is passed easily. People would go and vote if they thought that the proposition was likely to be defeated, but as it is not they do not bother. That does not invalidate the result.

There are two further arguments about the New Zealand and London referendums. I do not recognise the description by the right hon. Member for Bromley and Chislehurst about the New Zealand "preferendum". There were two referendums on the voting system. In the first, the people of New Zealand clearly indicated that they wanted a change—[HoN. MEMBERS: "Of what?"] They wanted to change the system.

A commission was set up and recommended an alternative—the mixed member proportional, or MMP, system. That was put to the people in another referendum and they voted in favour of it, despite a well financed campaign for the first-past-the-post system. That campaign spent much more money than its opponents could find, but, despite the overwhelming superiority of resources behind the first-past-the-post system, MMP won fairly and squarely. It was clearly the expressed view of the New Zealand people that that system should be used.

The fact that Winston Peters, the leader of the New Zealand First party, allowed himself to be elected as an opponent of the National party only to announce three weeks later that he would support that party, is a function not of the voting system but of the fact that Winston Peters changed his mind. [Interruption.] The hon. Member for Ribble Valley (Mr. Evans) should speak for himself.

In the previous New Zealand election, carried out under the first-past-the-post system, Winston Peters would have been in exactly the same situation—holding the balance of power—had it not been for a handful of votes. Only after the final recount under first past the post did it turn out that he would not hold the balance of power. Had he won that vote, he would have been able to do exactly the same after the previous election. That shows that the situation was a function of the behaviour of Winston Peters rather than of the voting system.

Could the hon. Gentleman tell us what that has to do with today's debate, as opposed to yesterday's debate?

Does the hon. Gentleman think that he is the Speaker?

I look to you, Mr. Deputy Speaker. We are arguing about the use of referendums, and the right hon. Member for Bromley and Chislehurst said that what happened in the New Zealand referendum showed that the use of referendums was invalid. I am pointing out that the use of referendums in New Zealand was perfectly legitimate. The decision was clearly arrived at, despite the overwhelming superiority of the resources deployed against it. Nothing in the New Zealand experience should disillusion us about the use of referendums; rather, it should disillusion us about the election of politicians who subsequently change their minds.

I am sorry that I was slow to rise to my feet, Mr. Deputy Speaker; I was stunned by the prospect that the debate might be returning to the track on which it started.

Today the House has the opportunity to reassert its authority. One of its principal functions is to hold the Executive to account. With a Government majority of 179—and, I must add, the comfortable pact between the Labour party and the Liberal Democrats—such issues are left to the Conservative Opposition to raise. They are of vast importance, and I am appalled by the low attendance on the Government Benches.

Not content with the mathematical domination of this place, Ministers, especially the Prime Minister, have decided to ignore the House. They declare that the people should decide. Of course, there is a compelling argument that a Government should listen to the people and consult. Certainly it would be wrong to proceed otherwise on issues such as the single currency.

I believe that my constituents have already made a choice—having heard, questioned and endorsed my views, they sent me to Westminster to decide. Now, however, the peoples of the nations that make up the United Kingdom are being sent to the polls again and again. A referendum was held in London about whether to have a mayor, and the Prime Minister promises that more will follow.

I do not rule out referendums altogether, especially on matters of major constitutional reform, but where does one draw the line? Why, having had referendums on Scottish and Welsh devolution, should not we have a referendum on English regional government? Perhaps the Government draw the line where they fear that they will not win, even though they have the power greatly to improve the chance that a referendum will go their way—they set the question and the programme for the vote, and decide how the vote should be construed. In reality, the people do not decide—the question is rigged, and the answer is therefore open to interpretation.

Leaving aside the point that referendums undermine the power and the authority—and, indeed, the sovereignty—of Parliament, I believe that the time has come to set out some rules. A framework is now needed—that is the point of this debate. There must be firm rules, so that the system cannot be abused. Issues of time allocation and broadcasting must be addressed.

We must tackle four key areas. First, we must decide what subjects are appropriate for a referendum. For example, having voted on a tartan tax, should the people of Scotland—and the rest of us—now have the opportunity to vote on all new taxes? Secondly, should the result of a referendum be binding on the Executive? At what level does a referendum have moral authority—is it 50 per cent. of those who vote, or 50 per cent. of those who are eligible to vote? If a threshold based on those who are eligible to vote is good enough for trade union membership, should not that principle be extended? I hope that the Minister will answer those questions.

Many people in Scotland are interested to know why the Conservative party did not call for a threshold in the London referendum, given that it so loudly called for one in the referendums in Scotland and Wales. Why does it not argue that the result of the London referendum is invalid, as no great threshold was reached?

We called for a 50 per cent. threshold, although I shall not dwell on that, as we do not have much time.

Thirdly, we should ask how the question should be framed to command universal, or near-universal, acceptance. I believe that an independent body should devise the question, so that the charge that the question had been fixed can be avoided.

Fourthly, and most important, has the issue been closely defined? How do the people know, in detail, what the consequences of a yes of no result will be? Has a problem with existing arrangements been identified before the referendum takes place? Has a White Paper been published or a Bill drafted? Unless we deal with those questions, it will continue to seem as though the purpose of the referendum is to short-circuit debate in the House, so that Labour Members can repeat, parrot-like, "The people have decided."

The referendum has been used by every dictator in history. It would be most inappropriate to suggest that the Prime Minister is a dictator—I would not dream of doing so—but one has to question whether the plebiscite is a vehicle for true democracy or a vehicle to dupe the people, so that the Government receive blanket approval to do what they please. I fear that experience since May last year suggests the latter—as my hon. Friend the Member for Mid-Bedfordshire (Mr. Sayeed) said, in Scotland and Wales the referendums were held before Parliament could scrutinise, amend and enact the legislation.

The Labour Government were elected to govern, to make decisions, and to be responsible for the effects of those decisions. Why do they accept the responsibility of government, but avoid the responsibility of making decisions? As Lord Lawson once said, quoting Pierre Mendes France:

"To govern is to choose. To appear to be unable to choose is to appear to be unable to govern."

Constitutionally in this country, decisions have been made by Members elected to the House of Commons. The public have never questioned the integrity of the decisions made in the House by a majority of the governing party—[Interruption.] They may question it at times, but they accept the validity of the right of the majority party to implement measures—they know that there are rules to govern the election of Members of Parliament.

There is a brief period after elections when individuals may be challenged on their election expenses, but no one challenges the Representation of the People Acts, which lay down rules governing our election. All the important decisions that are taken in the House have their roots in a system of rules laid down in legislation to deal with how Members are elected, the expenses that may be incurred and the broadcasting of elections. That system has worked exceptionally well.

I do not intend to quibble with the results of the various referenda, although I understand why some people nit-pick—to use the word of the hon. Member for East Lothian (Mr. Home Robertson)—the results, given the way in which the Government chose to conduct the referenda. We are moving into a new political landscape—I do not particularly like it, as it has not benefited my party in the past year—but, if that is to involve the regular use of referenda, we must have rules to govern how they are conducted, just as we have legislation to govern how we, the current decision makers, are elected to the House of Commons.

As many of my hon. Friends want to speak in the short time available, that is the only argument I want to make today, but the Minister must address it in all seriousness. I regret that this is the second consecutive day when I have had to say that the Home Secretary is an honourable and decent man, but he must see the validity of the argument. If referenda are to become a regular part of the political scene, they must be governed by detailed rules on timing, the question asked and all the other points that have been raised today—whether the referendum should be pre-legislative, whether it should be binding, and whether there should be a threshold.

Even though, God help us, there are already 150 review groups and task forces telling the Government what to do, we need one more. We need a properly independent commission, not the partial—or, as the Home Secretary described it yesterday, "relatively independent"—Jenkins commission.

Unlike the Cookie whitewash inquiry, the commission should be chaired by a properly independent judge; it should comprise not necessarily the great and the good, but those who understand these things and who can recommend the procedures that should be followed. All players in the House will accept the recommendations of a commission only if that commission is independent, with the Home Office acting as an able secretariat; we shall accept referenda only if there are rules, guidelines and legislation to govern how they are conducted.

It is no good for the Labour party to complain that individual Members of Parliament are quibbling about referenda. Of course Members of Parliament from other parties will quibble, as, at the moment, referenda are perceived to be set by Millbank and the Labour party hierarchy—they are phrased, timed and manipulated by the Labour party. I believe that the Government want to use referenda as a legitimate tool of government, but referenda can be a legitimate tool of government only if they are legitimised through legislation.

Despite a leaflet being put through the letter box of every house in London, and despite the Minister for Transport in London handing out scratchcards at tube stations encouraging people to vote in the London referendum, there was a derisory turnout. Only 35 per cent. of the public voted, and about 75 per cent. either said no or expressed no opinion. In my opinion, the London referendum lacked legitimacy: its result cannot be considered representative of the overall view of Londoners. If we are to continue to have referendums as a matter of course, there should be a threshold.

On Report on the London Referendum Bill, the Opposition tabled an amendment calling for a 50 per cent. turnout, so that at least half the electorate should express a view on the proposals before them.

Is the hon. Gentleman therefore of the view that all London borough councillors should resign, since there was a similar turnout at the local elections?

Is he also aware that 75 per cent. of the voters in Westminster did not vote for the Conservative council there?

The hon. Gentleman's intervention brings me to the second part of my point. I have no idea how many people voted for him at the general election, but I understand that it was not very many.

It was more than 50 per cent.

Then I wish the hon. Gentleman the best of luck.

If a proposal is of such extreme constitutional importance that it is the subject of a referendum, that raises it above the tone of normal council or parliamentary elections. If we are to change the constitutional basis of our country, surely a 50 per cent. threshold is appropriate.

The hon. Gentleman proposes a 50 per cent. turnout, but the threshold that the Conservatives tried to introduce in the Scotland Bill involved not a 50 per cent. turnout, which is normally easily surpassed—for example, in Scotland in 1979—but 40 per cent. of the total vote. Why do the Conservatives propose one threshold for London and another for Scotland and Wales?

The hon. Gentleman should consider our proposals as alternatives. We are an Opposition party putting forward our ideas. I am not that familiar with Scottish affairs, but I think that a 40 per cent. yes vote was a feature of the 1979 referendum, so it would seem not illogical that the Scottish team should make a similar proposal. It is a different matter in London.

Will the hon. Gentleman give way?

No. I am very short of time, and I have already given way twice.

I do not find it illogical to suggest that more people should express a view than not for a proposal to become binding.

My second point was touched on by my right hon. Friend the Member for Penrith and The Border (Mr. Maclean) and relates to the representation of the people legislation. If a television broadcaster running a London current affairs programme supported one side of the referendum, should he come off the airwaves?

In London, Mr. Trevor Phillips, the presenter of a programme called "Crosstalk", was an active member of the yes campaign. Indeed, it is rumoured that he will be a mayoral candidate for London. I make no criticism whatsoever of Mr. Trevor Phillips—indeed, I have much praise for him. He conducts his programme in a genuinely neutral way, and when I have been interviewed by him, I have never felt that his party allegiance has in any way prejudiced what he has to say. However, there was nothing in the London Referendum Bill that gave any guidance on whether he should be allowed to stay on the airwaves.

I referred the matter to the Independent Television Commission, which has a code of conduct on such matters. Its view was that the principles enshrined in the representation of the people legislation should apply in a referendum. I do not know how it happened, but within a matter of days, Mr. Phillips came off the airwaves. However, it should not be left to Opposition Members to raise such matters with the ITC. They should be dealt with in the Bill. The position of the representation of the people legislation is far from clear. If nothing else happens, it should be incorporated into future referendum Bills.

My third and final point is whether or not there should be funding for a no campaign. In London, some £3 million was allocated to a so-called awareness programme, including the leaflets to which I referred. There was an awareness programme on the radio, and leaflets were put through every door, but there was no funding whatsoever for those who wanted to make counter-proposals or to express outright opposition. The Government believe that their proposals were put forward in a neutral way, but they were actually saying, "This is what we think—take it or leave it. Say yes or no in the referendum."

There is no justice in that attitude. It is like a jury at the Old Bailey being asked to make a judgment after hearing just the case for the prosecution, not the case for the defence. In truth, it is impossible to be neutral about a positive set of proposals. Therefore, I believe that a no or counter-proposal campaign should have the opportunity to express a view, given that so much taxpayers' money is being spent putting over the positive set of proposals.

We have had four referendums so far, and on the strength of their results, the Government believe that they have a mandate for action. There are at least two more to come—on monetary union and electoral reform. The issues require clarification. There should at least be some legislation setting up an organisation, so that they can be addressed.

Referendums are becoming very much a part of our political life; they are much more common than they were, and the practice of treating the electorate as an opinion poll sample is likely to continue in future. That is dangerous in our constitution, especially as there may be a big question mark over the future of the House of Lords. A two-House system provides a check on the Government, and if the other place is weakened, watered down or abolished, the referendum may become a far more dangerous constitutional innovation.

In many nations, referendums result from citizens' action and petition; the referendum is a bottom-up procedure. In the British political context, however, it is a device of the majority party. Governments institute referendums; they decide the wording and the timing. With all the temptations of power and of government, that is pretty dangerous.

I shall not dwell on what has happened in the past; it is more important to look to the future. It is important to establish an independent commission, or at least a code of conduct, so that we all know where we stand. That is a matter not only for the Opposition but for the Government, as the majority of today may be the minority of tomorrow, and a future Government may well use the lack of rules to reverse or change the position or to promote a very different agenda.

It is sensible that rules that we all understand should apply to the body politic. As my right hon. Friend the Member for Penrith and The Border (Mr. Maclean) said, we make almost a fetish of rules for parliamentary elections, and agents spend all their time telling us what we can or cannot do. Yet referendums are open season: there are no tight rules.

Referendums must be seen to be fair and legitimate. If we are to face the expense and upheaval, it is in everyone's interests that they are seen to be so; that requires the establishment of a code of conduct or an independent commission.

Certain questions need to be addressed. Who may initiate a referendum, and on what issues? We must not forget that referendums can be very bad news for minorities—and in a democracy it is important to protect minorities. Who will decide the wording—the Government or a special commission? How many questions should be asked? How will the referendum be organised and financed? How should money be raised, and should there be expenditure limits? What constitutes approval? Should it be by a majority or by a percentage of the electorate? Can a question be put again? Denmark, for example, was forced to hold a second referendum, having given what might have been thought the wrong answer. Should a referendum be pre-legislative or post-legislative? Finally, what rules should govern television and media access?

Those are all important subjects. Since we started to hold referendums, many academic conferences have been held on how they should be structured. We in the political class should set ground rules that are clear, transparent and widely accepted. Then we will know when people are cheating and when they are not. If referendums are to be held, they must be fair, legitimate and accepted by all participants at least as a democratic exercise in which everyone has a chance to put their point of view.

I find myself in an unaccustomed position. Luckily, the organ grinder is here should the monkey fail.

I congratulate my hon. Friend the Member for Mid-Bedfordshire (Mr. Sayeed) on bringing an enormously important subject before the House. Now I come to think of it, I am amazed that we have not debated it many months, or even years, before now. This is a useful and timely debate.

My right hon. Friends the Members for Bromley and Chislehurst (Mr. Forth), and for Penrith and The Border (Mr. Maclean) and my hon. Friends the Members for Mid-Dorset and North Poole (Mr. Fraser), for Croydon, South (Mr. Ottaway) and for Poole (Mr. Syms) all made significant points.

I can summarise the consistent theme that has run through the debate in five points. First, a range of questions clearly remains unanswered. There is no doubt that there are issues that have not been resolved concerning the holding of referendums. Secondly, it is abundantly clear—for this we also have to thank hon. Members from other parties—that there needs to be cross-party agreement on a framework; the issue should be raised above party politics.

Thirdly, there needs to be an independent commission to conduct referendums. As several of my hon. Friends said, it is implausible that a fair referendum—or at least one that would be seen to be fair—can be conducted at the behest of a Government who are necessarily a participant in that referendum and in the arguments within it.

Fourthly, there needs to be a set of rules governing access to the media, as there is for general elections, although the rules will have to be different, because equal access to the media needs to be provided for the yes and the no campaigns—which may be a quite different proposition from equal access for political parties. For example, all political parties could be on one side in a referendum, but the other side should be equally represented in the media. Finally, there needs to be a settled decision—the will of the British people—about what should constitute a fair threshold for a result.

None of that is new; the issue has been studied by a group of people, under the aegis of the constitution unit of University College London and the Electoral Reform Society—not, as the Home Secretary's phrase, a relatively independent group, but a genuinely independent group. It is chaired by Sir Patrick Nairne and includes Dr. David Butler, representatives of all the political parties, and a number of distinguished academics.

That group sat for some months and considered the issue in great detail. Its findings have been much spoken of in the other place. It recommended, among other things:

"It is essential that referendums should be conducted in a manner which enables all competing views to be heard…special guidance should be drawn up…An independent statutory Commission should be established…A balance should be maintained between the 'Yes' and 'No' viewpoints rather than between the different political parties…Every household should receive a publicly funded leaflet giving general information on the holding of the referendum and statements of the 'Yes' and 'No' cases".

If an independent commission has reached such a conclusion, if there is broad cross-party agreement that such rules are necessary, and if—as the Home Secretary graciously came close to telling the House yesterday—the Government impose an orderly procedure on the referendum on proportional representation, we have every reason to hope that, in just a few minutes, the Minister will tell us that the Government have at last concluded that it is necessary to impose such order on referendums generally.

I want to take the debate one step further and ask a question that has not been sufficiently explored—why is all this so important now? Why was my hon. Friend the Member for Mid-Bedfordshire right to raise the matter today? One point that has been raised, by implication, in the debate is the dizzy speed of constitutional change under this Government. Indeed, constitutionally they are the most radical Government since 1688—

Thank God for that.

I would not echo the hon. Gentleman's sentiment. I regret almost every aspect of the Government's agenda for constitutional change. However, that is not the burden of my argument today. Whether one welcomes it or disdains it; whether one regards it as unsettling to the whole nature of our constitution and our democracy or the best thing since sliced bread is neither here nor there. It has happened and is continuing to happen at a dizzying pace. It is happening by means of something which is itself a constitutional innovation, on which we do not yet have a settled view or settled rules. We cannot be confident that fair play will be involved—a necessary tool of any referendum. It behoves the Government, much more than their predecessors, seriously to take this question in hand and do something about the structuring of referendums.

There is a second point, of equal importance. The most important referendum that will be held—perhaps not in this Parliament, but shortly thereafter if the Government have their way—is that on a European currency. Many of us see that as a Rubicon. In that referendum, if none of the action recommended by the independent commission and many of my hon. Friends and other hon. Members is taken, there will be a severe danger that that critical referendum will not be, and will not be seen to be, fair.

In that case, there will be an awesome power of money behind one position. There is a great danger that a Government allied with the European Commission would use taxpayers' funds and a set of rules that did not have cross-party support or national acceptance to distort the likely result. Whether we fall on one side or the other of the argument in that referendum, it is of the greatest importance to all in this country that the result is seen to be fair and to have been fairly obtained.

There is a further point. It is not simply a matter of the European referendum; we were told yesterday that there is likely to be a referendum on proportional representation. In respect of the conduct of this House and the British constitution, that referendum will probably be, in its long-term effects, the biggest issue to be faced in this Parliament. The Home Secretary gave us at least a hint that the Government might impose rules that would establish fairness in the conduct of that referendum. However, that is not enough.

The Government want to seek parliamentary approval—unfortunately, they are likely to obtain it—to constrain the way in which political parties are funded at general elections. We understand that the Government will try to establish a position in which internal political debate, when it is conducted outside the context of a referendum, will be constrained by the amount of money that can be spent by either side. Yet within the referendum itself, there will be no rules to preclude the Government spending not politically raised money, but taxpayers' money, on trying to persuade the public to take one view rather than another.

It is therefore wholly possible under the current regime—although the Home Secretary has assured us that he does not want this—for the Government to issue large-scale information on one side of the issue, in reality propaganda posing as information, in a referendum on proportional representation. If the Government were to act in that way, they would be undercutting the rules on political funding, using taxpayers' money to distort a constitutional outcome. That would seriously undermine the structure of our democracy and people's faith in it.

The Government must translate the Home Secretary's hints of yesterday into the reality of guidelines and an independent commission that would make it clear that taxpayers' money will not be used to distort the critical outcome of a referendum on proportional representation or any other referendum, whether European or domestic. If the House takes heed of that, and if the Minister conveys that to the Home Secretary so that the Government can take heed of it, my hon. Friend the Member for Mid-Bedfordshire will live in history as having contributed, through a debate that has hardly been attended by Labour Members, to a major constitutional improvement.

I congratulate the hon. Member for Mid-Bedfordshire (Mr. Sayeed) on securing the debate and on having, for the most part, presented his arguments thoughtfully and interestingly. I also commend him on his timing, as it is less than two weeks since the fourth referendum of this Parliament was held. Each of the constituent countries of the United Kingdom has recent experience of a referendum, and this is a good time to reflect on that experience.

Most of the points made in debate were thoughtful, and I shall shortly say a little about the general principles raised. I should cover two points immediately, however, because they do not fall under general headings. First, the right hon. Member for Bromley and Chislehurst (Mr. Forth) asked, under the heading of reversibility, how long referendum results will last and when questions can be reconsidered. It is open to Parliament to reopen any issue on which it has already legislated, whether or not it has been subject to a referendum.

I hope that the right hon. Gentleman will accept it in the spirit in which it is intended if I say that I am confident that the referendums we have had have been popular and reasonably successful. I do not think that there will be any immediate demand from the people of Scotland or Northern Ireland—possibly even the people of Wales—to revisit those issues. However, if there is at any time such popular demand, the House will debate the matters, and further action will flow from that. The option is always open.

The second point, raised by several hon. Members, including the hon. Member for Sheffield, Hallam (Mr. Allan), was the question of thresholds. Different circumstances require different rules, and it is not possible to generalise. In some cases, a threshold may be appropriate, but in others it will not. Even where it might be appropriate, different levels might apply in different cases, as my hon. Friend the Member for Battersea (Mr. Linton) said.

It was not appropriate to set a threshold in any of the referendums that we held over the past year.

rose—

I will give way to the hon. Gentleman, but I do not intend to give way often, as I have very little time.

I certainly agree that there should have been no thresholds in the referendums that we have had. However, the Minister seemed to suggest that there might be some reasons for having a threshold. I plead with him not to do that. Thresholds have caused any amount of trouble in Scotland, and if a threshold had been imposed on the London referendum, it would, by any description, have been considered a failure. I want a principled statement from the Government that they will not indulge in any fancy franchise at any referendum.

My point was that I do not want to prescribe the position for every set of circumstances. So far, we have seen no case for a threshold. My hon. Friend the Member for Battersea spoke very clearly on the general principle of thresholds, but I would not want to rule them out in every case, because we cannot see what will happen in future.

rose—

I will give way to my hon. Friend, but I ask him to appreciate that my time is very limited.

Yes, but this is a very important point. This is a minefield. A 40 per cent. threshold was imposed in the referendum held in Scotland in 1979, and, although there was a clear yes vote, that artificial rule meant that the decision of the people of Scotland was thrown out. We had to wait nearly 20 years before we got our Parliament. That sort of fancy franchise cannot be tolerated anywhere.

My hon. Friend is quite right, and that is why it was not considered right to set a threshold in the Scottish referendum this time. That supports the point I am making about what is or is not appropriate.

Referendums are not a new device. Indeed, their use can be traced back to Roman times, and we have had an interesting diversion on the origin of the word itself. In the last century and until quite recently, there were temperance ballots in Wales. I believe that the last dry area went wet last year; if I am mistaken on that, no doubt someone will write to me. A so-called border poll in Northern Ireland 25 years ago under a Conservative Government produced a yes vote of 98.5 per cent., but its usefulness was undermined by the fact that it was boycotted by the nationalist community. The very high turnouts in the north and in the south of Ireland in the referendums on 22 May show the progress we have made since then.

In 1975 we had the United Kingdom's first, and so far only, national referendum, when there was a two-to-one vote to stay in the Common Market, as it was then called. That was followed by the first Scottish and Welsh devolution referendums. The recent referendums in those two countries make it possible to measure how far public opinion has moved. In 1979, the people of Wales voted four-to-one against devolution, but by 1997, a majority—albeit not a large one—of those who voted were in favour of the Government's devolution proposals. On the present crop of referendums, we made a clear manifesto commitment that our devolution proposals would be subject to referendums, and they were.

I was remiss earlier in not congratulating the hon. Member for West Dorset (Mr. Letwin) on his first outing at the Dispatch Box. I am sure that there will be many more. His speech was very clear and, though partisan, thoughtful. I have no doubt we will hear much more from him.

The hon. Member for Mid-Dorset and North Poole (Mr. Fraser) and others raised the question of the single currency referendum. We are committed to a referendum on that. What characterises these subjects is that they involve a transfer of power away from central government, and bringing decisions closer to the people.

The hon. Member for Mid-Bedfordshire made a key point about the conduct of referendums. Overall, the experience of the recent referendums has been very positive and it is a considerable tribute to those responsible for the conduct of elections that everything went so smoothly and efficiently, particularly bearing in mind the fact that the referendums in Scotland, Wales and Northern Ireland went ahead with relatively little notice, and the poll in London was combined with local elections. I certainly pay tribute to the electoral administrators involved.

The hon. Gentleman also suggested that there would be merit in establishing a permanent referendum commission to oversee the operation of regional and national referendums. I am not wholly persuaded of the merits of that suggestion. It was considered by the Electoral Reform Society and UCL constitution unit. In the recent referendums, we considered it right that Parliament should determine the wording of any question in a referendum being conducted by central Government. The number of amendments tabled to subsequent Bills bore out our contention that that was the right way to act. The polling and counting arrangements were not subject to any criticism as far as I am aware.

The hon. Gentleman suggested, unless I am mistaken, that public money was spent to fund the yes campaigns in Scotland and Wales. I flatly refute that allegation: no public money was spent on those campaigns. I hope that the hon. Gentleman will check the facts and retract that statement.

Will the Minister give way?

No I shall not give way—it is very late.

The position is clear: there will be occasions when referendums are appropriate, and occasions when they are not. They cannot create unity where no unity exists, and they cannot change the fact that Parliament is a sovereign body. However, they provide a unique way of consulting the people on specific issues, particularly on policies that are important in particular countries or parts of the country. That is why the Government committed themselves to holding a number of referendums. The electorate endorsed that principle and elected this Government, and we have carried out those promises.

We have had a useful debate, but we should be clear that referendums have a place and will not always be used in every circumstance. They will be used where appropriate.

The Labour party welcomed the Turnberg proposals in February this year. As I could not ask questions of the Secretary of State following his statement in the House, I will concentrate the bulk of my comments on the effects of the proposals on my constituency. Some of my hon. Friends have said that they will touch on the report's wider implications and what has happened since February. The report was widely welcomed, not least in Putney, whose residents suffered years of cuts in services and uncertainty, particularly in the provision of hospital services.

May I make a declaration of interest? Since 1966, my family and I have been treated at Queen Mary's hospital, Roehampton, my local hospital. I have fought for its retention almost all my adult life. My predecessor also fought for it, but in the last two years of the Tory Government, Queen Mary's suffered severe cuts. Under the Tories, and before I became the Member for Putney, the hospital lost acute surgery, paediatrics, orthopaedics, maternity services—my sons were among the last to be born there—gynaecology and obstetrics. Also before the last election, the accident and emergency department was downgraded. Those cuts totally undermined the viability of the burns and plastics unit remaining on site.

I state those facts because the local Conservatives have been reinventing history in the recent local elections. It is worth reminding the House that those cuts in services were not opposed by my predecessor or by the local Conservative council at the time. It is only since the general election that the Conservatives have done a U-turn, conveniently forgetting that they made the cuts themselves. The cuts were not opposed by the Conservative nominees on the community health council, with the honourable exception of the late councillor, Duncan Hawkins.

The doctors and nurses at Queen Mary's hospital, Roehampton have coped brilliantly and have performed miracles over the past year to cope with those Tory cuts. The Turnberg report gave a vision for a new, secure Queen Mary's hospital—a secure community hospital for the 21st century. I shall devote the remainder of my speech to the future of Queen Mary's and how it has fulfilled that vision in implementing the Turnberg proposals.

More than 90 per cent. of the services previously provided on the site will continue into the next millennium. The transfer of the remaining acute services to neighbouring hospitals is proceeding to plan and the new wards at Kingston hospital will be available in August. However, the out-patient services, which form the vast bulk of the services available to my constituents, will be immeasurably strengthened and improved by a new, integrated care centre offering rapid diagnosis and treatment, out-patient and clinic services in ENT, gastroenterology, elderly care, dermatology, gynaecology—including ante-natal, post-natal and assisted conception—neurology, oral and orthodontics, ophthalmology, orthopaedic and fractures, paediatrics, pain control, plastics, rheumatology, urology and HIV-AIDS, haematology, and a beta-cell diabetes service.

Some 200 in-patient beds will cover rehabilitation and respite care, mental health and elderly continuing care. Day units will continue, including the Bryceson-White unit for elderly people, the mental health resource centre and the Bader rehabilitation unit. The nationally renowned skin bank will remain.

I could go on with a laundry list of all the services available at the new Queen Mary's, but suffice it to say that it is a substantial hospital. I thank the Minister for his rapid and positive response to the referral of the proposals from Wandsworth community health council this year. I am grateful for his support for the rapid diagnostic centre, the minor injuries unit, the day surgery up to level 9 under local anaesthetic, and primarily for his support for the financing of brand new hospital buildings through the private finance initiative under a successful business case. A project manager has been appointed; the business case is being worked on and should go to the Minister this autumn. We all hope that building will commence within the next three years. In the meantime, the hospital will continue to use the existing buildings that have served the area well for so long.

The number of acute beds moving from Queen Mary' s is 172 but, as I said, more than 200 non-acute beds will remain; 137 replacement beds will open at Kingston, 34 will open at St. George's, 12 will open at Chelsea and Westminster, and two will open at West Middlesex. Those new beds reflect the range of choices that the people of Putney should have. I obtained those figures before yesterday afternoon's announcement of additional beds for London.

The movement of the burns and plastics unit will be accompanied by an identical number of beds in its new location. The new wards that will be available at Kingston in the autumn are of the portakabin type, and it is important that capital is made available for permanent buildings at Kingston and elsewhere. It is also important that the once-an-hour bus service between the two hospitals becomes a half-hourly service. Kingston out-patient services are becoming overcrowded. With shorter waiting lists at Queen Mary's hospital, local health care experts should perhaps look at transferring all out-patients to Queen Mary's hospital from Kingston, thereby releasing space for the required permanent acute care facilities at Kingston.

I reassure the hon. Gentleman that we have one thing in common: both our sons were born in Queen Mary's hospital. However, I am not sure what the hon. Gentleman is trying to convey to the House. He has listed new services and said that many of the services have been moved to other hospitals around Putney. Is that not precisely what is necessary to give rationality to our health service? The hon. Gentleman complained about Tory cuts at Roehampton, but have any of those services been restored on-site? If not, is he not saying that the Labour Government are continuing the previous Government' s policies of rationalising the NHS?

Clearly, the hon. Gentleman does not realise that, once services are moved off-site, doctors, nurses and facilities are also moved. That has happened. If he suggests that the Tory cuts can easily be reversed, he should go to his local hospital and ask how transferred services can be brought back.

The hon. Gentleman asks me to understand that point; it is a pity that some of his hon. Friends did not make that point when Edgware hospital was closed. They gave the impression that the accident and emergency department at Edgware could be reopened.

I am sure that my hon. Friend the Member for Brent, North (Mr. Gardiner) will make his point adequately if he is able to attend this debate. I must make it clear that what happened at Edgware and Queen Mary's happened under the Tory Government, and they were responsible for those changes.

The transfer of acute beds from Queen Mary's to Kingston created a balance, but it is important that, as soon as practicable after the transfer of those acute beds, the transfer of beds from Putney hospital should take place. There must not be a gap when Queen Mary's hospital is not used to its full capacity. Following that transfer, I look forward to new health care facilities in a public-private partnership with the local council, housing associations and the private sector, ensuring that Putney hospital continues to be a health care facility for the people of Putney. I further endorse the use of accommodation at Putney hospital by students of the Roehampton institute, a university that has a number of proposals on how it can work in partnership with the hospital across the road.

There is an urgent need to train general practitioners and hospital staff in management issues, particularly in the development of primary care groups and trusts. That could dovetail well with the Roehampton institute's plans for the expansion of health care subjects.

As I said, Queen Mary's continues to have the world famous Bader rehabilitation unit for amputees, with associated prosthetics and orthotics manufacturing workshops, and wheelchair manufacture and service. The workshops have been provided by two private companies—RSL and Steepers—which, in the past few days, have merged. I am pleased to tell the House that I have received assurances from Stephen Horam, the finance director of RSL, that there will be no reduction of the continued operational work force of more than 500, and Roehampton will continue, through the public-private partnership of the NHS and those companies, as a world centre for prosthetics and orthotics.

I welcome the White Paper on the future of the health service, particularly because of the way in which it backs up the principles outlined in the Turnberg report. I especially welcome the encouragement of trust mergers, and I look forward to a reconfiguration of trusts in south-west London, potentially based on the Queen Mary's site. A dialogue has now opened in south-west London between trusts, health authorities, GPs, local authorities and local communities. That dialogue must continue and seek ways in which to achieve a more holistic approach to community services in particular. With the development of larger hospital trusts, there must follow the development of a larger critical mass for community services, to provide an appropriate balance.

The next five years should bring much larger trusts, in terms of geography and service provision. Their roles will include co-ordinating and providing health promotion services, professional development of nurses and other clinical staff, provision of specialist managerial advice and support and, of course, the efficient running of comprehensive primary and community health services.

Queen Mary's and other hospitals like it in London have a key role to play in providing a more local and accessible service for their communities, while seeking ways in which to achieve greater flexibility in developing partnerships in care, and shaping local health services to meet the future needs of local people.

On a contentious note, as a former local authority leader, I feel that health authorities should be replaced by joint commissioning by primary care groups and local councils. The Berlin wall could then finally be removed from health care. Local health authorities, forced as they were under the Tories continually to cut back services, often did so in ways unacceptable to local residents—as is the case with Queen Mary's, as fully described in the Turnberg report. It is important to realise that local councils have been managing care in the community for the past six years with considerable success, and with at least 85 per cent. of services purchased from the not-for-profit or profit sectors. That has worked. Local councils should replace local health authorities in London.

I also welcome a single London-wide health authority, as recommended by the Turnberg report, but I hope that on the back of successful trials of local council purchasing of health care, the Greater London authority could take over that London-wide role. I realise that that may take time.

In the meantime, I pay tribute to the work of Sir William Wells, chairman of the South Thames regional health authority until its demise next year. He has done a huge amount in the past five months to ensure that the Turnberg proposals have been put into action in the South Thames region. I wish him well in his new role outside London.

Queen Mary's hospital has been through a difficult period over the past three years, but the time since February has been managed well. The new chief executive, Veronica Cotterill, has led her staff well into a secure future. I pay tribute to Dr. Elizabeth Nelson, the new chair of the Richmond, Twickenham and Roehampton trust, who has done so much to lead from the front and who has plans way beyond those that I have mentioned today. Finally, I pay particular tribute to Mrs. Alex Elliott, chair of the Queen Mary's League of Friends, who is sitting in the Gallery. She represents the most important people—the Queen Mary's community. She spoke last Sunday about an exciting new future for Queen Mary's and the friends' plans to support it. She has been brilliant.

After Turnberg, Queen Mary's has a different future. In the 50th year of the NHS, Queen Mary's future has been not only secured, but strengthened as a model of how the national health service can adapt itself to reflect new patterns of health care, while serving local residents in the most appropriate way for the 21st century.

I thank the hon. Member for Putney (Mr. Colman) for securing this debate, which is the first since the Government's announcement on the Turnberg proposals four months ago. On 3 February, I generally welcomed the report. It was also widely welcomed in the House and outside, as the hon. Gentleman said. It set out many good paths for the health service in London, and we can see that progress has been made.

First, I congratulate the Government on acting speedily on one of the recommendations, by accepting the logical proposal that London should have one strategic health authority. Many of us have argued that case for many years, and the Government have announced that it will be set up next year. Like the hon. Gentleman, I welcome that, but, as the Minister knows, I also believe that we should go further and make the Greater London authority, when it is set up, the strategic health authority for London. In all logic, that should be the case. I know that there are implications concerning what should be done in the rest of country, and that different management structures would be in place, but it would be far better if strategic planning were done by elected people rather than by people whom nobody knows or chooses.

Chapter 4 of the Turnberg report examined locality commissioning, and work is being done on that. I hope that the Minister will accept that there will be a problem if there is not a common set of boundaries with local government. There is a desire to have such common boundaries, within which locality groups fit, and for health authority and local authority boundaries gradually coming together. That would be common sense. However, there is a democratic deficit, and some people have a problem with the idea that developments in primary care will be led by practitioners, rather than by the public, who would make sure that practitioners did what the patients wanted.

The Secretary of State and I had an exchange yesterday on public involvement in health services. He was wrong to say that no party has ever proposed that there should be democratic management of the health service. My party believes that health and social services should be merged under local government control, and that the local authority should therefore also be the health commissioning body. The Government have not come that far, but they are moving in that direction.

The hon. Member for Putney rightly said that the Berlin wall in health care must be broken down. I ask the House and Ministers to accept that there will come a time when we merge health and social services commissioning, as in Northern Ireland. Those services deal with the same people at different stages in their treatment and need, and the illogicality of one service being a local government social services function and another being a separate health authority function does not work for the patient or the practitioner.

I hope that the Government will also seriously consider making more democratic the representation on trusts and health authorities, as well as evaluating the idea of health commissioning eventually being merged with local government. The Government are committed to reforming local government structures; let us not ignore health structures.

The Minister is well aware of the problems in primary care alluded to by Turnberg. In London, we face a severe prospective crisis in the number of doctors and GPs and, in some areas, of nurses and other practitioners. That is very worrying. Some areas of London have staff shortages of up to 20 per cent. By the end of the next five or 10 years, the health service must deal with these problems, particularly in the capital, where pressures are greater and travelling and housing are more expensive.

Ministers probably say privately to their colleagues over the road that they do not want Chancellors, including the present one, to insist on pay awards being staggered, as was done this year. Pay awards should not have been staggered this year. It has not helped; nurses were furious and other workers were unhappy. If the economy allows it, as it currently does, pay awards should be made in full to encourage people to come into nursing and the other professions in public services, such as medicine and therapies. I hope that the Minister will tell us—if not today, then soon—how he plans to deal with recruitment needs in London. If we do not meet those needs, we shall be unable to implement all the proposals made by Sir Leslie Turnberg and his colleagues.

On intermediate care, the health service is at an interesting stage. We now realize—as do the Government, and I commend them for it—that the community does not need only intensive care beds, high dependency beds or long-term beds, for respite care or convalescence, or to reduce blocking hospital beds. It needs a network of community hospitals in London, which we used to have. I do not blame this Government for closing them down. I should be interested to hear how the Government plan to respond to that need and open them up.

All areas of London should have a community hospital. To take a local example, I know that, when people, particularly the elderly, from the north of Southwark no longer need acute care, or need other care, they often cannot find it locally. They are cared for at home, if that is possible, or sent a long way from their community, where their partners, spouses, families and friends cannot easily visit if there is no public transport or they have no private transport. I hope that the need for a second tier of in-patient care in London, with and without nursing help, will be addressed.

Sir Leslie's report rightly concentrates on the needs of mental health care in London. Ministers understand the pressure, but the long-awaited paper on mental health has still not been published. It has been much delayed, and we keep being told that it is imminent. The Minister may make an announcement on that. The Under-Secretary of State, who is responsible for mental health matters, has promised to announce the Government's policy in this area.

My plea to the Government is that they ensure soon that London has the 24-hour services that Sir Leslie and his colleagues recommend. People's crisis needs can be greatly alleviated if there is somewhere they can go at any time. Mental health provision for people who are not in-patients is extremely under-resourced.

Some welcome announcements have been made about bed closures. Will the increase in the number of establishment beds in London be permanent? Yesterday's announcement referred to the new beds as beds to deal with the waiting list and waiting times problem. I welcome that, but will they be available next year and the year after? Turnberg said—thank goodness—that we could no longer afford any further closures of hospital beds in London. The NHS Confederation says that, between 1990 and 1996, the number of acute in-patient beds fell by 2,761, which is a hell of a lot of beds. It would be helpful if the Minister could tell us whether it is Government policy to have a particular number of beds and what that number is, and whether the new beds will be included in future projections.

The report considers that the sensible way in which to deal with the planned five parts of London is a separation of acute and elective care to ensure, among other things, that people's planned operations are not cancelled. If that can be achieved—it is the logic of the Bart's decision—it will be welcome. The two services should not be muddled.

The Minister would be surprised if I did not say something about the largest hospital trust in the country, Guy's and St. Thomas's. On or near his desk is a set of papers awaiting his decision about the final configuration of services. We must all try to ensure that no health service money is wasted. The Minister knows that, if we do what the trust proposes and move the paediatric department from Guy's to St. Thomas's, a new building will have to be built at a cost of about £50 million, and seven floors of a relatively new building at Guy's will be left clinically empty. The plan is to use them for administration, which is nonsense.

People in charge of the cardiac centre have told me that, at the same time, they do not have enough money to do their job properly. We must ensure that the money is used where the need is, which, I would argue, would require paediatric services to stay at Guy's without huge additional expenditure, and the cardiac centre to have the money it needs, rather than buildings to be built that are not needed.

I hope that the Minister will make people happy, will make the health service more effective and will use money more wisely by making the popular decision that Guy's shall have 400 to 500 beds and the elective care, while acute care is concentrated be on the St. Thomas's site.

The hon. Member for Putney was trying to ensure that Labour was not blamed for Tory decisions. In my part of London, we still believe that Labour should take its responsibility because it endorsed the Tory proposal to close accident and emergency services at Guy's. The Government cannot get out of their responsibility. That may not apply in the hon. Gentleman's part of London, but it was as much a Labour as a Tory decision to close our accident and emergency services. It was certainly not the platform on which the Labour party campaigned against me at the general election. People were told that Guy's would be saved on day one of a Labour Government. If that did not include saving the accident and emergency services, I do not know what they thought people believed they meant.

Yesterday, the Chancellor said that he would continue to be an iron Chancellor. The health service requires a Chancellor who understands its resource needs. Sir Leslie has said that the health service in London needs the resources to do the jobs that we all want it to do. Health ministers will make their case, but the proof of the effectiveness of the Government's health service pudding will be whether the Chancellor next month announces significant increases in resources for the health service in London and elsewhere. Without them, much of what is in this excellent report will not come to pass.

I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing this important debate. I should like to confine my remarks to two aspects of the report: chapter 11 on Harold Wood and Oldchurch hospitals, and chapter 6 on primary care.

Harold Wood hospital is in my constituency, and Oldchurch hospital is in the constituency of my hon. Friend the Member for Romford (Mrs. Gordon). Both hospitals come under the Barking and Havering health authority and are in the London borough of Havering. The Turnberg report made a firm recommendation. On page 71, it states:

"We endorse the single site Oldchurch area proposal as optimal on the grounds of access to a large proportion of the most deprived population and the strong support from the local authorities and GPs."

Those words, brief as they are, have been taken wrongly by some, including the BBC, to mean the closure of Harold Wood hospital, but that is not the case. I have had numerous discussions with the executives of the Havering hospitals trust, the BHB trust, the area health authority and the regional health authority about the implementation and recommendations of the report and its knock-on effect on Harold Wood hospital. It will undoubtedly mean different health services at Harold Wood, but it does not mean closure.

I could go on at length about the services that are planned and will be delivered in the future at Harold Wood, but that can wait for a more appropriate time, especially in view of the imminent launch of the local consultation process on the future of hospital services in the area. The indications are that positive proposals will be forthcoming, which will be welcomed by my constituents.

As my hon. Friend knows, Members from north-east London have worked well on local hospital issues, but the report acknowledged that its recommendation for Oldchurch will have an impact on King George's hospital in Ilford, which most of my constituents use. Will he join me in urging the Minister to consider the impact on my local services and on services in the whole of the north-east London area?

I am pleased to urge the Minister to consider the impact on hospitals in the surrounding areas.

Health care services will be fit for the new millennium under the proposed package of measures. It will ensure the maximum use of facilities developed through limited investment over the past 10 years. Despite the scare stories that have emanated from some quarters—mainly from our political opponents in the lead-up to the local elections—my main concern is about the time it will take to implement the report's recommendations. The proposals referred to in the report have been developed locally. They are exciting and will provide a new general hospital at Oldchurch close to the existing hospital and just four miles from Harold Wood. The new hospital will be built on land currently owned by the London borough of Havering, which will be exchanged for area health authority land.

After the new hospital has been built and services have decamped from the old hospital to the new, the old hospital will be demolished, leaving Havering council free to build its long-awaited sports stadium. A new hospital close to a public sports facility would enable the link between healthy living and sports injuries facilities to become more than a vision; it would become a reality. Such public facilities, developed in partnership across agencies, would be welcome.

I am concerned about procrastination and about delay which, unfortunately, has been the hallmark of past Administrations. There has been some investment, but it has been piecemeal, and there does not appear to have been a coherent strategy, which has understandably led to public scepticism and frustration. Procrastination and delay in implementing necessary changes have left health services deteriorating, which has affected the constituents of my hon. Friends the Members for Barking (Ms Hodge) and for Dagenham (Ms Church) especially harshly. I fear that further years of delay will fail the populations further, so I urge my hon. Friend the Minister to ensure that this recommendation is high on the list of priorities.

There is a popular misunderstanding about outer east London, which is considered to be a leafy suburb without deprivation. That is not the case, and the area is often overlooked because of that misconception. Recent reports commissioned by the area health authority and the local authorities contain ample evidence of serious health needs that must be addressed.

My constituents and those of my hon. Friends the Members for Barking and for Dagenham need and deserve the new facility, which will provide improved services closer to the centre of population that it would serve. Further delay would do our constituents a disservice; a quick advance would enable the partnership that has developed between the area health authorities, the hospital trusts, the London boroughs, the community health council and Members of Parliament to flourish, in marked and notable contrast to years gone by.

Lack of investment and failure to recognise the area's health needs, especially the almost crisis position of primary care, are evidenced by the Turnberg report, which states on page 33:

"Despite considerable investment in primary care services in the last few years, services lag woefully behind those in the remainder of the country. The number of practices below recommended standards remains high, too many premises remain poor, single handed practices represent a larger proportion than elsewhere, recruitment is difficult and the total number of GPs has fallen slightly in the face of a rise across England."

The table on page 36 shows the acuteness of the problem in east London: only 8 per cent. of premises in the Barking and Havering health authority area are above the minimum standard, and across east London generally, only 20 per cent. are above the minimum standard.

There is a considerable shortage of GPs: the area health authority is 50 short, which has a knock-on effect. GPs who practise in the area have to work under difficult circumstances with long patient lists, crowded surgeries and heavy demands. That has a contributory effect on the average demand on accident and emergency access services.

For those reasons, I welcome the report's recommendations in chapter 6, paragraph 23, especially paragraph 23.6, which states:

"London's health authorities should be required to ensure that the proportion of practice premises which are below minimum standards should be reduced from the current 50 per cent. by 10 per cent. annually. Funding for cash-limited GP premises nationally should be related to the proportion of practice premises which are below the minimum standards. The Regional Offices should ensure that there is co-ordinated advice and support for general practitioners on all aspects of premises provision for London."

In view of that, I invite my hon. Friend the Minister to comment on the timetable for the implementation of those recommendations, for only when they are implemented will we, as politicians who have been elected to improve the health service, have honoured our pledges.

I welcome the debate and the report, which was ordered speedily after the general election and delivered promptly by the independent panel. Its recommendations have been widely welcomed, and we have to implement them with urgency of purpose, so that the people of London have their health services improved and restored.

I also pay tribute to the hon. Member for Putney (Mr. Colman) for giving us the opportunity to comment on the Turnberg report and to make observations on the future of the health service in London, especially hospital services.

I represent a constituency on the edge of Greater London. Mount Vernon hospital, about which I initiated an Adjournment debate on Friday 6 March, is located there. Earlier this year, the Minister of State, Department of Health was good enough to receive a deputation which I took to the Department to discuss its future. On Friday 29 May, Hillingdon health authority produced a consultation document, "A Contract With Local People", which makes drastic recommendations about Mount Vernon hospital and other hospital services, especially Hillingdon hospital in the north of Hillingdon borough.

I fear that the Turnberg report and the Government's plans for the future of the health service in London do not take sufficient note of hospitals such as Mount Vernon, which, historically, have drawn patients from well beyond the Greater London area. I must repeat what I said on 6 March: Mount Vernon is the largest cancer centre in the south-east on a single site. More important, it is probably the premier cancer treatment location in the south of England, if not the country, and combines fantastic clinical facilities for the treatment of cancer with research facilities of international repute, especially the Gray laboratory and the Marie Curie centre.

Furthermore, there is an outstanding hospice, Michael Sobel house, and a scanner centre, the Paul Strickland centre, which have been built up largely by private contributions from generous people over many years. Another charity, the Reconstruction of Appearance and Function Trust, is at Mount Vernon, as is the Cleft Lip and Palate Association. Mount Vernon is a genuine centre of outstanding excellence, but such a cancer centre cannot stand on its own: it has to have a range of supportive services in general medicine, surgery and many other disciplines. They are being put at risk by wide-ranging reviews undertaken for reasons of supposed rationalisation and supposed better organisation of services in the area; but the conclusions are highly questionable and would be prejudicial to the long-term future of the hospital. Indeed, they would call into question its viability beyond the next 10 years or so.

The hon. Member for Southwark, North and Bermondsey (Mr. Hughes), from the Liberal Democrat Benches, and the hon. Member for Putney suggested that the health service in London would be better administered by the Greater London authority than by the single health authority for the capital proposed by Her Majesty's Government. I do not understand how the Greater London authority could have the range of competence and the professional expertise to run London's health service. How it would administer the budget is unclear to me.

The suggestion of the hon. Members for Southwark, North and Bermondsey and for Putney is contrary to the proposals of Her Majesty's Government for the future governance of London. The proposals are directed at the strategic development of the capital in terms of industry and commerce, transport, strategic planning and so on. They have nothing to do with the health service, and it would be a retrograde step if Her Majesty's Government took their advice. It would not, as they somewhat disingenuously suppose, constitute an advance towards democratic control of the health service.

The hon. Gentleman used the phrase "retrograde step". Does he accept, with the benefit of hindsight, that his failure to oppose the closure of the accident and emergency unit at Mount Vernon hospital when his party was in government was a retrograde step, and will he take this opportunity to apologise to his constituents—and, indeed, mine—for his failure in that regard?

I have no reason to apologise. I initiated an Adjournment debate calling for the accident and emergency unit to be kept open at night when there were plans to close it at night. The then Minister—now my right hon. Friend the Member for North-West Hampshire (Sir G. Young)—acceded to my request, and the unit was kept open at night for a while; but the health professionals believed that its closure would constitute a better use of resources. They felt that it would be better to concentrate on A and E services at what they considered to be better-equipped hospitals, such as Watford general, Northwick Park and Hillingdon. Hon. Members are extremely rash if they arrogate to themselves a professional competence in matters of health service clinical judgment which are rightly in the domain of health service professionals.

I was not happy with the proposal. It went against the grain. Local people, however, were informed that the unit had to close; they were told that the cancer treatment service would be built up, and that that would become the hospital's specialist role—which indeed it has, to the credit of all concerned. I am arguing that organisational changes in the health service in London are putting at risk even the long-term future of the cancer centre.

The proposed changes are fundamental. Paragraph 4.34 of the consultation document proposes that

"from April 1999 inpatient services for acute medicine and care of the elderly, including those provided in the medical assessment and coronary care units, be transferred from Mount Vernon Hospital to The Hillingdon Hospital".

That is to happen at the beginning of the next financial year. The document continues:

"inpatient services for non-acute medicine and care of the elderly, together with medical day care, medical outpatient services and the minor injuries service remain on the Mount Vernon Hospital site".

However, the next paragraph states:

"from April 2001 the above inpatient services of non-acute medicine and care of the elderly, medical outpatients and minor injuries, plus other services, e. g. children's services, should transfer into the community hospital in the north of the borough".

In other words, there is a stay of execution. In the early part of the next century, Mount Vernon will be deprived of much of its bread-and-butter work.

Paragraph 4.37 states:

"Medical staff would work together as a joint team covering both The Hillingdon and Mount Vernon hospitals, providing acute inpatient care at The Hillingdon Hospital and outpatient and day hospital services across the borough."

That is all very well, and a reasonable person would commend such proposals to make better use of skilled personnel; but, at the same time, it is proposed that Mount Vernon hospital—which currently forms a joint trust with Watford general—should merge with Hemel Hempstead and St. Albans NHS hospital trusts in Hertfordshire. That will complicate the cross-London boundary dimension of the health service still further.

The North Thames regional executive dealt with both the home counties north of London and London north of the Thames. That allowed co-ordination, which was thoroughly healthy—especially for hospitals such as Mount Vernon, which took patients from north of Greater London. How things will work under the new regional authorities has yet to be defined: I hope that the Minister will be able to explain.

I am particularly perturbed about the future of the burns and plastic surgery units on the Mount Vernon site. Those specialties are crucial to the underpinning of the cancer centre. The possibilities under consideration appear to be the resiting of the entire unit at Northwick Park hospital in Harrow, the resiting of the plastic surgery centre at Northwick Park—with the burns element going to Chelsea and Westminster hospital—and division of the work between Northwick Park and Chelsea and Westminster, with the burns element going to Chelsea and Westminster. I do not comprehend why those changes are proposed; I do not see how they will help to ensure the long-term future of Mount Vernon as a cancer centre.

The same applies to Hillingdon health authority's further proposals. According to paragraph 4.54 of last Friday's consultation document,

"from April 1999 complex elective inpatient surgery, especially vascular surgery, should be transferred from Mount Vernon Hospital to The Hillingdon Hospital. From April 2001 all elective inpatient surgery should be transferred from Mount Vernon Hospital to The Hillingdon Hospital. Day case surgery for selected patients, together with surgical outpatient services, should remain at Mount Vernon Hospital until such time as a community hospital is developed in the north of the borough."

Again, there is only a stay of execution.

All in all, it would seem that the powers that be have it in for Mount Vernon hospital—God alone knows why. Mount Vernon is an outstanding institution. Most people who have been treated there, have visited the hospital or have the privilege of working there describe it as a centre of excellence. This death by a thousand cuts would be a tragedy.

I am convinced that my constituents, and those who benefit from the hospital's services, will fight for its future. They believe that it ought to be built up rather than run down, and that the fact that Her Majesty's Government—who have made such play of their commitment to the NHS, during their election campaign and since—should contemplate damaging a premier cancer centre beggars belief. I hope that wiser counsels will prevail.

I congratulate my hon. Friend the Member for Putney (Mr. Colman) on obtaining the debate. I know how hard he has worked to secure the future of Queen Mary's hospital, both before and since his election. I, too, campaigned, in my neighbouring constituency, to keep Queen Mary's accident and emergency unit open. We did not claim that it would automatically be restored if we were elected, but I venture to suggest that had my hon. Friend been the Member for Putney since 1992 rather than 1997, the situation at Queen Mary's might be very different.

The Tory Government left the new Labour Government an appalling legacy of underfunding and huge regional disparities in health care. However, we also have another inheritance: the Labour party set up the NHS, and initiated the principles and philosophy behind it, along with the commitment to rebuild it. If there was one reason why support for Labour was so strong in my constituency last May, it was the belief that Labour would rebuild the NHS.

Underfunding in London, including my area of south-west London, is a particular problem, as the Turnberg report makes clear. Some time ago, my health authority, Merton, Sutton and Wandsworth, produced a report called "The River Runs Dry". According to the health authority, that phrase

"most accurately describes our financial position…We do not believe that it will be possible to achieve an income and expenditure balance"

in the next financial year

"without major reductions in staff and other costs of our providers."

Since the publication of that report, the Government have made additional resources available, and detailed negotiations to secure a bridging loan have taken place with the NHS regional executive.

I do not share the rosy view of the South Thames regional executive that is held by my hon. Friend the Member for Putney. I hope that proper funding arrangements for the Merton, Sutton and Wandsworth health authority can be secured. Difficult and acrimonious negotiations have been taking place. A local GP told me, "The deficit is being passed from the trusts to the health authority and back again. Nobody wants to be left with the deficit when the music stops."

If the Merton, Sutton and Wandsworth authority cannot get a bridging loan to cover the non-recurring part of its deficit, the consequences for my constituents will be severe. They will look to the Government, in responding to the Turnberg report, to address the specific problem of resource allocation in London. The NHS needs more resources nationally and more must flow to where they are needed most.

My constituents welcome, as does Turnberg, the Government's commitment to a review of the national distribution of funds for the health service. Page 26 of the Turnberg report suggests that that should be done

"through the creation of a working party to review the resource allocation formula and to study the implications of its findings for London."

In the report "The River Runs Dry", Merton, Sutton and Wandsworth health authority states:

"We have major concerns about aspects of the capitation formula. We spend the vast majority of our resources on what we would regard as high priority unavoidable need and the allocation that we receive does not appear to adequately reflect the needs of our population."

That assessment is consistent with Turnberg's findings for London as a whole. All is not well with London's health service, and the problems must be sorted out.

Coming to grips with the immensity of London's population and the diversity of health needs and life situations of Londoners will be no easy task. One could do worse than consult the list of special factors that are part of the everyday reality of health care in south-west London and which are cited in the Merton, Sutton and Wandsworth report. Do other areas spend the same amount on AIDS and HIV treatment and care, on serious mental illnesses, on people with learning disabilities and on mentally disordered offenders? Do other regions have the same diverse cultural mix, the same mobility and the same age profile of the population as London does? Does the present capitation formula adequately reflect those factors? My interpretation of Turnberg is that it does not.

If those factors had been taken into account in the Government's review of the formula, the health needs of my constituents would have been more truly reflected, the Merton, Sutton and Wandsworth deficit would be reduced or eliminated, and local health care resources would be increased.

There are some important proposals in the Turnberg report for cutting the cost of administration by the merger of South Thames and the North Thames regional health executives. In the short term, I am sure that the South Thames executive will ensure that my local authority gets the bridging loan that is needed. In the longer term, we must move away, as my authority wishes to do, from the continuing need for such transitional arrangements by making sure that the formula more truly reflects local health needs. We must also increase the share of national income that is spent on health.

Does my hon. Friend agree that one of Merton, Sutton and Wandsworth health authority's major problems is underfunding of the treatment of mentally disordered offenders, and that that underfunding amounts to almost £7 million a year? That dates back to the previous Government because I understand that those costs were moved from the Home Office to the Department of Health, and that the issue has never been properly dealt with. Given the importance of Springfield hospital, which is within the Merton, Sutton and Wandsworth health authority—

Order.

—that matter should be addressed.

Order. When I rise the hon. Gentleman should sit down immediately.

I apologise, Mr. Deputy Speaker.

The hon. Gentleman has already made a speech and he is starting to make another one.

I understand that the non-recurring deficit is down to about £5 million. The £7 million to which my hon. Friend refers, if properly reflected in the formula, would solve the immediate funding crisis. I have cited some other pressing underfunding issues, but the one to which my hon. Friend refers would in itself deal with the health authority's current problems.

However, it is not just a question of more money for the NHS, although, of course, more for London and especially south-west London is crucial. As the Turnberg report makes clear, we must also involve and consult local people in deciding how that money is spent. As Turnberg puts it, the problem is not whether the public should be involved but how they should be involved.

The report is rightly critical of old-fashioned and out-moded methods such as public meetings, circulars and so on. It criticises the NHS Executive guidance on public consultation, which, as Turnberg says, needs to be urgently reviewed. Some of the suggestions in the report, such as focus groups and citizen juries, will be familiar to students of modern-day consultation techniques, but consulting the public is a difficult and many-sided job. and deciding how best to do it is difficult. I congratulate the local health authority on setting up a series of regular meetings with hon. Members in my area. They have been valuable, and, as Turnberg acknowledges, the community health councils also play an important local role.

Local civic forums and health forums, and consultations with voluntary and community groups also have a role to play, but the overall question of how genuinely to involve the public remains difficult, given the immensity and diversity of London's population. Moreover, a sustained effort is needed if consultation is to be effective.

My community health council and the health authority produce excellent leaflets from time to time, but, after one or two issues, they peter out. When there is a funding crisis, the flow of information dries up because there is no money to pay for consultation materials. Just when maximum consultation is needed, there is silence followed by cuts in services.

I congratulate the Government on opening the meetings of health authorities and trusts to the public. With the help of my local community health trust, I have obtained the dates of public meetings and, in the coming months, I plan to distribute a list to all interested parties for wide circulation in my constituency. However, we must go further, by having lists of such meetings posted in GPs' surgeries. Perhaps every surgery should have a television set, which could also show films and videos to inform local people. We must grapple with this difficult subject of consultation, so that we can formulate a coherent, sustainable and effective strategy for consultation of local people. It will be a daunting task. The Turnberg report gives pointers, but we need to go further.

The report states that a positive communication strategy is necessary to facilitate pan-London debates on the capital's health service. Does my hon. Friend agree that the excellent result in the recent London referendum augurs well for such a debate under the auspices of a Greater London authority? Does he further agree that one of the reasons for so much under-investment in London's health service is precisely because London has not had a voice?

I agree. Londoners are not as aware as they should be of regional disparities in health care. Although the authority may not have a direct role in the expert provision of health care, it should give Londoners a greater say in the shaping of local health care. The Greater London authority will be valuable, as will the London civic forum, in informing Londoners about the key issues of strategic health care in the capital. Involving local people will be the first hurdle that we must surmount, and it is part of the wider consultation strategy on health services in which those bodies will play a vital role.

Local commissioning groups are mentioned in the Turnberg report and they are beginning to take shape in my constituency in line with the White Paper proposals. There is a potential cluster of important primary health care trusts in my constituency. At its heart is the Nelson hospital which can be a hub for the services and a future high-quality community hospital. I am working on that with the full co-operation of the St. Helier trust and I should also like to involve the Government and my constituents in that process. I was delighted by the recent visit to my constituency of the Minister's PPS, my hon. Friend the Member for Salford (Ms Blears), to discuss how we can proceed.

It is the 50th anniversary of the NHS, which should be allowed at least to voice a wish list of what it wants for its birthday. For my constituency, I should like to see not only a start made on improving services at Nelson hospital, making it the hub of new services, linking it with the new primary care trusts, but a review of the capitation formula and more resources nationwide for the health service, so that my constituents and those throughout London receive the health services that they certainly deserve and desperately need.

I wish to make just three quick points under the auspices of this debate. I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing the debate. As has been said, it is much needed.

The three quick points that I want to make are, first, that I think I sit somewhere between those who suggest that we should have directly elected borough health representatives and those who suggest that the Greater London authority should fulfil the role. I said on Second and, I think, Third Reading of the Greater London Authority (Referendum) Bill that it was crucial that the Greater London authority had a key scrutiny role at least in relation to strategic provision for London's health. I still adhere to that view and hope that that comes out when we get to the legislation, but I agree that it should have a strategic role rather than a specific Londonwide commissioning role.

Secondly, it is interesting that the hon. Member for Chipping Barnet (Sir S. Chapman), who mentioned me carte blanche, I suppose, with other north-west London Labour Members in relation to Edgware, has now gone. It is touching that he is now suddenly involved and concerned about Edgware's accident and emergency department. I was a key figure in the campaign for that department for four years and can say happily, hand on heart, that we saw the hon. Gentleman precisely zero times throughout that campaign.

Guilty men were involved in that campaign, but happily we have seen their demise as Conservative Members of Parliament. They are Messrs Gorst and Dykes, who—I choose my words extremely carefully—have lied through their teeth to the public in the past year about some silly bit of paper that they had by way of a promise from the then Secretary of State for Health, the right hon. Member for Charnwood (Mr. Dorrell), about the A and E department remaining open.

The only honest person—again, I choose my words carefully—in the whole process in the then Government was the right hon. Member for Charnwood, who said in June 1996 that the A and E department was closing and that he would do all that he could to ensure that it closed long before the general election ensued. He stuck to his promise and, on April fools' day 1997, the department was closed beyond redemption in terms of buildings, legal contracts and assorted other tendering processes. Therefore, we will take no lessons from the now absent hon. Member for Chipping Barnet or from any other Conservative Member—the hon. Member for Rutland and Melton (Mr. Duncan) should please rub the bit about Edgware out of his debut speech from the Dispatch Box.

The third point concerns specialisms, one particular sector on which Turnberg does not really touch; it was not in the brief, which is fine. I have the great pleasure of having the Royal National Orthopaedic Hospital NHS trust slap bang in the middle of my constituency. It carries out orthopaedic work of international repute, which is beyond any challenge. The hospital is a fairly substantial one and carries out a major specialism.

The hospital has been waiting for the best part of 15 or 20 years for the regional health authority to secure its future on the current Stanmore site. The latest bureaucratic nicety from the authority is a musculo-skeletal review, which will determine whether that orthopaedic provision will be available on the Stanmore site, or otherwise. There will be serious ramifications and knock-on effects for surrounding local hospitals throughout north-west London if the future of the Royal National Orthopaedic is not secured.

Happily, the Minister of State, Department of Health, my hon. Friend the Member for Darlington (Mr. Milburn), has agreed to meet me and other north-west London Members to try to resolve the situation. For such a significant national treasure in the NHS still to be floundering after 15 or 20 years with its future not secured is wrong; that situation must come to an end at the earliest possible time. If it does not, and it lingers on and on, the hospital will fail. It will fail ultimately to attract key international personnel, who happily come to it for some work experience and training, and it will fail to attract the brightest national brains in terms of orthopaedic provision and musculo-skeletal work.

I hope that the Minister of State—not necessarily in his winding-up speech, but subsequently, when we meet—will tell us that the position of the Royal National Orthopaedic is assured. I know that His Royal Highness the Duke of Gloucester, who opened a significant scanner on the site yesterday and had the pleasure of visiting a ward there that was named after his father, would endorse the proposals. Everyone in north-west London would. I hope that that proposal, which is, I accept, a non-Turnberg proposal, is addressed sooner rather than later, for the betterment of health provision.

The hon. Member for Harrow, East (Mr. McNulty) kindly referred to this as my first attempt to reply at the Dispatch Box, and indeed it is. It is a great pleasure at last to be dealing with doctors rather than spin doctors.

The hon. Member for Putney (Mr. Colman) has done the House a service in raising this topic for debate. It is a matter of great importance and, of course, of legitimate constituency interest to him. However, he suffered something of a memory lapse when he said that Queen Mary's hospital would enjoy a different future. Indeed it will, but it is very different from the future that his party promised in the run-up to the general election.

The Conservative health team will endeavour at all stages to be constructive. As we approach the 50th anniversary of the NHS, our mission is to help to develop and to improve it. It may be fertile territory for political combat, but our side will never join battle at the expense of the NHS. This issue requires mature attention. A capital city is a complicated area for health provision. The issue is politically charged, but where there is rapid medical progress, where there are demographic and infrastructure changes, where there is deterioration in buildings and development pressure around them, there is a need from time to time for a fundamental review, which is exactly what we did with the Tomlinson report and, for rather different reasons, what the Government are doing with the Turnberg report.

It is sad that the response to Tomlinson when we were in government was not mature. The then Opposition did not attempt to improve the health service. It was low party politics. The result was that the present Government became boxed in, which is why the Turnberg report was necessary in the first place. It was designed as something behind which the Government could hide. Perhaps the most cynical would say that it was designed as a convenient dustbin for their pre-election promises. It was not about saving hospitals: it was about saving the Minister's face. It is no thanks to the Government that Sir Leslie Turnberg managed to convert his task into such a useful exercise. His starting point was that primary care in the capital matters. I think that we all share that view and recognise that the debate principally centres on hospitals.

The Government came to office with a pledge to review London's health service. They came with a certain amount of pre-election baggage because they had promised an enormous amount to local communities. They played on the fears about the future of local hospitals; many of those who voted Labour believed that a Labour Government would save those hospitals, just as Labour had promised, only to find that they are now severely disappointed.

Is the hon. Gentleman suggesting that it was a mature decision by the previous Government to close Bart's, and that it is part of the pre-election baggage of this Government to ensure that it remains open as a facility for Londoners?

I will come in a moment to the deceit that the Government have shown on the issue of Bart's and the promises that they made in the run-up to the election which have not been met.

In opposition, the Labour party complained that London had too few hospital beds. One function of the Turnberg report was to allow the Government to claim that London now had about the right number of hospital beds. That was the first step towards their current programme of closures and cuts. The paltry number of extra beds announced the other day by the Secretary of State does not make up the 200 that the Government have slashed from our plans for the new Royal London hospital.

As the hon. Member for Barking (Ms Hodge) has suggested, the Government needed to be able to claim that they had saved Bart's. Turnberg has given them an excellent public relations formula for doing so, despite the fact that Bart's is now closed as a district general hospital for the local community—a fundamental element of the campaign to save Bart's.

Will the hon. Gentleman tell us exactly when he will start being mature and constructive?

The hon. Gentleman should perhaps listen to the facts and feel ashamed that the Government he supports have betrayed so many of the promises which, no doubt, helped him get elected.

A raft of promises were made to the people of Edgware and Roehampton, and the Turnberg report has been able help here, too—offering a convenient way of removing accident and emergency facilities from local people.

I should like to ask the Minister certain specific questions which it is his duty to answer. The Turnberg report recommends the downgrading of Queen Charlotte's hospital, with Hammersmith taking on most of the extra work load. We are concerned, as is Turnberg, about the clinical base of Hammersmith hospital. If it is to be able to handle the extra work caused by the transfer of Queen Charlotte hospital's facilities, significant investment in Hammersmith will be needed, and there are concerns about the suitability of the Hammersmith site for such work. May I have an assurance from the Minister on his plans for investing in Hammersmith?

I should like the Minister to explain how the interim period before such investment occurs will be handled. What plans does he have for increased co-ordination with Queen Charlotte's hospital and Charing Cross hospital? How will the financial base for the hospital be managed? Those are important questions which I hope he will answer.

The Secretary of State was proud to have saved Bart's. He admitted as much in the original debate on Turnberg, when he said that one of his principal reasons for commissioning the report was to avoid the history books recording that it was he who closed that ancient hospital. That was noble of him, but Bart's, in the way he promised, has not been saved. Bart's has been closed as a district general hospital for local people. It will no longer serve the community. To its traditional patient base, Bart's no longer exists.

In addition, health care in south-west London was a significant pre-election battleground for the Government. The people of Roehampton—who the hon. Member for Putney conveniently seems to have forgotten—were given specific assurances by their Labour candidates, and they must feel disillusioned that they put their trust in them. The decision in effect to close Queen Mary's hospital, with the removal of its accident and emergency facilities, has broken Labour's pre-election promise to keep that institution open.

I see this as a personal attack on me. Will the hon. Gentleman confirm that the decisions to close the acute surgery service and other acute services and to downgrade the accident and emergency department were taken in the November before the general election and were acted on on 1 April, all fools' day, one month before the election?

All Labour candidates who had an interest in the hospital—and in the party's campaign nationally—led the country to believe that such a decision would be reversed. That has not happened, and it is that deceit which I find so contemptible.

The Turnberg reforms have many merits. There are questions that I hope the Minister will answer, but it is difficult to trust the Government on something like this in the climate in which they are running the NHS today. People should be aware that, when the Government say that they have increased funding, they have not. There is £940 million less going to the health service than would have been the case had the Conservative party returned to office. Waiting lists have gone up by 137,000.

What in Sir Leslie Turnberg's proposals will suffer as a result of the Minister's panic and efforts to restore waiting lists to the levels that the Government inherited from us? I have high hopes for health care in London, but little confidence that the Government will deliver. They are spending less, closing more and making people wait longer. In that context, it is unlikely that the Turnberg proposals will deliver the health care that we all expect.

I congratulate my hon. Friend the Member for Putney (Mr. Colman) on securing this debate. This debate is extremely important, not just for his constituents and for him, but for the House as a whole—and particularly for hon. Members representing London constituencies.

The Government share my hon. Friend's aim of ensuring that Londoners in all parts of this capital city have access to the highest-quality health care possible—not just in hospitals, but through primary care and community health services.

For the first time in decades—thanks to Sir Leslie Turnberg and his team, and the Government's adoption of all the recommendations—there is now a clear agenda for health, health services and social care in London. As my right hon. Friend the Secretary of State said when announcing the Government's acceptance of the Turnberg report on 3 February, the time for action on London's health service has arrived.

Sir Leslie Turnberg's team did a remarkable job, and I pay tribute to him and them. The comments of the hon. Member for Rutland and Melton (Mr. Duncan) were astonishing. He must be the only person in this building—he is probably the only person in London—who supported the Tomlinson report, which found no favour with the public, politicians and, most important, with the people who work in the NHS in this city. As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) rightly said, there has been universal praise for the way in which the review was carried out, and there has been broad agreement on the diagnosis of the problems.

The recommendations not only tackled major strategic concerns—to which the hon. Member for Rutland and Melton referred—but dealt in a hard-headed way with extremely difficult operational issues. As the hon. Member for Ruislip-Northwood (Mr. Wilkinson) reminded us, those issues do not go away. Change is endemic in the NHS. Turnberg, and the Government's acceptance of the report's recommendations, does not put a halt to change in the NHS; it is the start of a 10-year modernisation programme for the NHS in London and its environment.

Watford and the surrounding hospitals are the subject of consultation. We will bear in mind what the hon. Member for Ruislip-Northwood said and ensure that, when the final decisions are taken, they will be in the best interests of patients in his constituency and others served by those hospitals.

We are at the start of the programme which will see London's health service getting better step by step, year by year. It is important that we make it clear from the outset that there is much on which to build. We often concentrate in these debates on things that are wrong, and there is much that is wrong in London's health service. However, there is a great deal of which to be proud as well—great hospitals at the cutting edge of medicine, science, teaching and research, high-quality local hospitals, GP surgeries and more. There are also formidable challenges for London's NHS. The best services in the land sit cheek by jowl with some of the worst.

Turnberg reversed the absurd Tomlinson position that London was over-bedded compared with the rest of the country. The Government seek to build on that important recognition. The hon. Member for Southwark, North and Bermondsey asked whether the commitment to improving waiting lists was continuing. I remind him that Turnberg called for more detailed work on ensuring that we have the right number of beds. That work is being done, and the evaluation is continuing. We will have to ensure that we have the right resources, staff and bed numbers to ensure that we get waiting lists down—we want to do that not only this year, but in subsequent years.

There was a recommendation that the panel should examine the bed issue. The Minister said that that work has already started. Does he have any idea when he will receive recommendations on bed numbers and the implications of those numbers?

I do not, but I shall let the hon. Gentleman know as soon as I do. If he contacts my office, we can arrange a response.

My hon. Friend the Member for Wimbledon (Mr. Casale) spoke about the sheer size of London and the problems that that creates. Our capital city has a unique health service, which has unique problems in serving massive health needs. We are determined specifically to tackle London's deprivation and inequalities. The fact is that 40 per cent. of Londoners are among the most deprived 10 per cent. of our country's population. Sir Leslie and his team rightly highlighted the special needs of many groups in London, such as elderly people, the mentally ill, ethnic minorities, homeless people, refugees and asylum seekers. We have to translate our good intentions for those groups into action.

From the Minister's statement today, may we have confidence that there will never be a translation of financial resources out of London into the provinces? The old resource allocation working party system did the health service in London great damage.

If the hon. Gentleman will bear with me for a moment, I am about to deal with the resource allocation issue, partly in response to the issues raised by my hon. Friend the Member for Wimbledon.

The action necessary to deal with problems cannot occur without partnership. Working together in partnership, across boundaries, is vital if we are to improve services, improve the health of Londoners and—most important—tackle the appalling health inequalities that scar our capital city. We are therefore fostering co-operation in the NHS, by getting rid of the internal market introduced by the Tories when in government. To tackle those inequalities, we are also breaking down the Berlin walls between health and social care, the NHS and local authorities, and the public and voluntary sector.

New ways of joint working are being pioneered in London's two health action zones—which represent a recognition of the fact that the job of improving health is one for local government, employers, community organisations and the NHS. Such an approach to partnership is in line with the Turnberg recommendations.

Will my hon. Friend mention the widely supported proposals on pooling health and social services budgets?

My hon. Friend raises an important point. We will soon produce a consultation document on how to ensure greater flexibility in the provision of health and social care services—for the benefit of patients, especially those who are at the interface of those services, such as elderly people, people with metal health problems and people with disabilities. The document will deal with the pooled budget issue.

The Government accepted all the Turnberg recommendations, and we have acted quickly to create a programme to implement them. We will deliver better services for Londoners through investment and modernisation. The two go together.

We are committed, first, to sustained investment in health services and facilities in London. Since we came to power—to contradict the hon. Member for Rutland and Melton—the Government have invested £300 million in London's national health service. Last year, £26 million went to the capital, to ease pressures on health and social services provision. This year, £48 million has been targeted specifically at lowering waiting lists in London. As a consequence of the tough targets that we have set ourselves in reducing waiting lists, by March 1999 London's national health service should have more than 10,000 fewer patients waiting for treatment than the record level of March 1997 which we inherited from the Tories.

The extra money for this year includes £30 million targeted on primary care, mental health, intermediate care and community services. We will provide at least an additional £140 million of investment in those services for London over the lifetime of this Parliament.

Today's debate has rightly concentrated on London's hospitals. However, primary care is the primary point of contact with the NHS for the overwhelming majority of Londoners. As we know, there is much to commend primary care services in the capital. However, there is also much that is wrong with the services, which we are determined to put right.

My hon. Friend the Member for Upminster (Mr. Darvill) and the hon. Member for Southwark, North and Bermondsey mentioned the problem of recruiting a sufficient number of general practitioners in the capital. We fully endorse the need for Londoners to receive their fair share of GPs. A national group—which includes Professor Jarman, who was a member of Sir Leslie's team—is working to identify a formula that would accord every area its proper share of family doctors. The results should be available in the summer.

Is consideration being given to introducing salaried general practitioners in those London areas where it is extremely difficult to recruit people into general practice?

I assure my hon. Friend that we have successfully reached an agreement with the British Medical Association, and have—for the first time in the history of the NHS—introduced a salaried doctors scheme, which I believe will be the way forward in many areas where it is currently difficult to recruit GPs. The scheme will bring new, younger and energetic GPs into general practice, which will be a great improvement in primary care in many parts of London.

My hon. Friend the Member for Wimbledon asked about resource allocation, and how we can ensure that London receives its fair share of resources. As he knows, a working group is dealing with the matter and will report later this year. I expect that its recommendations will be implemented in the next financial year.

As part of a modernisation programme, there is more investment in London's front-line health services. Moreover, that money for front-line services is backed by capital investment, as we cannot build a 21st-century NHS in London in 19th century hospitals. The Turnberg report paved the way for £800 million of new investment to build more new, modern hospitals and to improve existing ones—such as at the West Middlesex, University College hospital, King's and St. George's. It paved the way also for a proper, 21st-century hospital in Whitechapel. Furthermore, we are not only saving Bart's—which the previous Government intended to close—but giving it a great future.

There will also be a great future as a local community hospital for Queen Mary's hospital, Roehampton. Five years of uncertainty is at an end. Queen Mary's will have a robust and healthy future, providing services for local people into the next century. I pay tribute to the work done by my hon. Friend the Member for Putney and by the hospital league of friends. Most of all, I pay tribute to the work done by the hospital's staff, who have ensured that services are delivered throughout a most difficult period of uncertainty and confusion—which is now at an end. Our plans will give staff and the local community a new hospital for a new century.

We have also endorsed the London review recommendation that a new hospital should be built in the Oldchurch area. The Havering Hospitals NHS trust is producing a strategic outline case for that investment. We expect the case for making the investment to be a strong one. If it is, the trust will be able to take forward procurement in 1999.

My hon. Friend the Member for Upminster expressed concern about the Harold Wood site. Harold Wood's future will have to be considered in the light of the Oldchurch development. Similarly, I assure my hon. Friend the Member for Ilford, North (Ms Perham) that plans for the new hospital will take account of the relatively new facilities at King George's hospital, and that clinicians from King George's are actively involved in helping to plan services at the new hospital.

I am aware that, because of work done by the trust, submissions on Guy's and St. Thomas's will be made to me. I also realise that the hon. Member for Southwark, North and Bermondsey has an alternative proposal. As I said when I met him, I should be more than happy to consider his proposal. I should be happy to meet him again, if he thinks that that is necessary.

I also assure the hon. Member for Rutland and Melton that Hammersmith is a very important hospital and that it has a secure future. However, we have to assess how best it should play its part in delivering local health services within the overall context of services in west London. That is why we are reviewing services in the area and the Hammersmith is part of that review.

Those are all far-reaching changes for London's NHS, which will not be easy to achieve and which will require time and careful management. We have faced difficult decisions and an unenviable legacy from our predecessors of uncertainty and failure, but we are making considerable progress, with new hospitals being built, extra cash being invested and a new direction for London's health service being implemented. There is a long way to go to deliver the first-class NHS that the Government want to be available throughout London, but we have made a good start and we are determined to make rapid progress. We believe that Londoners deserve no less.

I am pleased to have this opportunity to initiate a debate on a matter that is vital to my constituency and, as I shall try to shows, to the economy of a much wider sub-region.

This is a critical time for Newhaven. The port is at a crossroads, if the House will forgive the mixed metaphor. It has the potential to become a major success story of the next century, but might also slip away, leaving a shell of derelict buildings, rusting metal and high unemployment. It could go either way, and which way it goes will depend, at least in part, on the events of the next few months. The Government, local councils and, crucially, the private sector must all deliver if we are succeed, and I see it as part of my job to ensure that that happens.

Let me deal with the port's potential. First, there is the its geographical location: it is not, as some tend to portray it, at the periphery, but well inside the triangle that takes in London, Paris and Brussels; if one draws a line from London to Paris, Newhaven is the port closest to that line. The port's potential is shown by the fact that 1.2 million people live within an hour's drive of Newhaven. However, when people think of channel ports, they think of Dover, Southampton and Portsmouth, and consistently underrate Newhaven's potential.

Secondly, there is the Newhaven Economic Partnership which, as the Minister will know, is a private company, limited by guarantee, set up to revitalise the port. All the town's major employers are represented, including Sea Containers, which owns the port; P and O Stena, which operates the ferry service; James Fisher and Sons, which has in Newhaven the largest cold store for imported fruit and vegetables in the country; and companies such as Parker Pen and Concord Lighting, which are major employers in Newhaven.

All three levels of local council are represented—the county, the district and the town—and so am I, as the local Member of Parliament. In addition, Lewes tertiary college is also an active member, giving valuable help on employment training.

The NEP has been successful in securing single regeneration fund money from the Government, capital challenge funding for a new port access road and Interreg money earmarked for local schemes. In addition, the partners, especially the local councils, have committed funds to the partnership's pot. That has helped with several valuable local projects, such as saving the Hillcrest centre, which is a focal point for the community.

Thirdly, there is the unique and strong relationship with Dieppe. The ferry crossing between the two ports goes back well into the last century. In recent years, Dieppe has had a huge amount of investment in its port, and the French now want the same to happen in Newhaven. To that end, a joint action group was formed between Dieppe chamber of commerce and Lewes district council. More recently, the chamber became a full member of the NEP, which is the first time a French chamber has voluntarily put itself under the jurisdiction of English law. Dieppe believes in the crossing and in Newhaven; it is now time to show clearly that people on this side of the channel also believe in Newhaven.

That leads me to the current situation. An improved port is absolutely essential to the future of Newhaven and to the wider sub-region, including Brighton. The regeneration project in Newhaven is a complex jigsaw, which will not work unless all the pieces are in place. An improved port is the key piece, to which all others are connected.

The port in its current configuration is limited in capacity in a way which, if it remains unimproved, spells had news for Newhaven tomorrow. The present generation of ferries can only just negotiate the port, and, with bigger ferries coming on stream elsewhere, Newhaven faces a loss of competitiveness against other south coast ports if it cannot match any increase in size.

Furthermore, the depth of the port—only 5m—means that James Fisher and Sons is operating well below capacity, because boats are getting bigger, and now touch the bottom when they arrive. That in turn makes it difficult for shippers to obtain insurance cover, with the result that business goes elsewhere. Time and again, contracts have been won by Fisher, only to be lost at the last minute because of the insurance problem. Put bluntly, there must be a possibility that Fisher, a major employer in the town, will close and the ferry operation be scaled down, with the loss of numerous jobs, if an improved port cannot be provided soon. It was that fact that provided a major impetus for the setting up of the NEP.

The good news is that many of the jigsaw pieces have been assembled, and some are fixed together. Planning permission has been achieved for a new outer port, subject to a few final details being ironed out by the district council as the planning authority. Planning permission has also been granted for a new port access road, which will link the trunk road network with the port. Those two proposals are inextricably linked to the port's future. Formal withdrawal of outstanding objections to compulsory purchase orders has been achieved, so that obstacle is out of the way.

The existing road winds around residential streets, passing a nursery school and local shops. It is the most inappropriate port access imaginable. The new road will not only solve that problem and link the trunk road network with the new outer port, but also open up access to the biggest unused piece of land identified for industrial purposes anywhere along the south coast—at least between Eastbourne and Worthing, and probably further. The land will be used to provide an Eastside business park. The road scheme is estimated to cost £7.8 million, with £6.8 million coming from a successful capital challenge bid and the rest from Interreg funding.

It is worth noting that East Sussex county council has already spent around £500,000 on design and securing planning permission for the road. The council also says that it is prepared to shoulder the debt payments from servicing the capital challenge funding, which will come to another £500,000. The county council tells me that it is fully committed to building the road, and I and the people of Newhaven intend to hold them to that commitment.

That is the background; I apologise for the fact that I have taken some time to set it out, but I thought it best to put matters in context. I come now to what I should like the Government to do to help Newhaven.

First, it would be helpful if the Minister could set out exactly what the Government's strategy is for ports, especially their vision for the south coast. The hon. Lady will no doubt be aware of the European Union Green Paper on sea ports and maritime infrastructure, so I presume that she has already given that key matter some thought. Currently, 80 per cent. of cross-channel traffic goes through Kent. Does the Minister agree that it is sensible not to put all one's eggs in one basket? The benefits of diversity alone suggest that Newhaven should be protected and enhanced—small ports have an important role to play. Will the Minister confirm that the Government are committed to a diversity of ports, and that they will oppose any contraction of the number available on the south coast?

Given that Newhaven is already on the trans-European rail network, will the Minister undertake to help to put together a case for EU funding for Newhaven port, which might well be available under the proposals in the Green Paper, as I understand them? In short, I am asking for an assurance that the Government, like people in Newhaven and Dieppe, believe that Newhaven port has a solid future in the next century. If the answer to that is yes, I ask the Minister to put that on the record today, because that assurance alone will help in the current circumstances. In addition, it is unclear what is to be the role of the regional development agencies in port policy and support, so some clarification would be helpful.

I said that the trans-European rail network includes Newhaven, and I ask for the Minister's help in that respect. Is she aware that Railtrack's published plans for the next 10 years do not even mention Newhaven? That is despite the trans-European link, despite the fact that major redevelopment of the port would give an opportunity to combine the current three railway stations—which are a shambolic first sight for visitors arriving in Newhaven from the continent—into one brand-new one, and despite the fact that there is considerable potential for moving freight by rail from Newhaven. The infrastructure from decades ago still remains, and the rail lines literally go down to the quayside.

There is still plenty of land for expansion, and, as the Minister knows from our correspondence, English, Welsh and Scottish Railfreight has expressed considerable interest in the site. Indeed, the company's No. 2 in this country, Julian Worth, has met me and others from the Newhaven Economic Partnership on site to discuss the potential. He went away interested in Newhaven port.

The Government are rightly committed to shifting the bias of transport away from the private car and lorry and on to more environmentally friendly transport, including rail. Does the Minister therefore share my view that plans for a new port in Newhaven provide a wonderful opportunity to achieve the Government's objectives? If a new port were almost totally dependent on private road transport, a great opportunity would have been missed.

My requests of the Government in respect of rail are as follows. Will they continue to support Newhaven's place in the trans-European network? Will they give support today for the principle of rail freight movements from and through Newhaven? Will they make representations to Railtrack in order that it assesses the potential for Newhaven, with a view to putting the scheme in its forward programme?

Will the Government please reconsider their decision not to stop the sale of so-called redundant rail land in the town, the loss of which might jeopardise the development of rail freight in the port? I apologise to the Minister for raising that yet again, but I am working on the basis that, if I raise it frequently enough, I may get the answer for which I am looking. Even limiting sales to companies with rail interests would help. The policy of disposal of land that was identified as surplus by the Tories, who were not interested in rail and are not present for today's debate, is so out of line with the Government's mainly refreshingly sensible transport policy.

On the wider transport infrastructure, will the Government examine what is being done in Dieppe to see how improvements in Newhaven might dovetail? Will the Government undertake to consider the A26 and the parallel rail line as part of a corridor study on the route north of Newhaven, in line with proposals for such studies in the Government's forthcoming White Paper on transport—if newspaper stories are to be believed?

I return to the key aspect of the debate: proposals for an improved port and a new port access road. The start of construction on the port access road has slipped due to uncertainties over the new port and the merger of two ferry companies. The merger has also made it very difficult for P and O Stena Line and Sea Containers to reach a long-term agreement, given the merger's restrictive conditions.

Under those circumstances, it is being discussed whether, in the interim, it may make sense for the road to access a new deeper berth in the existing harbour rather than a brand new port immediately. That could well cut through some of the problems, deliver an improvement in time to safeguard the port, and achieve the aims that the Government originally set out when approving capital challenge funding. I am advised that such a modified route for the road would not require a new planning application.

I ask the Government for time and flexibility to tie up negotiations among the various partners. In the past few days, as the Minister will imagine, I have spoken to several partners in the public and private sectors to assess progress, and I believe that a solution is in sight and achievable. It is therefore crucial that the rug is not pulled from under our feet by rigid adherence to a timetable that was set under different circumstances.

The Government office for the south-east has been constructive and entirely helpful in the process, but can obviously go only so far without a ministerial steer. Will the Minister use her contacts to put pressure on the private sector in particular to reach agreements that will enable investment to proceed? The public sector locally has, by and large. delivered its part of the bargain.

Newhaven has suffered from years of under-investment. The merger of P and O and Stena Line, although representing a strengthening of the position in Newhaven, has nevertheless caused short-term uncertainty. The forthcoming loss of duty-free trade has added to that, and could be bad for the town. I cannot emphasise enough, however, that Newhaven's potential is enormous as a cross-channel ferry port and railhead, a back-up to the channel tunnel—the only potential one—a major import-export location, and an economic engine for the entire sub-region as far north as Haywards Heath and East Grinstead.

Like a game in a Christmas cracker, this matter is a question of getting all the silver balls into the holes at the same time. The Government's attitude to Newhaven, how flexible they are in funding the port access road, how seriously they take the potential for rail freight, how hard they are prepared to lean on those in the private sector, the signals that they send out and the stance that they take, are all crucial. I ask the Minister to respond positively and helpfully to my points—I am sure she will—in order to let the people of Newhaven know that the Government are on their side and will help them.

I congratulate the hon. Member for Lewes (Mr. Baker) on obtaining this Adjournment debate. As he so rightly says, the topic of Newhaven port is of importance not only to his constituents but to the entire region.

The port of Newhaven is a major local employment provider through companies such as P and O Stena Line and James Fisher, employing several hundred people. As the hon. Member pointed out, it plays an important role in linking the south-east region with the markets of continental Europe, and, like neighbouring Shoreham, is a key port in handling marine aggregates for the construction industry. As the hon. Gentleman also pointed out, it handles a variety of traffic, including passengers, fruit and vegetables, forest products and fish. As he further pointed out, there has been recent investment in a cool storage facility for fruit and vegetable traffic. In all, the port handled 1.3 million tonnes of cargo in 1996, with a passenger throughput of 841,000 and about 160,000 vehicles.

In December 1996, East Sussex county council was awarded credit approval of £6.8 million under the capital challenge towards the £7.8 million cost of the port access road. The road, as the hon. Member for Lewes also pointed out in great detail, is seen as the key to the regeneration of Newhaven. The wider regeneration scheme for Newhaven amounts to more than £80 million, which includes £6.5 million single regeneration budget challenge funding. Most of the private sector investment—Sea Containers Ltd. and P and O Stena Line—will be in the renewal of Newhaven port, including the construction of the outer harbour. The road, the harbour and the wider regeneration of the town are inextricably linked.

East Sussex county council has also submitted a bid through the European funding programme, Interreg, for a £1 million contribution towards the port access road. The application has been received, and is being considered by the Government Office for the South-East and my Department.

In addition, Lewes district council has applied to the Ministry of Agriculture for grants to aid the fisheries aspect of the port's modernisation. Up to 50 per cent. grant is available from MAFF for work including rebuilding the fishermen's jetties and a new fish market building. The application is under consideration by MAFF. Grant for a feasibility study for the development of the port has already been made available under the PESCA scheme for restructuring fishing dependent areas.

Although I am aware of such plans for a major redevelopment of the port facilities at Newhaven, and cognisant of the pleas of the hon. Member for Lewes, I cannot comment on the detail of the plans, because they may be subject to approvals from my Department, for which formal applications have yet to be made. The environmental impact of such a project will be carefully considered as part of the approvals procedure.

As well as raising several detailed points about Newhaven port, the hon. Member raised a number of points about the Government's general policy towards ports and port development. As he will be aware, and as the House knows, we are shortly to publish a White Paper setting out the Government's integrated transport policy. We fully recognise that our ports are a vital link in the supply chain. Some 95 per cent. of our international trade by volume, as well as considerable domestic traffic, goes through them. We must ensure that they are integrated into our transport networks in ways which contribute to the aims of a more effective and more environmentally friendly transport system.

It is important to recognise that our ports are competing vigorously both in the United Kingdom and the European market. We therefore support measures to develop a level playing field throughout Europe, and we will continue to support policies that encourage competition and efficiency in the ports industry on a fully commercial basis. In doing so, we will also seek to ensure fair employment standards and better, more effective regulation of safety issues and environmental safeguards.

Our broad aims are to ensure that ports play a full role in supporting the competitiveness of their regions: that any port development is sympathetic to the surrounding natural environment and local communities. Ports can enhance sustainable freight distribution by their connection to more environmentally friendly modes, and increased port efficiency can increase the attractiveness of those modes.

Newhaven, like almost every other port, depends for its business on freight movements by road—but, as the hon. Gentleman pointed out, it is one of the many that also has rail access. We agree with him that we must try to ensure that in future advantage is taken of that fact wherever possible in encouraging the transfer of freight from road to rail.

The context for those broad aims is a forward-looking integrated transport policy that supports a strong economy, contributes to a sustainable environment and helps to create a just and inclusive society. That is a huge challenge, and one of the encouraging aspects of an ambitious task is the degree of consensus throughout the nation on the need to change.

I understand the hon. Gentleman's interest in good access to the port of Newhaven. He will know that we are carrying out a review of the role of trunk roads, including the A27. We have involved a wide range of advice and expertise, including local authorities, businesses, trade unions, transport professionals and transport users. As he also knows, we are developing a new appraisal methodology that takes a wider view of accessibility by all modes in terms of the economy and the environment.

Against the background of increased congestion, we have three broad options for roads. To make better use of existing infrastructure is the obvious first choice. It has been provided at substantial cost in both financial and environmental terms, and we must make the best use of that investment. We need, however, to be realistic about what the various options can deliver.

We must also look seriously at other harder options, such as managing demand and providing new infrastructure. Managing demand is a vast topic. It encompasses reducing the need to travel, an assessment of the extent to which a shift to other modes can be encouraged, and, inevitably, the question of controlling demand by pricing or rationing mechanisms.

Providing new infrastructure is a difficult option, both financially and in terms of the impact that it may have on the environment. Our starting point is that we will not proceed with major new road construction unless we are satisfied that there is no better alternative; even then, there will be difficult choices to be made within the limited resources available.

We have held regional consultations to elicit views on whether the schemes in the inherited roads programme address the most important transport problems, or whether other problems deserve greater priority. We envisage two outputs from that part of the review—a firm short-term investment programme and a programme of studies to look at the remaining problems, out of which the medium and long-term investment programme will emerge.

The hon. Gentleman raised the question of the proposed access road to the harbour. As he said, that scheme, designed to link the trunk road network to the proposed new port and ferry terminal, received credit approval of £6.8 million through the capital challenge pilot scheme in December 1996. Capital challenge is a three-year pilot, and all funding is programmed to terminate at the end of March 2000.

Cognisant of the plea that the hon. Gentleman has repeated, I must tell him that there are no plans to extend that deadline at present. Proposed changes to the scheme, resulting from any revision of the development plans, would have to be consistent with the initial aims of the capital challenge bid. I understand that to date no firm proposals have been received, although there have been some preliminary discussions of different options.

The hon. Gentleman also talked about the possibility of the scheme's slipping. I understand that the county council has resolved not to proceed with the road until there is valid planning permission for the port and a firm commitment from Sea Containers to proceed with the port improvements. Of course, as he rightly pointed out, the road network is only one piece of the transport jigsaw. He also mentioned freight to and from Newhaven port.

The Government are determined to encourage greater use of the railways for passengers and freight. We want to see improvements in existing rail services. As the hon. Gentleman knows, we inherited a fragmented rail system with no strategic vision for the development of the network, a confusing regulatory system, and a need for leadership and direction.

The Government have already demonstrated their intentions by conducting a fundamental review of rail regulation, including the Rail Regulator's inquiry into the rolling stock leasing market. We have also taken action within the existing regulatory constraints. Last November, my right hon. Friend the Minister for Transport announced an interim package of measures designed to boost regulation of the railways, which included new objectives for the franchising director. Those require him to manage existing franchise contracts tightly in the public interest, by making sure that train operators live up to their contractual commitments.

We have made it clear that our overriding goal is to get more freight on to rail. We are currently considering what further action we may take to boost rail freight in the context of the integrated transport policy White Paper. Action has already been taken to encourage more freight on to the railway by overhauling the freight grants scheme. Shortly after coming to office, we doubled the grant available for moving freight from the roads, and we have increased it by a further £10 million for the year 1998–99. An initiative to publicise the system has resulted in nearly all last year's £30 million being taken up, and £28 million of this year's grant money is already accounted for.

Railtrack is investigating the scope to develop several major routes for freight, and, with a group of local authorities, is studying congestion on the south coast rail route from Weymouth to Dover with the aim of improving services to encourage more use of the route. We are watching that study with interest. The new freight companies have adopted positive attitudes and ambitious targets that would quadruple the proportion of freight tonne kilometres by rail over the next 10 years. Rail freight volume has already shown a 5 per cent. growth in tonne kilometres over 1996–97—the first such increase in many years.

We acknowledge there is more to be done. We are committed to the creation of a new rail authority, and will announce our proposals in the White Paper. The authority is likely to have responsibility for, among other things, managing and enforcing existing franchise contracts, developing a strategic vision for investment in the network, promoting integration between rail and other modes of transport, and balancing the needs of passengers and freight users, as no one body currently can.

I understand that a community partnership venture between the operating company Connex South Central and Newhaven Economic Partnership has been set up, as a result of which the station at Newhaven will receive a face lift later this summer. The hon. Gentleman mentioned the bad state not only of the network but of stations in his area. We too recognise the importance of clean, smart, comfortable and safe public transport facilities in helping to encourage people to switch from their cars to using public transport.

The hon. Gentleman asked about the abolition of duty-free sales, and its anticipated effect on the port of Newhaven. I can only say that the decision to abolish intra-European Union duty-free sales was taken unanimously by the Council of Finance Ministers in 1991 as part of the single market programme. It is primarily a fiscal matter, and not a matter for the United Kingdom in isolation but subject to unanimity among the 15 member states.

We have said that we would not oppose any move by the Commission to set up a study into the effects of the abolition of duty-free sales. There is, however, no consensus of support among the member states for a continuation of duty-free sales, or even for a study of the impact of abolition. We are, through Customs and Excise, in discussion with UK trade interests and the Commission to explore the practicalities of implementing the successor regime after June 1999, when abolition takes effect.

I am grateful to the hon. Member for bringing Government support for Newhaven port to the attention of the House. As I have said, more than £13 million in Government funding has been committed so far to assisting the regeneration of Newhaven, and I can assure him that the Government are fully aware of the importance of Newhaven port to the local, regional and national economy.

I am sure that the hon. Gentleman is aware that many of the specific issues on which he wanted a direct commitment on my part will be covered in our White Paper on an integrated transport system. They will also be covered in the more detailed documents on regional development. He rightly raised the subject of the sale of railway land, and, from a sedentary position, I responded by referring to the "drip, drip" technique. He is well aware that, when the railways were privatised, the land deemed most essential for the future expansion of our railway system went into Railtrack's ownership—that is, the remaining lands in Railway Properties Ltd.

All such land is advertised before sale, and the freight companies are advised of proposed sales. I understand that the piece of land that the hon. Gentleman mentioned is shortly to go out to tender, and I know that Railway Properties Ltd. has made it abundantly clear to interested parties that it is available. I well understand his argument that such land should be reserved, but I am sure that he will understand that freezing the land could have a most deleterious effect on the market for such properties, and that Railway Properties Ltd. has a duty to ensure that such sales are for the benefit of the public purse.

Although I cannot give detailed responses to many of the pleas that the hon. Gentleman made in a most interesting speech, I assure him that the Government are fully aware of the importance of Newhaven port—as he rightly said, it is important to the economy not only locally, but regionally and nationally. I have little doubt that, when he sees our White Paper, he will be very pleased with its content.

I am grateful for this opportunity to draw the attention of the House to Western Sahara, which is under Moroccan occupation. I should be interested to hear the views of my hon. Friend the Minister on that sadly neglected country.

I first became aware of the situation in Western Sahara in 1985, when I was an aid worker with the charity War on Want, the first United Kingdom organisation to provide assistance to Saharawi refugees from Western Sahara. Since then, I have followed events in the area with interest and, since I was elected to Parliament, I have had the honour to serve as chair of the all-party group on Western Sahara.

I hope the House will forgive me if I indulge in a short history lesson and give the background to the situation, as I am sure that many people, even many hon. Members, are not fully aware of the plight of Western Sahara and the Saharawi people. That is itself a scandal, as the Moroccan invasion of Western Sahara closely mirrored the Iraqi invasion of Kuwait. The Iraqi invasion attracted worldwide condemnation and swift international intervention, whereas the Moroccan invasion was swept under the international carpet—there was no international uproar or military force to liberate Western Sahara, although cynics may say that that was because there are no working oilfields in Western Sahara.

Western Sahara lies on the Atlantic coast of Africa, between Mauritania and Morocco. Historically, the people who lived there—the Saharawi—were nomadic and had a life style similar to that of their Tuareg neighbours. The area was colonised by the Spanish in the 19th century and named Spanish Sahara. The indigenous people, as in most other African countries that were colonies, set up an independence movement to resist colonisation, the Polisario Front. In 1966, the United Nations General Assembly called on Spain to organise a referendum of self-determination for the people of Western Sahara. Spain organised a census in 1974, which revealed that 74,000 Saharawi people were living in the territory—that figure was supposed to serve as the basis for an electorate for the referendum, which, it was planned, would happen speedily. The road to independence seemed to be laid out.

Morocco did not like that one bit, and laid claim to the territory. The International Court of Justice was asked to deliver an opinion on whether Morocco or Mauritania had any claim to the area; it found that there were no historic ties that could debar Spanish Sahara from decolonisation or from self-determination. Again, the way seemed clear for the Saharawi people to move forward to independence.

In response, Morocco almost immediately invaded Western Sahara. Tens of thousands of Saharawi people fled. Women and children were bombed by Moroccan forces and napalm was used against them—it was an international scandal, but, sadly, the international community turned its face away. Around 180,000 refugees fled to southern Algeria, where they have lived in enormous camps—huge tented cities—for the past 23 years.

The Saharawi refugees are mostly dependent on food aid administered by the United Nations High Commissioner for Refugees. Despite the dire conditions in which they live, however, they have created a society in their camps whose rates of literacy are unparalleled in Africa. They have created a good health system and a democratic structure that ensures that women play a full part in running and managing the camps. The fact that the Saharawi people have survived those conditions for 23 years demonstrates their deep desire to secure their right to self-determination—many other groups would have packed their bags and gone home.

For more than 20 years, the Polisario Front waged a guerrilla war against the occupying forces. It had steadfast support from the Organisation of African Unity. When, in 1985, the Saharawi Arab Democratic Republic—the state in exile—was admitted to OAU membership, Morocco promptly walked out of the organisation.

In 1990, the United Nations—freed from the shackles of the cold war—turned its attention to Western Sahara. A peace plan was drawn up, calling for a referendum based on the 1974 Spanish census to be organised and supervised by the UN. A ceasefire between the warring parties was agreed, and, yet again, all looked set for the Saharawi people to decide whether they wanted their territory to become independent or to be part of Morocco. Sadly, eight years later, the UN Mission for the Referendum in Western Sahara—MINURSO—is still in the area and the Saharawi people are still waiting for their referendum.

In the intervening years, the UN has failed to enforce its peace plan for Western Sahara. I believe that the main problems have been Morocco's refusal to accept the 1974 census as the basis for the referendum, and its continual disruption of the peace process. The UN mission has faced criticism from its own members. In 1995, Ambassador Frank Ruddy, the former deputy chair of the MINURSO voter identification commission, said that, during his time in Western Sahara,

"Morocco conducted, without a raised eyebrow from Boutros Ghali's hand picked representative who ran the referendum, a campaign of terror against the Saharan people. I had not seen anything like it since I observed the apartheid government in South Africa."

In October 1996, Douglas Dryden, the former United States military representative to the special liaison office of MINURSO, said:

"the atmosphere at the MINURSO force HQ in L'Ayoun is practically a siege mentality. The mission is not allowed to function independently, but as a creature of the Moroccans. It is the only UN mission that I am aware of where the flag of one of the parties"—

he means the Moroccan flag—

"is required to fly alongside that of the UN."

Thankfully, the appointment of Kofi Annan seems to have galvanised the UN into action, giving it a new willingness to make a reality the Saharawi referendum for self-determination. In March 1997, Kofi Annan appointed James Baker, the former US Secretary of State, as his personal envoy to Western Sahara. James Baker moved quickly and, following meetings in London—which were facilitated, I am pleased to say, by the new Labour Government—Lisbon and Houston, Morocco and the Polisario Front agreed to a proposal on voter identification and a code of conduct guaranteeing the UN authority to oversee a fair and free referendum for the Saharawi people.

That agreement, known as the Houston agreement, was endorsed by the UN, and, in December 1997, voter identification was under way. Once again, the referendum seemed to be back on track. Unfortunately, however, things are not progressing smoothly—in his recent report to the UN Security Council, Kofi Annan admitted that the referendum was unlikely to take place in 1998 as planned. I believe that much of the delay is caused by the Moroccan Government's stalling tactics.

Morocco has, for many years, been engaged in a sustained campaign of intimidation against the Saharawi people in the occupied territory. Saharawi people who call for independence have been systematically detained, tortured and subjected to extra-judicial killings. Amnesty International continues to receive reports of disappearances and torture. Morocco is also pushing for the registration of 12,000 extra voters from specific tribal groups, all of whom live in Morocco; none of them appeared in the 1974 Spanish census, which was, as I said, the agreed basis for the electorate for the referendum.

Like many other organisations, the Labour party has long supported the right of the Saharawi people to self-determination. I welcome the role that the Government played in helping James Baker to put the peace plan back on track, and I strongly welcome the part that they have played as president of the Friends of Western Sahara Group at the UN Security Council. I now welcome the chance to ask my hon. Friend the Minister for his response to some questions, whose resolution would, I believe, strongly help the peace process to move forward fairly and speedily. I believe that the British Government can play a dynamic role in moving the peace process to a free and fair referendum and in ensuring that both parties in the dispute keep to the spirit of the Houston agreement.

I understand that the Minister recently visited Morocco, and I should be interested to hear how his discussions with Moroccan Ministers went. In line with our ethical foreign policy, I should particularly like to know whether he has raised the issue of Morocco's continued human rights abuses against the Saharawi people—the arbitrary detentions and torture—with the Moroccan Government. I understand that our Government's position is one of positive engagement with countries with poor human rights records such as China and Indonesia, and I hope that we have been consistent with that in respect of Morocco's poor human rights record. I should also like to know what plans my hon. Friend has to meet representatives of the Polisario Front in order to obtain a balanced view of the current situation in Western Sahara.

My hon. Friend is also aware that, at the beginning of the UN peace plan, the United Kingdom provided personnel to MINURSO, but, for some time now, we have had no presence. We are the only one of the permanent five countries on the UN Security Council not to be providing military or civilian personnel. I feel quite ashamed, given our long-term support for the peace process, that we are not providing that support. I hope that the Minister will be able to give me some encouraging news on that.

I also hope that we shall send a United Kingdom delegation of election monitors to cover the run-up to the referendum and the referendum in Western Sahara. As a former election monitor in Albania for the United Kingdom Government, I know how important that is.

Finally, I should like my hon. Friend's assurance that we shall continue to do all we can to ensure that a free and fair referendum happens speedily for the Saharawi people. They have waited long enough. I am sure that the British Government will never allow strategic interests and EU trade negotiations to muddy our view of the justice of the issue. The parallels between the invasion of Western Sahara by Morocco and the invasion of Kuwait by Iraq are indisputable. I sincerely hope that the Government will be as tough in their dealings with Morocco, in persuading her to abide by UN resolutions and international law, as they were with the Iraqi regime. The Saharawi people deserve nothing less from a Labour Government.

I thank my hon. Friend the Member for Gloucester (Ms Kingham) for the way in which she introduced the debate. We all know of her long-term interest in and keen commitment to the issue, and I am grateful for her opening comments.

My hon. Friend asked a number of questions, and I shall try to answer them fully. She gave us a useful background to the current situation. I shall repeat some of the points she made in the context of my response, but not in any sense to deny the historical background that she set out.

My hon. Friend asked about the Government's policy towards Western Sahara. It is very simple: we seek a just and lasting settlement and we support the United Nations' efforts to bring one about. We want to see a clean, fair and transparent referendum that will give the people of the territory the opportunity to decide whether their future lies with Morocco or as an independent state.

Our commitment to do all that we can to help underlies our support for the United Nations Secretary-General, his personal envoy James Baker and his special representative Charles Dunbar. We have also used our presidency of the European Union to bring the on-going developments in Western Sahara into sharper focus. I hope that my hon. Friend recognises that we have played and will continue to play a positive role.

My hon. Friend rightly said that the dispute in Western Sahara has lasted too long and needs to be brought to a swift, mutually acceptable conclusion. We welcomed the United Nations Secretary-General Kofi Annan' s appointment just over a year ago of James Baker as his personal envoy to Western Sahara. That was an important step forward. As hon. Members will know, James Baker was charged with the task of assessing the situation and considering whether the United Nations' settlement plan for Western Sahara, which at the time had been stalled for more than a year, could be fully implemented.

James Baker visited the region and decided that, if he was to make any progress, he would have to bring together the parties to the dispute—Morocco and the Polisario—for talks. When he asked the British Government whether we would be able to assist him in his first steps towards achieving that, we were, of course, pleased to help. We provided a suitable venue and logistical support for meetings that he wanted to hold with Morocco, the Polisario, Algeria and Mauritania. I am delighted that we were able to assist in that way, and I can tell my hon. Friend that James Baker was delighted with the support he received from the United Kingdom Labour Government.

The two days of talks that followed, in summer 1997, concluded with Morocco and the Polisario taking the landmark decision to meet face to face, under United Nations auspices, in an attempt to iron out their differences. I hope that, along with James Baker, we can take some credit for that progress. There followed a series of meetings to which my hon. Friend referred—some in London and some in Lisbon—which made valuable progress. In particular, the talks quickly established that both Morocco and the Polisario had no interest in pursuing any political solution other than implementation of the settlement plan. Neither party showed any enthusiasm for any kind of autonomy for the people of the territory within the kingdom of Morocco.

Differences over how the eligibility of individuals to vote might be assessed remained—and remains—the key issue. When they were resolved at the final session of talks in Houston, the Moroccan authorities and the Polisario signed what is now termed the Houston agreement, to which my hon. Friend referred. It included a code of conduct for the referendum. The Secretary-General's report of 13 November 1997 set out the plan and timetable for the referendum, which is scheduled for 7 December 1998.

I hope that I have been able to persuade the House that the Government have been active in respect of Western Sahara. Let me set out some further initiatives and responsibilities that we have pursued. Whenever Western Sahara is discussed at the United Nations, we firmly support the United Nations Secretary-General and his personal envoy. We are also responsible for co-ordinating the Friends of Western Sahara Group at the United Nations. We therefore have played, and will continue to play, a central role in New York and elsewhere.

Although we are conscious that Western Sahara is inevitably an agenda item on which the United Nations has the lead, we have sought to raise its standing within the European Union. During our presidency of the European Union, we have ensured that Western Sahara regularly features on the agenda at the monthly Maghreb-Mashreq working group meetings in Brussels. I am delighted that my hon. Friend is pleased about that. I am sure that many others will be, too.

As a result of one United Kingdom initiative, the European Union heads of mission in Rabat are now permitted to visit Western Sahara to see things for themselves, whereas previously visiting was restricted to junior members of embassy staff. We believe that not only visits but the level of those visits is important. Additionally, we know that many of our European partners do not enjoy the range of information on events in Western Sahara that we possess, so we have circulated comprehensive reports from our ambassador in Rabat.

We were pleased that the United Nations Secretary-General was able to put together a timetable for the run-up to the referendum so quickly, and that MINURSO in Western Sahara was able to recommence the voter identification process at the beginning of December last year. That has continued, with few interruptions.

It is very encouraging to note—I shall come to my hon. Friend's points—that the United Nations Secretary-General's report of 13 April 1998 included the 60,112 applicants identified during the first phase of the identification process, which ran from August 1994 to December 1995. More than 100,000 have been identified as potential voters, and fewer than 60,000 remain to be convoked.

Since the identification process resumed, British Government officials have made three separate visits to Laayoune in Western Sahara, where MINURSO is based. We also try to visit Tindouf, the Algerian town around which the Polisario camps lie, as often as possible. Unfortunately, the logistical difficulties are such that our last visit to Western Sahara, outside Laayoune, was in September 1997, when officials visited Tindouf, the MINURSO team site at Mehaires and Smara. They travelled from Mehaires through minefields and across the Berm to Smara, and saw for themselves the terrain and conditions that have hindered the work of the United Nations for so long. That is an indication of many of the problems and difficulties resulting from the fighting in the region.

I am pleased to be able to tell my hon. Friend that British officials are undertaking another visit to Western Sahara at this very moment. I should like to take this opportunity to reiterate our gratitude to the United Nations for its assistance with these visits. I hope that my hon. Friend will appreciate that on the ground, through our embassy and other staff, we are active in finding out what the conditions are within Western Sahara.

I also believe that practical demonstrations of support, such as visits, are vital for MINURSO. They not only provide a visible and much appreciated sign of our support, but help us to understand the conditions that it has to work under and the difficulties that it has to face. We are also keen to take every possible opportunity to improve our knowledge and understanding of developments in the territory itself. I know from the many letters we receive in the Foreign Office that there is great interest in the United Kingdom in what is going on in Western Sahara. Indeed, I am delighted to see so many of my hon. Friends in the Chamber for the debate. Yet again, there is not one Opposition Back Bencher here—but we are becoming accustomed to that.

We are told of allegations of human rights abuses, the manipulation of the press, demonstrations and disturbances. The United Nations independent jurist, Professor Rocounas, is engaged in those issues, and we support him in his work. Our regular visits offer us the ideal opportunity to find out from those on the spot what is really happening. I know that those visits are important for MINURSO morale, and they underline, in a practical way, our continuing commitment to the successful resolution of the dispute.

It has been said by some that, if the UN process stalls again, for whatever reason, Morocco would not be too bothered—it would continue to inhabit the towns west of the Berm, much as it has done since the Spanish, and latterly the Mauritanians, withdrew from the territory. I do not believe that that is what the Moroccans want. Nor is it in Morocco's interests for the sovereignty of Western Sahara to remain unresolved. My hon. Friend asked about my recent visit to Morocco. I reassure her that the issue of Western Sahara was a key element in my discussions with the king, the Prime Minister and other Ministers. Our commitment to a resolution of the issue and to the United Nations position was stressed during all those meetings.

There are also some who argue that MINURSO is biased; that it is somehow pro the Polisario and anti-Moroccan. We believe otherwise. MINURSO has proved its value and its integrity, and we shall continue to hold that view unless there is any available evidence to the contrary. At the moment, there is none.

My hon. Friend asked me about the possibility of UK Government contacts with the Polisario. As she knows, I was due to meet the Secretary General of the Polisario, Mohamed Abdelaziz, this morning. I understand that Mr. Abdelaziz is in London for this week. Unfortunately, because of other diary commitments, it was not possible for me to have that meeting. I assure my hon. Friend that it is important that Britain, as a key player in Europe, in the region, at the Security Council and in the Friends of Western Sahara Group in New York, should know what is really happening at this crucial time for Western Sahara. We shall seek that information from all possible sources.

There seems to be some difficulty in arranging meetings with Mohamed Abdelaziz. I understand that my predecessor, Jeremy Hanley, arranged to meet him in north Africa early in 1997, but Mr. Abdelaziz had to pull out of that meeting. We may be fated not to meet. However, I again assure my hon. Friend that we shall seek information from all the key players in the process.

I reiterate to the House our continued determination to see the Western Sahara dispute resolved through the referendum. Britain takes no position on the outcome, and we will not alter that stance. We neither support the Moroccan claim to sovereignty over the territory, nor recognise the Polisario's self-proclaimed Saharawi Arab Democratic Republic. Indeed, my hon. Friend would not wish me to take any other position. Her argument is that the matter is one for self-determination by the people. We support the United Nations, and we want to see the dispute resolved peacefully. Morocco and the Polisario have agreed to put the matter to a free vote. We shall do all we can to make sure that there is a vote and that it is free and fair. We shall do all we can to help implement whatever decision the people make.

In February this year, I was pleased to be able to meet the United Nations Secretary-General's newly appointed special representative to Western Sahara, Mr. Charles Dunbar. Mr. Dunbar is a former US ambassador who has worked extensively in the region. I know from reports received that he has been extremely active in his efforts.

He has been admirably and effectively supported by Mr. Robin Kinloch, the British UN staff member who heads the identification commission. My hon. Friend asked about the British role. Robin Kinloch is a key element in the resources that we make available.

I pointed out earlier the progress made on the identification of the non-contested applicants who wish to be assessed as to their qualification as voters in the referendum. As my hon. Friend and others will be aware, there are about 65,000 individuals whose eligibility to submit themselves to MINURSO for interview remains to be confirmed. That is a key issue, to which my hon. Friend referred. Now is not the time or the opportunity for me to go into the problem of the contested tribes in depth. However, in brief, Morocco believes that the members of those tribes should all have the opportunity to submit themselves for identification as voters. The Polisario believes that to do so would be contrary to the Houston agreement. It is clear that both parties see the issue as of paramount importance. We agree that a successful resolution in regard to Western Sahara requires the settlement of the dispute over those tribal groups. If there is any way in which we can assist in that process, we shall be happy to do so.

All applicants in Western Sahara, including those from the contested tribal groups, have been convoked to attend one of the UN identification centres. Those who attend are interviewed by MINURSO staff and representatives of the Polisario and Morocco. Their eligibility for registration is assessed under UN criteria. On the dates on which the 65,000 members of the contested tribes were invited to attend for identification, only 4,000 came forward. Only 1,500 have been interviewed. I regret that the Moroccans have refused to participate in interviewing the remaining 2,500 until they have received satisfactory assurances from the United Nations about how remaining members of those tribes will be dealt with. Charles Dunbar is working hard on that issue, which is crucial to the resolution of the problem, and we shall continue to assist in whatever way we can.

I hope that I have been able to answer the points raised by my hon. Friend, and to assure her that we are active on this matter and are looking for a peaceful solution through the referendum process. If the United Kingdom can assist the UN in any way to resolve this long-standing issue, we will be keen to do so. I congratulate my hon. Friend on raising an issue of such importance, and we look forward to the existence of a map of north Africa without this dispute.

I am delighted to open a timely debate on the crisis—that is not too strong a word—that affects our health service. Community hospitals are particularly under threat, and not only hospitals but community beds. Abingdon community hospital in my constituency, and the hospitals at Burford, in the constituency of the hon. Member for Witney (Mr. Woodward), at Wantage, in the constituency of the hon. Member for Wantage (Mr. Jackson), and at Watlington, in the constituency of the right hon. Member for Henley (Mr. Heseltine), are all at risk. Although none of those right hon. and hon. Members is present, I know that they feel strongly about the potential closures of those hospitals.

The closures faced by the people of Oxfordshire are caused by chronic underfunding of the health service and the acute financial crisis facing the health service this year, both of which are particular problems for Oxfordshire. It would be a false economy—bad not only for patients, but for financial reasons—to close community hospital beds in the way proposed. I plead with the Minister to intervene, even at this stage, because community hospital beds are threatened throughout the country. I ask him to ensure that extra money allocated this year is used not only to provide adequate community services for patients, but to avoid false economies and thereby to release cash for the health service.

The overall funding problem in the NHS has been well stated by the Liberal Democrats over the years. The NHS is chronically underfunded, to the tune of several billion pounds. Government leaks to the press confirm that sort of figure. The Daily Telegraph this morning says that the Department of Health will put in a megabid to the Treasury of around £8 billion. I do not know whether the Government will confirm that figure, but the British Medical Association and others who work in the field recognise that the NHS is chronically underfunded to around that sum.

On top of that, the health service, where the staff have to work hard just to keep it afloat, needs real-terms increases of about 3 per cent. a year to cope with NHS inflation, over and above retail price index rises. The Conservative Government wasted money on bureaucracy and the internal market, but they still managed to average 3.1 per cent. over their period in office, although it came in fits and starts. By adopting Conservative spending plans, the new Government have, sadly, managed real-terms spending increases of only 2.2 per cent. in the NHS budget for England in 1997–98 and 1998–99. That is not sufficient to keep the NHS going without cuts in services. We have seen the pressure on waiting lists. It is not so obvious in community hospitals, where there is no obvious proxy such as waiting list numbers or waiting times, but the pressure is there. It is also on mental health services.

It is fair to say that the Labour manifesto promised a real-terms increase of only 0.1 per cent. or less. However, the Government have revised that upwards, and have claimed that Labour is the only party able to revise its pledges upwards. They have done that not by allocating new money, but by using money initially allocated in other areas, such as the Department of Trade and Industry's underspend in 1997–98 for the £270 million allocated for winter pressures, and £1.2 billion from the Treasury reserve for this year. That is not new money. It is hard to believe that only a Labour Chancellor would spend that money from the reserve on the health service, while a Liberal Democrat or Conservative Chancellor would merely burn it on a bonfire.

An increase of only 2.2 per cent. is not enough to prevent pressures on waiting lists and other services. At the general election, I made it clear to the people of Oxfordshire, who were already worried about their community hospitals, that the Liberal Democrats would match existing resources, including the reserve and underspends, and, in addition, would give £550 million per year in new money raised by increasing tax revenues.

The extra money from the Government is based on old inflation figures, not the new figures that they found when they took office. In real terms, the money allocated in 1997–98 and—without including the allocation from the reserve, which all parties would have made—for 1998£99 is less than the Conservatives planned. More important, it is less than health authority finance bosses figured would come from a Government elected on the platform that there were "14 days to save the NHS" and "things can only get better". On community hospitals, and on waiting lists, things have only got worse.

It is important to nail the myth that the Government have offered more money than the Liberal Democrats promised at the election. They have offered significantly less. It is embarrassing for the Government that the money for community hospital services and other NHS services is less even than the amount that the Conservatives planned to spend in real terms.

Health authorities such as Oxfordshire face a bill for millennium compliance, for which there is no separate funding allocation. They face initiatives, on pain of sanction, to reduce waiting lists. They face those things with a level of overall increased funding—including the new £500 million announced this year, which is still less than 3 per cent. more in real terms—that is likely to increase waiting times.

Oxfordshire is particularly badly affected, as it is significantly below its target funding. It got a little more than the average allocation, but that was nowhere near the 3 per cent. minimum increase required. All trusts in Oxfordshire are in recovery plan mode, except the community hospital trust, which still faces cuts. As all the trusts face cuts, the health authority cannot be accused of picking on the community hospital trust. It is seeking even bigger cuts from the bigger budgets of the area's acute trusts.

It is hard to say what makes me and the people of Oxford, West and Abingdon more angry. Is it the raised expectations that were dashed after the Government said that "things can only get better"? Is it the stance of Conservative Members, who blame the Government for underfunding the NHS although the Government are merely adopting Conservative spending plans?

Is it premature for the health authority to agree a three-year or four-year funding cut, including closure of community hospitals and community hospital beds, at a time when the new structure of the health authority will, at least in the medium term, move such decisions to primary care groups? They are keen to be given a chance to take a view on whether those cuts should happen, or whether, when they get the budget in one or two years, time, another way can be found to make the savings that the Government are forcing on them.

Given that Oxfordshire's problems result from the Government's underfunding of the health service, and given that cuts must be made, there is a question of whether those are the most appropriate cuts. They will affect local services that are delivered to people near their homes. Oxfordshire has rural areas, in my constituency and in that of the hon. Member for Witney, who is now here, in which transport is difficult. The requirement for community hospital beds to be locally available to people and to their general practitioners is vital to better care. The community hospitals uniquely offer what I have called—in a separate debate on community care with the Under-Secretary of State for Health—the three Rs of NHS community care.

The first is rehabilitation, which allows, for patients who need it, enough time for active physiotherapy before they are discharged to home care. Instead, too often, they are discharged to a nursing home or residential home care because there is no time for the active rehabilitation that would enable them to return to their homes. Most patients would rather be at home and, in many cases, although not all, that provides a cheaper package of care for the local social services, particularly if the patients do not have their own funding.

The second of the three Rs is recuperation. It is vital that patients are given a chance to recuperate from operations or acute emergency admissions—perhaps for serious illnesses such as pneumonia—in their own time. If they are rushed back into the community, an extra work load is placed on community services, which are already underfunded. When patients are discharged from acute hospitals too early and a community hospital is not available to help them recover in their own time, the work load falls on social services. Alternatively—this is just as bad—the acute hospital cannot discharge the patient because of the lack of services available to pick up the care. That causes an increase in delayed discharges, which are already high in Oxfordshire. A lack of recuperation beds is not only bad for patients: it is financially bad.

Is my hon. Friend aware that, in my constituency, we have three community hospitals? The first, at Burford, certainly faces closure under Oxfordshire health authority's plan. The second faces a 25 per cent. cut in the number of beds and the third faces further cuts. Thus, all three hospitals face either closure or dramatic cuts in beds. In the light of what my hon. Friend has been saying, does he feel that savings could be made by reducing the huge number of trusts in Oxfordshire to free up funds that would prevent dramatic cuts, not only in my constituency but in his and others in Oxfordshire?

I thank the hon. Gentleman for his intervention. I remind him that I am his hon. Friend only in that I seek to preserve community services. Given the Conservative funding that undermined the health service before the current cuts, I could not describe myself as his friend.

I accept the hon. Gentleman's point that his constituency hospitals are particularly badly hit, although the scale of the underfunding in Oxfordshire is such that even radical trust mergers would not release sufficient management savings to provide the necessary funding to preserve those hospitals. That approach could be considered, however, as Oxfordshire has too many trusts. The Liberal Democrats have never opposed trust mergers. We feel that the issue of losing separate trust status is far less important than the loss of services.

The third R that community hospitals provide for local patients is respite care. If community beds are cut, patients will have less opportunity for respite care. That could mean extra admissions to acute hospitals when patients and their carers cannot cope at home for long periods. General practitioners use community hospitals as an alternative to acute hospital admission. The Government have considered it useful to fund that with their "winter pressures" money, with hospital-at-home schemes as an alternative to admission. I would argue that community hospitals are large-scale hospital-at-home schemes and are an alternative to expensive or inappropriate acute hospital admission.

Social services in Oxfordshire are badly affected by Government spending cuts. They have not benefited from a release from the reserve or from special money. I remind the Minister that the total social services standard spending assessment has, according to House of Commons Library figures, been cut by 1.4 per cent. in real terms in 1997–98 and by 1.1 per cent. in real terms in 1998–99, even before demographic pressures are taken into account.

Social services are simply unable to take up the extra work load that will be put on them as a result of hospital closures and reductions in community hospital beds. Therefore, I fear that the biggest work load will fall on acute hospitals. As has been predicted not only by me but by Lord Walton of Detchant, a local resident of Oxfordshire and an acknowledged expert on those matters, there will be a massive increase in delayed discharges and in admissions to hospital of people who could otherwise be managed at home or in a community hospital.

That makes no financial sense, because it is twice as expensive to keep people in acute hospital beds than it is to look after them in community hospital beds. It is certainly more expensive to the state to send patients without their own funding to a social services-funded nursing home than it would be, in the long term, to give them the rehabilitation that they may need in a community hospital.

As the matter is still out to consultation, I understand that the Minister will not be able to give his view, or even his likely view, on his decision on the proposal to close those community hospitals and beds. However, does he consider it reasonable for the local health authority and the NHS regional office to look carefully at whether the extra £65 million announced nationally, specifically for community and mental health services out of the extra £500 million announced for the NHS this year could be used profitably as a cash-releasing measure to avoid the false economy of increasing the number of delayed discharges? If he looks, as I suspect that he will have to in due course when the measure comes before him, at the consultation document issued by the health authority, he will notice that that question is not even addressed.

The question of whether the number of delayed discharges and admissions of patients who would otherwise be treated in community hospitals would increase was glossed over in the section on the effects on other acute trusts. Already, we read in the local newspapers today and yesterday that the Oxford Radcliffe hospital trust must close wards because it cannot provide enough staff to keep them open. Will it not result in double trouble for the Government's waiting list initiative if wards are closed to new admissions not only because of staff shortages but because of delayed discharges?

There is a good case for allocating the money given to the Oxford and Anglia region not on a weighted capitation allocation basis—that would be an unthinking way of proceeding—but as a cash-releasing measure to provide the resources that Oxfordshire needs to expand its services so that local people begin to see improvements. The Oxfordshire social services settlement suffered not only from an overall real-terms cut in the past two years, despite increased demography, but from a savage cut of 10 per cent. in its SSA for elderly residential care because of formula changes.

No reasonable explanation has been given to Oxfordshire county council why the Labour Government think that it suddenly costs 10 per cent. less to keep elderly people in residential accommodation. It is also hard to understand how local social services, which interlink crucially with community hospitals, can be rescued from such a huge cut in their resources.

Oxfordshire has suffered particularly badly under the Government's spending plans, which owe much to those that they adopted—unnecessarily, the Liberal Democrats believe—after the last election. There is therefore a strong case for providing the limited extra money that the Government allocated to Oxford and Anglia regional health authority to Oxfordshire health authority specifically to avoid cuts in community hospitals and in mental health services in Oxfordshire. Otherwise, those cuts will be bad, not only for the finances of the health authority, but for patients across Oxfordshire.

I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing this debate. This is an important issue, as community hospitals can be a valuable part of the local health service in many parts of the country. I know that there are real concerns not just in the hon. Gentleman's constituency but in the constituency of the hon. Member for Witney (Mr. Woodward) about the health authority's proposals.

I should say at the outset that there is no single national blueprint for the configuration of services that will suit all localities. As I am sure the hon. Gentleman recognises, all localities are different and, in some cases, community hospitals may not be the best way of delivering local services. It is the job of health authorities and NHS trusts to ensure that local services are matched to local need.

The hon. Gentleman knows perfectly well the Government's position on the future of Oxfordshire's community hospitals. If a local community health council objects to the health authority's proposals, the matters will be referred to Ministers. Until then, we must remain impartial about any future decision.

The public consultation on the proposals to reshape community services in the county began on 4 April. Public meetings have now been held in all 11 towns that have community hospitals. I understand that the health authority has circulated more than 5,000 consultation documents and 10,000 summary documents. I urge all hon. Members and members of the public who are concerned about the issue to submit their views to the health authority. The whole point of having a consultation is for the health authority to ascertain the views of local people and interested parties. I can tell the hon. Members for Oxford, West and Abingdon and for Witney that, if the issue is referred to Ministers, we shall listen carefully to what they and local people have to say.

Two options are being considered by the health authority and the NHS trust. Both options would mean that the 12-bed hospital at Bicester would be replaced by a new 30-bed hospital and a new minor injuries unit would be developed for Witney. To achieve that, the first option would involve closing Burford and Watlington hospitals and reducing the number of beds at five of the other community hospitals. The second option would also involve closing Burford hospital, and the wards and day hospital at Wallingford, and reducing the number of beds at four of the other community hospitals. Under that proposal, a new day hospital would be developed at Didcot, and there would be an increase in beds at Watlington. The health authority claims that, with both options, the aim is to reduce bed numbers in areas where there is relatively generous provision and to increase bed numbers where there is a greater need.

Again, it would be inappropriate for me to comment further on the pros and cons of the options while the consultation is still going on.

The Minister said that both options include the proposal to close Burford hospital. It may help him to know that the hospital has an average annual occupancy of over 90 per cent. If Burford were to close, the nearest available community hospital would be at Witney, which has 61 beds. It is proposed to close about 25 per cent. of the beds at Witney. When I was there a few weeks ago, there was only one empty bed, and the hospital's average occupancy was also over 90 per cent. As the acute hospital, John Radcliffe, has spent many months of this year on red alert, not only will be there be no community bed provision, but there will be no acute bed provision. That makes nonsense of the NHS White Paper's support for local provision, because there will be no provision for such patients in west Oxfordshire.

All I can say to the hon. Gentleman is that, if the health authority's proposals come to Ministers, they will of course be judged in the context of the White Paper. However, I understand that the health authority claims that the proposals, which are fully supported by the community health trust, aim to tackle fairness of access to services. Our White Paper clearly states that there should be an end to unfairness and that high standards should be available to all patients. I expect that the hon. Members for Witney and for Oxford, West and Abingdon would support that principle. I understand that, even without any financial pressures, the health authority and the NHS trust believe that change would have to be made to ensure a fairer distribution of health care in the county.

The health authority has stated that there are considerably more community hospital beds for people aged over 65 in the south and west of the county than in the north. Clearly, those are difficult issues, which will need to be considered carefully. As I said, they will be considered within the policy context of our White Paper, "The New NHS". There is no doubt that community hospitals will be part of our vision for the NHS. As the hon. Member for Oxford, West and Abingdon rightly said, nobody benefits if people are admitted to hospital unnecessarily or are kept in acute hospitals longer than necessary. Waiting lists get longer and hospital services become stretched to the limit.

Much work is being done to provide imaginative alternatives to traditional rehabilitation and recuperation services which meet patients' needs. However, we need to ensure that access to such services is dependent not on where patients live but on meeting their needs. Again, if proposals come to Ministers, we shall judge them in the context of that principle.

We currently do not have enough evidence to stipulate whether intermediate care should be provided through community hospitals or in the patient's home. There is a need for better evaluation as models of care develop. In particular, the health authority will need to consider how community hospitals best fit in with acute hospitals and other community facilities to ensure the best balance of emergency, planned and rehabilitation care.

The Minister has highlighted the national importance of having a policy for community hospitals. Would it not would be a great shame if the hospitals that he has mentioned—which I visited recently—were to close and the opportunity to use the set-up in Oxfordshire as a national pilot for a more integrated health service were lost?

As I said, first, there is no uniform community hospital and, secondly, local needs vary according to local circumstances. That is why the health authority and the NHS trusts concerned must be clear about the relationship between community hospitals, acute care, primary care and other NHS services. That is for the health authority to determine following consultation. There is no single national blueprint. If we tried to impose one, the national health service would not best meet local patients' needs, and we want to avoid that result at all costs.

No part of the national health service stands alone. Clinicians, other members of staff and, increasingly, patients have reached that understanding over the past few years. The NHS is an interconnected system. The hon. Member for Isle of Wight (Dr. Brand) is right, and we want more integrated forms of care in future so that patients who need access to hospital services, and, equally, to primary care, rehabilitation and social services, have a greater continuum of care than in the past. In some parts of the country, community hospitals will provide a vital role in providing that form of integrated care, but that is a matter for local determination.

That brings me—sadly, because the debate had been going well—to money. I say to the hon. Member for Oxford, West and Abingdon that the Liberal Democrats are playing a tired old record. Time and again, we hear fantasy figures conjured out of thin air. The facts are straightforward: the Government have allocated an extra £2,000 million to the national health service on top of the allocations planned by the previous Government. [HON. MEMBERS: "Hear, hear."] I am grateful for the support for that proposition from the Liberal Democrat Benches, where there is at last a glimmer of reality.

I remind the hon. Member for Oxford, West and Abingdon that it is important that all hon. Members remember what we promised the electorate at the general election. We promised real-terms increases in funding for the national health service, and we are delivering them. The Liberal Democrats promised increased investment of £540 million per annum. That was generous, but we have doubled that. Now the hon. Gentleman is crying crocodile tears and trying to leapfrog the Government's additional investment in the NHS.

I make it clear to the hon. Gentleman that we recognise that Oxfordshire has particular problems. That is why we have allocated an extra £2.8 million to help with the strategic changes taking place in the county. That is why more money was given to Oxfordshire to help with winter pressures than to any other county in the region. That is why, since we came to power on 1 May last year, we have allocated to the health service in the county £20 million more than the previous Government were planning. I hope that the hon. Gentleman will welcome that.

It is necessary to point out, for the record, that the cheers for the Minister's statement came from Labour Members—including the Chairman of the Select Committee on Health, the hon. Member for Wakefield (Mr. Hinchliffe)—sitting in Liberal Democrat seats, who are queueing for Gallery tickets. Clearly, the Liberal Democrats would spend more in real terms than the Government, and for the Government to ignore inflation is to ignore reality for patients in Oxfordshire.

Finally, does the Minister agree that it would not be unreasonable for the local NHS executive to make specific cash releasing allocations of extra money to prevent false economies?

That is an extremely good point. As the hon. Gentleman is aware, £65 million was made available for the waiting list initiative and to improve primary, community, mental health and social services. I expect that the region will take account of local circumstances in determining how best to allocate that money for the maximum benefit of patients.

We all want a modern national health service. There is no doubt that community hospitals will have a role to play in some areas. If the matter comes before Ministers, I can assure the hon. Gentleman—