It is difficult to believe that this debate is necessary, but I thank Madam Speaker for granting it. I have made six unsuccessful attempts to ask a private notice question during the past two and a half weeks. The hon. Member for South-West Devon (Mr. Streeter), the Conservative spokesman, has also requested a PNQ. That is unusually coy behaviour on the part of the Minister.

On a point of order, Mr. Deputy Speaker. I think that you will be aware, as the hon. Lady should be, that the granting of private notice questions is nothing to do with the Government. They are entirely in the gift of Madam Speaker. Normally, such matters are not referred to, but had that request been granted, my right hon. Friend the Secretary of State and I would have been only too pleased to answer a PNQ on the subject.

Order. The Minister has given as good a ruling on that matter as I could have done. The hon. Member for Richmond Park (Dr. Tonge) would be well advised to note the criteria that govern private notice questions.

Further to that point of order, Mr. Deputy Speaker. Will you advise the Committee that nothing could have prevented the Government from volunteering a statement?

Order. That is verging on matters of debate. We might be advised to deal with the substance of the matter before us. I call the hon. Member for Richmond Park.

Thank you, Mr. Deputy Speaker. I stand corrected. As a relatively new Member, I am not aware of the procedural niceties of the House.

I am nevertheless delighted that the debate has been granted, although I still find it difficult to believe that it is necessary. We all remember the terrible famine in Ethiopia in 1984. I remember it particularly well because, thanks to Bob Geldof—now Sir Bob—my eldest son, who was a young teenager at the time, was terribly interested in development issues. My son described himself as a rockabilly, but I never found out what it meant. However, the famine in Ethiopia geared up a whole generation of young people to become interested in development issues. That interest has remained with them.

I am sure that at that time, the House agonised and debated, held inquiries and resolved that such a famine should not happen again. Some hon. Members will be able to remind us about that. Since then, many other disasters have occurred, including the famine in the Sudan in 1989. In 1998, I was a member of the Select Committee on International Development, when it debated those problems. I remember, during that terrible time in southern Sudan, that systems were set up and we all thought that it could not happen again in that part of Africa.

Operation Lifeline Sudan was set up after the famine in southern Sudan in 1989. We had been warned of food shortages and famine in October 1997, but it was not until February or March 1998 that the usual images of starving children appeared on our television screens—the harrowing sight of families with little children literally starving to death before our eyes. That is when people responded. That is when the non-governmental organisations responded and when the Government kicked into activity.

It feels horribly as if the same thing is happening again. By the spring of 1998, many thousands of Sudanese people had died. Ethiopia is not unlike the Sudan; there is conflict, drought, poverty and a lack of long-term development, which is the ideal mix that leads to famine. There has been drought in Ethiopia for the past four years. The Ethiopian Government have been issuing warnings about food security during that time and they are now appealing for 1.2 million tonnes of food aid. If that aid does not arrive, 8 million lives will be at risk in Ethiopia alone, and it is estimated that 16 million lives could be at risk in the Horn of Africa as a whole.

To coincide with the hon. Lady's success in this debate, the Department for International Development has published an information bulletin on Ethiopia. It is available on the internet and hard copies are available now—I have already given the hon. Lady one.

I thank the Minister for that intervention, but I will not suggest that we should all go home and read the document instead of staying here. The title of the debate was deliberately broadened in an attempt to enable us to consider some of the issues behind the knee-jerk reaction that has to take place when a famine occurs. The matter is much more complicated than that reaction would imply.

Once again, starving children are appearing on our television screens, although they have been wiped off them during the past couple of days because of the troubles in Zimbabwe. I am sure that we will see them again during the Easter weekend. Apparently, the situation is not yet a famine. It is not a famine because the United Nations assessors have not reported back, as the war with Eritrea is said to be using up Ethiopia's resources and not enough people are dying each day. Apparently, a particular number of people must die every day for a famine to occur. In spite of what we have seen, not enough people are doing so, which is very inconvenient. It is tempting to remind the House of these words:

Any man's death diminishes me…And therefore never send to know for whom the bell tolls.

Surely famine does not have to be a matter of numbers.

I am pleased to inform you, Mr. Deputy Speaker, that Madam Speaker has recognised the great need that exists. Last night, in Speaker's House, under the auspices of a non-governmental organisation called Farm Africa, Madam Speaker launched a campaign called "Send a Tonne to Africa", meaning a tonne of grain or cereal. People are asked to contribute large or small sums that will be used to purchase grain locally from African farmers. The amount can be a kilo or a tonne, or whatever can be afforded. Madam Speaker has pump primed the appeal by donating £3,000, and last night she raised £10,000 in an hour, which was not bad going. We should all thank her and congratulate her on the effort that she is making to highlight the problems in Ethiopia.

What is going wrong with the world's response? As I said, Ethiopia needs 1.2 million tonnes of food. So far, or at least until 10 April—I have not yet read the Department for International Development briefing—350,000 tonnes have been pledged. After the previous famine in Ethiopia, the Ethiopian Government established a disaster prevention and preparedness commission to provide early warnings and an emergency food security reserve to provide relief food. A pharaoh's granary exists in Ethiopia to provide for the lean years by storing up food from the fat years. What has happened to it? Sadly, it has been depleted by loans to donors, which include the United States, the European Union, Canada, the Netherlands, Germany and the World Food Programme, which have plundered the store of food that was set aside for Ethiopia. The World Food Programme is on that list, but also runs Operation Lifeline Sudan in northern Kenya to provide food aid to southern Sudan.

What sort of madness is that? It is not as if the world is short of food. Why were not the resources replenished by the international community or, on our own doorstep, by the European Union? That question is especially important in the light of the warnings of food shortages that were given last year. How much has the United Kingdom contributed to the European Union food aid fund? Why have we not pressed Brussels to act sooner? Why have we failed to respond adequately to the United Nation's appeal in January for $10 million for health care and water supplies? Only $1 million has been received so far. What is happening about the rapid response force to disasters called for by Sir Bob Geldof a couple of days ago? The Liberal Democrats discussed such a force extensively during the Mozambique disaster. The idea is not new but neither the European Community Humanitarian Office nor the United Nations seem able to provide the world with that much-needed facility.

I am very much enjoying the hon. Lady's speech. She touches on an important matter—the performance of the multilateral agencies in such situations. Does she agree that the response is disappointing more often than not? I was wondering this morning whether I could think of a situation in which the multilateral agencies had responded well in such a crisis. Can she think of an example? What would she suggest we do to improve the performance of the UN and the EU?

That intervention was useful. I am a great European and a great fan of the United Nations, but I am the first person to admit that they are not getting matters right. We must get them right. A country on its own cannot deliver the response needed in a disaster. Consider the problem of heavy-lift equipment in the Mozambique disaster. Provision of such equipment is not for one country alone. Not all countries can have their own heavy-lift equipment to use once in a million years. We need to work together as a group of countries and we must put much more effort into doing that. I am not apologising in any sense for the European Union or the United Nations. I am simply saying that there must be a way. The world needs us to find a way.

No wonder I have a sense of deja vu. The same confusion, lack of response and failure to heed early warnings before the media and the newsmen arrive happened two years ago and it will all happen in two years' time if we are not careful.

Before I leave the subject of immediate humanitarian aid, it must be noted that the war with Eritrea has made the use of ports in that country impossible. That is undoubtedly a factor. Can Djibouti cope with the demand for ships bringing in grain and other supplies? There are good reports, including some from the Ethiopian Government and the non-governmental organisations, that much is being done in that port to make access easier and to get supplies in.

I have studied the atlas hard to try to work out whether it would be possible to use Lokichokio in northern Kenya. The question interests me. I have seen the fleet of Hercules aircraft and the tonnes and tonnes of food aid stored there. Yes, the food is needed for southern Sudan, but the Hercules aircraft are a possible means of transport. I wonder whether it would be possible to use that facility.

In responding to the crisis in the Sudan two years' ago, the Secretary of State for International Development said:

Spend less on development, fail in development, more and more poverty, more and more crisis, more and more humanitarian disaster, more and more appeals, more and more failure, more and more suffering, more and more poverty. No addressing the causes or underlying concerns.

As the statement makes clear, without proper long-term development, famines and catastrophes will continue.

Ethiopia has doubled its population in the past 15 years. There is over-crowding, poor farming practice, soil deterioration and deforestation. All those factors contribute to conflict and famine. Many NGOs, including Christian Aid, have been working in the region to develop sustainable practices, such as the construction of earth dams to collect water and the better roads that are essential if Ethiopia is to haul itself out of poverty. The Government of Ethiopia has conducted a massive road-building programme and are making huge efforts to improve agriculture. Why, then, is the United Kingdom cutting long-term development aid to Ethiopia from, as I understand it, £39 million to £19 million in the next three years? In a country where 45 per cent. of the population live on less than a dollar a day, the Ethiopian Government spend twice as much on debt servicing as they do on primary education. All the factors are present. Why are we cutting aid?

I understand, and have been told many times by the Secretary of State, that long-term development aid is not provided to countries in conflict—or that there is a reluctance to do so. The war between Ethiopia and Eritrea costs Ethiopia £1 million a day. That is a terrible waste. However, if we cut development aid because it may be misappropriated by warring factions, as it is alleged is happening in southern Sudan, how can we break the cycle of poverty, conflict and famine that repeats over and over again? I am not suggesting that this is an easy problem to deal with, and I am not apportioning blame; I am just opening the matter for debate.

Can we not provide the development aid through the NGOs that are brave enough to work in dangerous zones? Indeed, the United Kingdom Government do that in some places. Despite what is happening in Zimbabwe, there has been an increase in development aid via the NGOs, for which I applaud them. That aid is provided despite Zimbabwe's involvement in the war in the Congo, also. Development aid to Sierra Leone has also increased, but the situation there is hardly stable or safe. However, that is not to happen for southern Sudan, where the civil war has been running for 30 years, or for Ethiopia. Why?

Southern Sudan and Ethiopia are to receive no, or little, development aid. Apparently, the carrot and stick are to be offered to them. Aid will come only when the fighting stops. The civil war in southern Sudan has been going on for 30 years. The one plea that I received from mothers during my visit was for teachers to educate their children. Not only did their children have nothing to do, but the mothers argued that, however the war continued and whatever raids were made on their villages, education could not be taken from their children. Once it was in their brains, it was there. Generations are missing out.

Are the children of Ethiopia to suffer the same fate? I do not defend the war in either country. In fact, I was appalled by President Zenawi's remarks last week that he would not attempt to broker a peace with Eritrea. He said:

We do not believe that protecting one's sovereignty is a luxury for the rich alone.

Nevertheless, we must ensure that aid for education and basic health care is provided, even during conflict. It is the only way to break the cycle.

Surely the dilemma is how much the hon. Lady would expect food aid to perpetuate the war and the conditions that prevent children from benefiting from education, because they die from malnutrition.

That crosses the two issues. I do not suggest that we should not give humanitarian aid—food and water. Those things must be got to the children, whether there is war or not. My argument is that development aid—particularly education, because we all know how important primary education is to a country's development—should not be cut simply because of conflict. Not only is it crucial, but not much is needed. In the Sudan, little is required to educate children—a teacher, a shady tree and, with luck, slates and chalks or a few bits of paper and the odd book. They are not asking for much. Those things cannot be destroyed by war. If the teachers and children flee, education can carry on.

Many questions need to be answered about the reaction to the immediate crisis in Ethiopia and about our long-term policy on development aid to countries in conflict. I thank the Minister for listening. I hope that he will provide answers before the images of death and suffering return to our television screens.

I congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing the debate. She was not alone in wanting to raise this subject. Many people have been involved in activities similar to those that have occupied her in previous weeks. The Department for International Development has been keen to explain its position on the response to the famine in Ethiopia.

In a debate on Ethiopia that I initiated in December 1989, I quoted the Foreign Affairs Committee report of 1988 on famine in the Horn of Africa. It said:

An impression may have been created in the donor countries that, since so many lessons have been learnt, the horrors of 1984–85 would not recur. This would be dangerously false optimism… But droughts will occur again—the rains have failed or been inadequate in 3 of the last 4 years—and with a fast-growing population, poor farming techniques, widespread deforestation and land degradation, the consequent famines are likely to be increasingly severe…And by each successive drought the resilience of the people and of the land is diminished. It is a spiral which, if unbroken, may result in tragedy.—[Official Report, 13 December 1989; Vol. 163, c. 1062.]

Who would have thought that in 2000 we would be debating the same problems? Weather is difficult to control in any country, however, and in the countries of Africa people are so dependent on it for their survival.

The Secretary of State for International Development said in a written answer that the UN estimates that more than 12 million people face serious food shortages in the Horn of Africa. Ethiopia, Eritrea, Kenya, Djibouti and Somalia are suffering to a varying extent. We know, however, that the people of Ethiopia are most at risk. Even in good rain years, 5 million to 6 million Ethiopians are partially dependent on food aid—about 8 million face famine in Ethiopia now. As the hon. Member for Richmond Park said, food aid is essential. We need to respond quickly to the plight of the Ethiopian Government.

Last night, I read a briefing paper by the Ethiopian Government, which most hon. Members will have received. It asks what the difference is between 1984 and now and explains:

Ethiopia has changed dramatically in the past eight years. Since the overthrow of the Derg regime in 1991, Ethiopia has been a democracy and the Government has been working continually to improve infrastructure, agricultural methods and training for farmers to alleviate the impact of rain failure and crop failure. Food security and self-sufficiency is the No. 1 priority of the Government. It should also be pointed out that Ethiopia has not been in the grip of drought and food shortages since 1984.

That certainly was not the case in 1989, when there was a similar problem. It goes on to say:

The improvements in agriculture and infrastructure since 1991 …meant that Ethiopia actually exported food to neighbouring countries in both 1996 and 1997. The problems since then have been unfavourable climactic conditions and the lack of adequate donor response,

to which the hon Lady has already referred. She also spoke about the extreme poverty in the country.

I visited Ethiopia just before the fall of Mengistu and saw the great efforts that were being made at the time by United Nations agencies. The United Nations Development Project was attempting to give information to farmers. I went out on field trips with people from that project and saw them instructing farmers on how best to use their poor soil. The farmers queued halfway up a mountain to receive that instruction. UNDP was bemoaning the fact that it did not have more resources at its disposal to provide more education programmes to farmers, who are keen to learn. There has also been an enormous population explosion, which was clear even in 1989. Again, the United Nations population programmes in Ethiopia were completely overloaded by demand, and long queues of people were waiting in the streets to obtain information from the UN clinics. Therefore, we must look again at the resources that the UN can deploy in countries such as Ethiopia.

Ethiopia has endured four successive seasons of drought. The rainy seasons—one in February and one in the summer—did not bring any rain, but they are vital because they contribute to 50 per cent. of crop production in some parts of the country. For the past three years, the rains that begin in February have been very short and this year they did not arrive at all. Ethiopia's farmers are probably more dependent on rain than farmers in any other African country. In its good briefing, Oxfam says,

Crop production has been decimated and 95 per cent. of the livestock have been lost in the Ogaden in the south.

We have seen the pictures on television of carcases lying all over the desert. The herdsmen, who are dependent on their livestock for milk and income, have been killing them as a last resort to survive. The population of Ethiopia has doubled since 1985, so land is being divided into smaller plots that allow farmers to produce a family's grain needs for three to four months of the year on average. The soil is being overused and exhausted as a consequence. Soil erosion is so bad that billions of tonnes of soil are washed away each year. Farmers are not allowed to own their land, which is a disincentive to investment in it. Deforestation in Ethiopia has made the problem of soil erosion worse. Only 3 per cent. of the land in Ethiopia is now covered by trees, which is extraordinary.

International Monetary Fund and World Bank policies mean that Ethiopia spends more on servicing debt than on health and education. I believe that Ethiopia has outstanding Export Credits Guarantee Department loans to the UK to the sum of £15 million. Its total external debt is $10.4 billion, which is 169 per cent. of its annual gross national product and 10 times the value of its exports. Clearly, that is ridiculous.

The new Ethiopian Government have attempted to put in place projects to mitigate the effects of drought, such as building earth dams to catch the limited rainwater. They have introduced measures to reduce poverty, such as establishing credit unions and initiating job creation schemes in urban areas. They have made improvements in infrastructure—for instance through road-building programmes—to speed up food delivery in times of famine. As the hon. Member for Richmond Park said, all those projects have been undermined by the cutting back of western aid in response to the war with Eritrea.

In the mid-1990s the IMF insisted on cuts in social spending to ensure budget surpluses. Ethiopia is not in the heavily indebted poor countries scheme and still pays a massive amount in debt service payments: last year, the figure was £60 million. Therefore, while ordinary people in the west generously donate money with one hand, western banks and Governments take it back with the other in interest payments.

The drought and famine have been compounded by the war with Eritrea, even though little fighting is going on at present. The Ethiopian Government should acknowledge that, because they maintain an enormous standing army of 400,000 men along the border with Eritrea, which costs the country £631,000 a day to maintain. My right hon. Friend the Prime Minister told me in an answer on 5 April that international efforts were in hand to bring the war with Eritrea to a conclusion. I do not know what those efforts are and would like to hear more about them. Perhaps my hon. Friend the Minister will refer to them in his reply.

The International Development Committee has looked many times at the impact of conflict, and at its draining effect on the economy and well-being of the countries where conflict is a perpetual fact of life. At the same time as we are trying to relieve the famine, international efforts should be made to bring that conflict to an end.

There are worrying reports that, despite the famine, Ethiopia is preparing to launch a new offensive against Eritrea. On 13 April, the Ethiopian Prime Minister refused to rule out launching another offensive. That again underlines the need for rapid international attempts to end the conflict.

The hon. Member for Richmond Park said that the Ethiopian Government had reserves of food, but they have dropped to 30,000 tonnes, which is only enough for about two weeks' emergency distribution. Western Governments gave the Ethiopians written assurances that supplies that were borrowed would be replenished as soon as possible, but the donors have failed to replenish. The European Union alone has failed to replenish 78,000 tonnes from the stores.

I thank the hon. Lady for emphasising that point. Like me, does she not feel outraged that, in spite of the experience of the past 10 to 15 years and after all the discussion, debate and inquiries, the world could have allowed those food stores to be depleted to such an extent?

I could not agree more with the hon. Lady. If those food stores were borrowed and promises were made on paper to replenish them, it is a disgrace that they have not been replenished.

Appeals were made for additional food aid as long ago as November 1999, but, as of 1 April, no food supplies had arrived in Ethiopia, and the Ethiopian Foreign Minister said that the world seems to react only when it sees "skeletons on screens". The United Nations launched an appeal for £190 million on 28 January 2000. Oxfam has accused the international community of dragging its feet by not sending aid quickly enough and sending only half the amount that it promised in 1999. Oxfam has provided some interesting figures, which are worth examining, but I shall not read them out now.

The Secretary of State for International Development stated on 12 April that since January, the United Kingdom has committed ££4.5 million in aid, including 16,500 tonnes of food. The Department has said that it is ready to do more as needs emerge, and, compared with many other countries, the United Kingdom's record has been extremely good and cannot be faulted.

The UN special envoy recently visited Ethiopia and made strong speeches, stating that it is now time for the international community to act. She met the Ethiopian Prime Minister and was told that the west was using the war with Eritrea as an excuse for its slow reaction to the famine. That may be his opinion, but the response has been good since the needs became fully known. Television has an important role because it puts pressure on Governments that need to be pressurised, and it leads to a good response from the public.

I shall spell out what the United Kingdom should do. If it is not doing so already, it must work with its EU partners and the international community to ensure that all food and non-food aid requested by Ethiopia and the aid agencies arrives as quickly as possible. It must provide cash so that food can be bought locally. Most urgently, it must bring the Eritreans, southern separatist groups and Ethiopians together to try to secure an agreement to end the conflict, at least in the short term, and open access to other ports in Eritrea to speed up aid delivery.

In the long term, the United Kingdom must try to bring that damaging war to an end. It must then discuss with the Ethiopians and aid agencies the problems of infrastructure and logistics to find the best and quickest means of overcoming them. It must try to deal with the underlying causes of recurring famine and break the cycle of crisis that arose in 1984, 1989 and now in 2000.

The IMF, the World Bank and creditor Governments should re-examine Ethiopia's and Eritrea's foreign debt and suspend, reschedule or cancel it and offer quicker and deeper debt relief, perhaps as a carrot for their efforts to end the war. The multilateral development banks and donor Governments should offer substantial and additional long-term assistance to Ethiopia and Eritrea. Finally, the Ethiopian Government, through the World Bank, the UN, and aid agencies, should be encouraged to develop an effective strategy to tackle land ownership and soil erosion. In the long term, that will enable Ethiopian families to feed themselves and, hopefully, bring the cycle of crisis to an end so that, after 2000, we no longer witness pitifully thin, exhausted Ethiopians dying on our television screens.

Order. It may be of assistance if I remind hon. Members of the convention during these 90-minute debates to give the Floor to the Opposition Front-Bench spokesman 30 minutes before the close of the debate. Only two Front-Bench speakers remain, so I shall call the Opposition spokesman at 10.40, leaving 40 minutes in which to fit four other hon. members. I therefore appeal to those hon. Members to be as concise as possible, so that we can accommodate everyone.

Thank you, Mr. Cook.

Order. I must also remind hon. Members that the House has decided, in its wisdom, that Westminster Hall is not a Committee. It is the House and the person in the Chair must, therefore, be addressed accordingly.

Thank you, Mr. Deputy Speaker. This is still a novel forum for some of us, and I must say that it is not a particularly pleasant forum. I like to be able to see the Minister's eyes when I address the Chamber.

I shall not repeat what the hon. Member for Cynon Valley (Ann Clwyd) has said, because she put it very well. I shall make several further points. My interest in Ethiopia started when I went there with the hon. Members for Denton and Reddish (Mr. Bennett) and for Roxburgh and Berwickshire (Mr. Kirkwood) in 1984 under the auspices of Save the Children and Oxfam. I was also chairman of the Anglo-Ethiopian Society for some time.

I must first express some sympathy for the Minister. I once held the post that he now holds and I know that there is a temptation in the House to criticise the Government whenever there is a disaster. Hon. Members must recognise that, for better or for ill, the Department extracts a sum from the Treasury in these circumstances; one can argue that it is not sufficiently large, but it is a sum. Under law, the Department must also meet its obligations to the dependent territories and to the Commonwealth. Then, we all ask the Department to enter into long-term development programmes. By definition, those require long-term funding.

Another problem that is sometimes forgotten is that, before the Department spends even a penny on bilateral aid, a substantial chunk of its budget is extracted to pay our contributions to the European Union. In this crisis, 17 per cent. of all EU aid comes from the United Kingdom. We do not get credit for that and we do not give ourselves credit for it. The EU will have given about 432,000 tonnes of aid to Ethiopia, a fifth of which will effectively have come from the United Kingdom.

We should not be so speedy to criticise the Department for International Development. Given the competing claims on its budget, Ministers have been trying hard to give continuing support to Ethiopia—a food security adviser is there now.

I also endorse the Government's decision not to give further long-term development aid to Ethiopia while the war against Eritrea is raging. We have few enough carrots and sticks in these circumstances. It is sad that the international community has not yet succeeded in making greater progress. The United Nations has not yet managed to establish a line of control.

As the hon. Member for Cynon Valley said, it is extraordinarily sad that a country as poor as Ethiopia is committing so many of its young, able-bodied men to a conflict a long way from home and spending so much money on it. The international community and the United Nations must give a higher priority to resolving that conflict. We have become very bad at international conflict resolution. We have almost accepted the conflict between Eritrea and Ethiopia as a fact of life.

The Department has the capacity to do much more about logistics—a point made recently in the other place by Baroness Chalker of Wallasey, who probably knows more about these aspects of Africa than anyone. The Ethiopian Government's briefing pointed out that pledges are not enough; it is delivery of aid that is needed. During the 1984 famine, the Royal Air Force and others put enormous effort into distributing food aid. In a crisis, one needs disciplined lines of command and controls. The Royal Logistics Corps is a brilliant organisation, which did fantastic work in Rwanda. If the Minister is pressured by the House to do more, he should send members of the Royal Logistics Corps and the Royal Air Force to help distribute food aid in Ethiopia, rather than simply persuading the Treasury to get out its cheque book. That would be a far greater contribution. It is also a visible contribution that would earn respect from the international community and enable us to lever in influence.

I endorse the Government's refusal to give long-term development aid to Ethiopia while the war against Eritrea rages. My right hon. and hon. Friends will probably agree that, while the terrible internal conflict in Zimbabwe continues, the Government must think in terms of sticks and carrots and it would be right to suspend development aid to Zimbabwe until the horrors cease. If one is pursuing a particular policy in one part of the world, it should be pursued consistently.

Considerable progress has been made in Ethiopia since 1984, and the situation has certainly changed since then. The international community appears to have a far better grasp on events, but we are clearly moving towards a crisis. Doubtless the Minister will assure us that, proportionate to the crisis, Her Majesty's Government are doing all that they can. Many people will give him the benefit of the doubt, recognise the limitations within which he works, and hope that he can persuade the House that all necessary steps are being taken. However, if the Government are seen to be responding disproportionately, they will be condemned by the whole country. As has been said, we should learn from previous lessons. We have considerable experience in contributing to food aid distribution in Ethiopia. I hope that, in those and other areas, we can be seen to be doing everything humanly possible.

Obviously, Mr. Deputy Speaker, I welcome this debate. Given the brief time available, I shall make only one point. In respect of the war, we must not let Ethiopia off the hook. We all carry the heavy burden of war throughout the world. Fifteen of the top 20 recipients of European aid are involved in wars and conflict.

I want to discuss the speed with which the European Union reacts to such crises through its European Community Humanitarian Office. In pursuing its stated task of ensuring that goods and services reach crisis zones quickly, ECHO repeatedly fails. That is a recurring problem. Wherever one goes, one sees evidence of ECHO's failure. We were told that European aid had been provided to ease the famines in Somalia, but we saw no evidence of that on the ground. Eventually, we discovered that the aid was stuck in warehouses in Mombasa, Kenya. It took many months to reach Somalia.

On visiting Mozambique, we discovered a similar problem. The Commissioner arrived on 1 March, long after the crisis had passed, and announced aid of €25 million. That money was not planned for; one did not know where it was going, and it would be spent long after the event. Similarly, the International Development Committee criticised ECHO's actions in Kosovo.

In Ethiopia, it is the same old story. Announcements are occasionally made that the European Union is to give relief food, but where it goes or when it turns up is covered in mystery. Arabic News—which, of course, I read daily—reported on 8 November 1999 that Ethiopia was to get 46,000 tonnes in EU relief. Where did it go? I believe that 30,000 tonnes of it has just turned up in Djibouti. However, it is five months late and its arrival in Djibouti does not mean that it will be quickly distributed in Ethiopia.

On 10 April, the Relief Web and the BBC reported that the EU plans to ship 800,000 tonnes to the region this year. Commissioner Nielson said that if we can now plan in a reasonably professional way to ship 800,000 tonnes, that will be a good start. Does the EU have plans or merely vague aspirations? I suspect that it may be the latter.

Two days later, the position changed. On 12 April, Chris Patten, standing in for Mr. Nielson, told the European Parliament that the Commission had programmed the delivery of 283,000 tonnes. A close reading of his words reveals that that includes the 48,000 tonnes that should have arrived last year. He also said that the EU was about to decide on the delivery of an additional quantity of up to 260,000 tonnes.

The organisation does not know what it is doing. What happened to the 800,000 tonnes that was mentioned two days earlier? Oxfam has said that the EU failed to meet its commitment last year. It provided only half the food that it promised and is now more than a year behind on its pledges.

ECHO does not give the impression of being under control. If one really wants to lose faith in it, one should go to its website. Clicking on the icon for financial decisions and selecting Ethopia brings up the information, "Beneficiary: Ethopia: last statement 16 December 1998". There is no reference to money going in or to the target population. The events section of ECHO's website gives information about events of September 1999. The speeches section offers the speeches of Emma Bonino, the former European Commissioner with responsibility for humanitarian affairs, who is no longer in post. If one looks up parliamentary questions asked about ECHO, it appears that the most recent question was asked on 6 April 1998. ECHO News, the organisation's publication for the public, seemingly last appeared in December 1997. ECHO does not know what it is doing; it is out of control. That is crucially important, because it claims to be the world's largest donor of humanitarian funds and is our major representative in that respect.

This problem concerns not only Ethiopia, but the entire Horn of Africa. Sudan, Somalia, Kenya, Eritrea and Djibouti are under the threat of drought and the position may worsen if the next rains fail to arrive. This is not an emergency such as that in Mozambique—an act of God whereby the rains suddenly fell out of the sky—because it was predicted. In July 1999, the Office for the Co-ordination of Humanitarian Affairs referred to the worsening drought in Ethiopia. Reference has already been made to the running down of the food stores—for example, the European Union borrowed 80,000 tonnes that it did not return.

Will the Minister explain the basis on which we contribute to ECHO? I have looked at the statistics on the amounts that are contributed by the countries involved. Astonishingly, the Netherlands is the most generous contributor. The Scandinavians contribute a large amount, while our contribution is approximately average. The French, Portuguese and Greeks give virtually nothing. I am beginning to think that they are wise in that respect.

I believe in international organisations. The hon. Member for South-West Devon (Mr. Streeter) asked for evidence of situations in which they work. They do work—the World Food Programme delivers brilliantly. On occasion, the United Nations High Commissioner for Refugees has worked well, but it does not always do so. However, I have never heard people praise ECHO's contribution to any emergency. What is the Government's view?

I shall be brief. I congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing this important debate and the hon. Member for Cynon Valley (Ann Clwyd) on her contribution.

It is tragic to see on our television screens once again the terrible suffering of the people of Ethiopia. We had hoped that we had found the solutions that would prevent such tragedies from recurring. I am afraid that we all have to take some responsibility. There has been a tragic failure in development and a great failure on the part of the Ethiopian Government. I do not seek to exculpate or to excuse them from their responsibility for this tragedy. Their pursuit of war and their military spending, which the hon. Member for Cynon Valley discussed, have been significant factors. They could have reorganised agriculture and infrastructure in a manner that would prevent the occurrence of such tragedies.

We all know what needs to be done. Twenty years ago, 70 per cent. of Ethiopia was covered in forest, but now less than 20 per cent. of it is. That reduction will affect rainfall and the soil's stability and induce drought. That canopy has to be replaced and we know how to do it—we know how to build dams to trap the water that is necessary to irrigate the trees when they are first planted. However, to do that, we need to put in place a thorough development programme that will encourage people not to cut down trees for heating and cooking purposes—other ways of cooking and providing warmth at night will have to be found.

Although we know how to take such steps, why have we not done so? Why have we not pursued those objectives during the past 10 years, after the previous tragic famine occurred? So far as I can gather, no progress has been made in southern Ethiopia. I imagine that more programmes have been put in place in the Tigrayan areas of Dese, because Tigrayans dominate the Ethiopian Government, which brings us back to the fact that the responsibility for the tragedy lies with that Government and their insane pursuit of a tragic war, which has killed many people on both sides of the border. They have unnecessarily spent huge sums of money on that war.

The British Government created a problem when they changed the direction of aid that is sent to Ethiopia. The Department for International Development decided not to give reduced amounts of money to non-governmental organisations and to give more through Ethiopian Government Departments. The problem with that approach is that once the money has been given, we do not know where it ends up. It has clearly been used to buy arms to pursue the war against Eritrea—it has not been used to preserve the environment, build dams or provide the water that is necessary for drinking, cooking and agriculture. The British Government's policy is mistaken. They must return to the previous policy of sending money to competent NGOs in the field and supporting long-term sustainable development programmes. That might prevent the occurrence of such tragedies.

In the meantime, we have to get food to the starving people and we must do so quickly. My hon. Friend the Member for Banbury (Mr. Baldry) suggested a quick way to do so. We may also be able to send aid through northern Kenya. We must get the process going quickly, get ECHO to provide the money and, above all, have the food delivered to the people who need it as quickly as possible. I beg the Government to take emergency action, with all our partners, to enable that to happen.

I am grateful to previous contributors for keeping their speeches brief, giving me rather more time than I had expected. I also congratulate my hon. Friend the Member for Richmond Park (Dr. Tonge) on securing this debate. It is an important debate, which ought to extend beyond the normal repertory company of those hon. Members who are interested in international development.

The tragedy is that the debate probably would have extended beyond the Chamber, had it not been for news values that put Zimbabwe in the headlines in the past few days, taking attention away from what is happening in the Horn of Africa. I am afraid that it is a reflection on our society that our view of what should be a priority issue is often dictated by the media. That gives particular value to our opportunity to discuss the issue.

We have had a good debate. My hon. Friend and the hon. Members for Cynon Valley (Ann Clwyd), for Banbury (Mr. Baldry) and for Hertford and Stortford (Mr. Wells) have all raised the essential issues in relation to what is happening in Ethiopia and Eritrea.

It is not my objective to criticise the Government. Providing effective aid is difficult, particularly in areas such as the Ogaden, which are inhabited by nomadic peoples. The underlying question is how we provide support for development in a conflict situation. It is a truism that the first casualty of war is truth—the second is civil society, especially its capacity to feed and educate the people and keep them healthy. Such issues come to the fore in every conflict situation. It seems to me, in opposition to the conventional view, that it is even more important to get development aid into those areas, to sustain and, where possible, build on the people's capacity to feed and educate themselves and keep themselves healthy under those circumstances. The attention of Governments, and the resources that are available to them, will, inevitably, be directed elsewhere.

What is the most effective way of providing aid? Is it Government-to-Government aid or multilateral aid to Governments? It almost certainly is not. That is why it is so important to find ways for peoples—rather than Governments—to communicate with each other, using effective NGOs, multilateral organisations, and perhaps even tiers below central Government, to provide effective support.

If the world is to deal effectively with the problem, it must be stopped at source. That means doing something effective to control arms and stop the arms sales that allow conflicts—particularly, but not exclusively, in the continent of Africa—not only to flare up, but to continue, year after sad year, with tragic consequences. Britain is far from blameless. The British Government did not cease the sale of arms to Ethiopia and Eritrea until after the conflict had started. Last February, a British company was found to be organising a shipment of arms to Eritrea—the case is with the Belgian courts at the moment—and Britons are still running guns in the Congo. We must take much more effective action both to control arms on a worldwide basis and to control the activities of arms brokers. We have the same argument about that time and again. The question is, when will it happen and when will effective action will be taken?

My third point relates to the comments of the hon. Member for Clydebank and Milngavie (Mr. Worthington), who asked how we should create an effective rapid reaction force. We all pay lip service to that concept and say that the United Nations should be doing more, but what an example the European Union sets with the gross deficiencies of its present arrangements. I agree with the hon. Gentleman. I do not think that we should send money to the European Union for this purpose, because far more effective action can be taken by the non-governmental organisations that exist in Britain and the international development teams that the Government have at their disposal. Why on earth should we use a route that has proven time and again to be ineffective and to lack proper urgency?

The constant problem is not merely the quantum of aid in terms of finance and food, but the means of getting it to the affected area. If the world community is to deal effectively with natural catastrophes, or catastrophes that have more than a little to do with the human element—as is the case in Ethiopia—we must have the means of getting goods from one place to another. In the Horn of Africa, east Africa and the whole rim of the Indian Ocean, such resources do not exist. It is not that they are not deployed in time; they simply do not exist, and they will not exist until the international community decides that it has to meet the need. It is no good asking our armed forces and our navies to help with such problems in areas that are far from their sphere of influence and from the locations that they usually patrol, which it takes weeks to reach and which they will have the wrong equipment to deal with. That was exactly the problem that the hon. Gentleman experienced in trying to assist in Mozambique, and it will happen time and time again in an area of the world that is prone to natural catastrophe but for which we do not have the resources to meet the need.

I hope that countries that are rich and have the civil and military resources will consider the rim of the Indian ocean and think about how to establish permanent resources to deal with crises in that area. I hope that that is not too utopian a view. Some countries are not always in the lead in providing resources. Indeed, some rich countries that are not a million miles away from the Horn of Africa might be tempted to contribute a little more to establishing a permanent resource that would be available as a contingency.

We can deal with problems in the Mediterranean, which is on our doorsteps. At a push, we can deal with problems in the Caribbean, which is on the doorstep of America and is the focus of some European interests. We can even deal with problems in the Far East. However, we cannot help the huge area under discussion, where so little exists and where the countries are so poor. With the best will the world, the Governments in the region are unable to deal with massive acts of God or acts commissioned by man that result in misery and tragedy for so many people. They are rendered powerless to deal with them by a combination of their history, the debt with which they are saddled and other different pressures.

I should like to leave the Minister with that one point. I do not imagine that he has a magic wand that will enable him to achieve those aims, but I ask him to argue seriously for them in the international forums in which he speaks. I hope that Britain can begin to take a lead in these important matters.

I congratulate the hon. Member for Richmond Park (Dr. Tonge) on winning the opportunity to have this debate, which concerns a very important matter. I shall try hard not to duplicate the excellent contributions that have been made. I want to give the Minister plenty of time to answer, which is the purpose of these debates.

It is heartbreaking to see the pictures that have been on television. The Horn of Africa, not merely Ethiopia, is affected. I agree with my hon. Friend the Member for Banbury (Mr. Baldry) that it is foolish to ask what the United Kingdom Government are doing to sort things out, as though they have a magic wand and can be everywhere and do everything. That is unrealistic politics. As I gain more experience in this context, I feel that it would be better for the Government to focus resources in preference to spreading them widely.

I am not saying that the problem is directly our Government's responsibility. The Government of Ethiopia must take primary responsibility for the way in which they spend money and use resources. It is good that we live in a world where more and more people know what is happening around the globe. Through globalisation, multimedia and technology, more and more people in developed countries such as ours find it utterly unacceptable to stand by and watch children die of famine in the 21st century. I welcome the increased involvement in the developed world of millions of ordinary people.

What is happening in Ethiopia shows up some of the fundamental issues with which people involved in development try to work? It highlights the responsibility of Governments. It raises the dilemma of what we should do to help a country whose Government are guilty of corruption and misuse of funds. It brings to our attention the distinction between long-term development and immediate humanitarian aid and the vital question of where the United Kingdom should focus its primary efforts. It leads us to ask how we can dispense essential humanitarian aid during conflict and it focuses our minds on the role and effectiveness of the multilateral agencies.

What we are doing to help resolve the conflict? As the Secretary of State has often said—and I agree—the key to helping a country in conflict is to bring the conflict to an end. That is common sense. Since the end of the cold war, we no longer have so much influence, through the power blocs in the east or west, with Governments in the developing world. The old colonial relationships are falling away. Both those changes are to be welcomed, but they lead us into a vacuum in which we wonder who has the primary responsibility for intervening in the conflict in Ethiopia and Eritrea. Which nation state is seeking the lead role? What are the United Nations, the European Union and the United States doing? I hope that we do not fall between two stools, with no country taking the lead. Perhaps, if aid and development departments are too carefully separated from foreign offices and diplomacy in Governments such as ours, full use will not be made of the leverage that development and aid can supply in bringing Governments to their senses.

What is the United Kingdom Government's policy on dispensing aid to countries in conflict? Simply cutting aid is a short-term and probably wrong-sighted response. Why are we cutting £20 million from our development budget for Ethiopia in the next three years? Would not it be better to suspend payments to the Government if they misuse the money, but to pump the same support through the non-governmental and other bodies that make up civil society there? Many of those bodies can tackle long-term issues such as education, heath care and the strengthening of civil society. I agree absolutely with my hon. Friend the Member for Hertford and Stortford (Mr. Wells) that the right response is to pump equivalent support through the NGOs rather than suspend payments to the Government.

How do the Government justify cutting aid to Mozambique—another country in turmoil—in the next three years? I do not understand the decision; I am not sure that the British Government understands it. I would love an answer to the question. Is it not baffling and upsetting that the sum cut from Government support to Mozambique in the next three years equates roughly to the sum given by the British people to the appeal launched some months ago by the charities? If that is the way in which the Government are playing the situation, it is a disturbing trend.

On our response to aid to countries in conflict, how can the Government justify cutting the aid to the Government of Ethiopia while increasing it to the Government of Zimbabwe, which is also a country in conflict? I am not seeking to cause trouble for the Government, I simply do not understand the way in which they justify the move.

The Government may say that they are pumping money into Zimbabwe through the NGOs, as I have called for, but that is not the case. Most of our support to that country goes directly to its Government. Some of it goes to the police force—the same force that is standing by and watching white farmers being beaten and killed. What signal is that sending out? Zimbabwe is involved in conflict in the Democratic Republic of Congo. We are told that 70 per cent. of Zimbabweans are opposed to the involvement. Military equipment worth $200 million has been lost and wasted by the Zimbabwean Government, which is involved in ethnic cleansing. Will the Minister give us an answer today? I have asked several times. How can they justify continuing their support for Zimbabwe while cutting support to Ethiopia?

I want to explore with the Minister the role of multilateral agencies versus nation states. The hon. Member for Clydebank and Milngavie (Mr. Worthington) gave a compelling contribution on the role and performance of the ECHO.The Independent yesterday described in detail the EU's procedure for making the decision to send aid that is required before aid can be sent and properly distributed in the right place.

Do we not learn again and again that the response of the United Nations and of the European Union is often deeply disappointing? Are two options not before us? We could put much more energy and attention into trying to improve the performance of the multilateral agencies. I would love to hear what the Department for International Development seeks to do on the matter. What focus are the Minister and the Secretary of State placing on getting a better performance from those organisations? Are the Government concluding, as many of us are, that time and again the response to such crises by nation states far outweighs the performance and response of the multilateral agencies? The difficulty is one of lack of co-ordination. What are the Government doing to improve co-ordination between nation states on situations such as those in Ethiopia and Mozambique?

We are told that such situations will arise more and more because of climate change. A key issue in the 21st century will probably be how we decide the way in which to respond. The hon. Member for Cynon Valley (Ann Clwyd) set out a five-point plan for the Government's response to Ethiopia, with which I agreed so much. There is a lack of clarity in the Government's response to the Ethiopian crisis and to countries in conflict generally. Will the Minister bring an end to that confusion and spell out precisely what the Department will do in response to countries in conflict in general and Ethiopia in particular?

Like everyone else, I congratulate the hon. Member for Richmond Park (Dr. Tonge) on obtaining this debate, which I welcome, although I would have welcomed a little more time to reply to it.

I take no lessons from the hon. Member for South-West Devon (Mr. Streeter), the Opposition spokesman. I have been a spokesman on international development for years, but the hon. Gentleman has never asked a question on the matter or taken part in debates on the subject. However, I shall take note of what was said by the hon. Member for Richmond Park and other hon. Members.

It is sad that the debate is necessary. Indeed, as my hon. Friend the Member for Cynon Valley (Ann Clwyd) said, it could have taken place at any time during the past 20 or 30 years. The story is far too familiar. Environmental degradation, military conflict, pressure from a growing population and ill-judged policies are a lethal mix. They bring hunger and misery on a massive scale. As my hon. Friend the Member for Clydebank and Milngavie (Mr. Worthington) pointed out, the international community's response is in many cases far too slow. We respond to the television pictures, but when the media interest dies down, we return to the same cycle. We should take time to consider the problem in a more measured way and learn from such sad examples as Ethiopia.

Although the food situation is certainly critical in the south and east of Ethiopia, the crisis is not on the same scale as that of 1984–85. That is not only the Government's view; it is what the 15 international non-governmental organisations working in Ethiopia said in their press release in Addis Ababa last week. Ethiopia is one of the poorest countries in the world. More than half the population scrapes by on less than $1 a day, and 85 per cent. of the people depend on agriculture for a living. Rural Ethiopia is exceptionally poor. Food insecurity is a common cause of rural poverty.

Every year, between 2 million and 3 million people experience food shortages. That situation has been made worse by the failure of the rains in the past three or four years. The 8 million people who are defined as being at risk are those who live in households with a chronically insecure food supply. Those people are desperately poor. For a large proportion of them—perhaps as many as 5 million—it would not matter whether it rained or not. Their principal problem is not drought but poverty—real, long-term, grinding poverty.

The press release issued last week by the 15 NGOs ended with the statement, with which we agree, that the people of Ethiopia need peace, a subject raised by the hon. Member for South-West Devon. The Algerian presidency is trying to resolve the conflict on behalf of the Organisation of African Unity. The President of Algeria has invited the Foreign Ministers of Ethiopia and Eritrea to Algiers in the coming weeks for further discussions. We and our international partners continue fully to support the efforts of the OAU. We have urged both sides—I now do so again—to co-operate with the OAU mediators to end that futile conflict immediately.

The 15 NGOs' also suggested that more development was needed and that debt relief was necessary. How true that is. Food aid will not lift those 8 million people out of their long-term, chronic poverty: sustainable economic and social development will. The Government of Ethiopia knows that; indeed, they have made good progress since they came to power in 1991. That success has attracted substantial support from the international community. The tragedy is that the war with Eritrea has seriously affected Ethiopia's economic and social progress. We cannot dismiss that as though it were unimportant.

I shall cite some statistics that were not previously available. Comparing the current financial year with the period from 1995– 96 to 1997–98, recurrent expenditure on defence has almost tripled as a percentage of gross domestic product. At the same time, expenditure in the social sector fell from 3.7 per cent. to 3.4 per cent. of GDP. More worrying is the fact that capital expenditure in the social sector—investment for the future in schools and health centres—has dropped by a third during the past two years. Domestic borrowing has risen and external reserves have halved.

Those figures highlight the unsustainability of the military conflict, which has caused dialogue between the International Monetary Fund and Ethiopia to break down. External assistance has, sadly, been reduced and grant financing by donors has been halved. It is difficult to estimate how much aid the Government have lost as a result of the war, but a good estimate is between £90 million and £165 million. That is all the more serious and regrettable because, in the pre-war period, public expenditure was becoming poverty-focused.

Hon. Members mentioned working with NGOs. We continue to provide support for NGOs. We are involved in programmes with Farm Africa—I, too, welcome the Speaker's initiative on that—and SOS Sahel and the affiliated regions. But hon. Members, especially mems of the Select Committee, know that to create real change, we need to work directly with Governments who have pro-poor policies. If they do not, we work around them with the NGOs. The two approaches are not in conflict; they are complementary with good governance.

My hon. Friend the Member for Cynon Valley mentioned debt. The war has had an effect on Ethiopia's access to debt relief. Britain has taken the lead on obtaining debt relief for countries such as Ethiopia. It should have reached its heavily indebted poor countries decision point by now. Sadly, however, it is unlikely to do so this year, even if it quickly resumes its dialogue with the IMF. Its payments to service the debt will consume resources that could and should be spent on the poor—the very people we have heard described today and who we see on our television screens. That is another calamity of that unnecessary war.

The war has also affected the relief effort. The hon. Member for Banbury (Mr. Baldry) referred to logistics in his helpful contribution. Unlike the hon. Member for South-West Devon, he understands what it is like to be in government. The war has diverted trucking capacity and increased costs by making grazing land inaccessible, denying rural households additional income sources in Eritrea and denying access to the ports of Massawa and Assab in Eritrea. The Ethiopian Government have argued that the ports are not well placed to help with the relief effort. As my hon. Friend the Member for Cynon Valley said, how can it be easier to manage a relief operation through two ports—Djibouti and Berbera—rather than four? It defies logic.

An international effort is under way to bring help to Ethiopia. Some 85,000 tonnes of food was brought into the country in the first quarter of the year. Substantial pledges have been made—433,000 tonnes from the European Community for this year and a further 110,000 tonnes by June next year to help replenish the emergency food security reserve, which we helped to establish. The hon. Member for Banbury rightly said that we pay 17 per cent. of the cost of that package. Total pledges are adequate to cover existing food requirements, but they need to reach the people in need quickly. We are providing more assistance and pressing the EC to speed up its procedures to move food quickly. Some 30,000 tonnes was delivered through Djibouti last week. The assistance is arriving.

We also need to remind the Ethiopian Government of the need to play their part. I welcome their pledge to provide 100,000 tonnes of food aid, but only 7,000 tonnes has been delivered and none to the hungry of the Somali region. Food shortages have been exacerbated by drought, but they have not been caused by drought alone. In fact, 1999 was the third best agricultural production year in Ethiopia's history. The main rains last year were good, and wheat and pulse production figures were high. Could not the Ethiopian Government have taken the opportunity to provide food aid to those areas where the rains have failed in successive years to help those communities cope?

An importance governance issue is involved, as hon. Members said. Is it reasonable to blame the international community alone? Of course we have a responsibility, but we cannot be blamed for the plight of so many of Ethiopia's people. Their Government also have a responsibility. It is not true that we have cut humanitarian assistance to Ethiopia because of the war. We see humanitarian assistance not as a carrot but as something that must be provided. Like all other major donors, we have reduced long-term development assistance, but we would like it to be restored. When a successful peace deal is achieved in Ethiopia, we will continue our long-term development assistance to Ethiopia and Eritrea.

If I had more time, I would respond to the questions asked by several hon. Members and explain why the hon. Member for South-West Devon is, as usual, completely misguided about Mozambique, Zimbabwe and Ethiopia—

Order. Time is up.

I am very pleased to have the opportunity to discuss with colleagues the implementation of good practice in maternity care. First, I must declare an interest as an honorary vice-president of the Royal College of Midwives, a position that I hold with great pleasure and pride. As many hon. Members will be aware, in 1991 and 1992 I had the honour and privilege to chair the Select Committee on Health when it undertook an in-depth inquiry into maternity services. As the Select Committee's 1992 report says, the inquiry was instigated,

hearing many voices saying that all is not well with the maternity services and that women have needs which are not being met.

Paragraph 33 of the report says:

Given the absence of conclusive evidence, it is no longer acceptable that the pattern of maternity care provision should be driven by presumptions about the applicability of a medical model of care based on unproven assertions.

It would be proper for me to pay public tribute to the Select Committee's advisers who were: Caroline Flint, a well-known independent midwife; Mrs. Rosemary Jenkins of the Royal College of Midwives; Dr. Naren Patel, consultant obstetrician at Nine wells hospital, Dundee; Professor Osmund Reynolds, a close personal friend for many years, who was Professor of neo-natal paediatrics at University college and Middlesex school of medicine; Professor Philip Steer, Professor of obstetrics and gynaecology at Charing Cross and Westminster medical school; and another personal friend, Dr. Luke Zander, senior lecturer in the department of general practice at the United Medical and Dental School of Guy's and St. Thomas's.

All those people were vital to the production of the Committee's report. I should like to express my appreciation, these many years later, for the tremendous support that I received during the inquiry as Chairman of that Committee from all Committee members. To mention just one, the hon. Member for Preston (Audrey Wise) was, with me, the driving force behind the inquiry. I hope that hon. Members will allow me to say that I wish the hon. Lady, who is in hospital at the moment, a full and speedy recovery.

The future reconfiguration of maternity units is currently under discussion, which I believe provides an opportunity to reshape the provision of maternity care in the United Kingdom. Where trust mergers are unavoidable, resources must be directed in such a way as to enhance the quality of maternity care. This is an opportunity for the Government to act on the growing research evidence that demonstrates the huge advantages of midwifery-centred care in the provision of maternity services.

Following the Health Committee report in 1992, an expert committee chaired by Baroness Cumberlege, a health Minister at the time, considered the implications of the Health Committee's recommendations. In due course a report called "Changing Childbirth" was published, setting targets for implementation and recommendations for good practice. On page 1, the report said:

The Select Committee concluded that a medical model of care should no longer drive the service and that women should be given unbiased information and an opportunity for choice in the type of maternity care they receive, including the option, previously largely denied to them, of having their babies at home or in small maternity units.

As the Chamber knows, "Changing Childbirth" became policy for the maternity services in England in 1994 and remains the policy today.

The report called for fundamental changes in the maternity services, based on three principles—the importance of involving women in making informed decisions about their care, making maternity services accessible and attractive to all women and having public involvement in the monitoring and planning of maternity services. A key to putting those principles into practice was reinstating more autonomous midwifery practice and enabling midwives to provide continuity of care. Time and again when we were taking evidence from mothers to be, they talked about the importance of the continuity of care—having women cared for by a named midwife through the whole of pregnancy, for labour and birth, when possible, and in the early weeks following birth. It was recommended that midwives be organised into small groups, working between community and hospital. An explicit target was to have 75 per cent. of women cared for by a midwife whom they have got to know for labour and birth. That is something that I feel strongly about, as did the Health Committee at the time.

The Royal College of Midwives has supported "Changing Childbirth" since its publication and throughout its implementation and remains committed to the principle of a woman-centred care structure. It is no longer appropriate for maternity care to be for the convenience of consultants and doctors; it is there for the mothers and babies.

In a new year press release, the Minister for Public Health stated:

Maternity services are at the heart of the service that women and babies of this country want and deserve.

In the opinion of some of the user organisations, this is now an issue not of choice but of public health. In the nearly 11 years since "Changing Childbirth" was published, maternity care has, sadly, not moved towards the ideals embodied in the report. Indeed, and I say this with some regret, for most women the likelihood of a normal birth with a known midwife is even less now. The centralisation and medicalisation of birth in large obstetric units has intensified rather than declined. Caesarean section rates since "Changing Childbirth" have increased to over 30 per cent. in some hospitals and have recently shown signs of rising still further. This is a major cause for concern.

Full implementation of "Changing Childbirth" depended to a large extent on good midwifery practice. With the severe shortage of midwives, many of the excellent pilot schemes that were originally set up have failed to continue. The latest statistical analysis of the register of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting reveals that there are 33,897 practising midwives and a further 58,286 who are registered but not practising. That is a lamentable waste of skills and talent.

Sadly, since 1994, the quality of maternity care has deteriorated. Consumer groups, including one for which I have the greatest regard, the Association for Improvements in Maternity Service, which is known affectionately as AIMS and is chaired by that splendid lady, Beverley Beech, is reporting many more serious complaints from all over the country. It attributes them to a reduction in midwifery staff, particularly in the more senior midwifery grades—it is worth emphasising that. At the same time, it is reporting many letters from former midwives who have left the service in despair because they were not allowed to practice normal midwifery and provide the normal births for which they had been trained. Instead, many became obstetric nurses in high-tech hospital units.

Caesarean sections are a matter that causes considerable concern. Some obstetricians now provide caesarean sections on request for women with no medical reason to have them, thereby adding to the risk to both mother and child as well as to national health service costs. At the same time, NHS trusts are failing to provide proper care for those women who want and should have a normal birth. Delivery by caesarean section carries a higher risk, as I am sure that many hon. Members know—not least among them the Minister—for both mother and baby. The mother has a slower rate of recovery, a reduced chance of successful breastfeeding, an increased need for post-natal care—which, sadly, is in short supply—and a greater risk of complications.

One of the major risks of caesarean section comes with the birth of the next child and any subsequent children. The mother has a greater risk of placenta praevia when the placenta blocks the outlet, leading to haemorrhage, an increased risk of the placenta becoming embedded in the wall of the uterus, and the risk of life-threatening haemorrhage when an attempt is made to remove it. There has been an increase in emergency hysterectomies carried out after birth to save the life of the mother who has had one or more caesarean sections for previous births. If those caesarean sections were unnecessary, surely the resulting problems are a high price to pay. Ironically, medical litigation costs the NHS more than £300 million every year and obstetric claims account for more than 50 per cent. of that total.

Good practice is the provision of a service that allows women who wish to have a normal labour and delivery without medical assistance to do so. There is now ample medical evidence that normal births at home are at least as safe as hospital births. However, it is rare for women to receive clear, unbiased advice—I say that with fervour—or to be able to choose where to give birth to their babies. Women are not told of the risks of hospital births, but the risks of home birth, both real and imagined, are heavily stressed by the medical profession. AIMS receives calls daily from women who want to give birth at home but are being persuaded into accepting a hospital birth and now that the midwifery shortage is acute, staff are telling mothers, "Should there be a staff shortage in the hospital when you go into labour you will have to come into the hospital."

I turn to midwifery education. The centralisation and medicalisation of birth in large obstetric units has resulted in a significant group of midwives who are not confident of supporting a woman who wants a normal physiological birth. They can only offer drugs for pain relief and are stressed by caring for a woman who is not immobilised by a foetal heart monitor and connected to an epidural. In a recent AIMS journal, a non-practising midwife, deploring the decline in good skilled midwifery practice, commented that student midwives learn good theory in the classrooms, but bad practice in the wards of our hospitals. AIMS hears from an increasing number of student midwives who say that, although they are nearing the end of their training, they have not witnessed a normal physiological birth. Is that not extraordinary? Surely there is something wrong with a system that allows that to happen.

At Chelsea and Westminster hospital, 80 per cent. of pregnant women are given epidural anaesthesia. As a result, student midwives are unable to understand and support a woman in normal labour. Such women behave very differently from those who are given epidurals. Because of that training failure, midwives no longer understand the natural progression of labour in a normal, unmedicated physiological birth. Indeed, AIMS files bulge with reports of the strategies adopted by many midwives to persuade women who had home births to give birth in hospital.

What is the way forward? The Royal College of Midwives wants maternity services to be orientated around primary care, and the use of midwifery-led units to be increased. Examples of successful units include Trowbridge hospital—which is part of Wiltshire Health Care NHS trust—where more than 600 deliveries a year take place. In inquiring into maternity services, members of the Health Committee visited that hospital. The Edgware birth centre recently presented the findings of its two-year project in an evaluation report.

Hospitals in which team midwifery has excelled include Bolton hospital—again, in my own part of the country—which is part of Bolton Hospitals NHS trust. At the Crewe health centre—which is even closer to my constituency and that of my hon. Friend the Member for Congleton (Mrs. Winterton), and is part of the Cheshire Community Healthcare NHS trust—the caesarean section rate has been reduced significantly. I applaud that statistic, the hospital, the midwives and other clinicians involved at Leighton hospital.

The current shortage of midwives in maternity units is a problem in terms of recruitment and retention. If depreciation in services is to be avoided, that shortage must be addressed by health authorities and, if I may say so, the Minister in particular. Education and training must also be emphasised. Salford provides a good example of a comprehensive training school. Students there experience deliveries from a variety of backgrounds. The recent practice of recruiting consultant midwives is an encouraging development that should be extended throughout the United Kingdom. If the theoretical training of student midwives is to be reinforced and supported, they must be provided with a thorough grounding and understanding of normal birth.

The education system should be linked to stand-alone midwifery birth centres, and I hope that the Minister will comment on that. A community-based service that supports case-load midwifery was introduced in Professor Lesley Page's one-to-one midwifery care scheme. I have met Professor Page and 1 have the greatest respect for her. Her contribution to maternity services is outstanding.

The Minister and hon. Members will know that one-to-one midwifery was established in November 1993 in the Hammersmith Hospitals NHS trust, at Queen Charlotte's and Chelsea hospital, and Hammersmith hospital, so that the "Changing Childbirth" principles could be put into practice. Each midwife has a case load of 40 women. Sensibly, each works with a partner and, so that they can cover holidays and so forth, they get to know the women in each other's case load. Partnerships are organised in group practices of six to eight midwives, which allows allocation of case load, mutual support and a forum for peer review of practice. Again, those are sound procedures. The one-to-one midwives survey geographical catchments area includes low and high-risk women. If the woman's pregnancy is low risk, the midwife manages the care, but if it is high risk, an obstetrician does so, although, importantly, the one-to-one midwife will continue to provide midwifery care.

The education system should be linked to a home birth service in which all midwives are supported and enabled to practise autonomously, should they wish to do so. For many years, midwives in independent practice have been able to provide a high-quality service for the women whom they attend—they are often high-risk women who are unwilling to have a second hospital birth. In order to practise autonomously and to fulfill their role to its fullest extent, those midwives have had to practise independently and, sadly, outside the NHS. It is time that their contribution to maternal and child health was recognised and those dedicated midwives were supported within our splendid NHS. The situation in New Zealand shows that an independent model in the health service would enable all women—not simply those who can afford the fees or those for whom the midwives provide charitable care without payment—to benefit from real choice, control over their body and continuity of care. That restructuring of care would enable obstetricians to focus on and develop quality of care for high-risk women and those who choose to give birth in a high-tech unit.

Several initiatives have had excellent outcomes, including the one-to-one midwifery practice, which I discussed earlier, and the Edgware birth centre. During the two-year evaluation period between 1 September 1997 and 31 August 1999, 387 women had their babies at the centre, which was in line with the targets that had been set. In that period, 727 women booked into the centre; 19.4 per cent. transferred ante-natally and 12 per cent. transferred during labour.

I am delighted to say that women who planned to deliver at the birth centre during the evaluation period recorded very high levels of maternal satisfaction, which is crucial when women give birth. They also had need of far fewer interventions than women who were in the same risk category but who delivered in hospital.

I hope that the Minister will bear with me while I give some statistics. In relation to planned caesareans among low-risk women, there were interventions in 3.3 per cent. of cases in local hospitals and in only 0.3 per cent. of cases in birth centres. The national figure, which includes all women and covers the period 1996–97, was 8 per cent.

In relation to inductions among low-risk women, there were interventions in 16.8 per cent. of cases in local hospitals and in 7.3 per cent. of cases in birth centres, which is significantly lower. The national figure, which includes all women and covers the period 1996–97, was 20 per cent.

In relation to epidurals among low-risk women, there were interventions in 30.7 per cent. of cases in local hospitals and in only 11.4 per cent. of cases in birth centres. The national figure was 19 per cent.

In relation to episiotomies among low-risk women, there were interventions in 18.9 per cent. of cases in local hospitals and in only 5.1 per cent. of cases in birth centres. The national figure was 20 per cent.

In relation to the use of forceps among low-risk women, there were interventions in 5.1 per cent. of cases in local hospitals—the figure for the use of the ventouse in that category was 9.5 per cent.—and in birth centres the relevant figure was 2 per cent. for forceps and just 1.9 per cent. for the ventouse, which is the vacuum extractor procedure. The national figure was 11 per cent. Some of those figures were provided by the Department of Health.

In addition, women who delivered at the birth centre had labours that were on average 15 per cent. shorter than the labours of similar low-risk women who delivered in local hospitals. Much less use was made of clinical anaesthesia such as pethidine. Remarkably, 50 per cent. of babies born at the centre during the evaluation period were born in water.

The cost of deliveries at the birth centre was significantly cheaper—by up to 30 per cent.—than that for similar women delivering in hospitals.

The research and evaluation has some limitations—the comparatively small sample, the difficulty of obtaining comprehensive and accurate financial information, the lack of information about women who choose not to book at the centre, and the fact that the research was done at the start of the birth centre project.

Another practice that I am sure is well known to the Department and the Minister is the Albany midwifery practice. The practice's costs are £180,000 for the midwifery care of 2,316 women, of whom 47 per cent. are Caucasian and 53 per cent. black African, Vietnamese or Asian. The home birth rate is 37 per cent. The rate for non-pharmacological analgesia is 65 per cent. The rate for spontaneous vaginal delivery is very high, at 78.9 per cent. The rate for intact perineum is 63.5 per cent—that is very important to women. At four weeks, 74 per cent. of women were breastfeeding.

For those who do not know, I shall explain the history of the south-east London midwifery group practice, which I shall call the Albany practice. It was established in 1994 as a self-employed, self-managed group of midwives and a practice manager. The aim of the group is to provide continuity of midwifery care to local women—ante-natally, during the intra-partum period and post-natally—with known midwives, with a policy of targeting certain groups and promoting equity of access, thereby meeting the objectives of "Changing Childbirth".

I am very impressed by the Albany statistics. Can the hon. Gentleman tell me whether the 26.5 per cent. of patients that did not have intact perineum had episiotomies or perineal tears? Earlier, he said that the episiotomy rate at the Edgware birth centre is extraordinarily low—much lower than the rate for intact perineum that he quoted for Albany.

I respect the hon. Gentleman for his professional knowledge. I cannot immediately give him an answer, but I shall certainly ascertain that statistic and come back to him. It is a relevant question, and I am sorry that I am not currently in a position to respond to it.

The Albany practice secured direct funding from the health commission to provide midwifery care for 130 women a year. The group also looked after a further 20 women from the Greenwich area. The mode of care offered quickly proved to be extremely popular with women, and the group's work soon became nationally and internationally acclaimed as ground-breaking. It is still valued as an important resource for all those who are interested in that type of innovative midwifery practice.

Towards the end of 1996, despite its success, the Albany practice was under serious threat. It became apparent that the health authority could not readily make funds available for it to continue. Having always had positive connections with King's college hospital with—especially strong support from Cathy Warwick, the director of midwifery—the practice proposed a subcontract with King's health care trust.

Although that would inevitably mean losing some of its autonomy, the group felt that it would be worth while in view of the potential of such collaboration. I am pleased to report that the health authority was supportive of such a solution and agreed to contribute to the funding required for the new approach. In the light of the practice's excellent outcomes and predicted cost-effectiveness and health gain among the local population, both parties are hopeful about the effects of making the Albany practice midwifery model part of what I would describe as midwifery mainstream. The proposal would also relieve some of the pressure imposed by long-term midwifery vacancies at King's college hospital.

The Minister will know that the Albany practice is one of eight midwifery group practices at King's. The group comprises seven midwives and a practice manager based at the Peckham Pulse and it is self-employed and self-managed. A sub-contract has been negotiated between King's and the Albany practice to provide maternity care for women in and around Peckham. I am sure that that is of great interest to a friend of the Minister's, the right hon. Member for Camberwell and Peckham (Ms Harman). The case load is generated by four local general practitioners, some self-referrals and some referrals from consultant obstetricians at King's.

The Albany midwifery practice offers women-centred care, as recommended by the "Changing Childbirth" maternity group. The practice offers continuity of midwifery care with two known midwives for each woman. It provides ante-natal, post-natal and intrapartum care. I believe that the Albany practice is unique in the United Kingdom, but I hope that that uniqueness is quickly lost and that its example can spread throughout the country.

The House and women owe a great deal to the Health Committee report and to the subsequent work of Baroness Cumberlege. It is important that maternity services in Britain are focused on the mother and the baby. Doctors have a role to play, but care should no longer be organised around doctors, obstetricians, gynaecologists and the medical profession. It should be a service specifically for mothers and babies, in which midwives have a pivotal role to play. I am delighted to be associated with them and I hope that the Minister will respond positively to my concerns.

I pay tribute to the hon. Member for Macclesfield (Mr. Winterton) for putting the case so fluently, in his own inimitable way. It is good to see that the Minister for Public Health is present to respond, as well as her shadow counterpart, the hon. Member for Meriden (Mrs. Spelman).

I want to speak almost entirely about the midwife-led aspect of maternity care. I was born through caesarean section, through no fault of my own, and I know what an important aspect of care midwifery is. Stroud has a midwife unit that is one of only two remaining units in the south-west. It was under threat of closure some two or so years ago, which is why I have spoken on these matters in a debate on national health service maternity services that was led by my hon. Friend the Member for Braintree (Mr. Hurst) in the House on 11 February 1998. I do not want to repeat the arguments that were rehearsed in that pertinent debate.

The hon. Member for Macclesfield was Chairman of the Health Committee when the seminal document "Changing Childbirth" was published in 1993. I make no apology for repeating, rather than stealing or plagiarising, an important part of that document, which was mentioned by my hon. Friend the Member for Braintree in the debate in February 1998. The key element is choice. He quoted a passage that I shall quote again now, because it is so important. The Committee said:

We recommend that the policy of closing small rural maternity units on presumptive grounds of safety be abandoned forthwith. We further recommend that no decision be taken to close such a unit unless it can be explicitly and incontrovertibly demonstrated that they are failing to provide value for money and that the costs to the consumers are carefully taken into account in making such calculations. We recommend that in considering an appeal against the closure of such a unit, the Secretary of State should make presumption against closure unless the case is overwhelming, since we believe that there is a shift in attitude towards maternity care which can only be met by maintaining such units as a realistically available option.

Choice is the keynote of the debate, and that was borne out in the "Changing Childbirth" report. The issue is one of disseminating best practice and keeping maternity care as local as possible. The size of units is also important. Within reason, women want smaller units for pre-natal and intra-partum care, but also postnatally, including perhaps transferring from a district general hospital when they want to be closer to family and friends.

My contribution to the debate in 1998 was to argue strongly for midwife-led services in Stroud to continue. The Stroud News and Journal led an effective campaign, which I was happy to support. Our proposal involved saving £150,000 from a budget of £248 million, which puts the matter in perspective. We wanted to show that women and families supported the continued operation of the unit in Stroud. That was partly due to its being part of a much larger operation in Stroud hospital, which has become a centre of excellence. I thank the Government for the recent upgrading of the accident and emergency department in Stroud. It seems important to have the appropriate range of services across the age range. There is an important development in elderly people's care on the hospital site, and it is important to keep the maternity unit there. In 1993, when "Changing Childbirth" was published, the unit was refurbished and was reopened by Dr. Mark Porter—some hon. Members know him—a constituent of mine who is known to me personally.

During the debate in February 1998, the then Under-Secretary, my right hon. Friend the Member for Brent, South (Mr. Boateng), promised that proper consultation would always take place on any proposal to close a unit, that the presumption would be against closure and that the Government would support best practice and new initiatives.

In discussing the two remaining threats I shall refer to a review document that I have just obtained. The two threats seem to be the economic case for further centralisation and medical opinion. The Government deserve praise for the money that they made available to my area's health authority in the Budget, and the commensurate changes made at the time, which have lifted the pall that was over the authority. However, a value for money argument can be made, and we cannot ignore it. Even so, very small sums are involved in relation to the overall budget.

When we last discussed the Stroud midwife-led maternity unit, it was decided to keep it open but to review it regularly. The latest 18-month review has just been completed. We did not talk explicitly about the cost, because that is a matter for the seven NHS trusts and the health authority. A more difficult problem was that of medical opinion. The hon. Member for Macclesfield made it clear that obstetricians and other specialists still continue to argue in favour of babies being delivered in district general hospital units.

I am not taking a dig at the GPs in my area, but they are generally somewhat ambivalent towards a local midwife-led service. That does not help, because most women will take their GP's advice when they receive the happy news that they are pregnant. If GPs gave a more positive response, on safety and the right to choose, we would have every reason to keep midwife-led units open. The risk factor is slight, but in difficult cases, Stroud is not a million miles away from consultant-led units in the district general hospitals at Gloucester or Cheltenham. We can have the best of both worlds. I hope that GPs and consultants will continue to listen.

The three keynote terms in the 1993 report and today's are the need for a service that is comprehensive, flexible and based on choice. The current review is now completed. The target was 350 births a year. That is difficult to reach; although the number of births has increased, it must be set against an overall decline. We are trying to go against the tide.

If complications arise, cases will inevitably be transferred to the district general hospital, which will reduce the number of women using the local midwife-led unit. Indeed, there is always pressure to go for the safe solution. I did not go for that option: two of my children, Laurence and Christopher, were born in Stroud maternity hospital. Esther was born at home with the help of the midwife service run from Stroud. I have personal experience of the quality of care and the personal service offered by the midwife service.

I do not wish to mix statistics with the hon. Member for Macclesfield—he left me for dead with his—but I have no reason to doubt their importance. The number of births each month can vary. For instance, in December 1998 there were only 13; last month, there were 27. That is obviously going in the right direction, but variations can occur. Transfers back to the midwife-led unit for ante-natal and post-natal care are somewhat unpredictable. However, such variations are inevitable because childbirth has yet to be completely sanitised. Long may that continue.

Some significant improvements have taken place. We now have the support of paediatricians at Gloucester Royal hospital. That has led to the drawing up of a protocol which shows that there is a belief that the service in Stroud is safe, that it has a high quality threshold and that it is popular. Much has been done to publicise the service and to show women in the area that it is open for business. The service wants to make itself known to as many people as possible. The fact remains, however, that GPs are not always as helpful as they might be. Anything that I can do to persuade them otherwise is important.

There is good support from the National Childbirth Trust, the league of friends of the hospital and the ladies circle that works with the league of friends. We are not yet at the threshold of 350 births a year. I hope that that will not be used as an opportunity to revisit the usual response—difficult meetings with officials—with many people being angry that their wonderful and well-loved service was threatened.

Much is happening. There are many initiatives. One of our midwives—Helen Conway—iswell known to me. She is in China learning about different ways of delivering and the use of acupuncture. Anyone who knows Stroud will be aware that we are very alternative there. I probably have more acupuncturists than general practitioners in my constituency. Acupuncture provision will fit centrally into what women seem to want.

I want from my hon. Friend the Minister a clear statement that there is a future for midwife-led units, that they are safe and that they should be there to respond to the choice that women wish to exercise. I want her to pass on my message to the local trust that we do not want to revisit the possible closure of the unit. Such threats lead to great public aggravation and take us no further forward. I want to hear that the costings, which are not as important as the medical opinion, can be put in place to show that the staff have a future. The staff may then breathe a sigh of relief and the women and families of the area may then be given the services that they so clearly want, not only in the local midwife-led unit but at the district general hospital. The choice must always be there for people.

I hesitate to contribute to the debate, as a man and, worse, a doctor with a qualification from the Royal College of Obstetricians and Gynaecologists. The college appears to be the baddie of the debate.

"Changing Childbirth" was a seminal document. It was important because it recognised that childbirth had changed over the years. When I first saw the title I thought that it was ridiculous. Women have always had babies and, other than Pallas Athene, who was delivered through an especially unusual route, they have had them vaginally or by caesarean section.

We have moved too far towards technical intervention in childbirth. However, I would like to remind the hon. Member for Macclesfield (Mr. Winterton), who spoke with great depth of feeling about the benefits of natural childbirth, that natural childbirth can also result in a high rate of dead or handicapped babies. It can result in significant mutilation of mothers with subsequent obstetric disasters and perhaps, even more sadly for them, incontinence, which is extremely difficult to treat. One need only consider what happens in the third world, where nature is all that people can fall back on, to understand that natural childbirth does not deliver an especially good service. Whatever we discuss with regard to maternity care, we must not deny that nature needs professional and high-quality help.

I am as one with the hon. Member for Macclesfield in saying that the approach should be woman-centred. I was pleased that he acknowledged later in his contribution the importance of the baby. He was right to say that we need a personal service for women. Childbirth can be the most wonderful experience, not only for the woman having the baby and the family concerned but for the other people involved in the birth. The experience can also be hairy and frightening when things unexpectedly go wrong and get slightly messy. Whatever model we adopt, we must ensure the flexibility to which the hon. Member for Stroud (Mr. Drew) referred.

I am listening carefully to the hon. Gentleman and, although it is early in his speech, he has not so far mentioned midwives. The midwife is a qualified professional, and if there is continuity of care, the mother to be can be provided with the confidence and expertise to have a normal birth. Midwives are professionals, and if it becomes necessary to involve a consultant, they will immediately pass over the case. However, the midwife can provide the continuity that is so essential to the woman in giving birth.

I am grateful for that intervention. The hon. Gentleman anticipated my next point. Professional help is required, and the lead professionals in this area are midwives. The expertise and time of midwives can make an enormous contribution to a normal delivery. I have no doubt that women who are well looked after, who feel relaxed and are confident of the support of someone they know, have much better births and the process is much more positive. I agree with the hon. Member for Macclesfield that there is evidence that women who are relaxed and confident need less anaesthesia, but I do not agree that it is necessarily a bad thing for a woman to choose to have analgesia. At times during his speech, I thought that we were listening to the critics of Queen Victoria, who indulged in artificial anaesthetics during some of her many deliveries.

The essence of my remarks is that giving birth is the province of midwives. The setting for giving birth should be the personal choice of the woman who is having the baby, but in promoting home deliveries, which are the most satisfying part of one's career, it is important to remember that they can be carried out only if there are experienced midwives in sufficient number. Otherwise, one might find that no one is available, except a midwife 30 miles away whom the mother has never met, which destroys the whole idea of continuity of care.

It is also essential that a second pair of hands is available at the time of birth in case there are problems with the baby. It is essential that someone at the birth can intubate the baby if required. It is also essential that the home circumstances can be enhanced if necessary. One of the reasons why the Dutch have much better statistics than we do is that they provide social support in the later stages of pregnancy, which makes an enormous contribution. It is also vital that there should be ready access to a flying squad. I am one of the wicked GPs who dissuaded people from having their babies at home because it took about one hour for a flying squad to arrive. That is a complete waste of time, and a flying squad should include someone with obstetric experience as well as an anaesthetist.

We heard some good stories from the hon. Member for Stroud (Mr. Drew). I had the privilege of witnessing the birth of both of my sons, but they were born in hospital. One of them would not have survived at home, and my wife would not have survived if she had been at home when she gave birth to the other. We must put this in perspective. Home deliveries require an adequate standard of professionalism at the home and back-up by the hospital unit. There should also be the option of the midwife transferring the mother to a midwife unit within the hospital or to an obstetric unit run by a consultant. We have made progress on that. The Cumberlege report was a bombshell for most obstetricians who withdrew into a professional laager saying, "The world will now stop." They realised that they had underestimated the professional capacity and capability of midwives and had overestimated their own importance in women's minds. Patients are sensible and pick who suits them best.

If we are to continue to extend the role of midwives, which is a positive approach, we need to do something about their training, as the hon. Member for Macclesfield said. We must also allow them to have a decent career structure. It is unacceptable for a qualified midwife to be employed at a D or E grade. That is what drives them out of the national health service. When we consider different patterns of deliveries—I was impressed by the statistics for the Edgware birth centre and the Albany unit—we must ensure that we compare like with like. Innovative units attract a different section of the population than a district general hospital, which is used by a more average part of the population. A pre-selected group might produce different outcomes.

The Health Committee last year, or possibly the year before, considered caesarean section rates published by the NHS executive. I asked how many home deliveries had occurred in the district for which the rates were being given, but that figure was not known. If 30 per cent. of normal babies are being born at home rather than in a hospital unit, it is obvious that caesareans are being performed on a different section of the population. We need to be clever with statistics because they can be used in different ways.

The hon. Member for Macclesfield mentioned the role of independent midwives. I have no problem with independent midwives, but they need to function within a framework that provides the full back-up that is available to other midwives. They must also accept clinical governance. I am afraid that independent midwives are sometimes reluctant to have their figures queried. It is not good enough to rely on high-profile press reports when something goes disastrously wrong. They should be licensed and have their competence evaluated, which should also happen to general practitioners. I hope that that will be part of the accreditation system. It is unacceptable for GPs to be on an intra-partum obstetric list if they are not involved in intra-partum care. It is unfair—and silly—to call out a practitioner who has not delivered a baby for two years to deal with a complication that is being handled by a professional who probably manages 100 deliveries a year. We need an ante-partum list and, with the right education, post-natal care will look after itself.

I am glad that we have had this debate. Not only is the way in which childbirth is being managed changing all the time, but so is the population that is giving birth. We must remember that women are now much older when they have their first baby. Again, I have some problem with the promotion of natural childbirth at all costs. We must consider the mother's age. It is rather rude to talk about elderly primates. The age used to be over 35; I think that it has now been raised to 40. There is no doubt that women have babies much more easily in their early 20s or late teens than in their late 30s or early 40s. It would be foolish to encourage people to take a completely natural route if any complications were envisaged.

Does the hon. Gentleman agree that the mother to be should make that choice—I accept with the best advice? To date the clinician has too often left no choice. Those who support the views that I have expressed want the mother to be to make that choice, but from a position of knowledge, if there are complications.

Of course the woman should make the choice, but it should be an informed choice and one that takes into account the outcome of the process—the baby. I do not accept that it is necessarily bad practice to have a high rate of epidurals, to offer analgesia or to have foetal monitoring, whether in the home or in hospital. If we are to screen out higher-risk procedures and anticipate events, the safest way to shift a baby to a place of safety is in the mother's womb, and not attached to something else.

Technology should help natural childbirth; we should not look to it as an alternative.

I congratulate the hon. Member for Macclesfield (Mr. Winterton) on securing this important debate and drawing attention to the Health Committee's work on this issue. I found it particularly interesting to hear all the information about the Edgware birth centre. When that is on the record, many more people will be aware of its interesting statistics.

I know that the Minister for Public Health gives midwifery a high priority, because in her new year message she said that maternity services were at the heart of Government. She perhaps knew at the time just how important that would be to those in government. Indeed, we wish the Prime Minister and his wife all the best in their imminent happy event.

For all the fine words, there is a gathering crisis in midwifery when a third of all trusts cannot provide one-to-one care for a woman. There is nothing more terrifying for a woman who is in labour, perhaps for the first time, than when the midwife leaves the room. Although I have no information to support my theory, I suspect that such non-attendance occurs more often in an institutional setting than at home, when, by definition, the midwife has to be there. At such times, prospective parents feel very vulnerable if they are left alone with the incessant bleeping of the foetal monitor. It is just the sort of thing that "Changing Childbirth" was designed to avoid. I am pleased that hon. Members on all sides have paid tribute to the work of Baroness Cumberlege in producing that document, which is a seminal work. All of us are united in wanting to see it implemented.

It is essential to quantify the extent of the crisis. The Royal College of Midwives survey shows that three out of four midwifery units carry vacancies and that the number of long-term vacancies has risen to 55 per cent. of all vacant posts. That translates into a shortfall in absolute terms of 1,000 full-time midwives. There is no doubting the strong sense of vocation that midwives feel, but their morale is not good at present. That is not hearsay; the facts speak for themselves. Only 36 per cent. of registered midwives are practising today and the number of students entering midwifery education is falling. Several hon. Members have suggested reasons for that.

I echo the view that there should be a review of the salary structure in midwifery. Nurses' pay has increased, especially at the upper end, but midwives often find that their wage levels reach a plateau, despite years of experience in midwifery that should be recognised. Midwives, by definition, travel a great deal as part of their work and a further aggravation is that their mileage allowance remains very low. In order not to sound hypocritical, I should point out that it is less than half that of a Member of Parliament.

The recruitment and retention problems are not only due to pay levels. The number of vacancies has a bearing on working conditions. When vacancies are not filled, those who remain must carry a greater load. The average shortage of midwives is 2 per cent., but that disguises big regional variations, especially in the London catchments area where competing salaries make retention even more difficult. In the North Thames area, the vacancy rate is 5.9 per cent., and in South Thames it is 6.1 per cent. Those figures are significantly above the national average.

Some of the low morale is related to the erosion of the status of the profession. Midwives feel that the integrity of their profession has been compromised by the fact that they are now trained jointly with nurses for much of their preparation for practice. Respect for that practice is undermined by forcing midwives to join nurses in, studying courses that are not relevant to midwifery—for example, courses designed to train nurses in the early detection of the signs of dementia. That is unlikely to be relevant to women of childbearing age. They may become demented during labour but it is not a permanent condition.

Another factor that has a bearing on the crisis in midwifery is the shortage of consultant posts in obstetrics. That is a piece of NHS mismanagement of the first order. In response to the shortage, an accelerated training programme—the Calman programme—was set up five years ago. It was agreed that the number of new grade, specialist registrars should increase at a rate of 6 per cent. a year. That was designed to achieve a target of 2,000 consultant posts over 15 years. However, the number of consultant posts has not kept pace with the target, and trained-obstetricians cannot now find jobs. Indeed, they are leaving the NHS altogether.

Last year, the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives jointly published a document called "Towards Safer Childbirth". One of its recommendations was that a consultant should be present in the labour ward for 40 hours a week. Speaking as a lay woman in this matter, I cannot help observing that babies are no respecters of the 40-hour week and have a tendency to arrive at night. As I know to my cost, things can go wrong very suddenly during childbirth. It is important to have specialised help on hand if, for example, a woman suffers a haemorrhage.

As the hon. Member for Isle of Wight (Dr. Brand) pointed out, the increasing age of women at childbirth is an important factor when considering the ratio of midwives and obstetricians to the number of women giving birth. For the first time, the average age of women at first birth is now over 30. There are more complications in childbirth as the age of the mother increases. The advancing age at first birth may also partially explain the rise in the caesarean section rate, although I agree with the main thrust of the argument advanced by my hon. Friend the Member for Macclesfield that there is a strong tendency towards technical births rather than natural ones. However, it is important to note that the advancing age of women at first birth is likely to give rise to an increase in the caesarean section rate.

In another place, Earl Howe drew attention to the unacceptable level of preventable accidents in labour. He said:

1995, 453 babies died as a result of asphyxia or trauma suffered during labour or delivery.—[Official Report, House of Lords, 12 January 2000; Vol. 608, c. 738.]

That represents half the total number of infant deaths in childbirth. The shortage of midwives must be a contributory factor to the state of morale in the obstetric profession.

Another important point that was brought out in the debate was that this country has one of the highest percentages of low birth weight babies, higher than even Albania and Latvia. That is a disgrace, and I would like to hear from the Minister what steps the Government are taking to tackle it. Low birth weight is, of course, associated with other health difficulties in later life. I suspect that it is not unrelated to the problem of childbirth to very young mothers and their level of knowledge about care of themselves and their babies during pregnancy. I want to hear from the Minister on that point.

Given the facts, it is surely time for the Government to restore the rate of growth in consultant posts, so that we are back on target for the full complement by 2010, as originally envisaged, and so that the considerable amount of public money that has gone into training doctors in obstetrics is not wasted because there are no posts to which they can be appointed. Then, we will see that training translated into helping women and midwives to ensure that we can improve on the number of safe deliveries. That must be our main goal, in implementing good practice in maternity services.

I congratulate the hon. Member for Macclesfield (Mr. Winterton) on securing the debate. It is an important issue and is close to my heart, because of recent personal experience. I am aware of his long-standing interest in the subject. The report by the Select Committee that he chaired in the early 1990s prompted real and lasting change in the provision of maternity care. I pay tribute to that report and to the "Changing Childbirth" report and the work done by Baroness Cumberlege on the issues in the mid-1990s.

Huge advances have been made in the past few years in changing the experience of women during pregnancy and childbirth. There has been real progress towards the provision of a safer, more personal, woman-centred maternity service that offers women greater choice, continuity of care and control. It is now safer to give birth than ever. The figures for maternal and perinatal mortality are at their lowest ever level, and it is the overriding expectation of pregnant women, their partners, their families and those who care for them that the pregnancy and delivery will be safe and healthy for mother and baby.

Childbirth is about more than safety. Maternity services exist to support women throughout their pregnancy, to help them to experience pregnancy and childbirth as a positive and life-enhancing experience and to give their babies the best possible start in family life. On the whole, satisfaction rates for NHS maternity services are high. The Audit Commission report on maternity services, published in March 1997, found that 90 per cent. of the women surveyed were very pleased or pleased with how they were treated during pregnancy and childbirth. That is a high satisfaction rate, and it is a credit to the dedication and skills of all the professionals who are involved in maternity care.

There is, however, no room for complacency. "Changing Childbirth" set out a vision of maternity services with which few could disagree. The report's central principles—appropriateness, effectiveness and accessibility in maternity care—are largely embedded in current mainstream practice. We are not, and cannot be, content to stand still. The Government must continue to examine maternity services to see what can be done to secure further improvements, particularly in the quality of care and in tackling inequalities of care.

I want to cover some of the issues raised during the debate. The hon. Member for Macclesfield referred to unacceptable variations in caesarean section rates. The Department is concerned about those variations throughout the country and we need to deal with the lack of clarity about appropriate standards and best practice. We are aware of concern about the widespread variation, so we have put in place a chain of work to deal with that. First, we have taken steps to strengthen local audit processes and to publish figures on caesarean section rates by individual trusts for the first time. Secondly, we have commissioned a national audit study on caesarean section rates from the Royal College of Obstetricians and Gynaecologists to set standards where they are badly needed. That move has been widely welcomed by professional groups, consumers and women. We shall look carefully to see what lessons can be learnt from the thorough audit and to ensure that the results are used to develop best practice in future. Thirdly, we have funded the development of clinical guidance in problem areas such as induction of labour and electronic foetal monitoring. Fourthly, we have worked closely with consumer organisations to improve information on caesarean section, because the information that is provided to pregnant women varies dramatically throughout the country.

The reconfiguration of maternity services was also raised. A report will be published shortly by the Royal College of Obstetricians and Gynaecologists and I am sorry that it was not published before our debate, because it could have been used to inform that debate. I apologise for the fact that it is not yet in the public domain and that I am commenting on it when other hon. Members have not been able to see it. The report was commissioned by the Department of Health to examine the changes in the way in which maternity care is provided. Women's expectation of services has changed. Hospital stays are shorter and care is provided, as much as possible, in accessible community settings and is delivered by midwives. That report does not recommend the closure of many small maternity units, as has been rumoured in the press. It provides reference criteria to be taken into consideration when changes in maternity services are planned and will be widely welcomed by those involved in maternity services. For example, it makes it clear that issues such as access, transport, availability and choice must be taken into account in local decision-making.

In reply to my hon. Friend the Member for Stroud (Mr. Drew), there must be a future for midwife-led units and they will continue to be a matter for local decision making. We believe strongly in a future for midwife-led care as part of reconfiguration.

As part of our response to the report, we shall examine obstetric risk assessment. Safety is always paramount for women and health professionals, but it must not be used as an excuse to return to the traditional medical model of childbirth. Pregnancy is not an illness and maternity services exist to provide care for a predominantly healthy population during a normal life event. The vast majority of pregnancies and births are uncomplicated and best cared for in a predominantly midwife-led service.

For the minority of pregnancies and births that prove complicated, there must be access to expert medical advice. One issue covered in the report is the need for national standards for obstetric risk assessment, so that low-risk pregnancies can be consistently distinguished from high-risk pregnancies and managed accordingly in appropriate settings.

I am encouraged by much of what the Minister has said. Before she finishes, will she comment on the exceptional success of the Edgware centre and on the Albany midwifery practice, which again sets a standard that could be repeated all over the country and provides the real choice and the midwifery-led service that so many of us believe in?

I was indeed planning to comment on some of the best practice issues that hon. Members have identified. I was lucky enough to benefit from team midwifery care in Pontefract, where a small team of midwives, whom women are able to get to know, provide support in the community before the birth, during labour and after the birth. I was very impressed with the service and the support that I was given and gained huge benefits from it.

A wide variety of models is in place across the country, but continuity of care is crucial. There is a huge gap in our knowledge about how successful and effective the different models are and what the benefits are for the women who experience them. The hon. Member for Macclesfield highlighted the successful results at the Edgware birth centre and mentioned other examples as well.

We need to obtain comprehensive information about the different models that are in place. That is why we have commissioned detailed research into this issue and will report over the next year on the nature of the models of midwife care around the country, the way in which they are organised, funded and arranged and the difference that they can make to the women concerned.

Could I encourage the Minister to consider, as part of that research, whether midwives are being replaced by less well qualified personnel for after-care visits? I am sure that, like me, she benefited from the midwife calling after the birth. I understand that there is a tendency for the midwife to be replaced after delivery by somebody who is less qualified.

I shall look into that. It is not an issue that I am aware of. High-quality care in the weeks and months after the birth is important, partly to prevent post-natal depression, which can have repercussions on the beginning of family life and can affect children's chances for many years to come. The research is being done by the national perinatal epidemiology unit to inform our development and our ability to spread best practice across the country and ensure that it is evidence-based.

Hon. Members also asked about midwife staffing. Maintaining and developing excellent midwifery services is at the heart of our agenda. The national recruitment, retention and vacancy survey, which we published in September last year, showed that only 2 per cent. of midwifery posts—some 370—have been vacant for three months or more, although there are variations across the country. We shall work closely with the trusts that are under pressure to address the difficulties, but we are making progress.

The hon. Member for Meriden (Mrs. Spelman) referred to midwifery training. I find her remarks slightly surprising. The 28 per cent. cut in the number of nursing and midwifery training places between 1992 and 1995 was felt throughout the NHS. I am pleased to report that the Government-funded expansion in training places during the past two years—some £50 million was involved by the end of last year—has meant that applications for midwifery training have risen by 50 per cent.

As a result of our national recruitment exercise, last year more than 550 midwives contacted NHS employers about returning to work. Since this year's campaign was launched on 28 February, more than 6,000 calls have been received from people who are interested in midwifery, including more than 120 calls from qualified midwives who are interested in returning to the NHS. We need to continue with that important effort and to resolve the concerns that hon. Members raised this morning about career progression.

"Making a Difference" sets out the Government's strategic vision for nursing, midwifery and health visiting. That strategy will ensure that midwives benefit from better support and that modern, flexible, family-friendly employment practices are promoted. Many midwives have family responsibilities, and introducing family-friendly employment practices into the NHS will make a difference to recruitment and retention.

Will the Minister explain what the minimum grade for a qualified midwife should be in the present system?

Hon. Members asked important questions about the progression of midwives' careers. We are currently appointing the first midwifery consultants—the most experienced and expert practitioners are being appointed to those important midwifery positions. The establishment of those posts will extend the clinical career structure, which will encourage practitioners who might otherwise have gone into management to remain in practice and to do what they came into midwifery and nursing to do.

"Changing Childbirth" was mentioned earlier. In the few minutes that remain, I want to discuss the way in which we have extended that approach. "Changing Childbirth" changed the scene dramatically, but we cannot stand still. One of the most important ways in which we can extend its values is to tackle inequalities across the country. In the United Kingdom, the poorer one is, the less healthy one is likely to be. Life expectancy at birth for a baby boy is about five years less in social classes 4 and 5 than it is for baby boys with professional parents. We are determined to tackle such differences, which can have an effect at the start of a child's life or in the womb.

Our debate has progressed, and we now need to build on "Changing Childbirth" and to take steps to deal with inequalities in maternity care. Drug misuse in pregnancy needs to be tackled. The number of women who misuse drugs has increased considerably during the past 30 years, and many of those women are in their childbearing years. Pregnancy can act as a catalyst for change, and it is vital for the mother and the baby that pregnant drug misusers have proper access to support from appropriate services. Earlier this month, the Department of Health published guidelines on clinical management, which include best practice for managing pregnant drug misusers.

Some innovative services have been established, including a project in Sheffield for pregnant mothers who are addicted to heroin. The project has established a coordinated approach that includes GPs and a central clinic that offers quick access to the usual primary care services and to specialist drug services.

Women who smoke and who are pregnant constitute another priority area. Each year, more than 400 babies are stillborn or die soon after birth because the mother smoked. Smoking during pregnancy is associated with health inequalities.

The hon. Member for Meriden asked about low birth weight. That is part of our concern about health inequalities because low birth weight is linked to low income and to deprivation. The sure start programmes will examine the matter across the country. Those programmes will provide £450 million over three years across England to give support to the children and families who are most in need. That must involve support for maternity services, including better support during the weeks and months immediately following the birth of the baby—as the hon. Member for Meriden said—and examination of issues surrounding post-natal nutrition and support for the mother and baby.

There is much excellent practice across the country; we need to build on that and to tackle variations in maternity care. Like hon. Members who have spoken, I believe that midwife care must lie at the centre of that.

Order. Time is up.

Last week there was an article in my regional daily newspaper about flying angels—nurses recruited from the Philippines to ease the national health service staffing crisis in the west country, which is not the only region to suffer from the problem. At the heart of the crisis is low pay for student nurses, which has led to a shortfall in recruitment and a 25 per cent. drop-out rate from many courses.

The issue was highlighted last month, when student nurses—I was pleased to see several from my constituency—lobbied Members of Parliament. Because of my concern about what I was told by constituents at the lobby, I was fortunate enough to secure this debate to draw the Government's attention to the situation. I look forward to hearing what the Minister plans to do about it.

There is currently a confusing three-tier system of funding for student nurses. That was the subject of early-day motion 569, which has so far attracted 70 signatures. As hon. Members will appreciate, they cannot all be the signatures of Liberal Democrat Members. The three-tier system has the following structure: first, those who are seconded on a salary from their trust; secondly, those who are on diploma courses, who receive a Department of Health bursary; and thirdly, those who are taking degrees, receive means-tested bursaries and are eligible for student loans. The Department apparently recognises the funding problem for the latter two groups, because it now encourages more trusts to second health care assistants to nurse education on a salary. So far, 1,000 students have taken up that offer. They retain supernumerary status on the wards.

One of the student nurses who came to see me had previously been a health care assistant on a low income, during which time she had been entitled to family credit. She is now a bursary nursing student, and has no entitlement to family credit and no help with child care costs. She is working harder than she did as a health care assistant, with much longer hours, and is financially worse off. How long does the Minister think that she and others like her can put up with the pressure for the sake of a long-term investment in her career and in the NHS?

Another student wrote to me to say:

The nursing course which I am on requires me to squeeze 4,600 hours of learning into 3 years. During the period when all other students are on holiday we are studying or on clinical placements. My friends who are taking other university degrees or diplomas have nearly 3 months holiday in the summer, I get 3 weeks. During this time I will be revising for exams and working extra shifts as an HCA to make up a wage large enough to live on. On my days off I work as a care assistant. I have no choice but to do this in order to pay my bills and be able to live. The Government states that nobody should live in poverty, £4,500 a year sounds like poverty to me!

If nursing students had kept their right to a nationally negotiated salary when Project 2000 started, they would now be earning about £10,000 a year—double the current bursary. Student poverty is not the only reason that student nurses drop out of courses, but it is one of the reasons most commonly given. That poverty is caused not only by low income, but by high costs— especially in rural areas such as my constituency. For example, student nurses told me that the NHS Executive has recently changed its policy on reimbursing travel expenses to clinical placements. That has caused a great deal of confusion. One student said that she often spends £30 a week on petrol to get to her placements. That money comes out of her standard bursary.

Unison and many student nurses would like to see a return to salaried student status. They believe that it would reduce the drop-out rate and aid recruitment, and that it would increase loyalty to the NHS. The Minister is probably aware that the Royal College of Nursing takes a different view. It would prefer bursaries to be increased. It fears that students would lose their supernumerary status if they were salaried. It says that students used to be used as cheap labour and that they had little time to learn, which was why Project 2000 was implemented.

Whatever the disagreement between the unions and students on the best way forward, they all agree that the Prime Minister will not be able to deliver his promised 10,000 new nurses while the funding to support students is so low. Many nursing and midwifery students face financial hardship. They suffer more hardship than most other students because many are mature students with family responsibilities. One third of nursing and midwifery students are more than 25 years old, one third are married or have partners and a quarter of them have dependent children.

At the very least, those students need higher bursaries. They should be reimbursed for the cost of travelling to clinical placements. Will the Minister clarify the position on reimbursement? Students—especially those with child care responsibilities—need access to social security benefits. I hope that the Government agree that it is a serious problem. They will not achieve their aim of recruiting more nurses into the NHS if it is not solved. I hope that the Minister will give us some idea of the way forward.

I congratulate the hon. Member for Taunton (Jackie Ballard) on her success in the ballot. She chose to raise the matter of maintenance for student nurses, an essential group of people who help to deliver on the Government's plans to modernise the NHS and to improve patient care—objectives that the hon. Lady supports.

I shall put the matter in its proper context. In the financial year 2000–01, the NHS will support about 50,000 nursing and midwifery students—about 45,000 diploma-level students and about 5,000 degree-level students. The average bursary is about £5,000 a year for diploma-level students and £2,100 a year for those studying at degree level. Additional allowances are provided for some older students, for some single parents and for those with dependants. The hon. Lady drew attention to each of those three groups. An additional allowance of £590 a year is payable to older students—those aged 26 and over—and a single-parent addition of nearly £900 a year and a dependants' allowance of between about £1,700 and about £3,000 a year are payable, depending on the number and age of dependants. The hon. Lady was particularly concerned about student nurses who had dependants. The scheme allows additional support for them.

This year, we shall spend well over £200 million on bursaries and almost £700 million on all aspects of nursing and midwifery training, of which about £500 million will be spent on pre-registration training. By anyone's reckoning, that is a substantial package of support. We recognise, however, that we need to increase the number of staff to match the expansion in services to be provided by the new NHS. We have already achieved a great deal. The latest annual work force figures show that 5,500 more nurses are working in the NHS this year than just over a year ago.

The hon. Lady referred to a crisis in nursing. We need to put the matter in context. As part of our plans to expand services and improve patient care, we are expanding the number of nurse training places by 6,000 and reversing the cuts made by the previous Government. I am sure that the hon. Lady would welcome that. Last year, more than 15,000 student nurses began training—the highest number to do so for six years. If the previous Government had matched that commitment to nurse training during their last five years in office, more than 14,000 extra nurses could be working on the wards. Sadly, that is not the case.

I do not dispute the numbers of people who have been attracted to nursing courses, but will the Minister comment on the drop-out rate? He may have been planning to deal with that point, about which I asked a parliamentary question some time ago. The drop-out figures for the year in which the 15,000 people began training are not yet available.

I think that that is the case, and I shall comment further on the matter in a moment. It is, however, important to be aware of the whole story. We accept that there are legitimate concerns and I know that the hon. Lady referred to them, but I want to try to set the whole picture of student nurse training in the right context.

As a result of the additional investment that we are making in the NHS, we shall be able to provide up to 15,000 more nurses to care for patients on the wards. Of course, it takes three years to train a nurse, so it will take time to reverse the previous Government's complacency and underinvestment in the National Health Service. However, more students are already embarking on the training that will deliver on this Government's commitment to improved patient care. The hon. Lady may be interested to know that the Universities and Colleges Admissions Service has recently released figures that reveal a 24 per cent. increase in people starting nursing degree courses this year. Strong indications suggest that people are willing and prepared to embark on this important career. The 24 per cent. increase is the second highest increase for any degree choice starting in the 1999–2000 academic year. The end-year figures from the Nursing and Midwifery Admissions Service show that, last year, the number of applicants for nursing and midwifery diploma courses rose by 73 per cent. to more than 32,000 people. The number of students taking up diploma courses has also risen by 18 per cent.

Those are positive indications that we are at long last starting to turn a corner in recruiting these key workers into the National Health Service. They demonstrate our commitment to nurses as key to the delivery of our modernisation plans and to tackling nursing shortages. Our substantial investment in non-medical training, which amounts to some £1 billion in the current financial year, is helping us to turn the corner on recruiting nurses to the national health service.

The hon. Lady may like to know that her local education consortium in Somerset is planning to invest some £44 million in training in this financial year. That is a significant investment in the future of the national health service in her part of the country.

A new NHS careers service is also helping to feed more students into nurse training. The service was launched in April 1999 and initially covers nurses, health visitors and midwives. It uses modern technology to provide an inquirer-led service that is both accessible and objective. A call centre operation offers provision for simple inquiries for help and information and for more detailed inquiries dealt with by professional advisers. It handles about 1,000 calls a week.

Another key part of our recruitment and retention strategy is pay modernisation. For the second year running, the Government have accepted in full the recommendations of the Nurses and Midwives Pay Review Body, this time for 2000–01. That will mean an increase in basic pay of at least 3.4 per cent. for all nurses., and some groups of staff will receive substantially more. After years in which pay rises were staged, it is right that the awards should now be paid in full. Together with last year's award, we have provided nurses who are completing their training with a greater increase in pay in real terms than they have received at any time since 1987–88. Starting pay for newly qualified nurses in grade D will rise from £17,325 to £17,915 in inner London and from £14,400 to £14,890 in locations outside London, including the hon. Lady's constituency. Our decision to implement the award in full recognises that nurses deserve a fair pay award, especially after they coped so magnificently with the huge pressures of the winter. The pay award will also help the NHS to recruit and retain more staff, which will mean that it can treat patients more quickly.

Equally—this relates to the hon. Lady's comments—we recognise the need to provide student nurses with the support that they need throughout their training. That is why the NHS bursary scheme continues to provide more generous financial support than is available for people in mainstream higher education. In contrast to what happened under the previous Government, bursary rates are being increased again by the rate of inflation from September. That will be the third successive annual increase. We are committed to maintaining the level of the bursary. It is worth pointing out to the hon. Lady that, prior to 1998, there had been no increase in the bursary rate for three years. The Government have acted decisively to improve the bursary arrangements.

We recognise the hard work and commitment required of student nurses, who undertake an exceptionally demanding education and training programme. The hon. Lady mentioned some of the pressures on student nurses.

I thank the Minister for giving way again. He said that the bursaries were more generous than the funding available to other students. I am sure that he would accept that the hours of work and study required of student nurses are quite different from those of other students.

Does the Minister know the gap between the bursary level, even with dependants' allowances, for someone with one or two children, and what the same person would receive in income support, which the Government would consider the basic level that anyone would need?

If the hon. Lady wants detailed figures and calculations, I shall have to write to her.

While the bursary scheme continues to provide effective support for students, we know that more needs to be done, particularly to tackle the difficulties experienced by some groups during the training period. We want to ensure the widest possible access to nurse training programmes, so that the future NHS work force will be diverse and fully representative of the communities that they serve. We want a system that provides adequate support in all circumstances, so that no one suffers undue financial hardship as a result of choosing to train as a nurse. That is why, as I am sure that the hon. Lady knows, the Government are currently undertaking a comprehensive review of the NHS support package for trainee nurses, to ensure that the best support continues to be provided.

The review of student support will be wide ranging and will include examination of the different levels of support provided for diploma and degree students; the need to ensure the widest possible access to nurse training; the issue of hardship; and the interface between our support arrangements and the benefits system. We shall also consider student accommodation and travel expenses.

The enhanced level of support available to diploma students was introduced to stem the year-on-year decline in the number of young people entering nursing training. To date, to safeguard recruitment, those differences have been maintained. Student nurses, of course, face particular pressures that other groups of students do not, such as their short vacations and their extensive involvement in clinical placements. Older students, and those with dependants, can also face particular difficulties in gaining access to nurse training. For that reason, student nurses are already provided with enhanced support in comparison with other higher education students. In addition, the NHS meets student liability for tuition fee contributions in full. That is normally worth £1,025 a year. We want to continue to provide the necessary support to guarantee the future supply of those key workers.

Hon. Members, and certainly the hon. Lady, will be aware of adverse publicity in the professional press, and from some professional bodies, following clarification of the rules on travel allowances for students attending clinical placements. There have been no changes in the rules since 1 September. Any students who incur additional travel costs—when compared with their normal daily travel costs—can continue to claim them in full.

My ministerial colleagues and I are also aware of the problems affecting predominantly rural areas, such as the south-west, where the hon. Lady's constituency is situated, and some of the smaller health care professions, in which opportunities for theoretical and practical training can be widely spread geographically. In developing our policy relating to travel expenses, our aim is to be fair to all students while safeguarding recruitment and ensuring that we do not impose an unacceptable administrative burden on students, universities or the NHS student grants unit.

I recognise in particular the importance, and the value to the NHS, of attracting mature students, single parents and those with dependants into nurse training. I am also aware of the particular difficulties faced by some of those students, many of whom have increased financial commitments, in accessing nurse education programmes. We want to find ways of ensuring the widest possible access to training in future, regardless of the individual circumstances of the student. This year's review of student support will therefore include examination of the interface between student support arrangements and the benefits system. The hon. Lady mentioned that matter.

The Department's officials are working closely with the student grants unit, education consortiums and the higher education institutions to ensure that we have in place an effective method of paying support to student nurses. Since taking on additional responsibilities in September 1999, the student grants unit has authorised payments to approximately 17,500 nursing students and those studying in the professions allied to medicine totalling about £38 million. That is a significant achievement for the unit's 25 staff. The centralisation of responsibility for the assessment and payment of bursaries at the student grants unit has been of real benefit to students, both in terms of providing a single point of contact for advice and as a way of ensuring equal treatment for all NHS-funded students.

We also want to ensure that nurses are provided with high-quality and affordable accommodation when and where they need it. My right hon. Friend the Deputy Prime Minister recently published his Green Paper on housing and announced the starter home initiative. Nurses will be helped to buy their own homes in areas where housing is costly.

The initiative will make a real difference, but we want to go further still. At the recent Royal College of Nursing conference, my right hon. Friend the Secretary of State for Health announced his appointment of John Yates as a new national nurse housing co-ordinator. His remit is to secure more affordable homes for more nurses. The accommodation will be in new high-quality developments—flats, apartments and houses—which will help to attract still more nurses to the profession. Surplus NHS assets will be used to kick-start investment in new homes for nurses. The new co-ordinator will spearhead a range of new partnerships with housing investors, councils and the Housing Corporation, to build affordable new accommodation for nurses in high-cost areas. That might go some way to meet the hon. Lady's concerns.

We want to ensure that as many student nurses as possible complete their training and go on to work in the NHS. Attrition rates from nursing courses vary from year to year, from university to university and between the branches of nursing. Figures from the English National Board for Nursing, Midwifery and Health Visiting show a continuing downward trend in overall attrition for diploma level students. That development is welcome. Those students make up the majority of the nursing student population. The figures compare favourably with those for other forms of higher education. It is our intention to ensure that we have in place a system that provides all students with appropriate financial support throughout their training, thus, we hope, minimising the loss of students from training courses.

We also intend to strengthen nurse education; the strategy was set out in the document "Making a Difference—Strengthening the nursing, midwifery and health visiting contribution to health and healthcare." We intend to continue to support other initiatives, such as the encouragement of former staff back into the profession. Implementation of the strategy will help to ensure the delivery of high-quality midwifery education, which will help to meet the needs of patients and clients in the 21st century. We are ensuring that nurses and midwives are properly prepared to contribute fully to a modern NHS and we are modernising career frameworks to provide more satisfying and rewarding careers.

Once qualified, today's nurses enjoy better pay and can look forward to more flexible shift patterns, improved career development and a service that rewards them fairly for taking on the additional responsibilities that we want them to undertake. Our initiatives to recruit more nurses, to encourage more former staff back into the profession, to support nurses properly throughout their training and to ensure that qualified staff are properly rewarded are clear signs of the Government's commitment to nurses, to services and, most important, to patients. Tomorrow's qualified nurses will form the backbone of the NHS and will help to deliver on the opportunity that we now have to modernise the health service and to provide the care that nurses know that their patients deserve.

Having returned from Peru only last Thursday with the hon. Member for East Londonderry (Mr. Ross), I am pleased to welcome this short debate. Sponsored by the British branch of the Inter-Parliamentary Union, we were invited to observe and assess the conditions of elections for the presidency and members of Congress, which took place on Sunday 9 April. We tried to observe in a spirit of neutrality and, where possible, help to make the elections in Peru fair and democratic. They held great significance for the future of democracy in that country.

The hon. Member for East Londonderry applied himself tirelessly to our responsibilities. He would agree that we were helped immeasurably by our excellent ambassador, Mr. Roger Hart, his staff at the embassy in Lima and the honorary consul in Truijillo. The visit was enjoyable and interesting, but we owe the House the same candid account that we gave to the IPU yesterday.

During the visit, it was necessary to convey to the United Kingdom our grave concerns about events as they unfolded. The ambassador made those known to my hon. Friend the Minister of State, Foreign and Commonwealth Office, the hon. Member for Leeds, West (Mr. Battle), whose letter, which was placed in the public domain in Peru, was timely and helpful. My hon. Friend shared our pressing concern to see how the election of the successful candidate for President was procured and to ensure that the process was not only free and fair, but seen to be free and fair by the people of Peru and the international community. Our priority was the electoral process rather than the candidates. We had no preference in mind.

There were times when our concerns deepened. I do not disguise the anxieties that we felt and expressed about the credibility of the campaign, the counting of the votes and the declaration of the results. Sadly, our perceptions were shared by thousands of Peruvians whose peaceful demonstrations were met with tear gas as they approached the presidential palace. They almost created an atmosphere of ineffable violence. Thankfully, that was prevented because, after days of waiting for the final result, the votes were counted and no winner was declared. There was a widespread belief that a second ballot would take place between the two front-runners, Fujimori and Toledo, but I was profoundly disturbed to discover this morning that no such announcement has been made 10 days after the polls closed.

I make the plea today that when the second election takes place, as we hope it will, it is free, fair, transparent and without harassment from any quarter. However, given our experience and that of our European colleagues, that will be no mean task. Some things must be changed next time round. The European representatives from Belgium, Great Britain and the Netherlands issued a joint statement at a press conference. It said:

The state resources have been abusively and largely used to serve one candidate. The examples are countless. The Belgian delegation has specifically seen peasants being taken to a meeting of the… candidate in trucks belonging to the State. The State television is almost a monopoly of this candidate—

Mr. Fujimori—

This situation is not acceptable since it breaks the equity among the candidates and turns the process into a non-democratic one.

The inequality between opposition groups and the existing state machine is best manifested in the significant irregularities of the constitutional tribunal in Peru, not least the fact that the President changed the constitution that he introduced to give himself an unprecedented third term, and promptly sacked three of the five judges who ruled in an appeal court that his actions were illegal. Indeed, the whole state institutional system seems to have been organised to re-elect the President. It is common knowledge that the President relies heavily on the Peruvian armed forces and some local authorities are run by the army.

Transparencia published a document that, on page after page, gives examples of abuses and irregularities. First, Toledo's name was cut from a huge number of ballot papers with scissors, so that if people wanted to vote for him, his name simply was not there. Secondly, in a region with 169,000 electors, 175,000 ballot papers were returned.

There were repeated reports of public resources that were intended for Government social programmes being used to gain support for the President's election campaign. That cannot be right. Transparencia, a body trusted by the international community, denounced what it described as "unprecedented irregularities and harassment", including attacks against its computing systems, electricity cuts and interception of telephone lines. To his credit, the ombudsman made his reservations equally clear.

We were not alone in noting—how could we have failed to do so?—the appalling imbalance on television, radio and the media, which would have been farcical had it not been so serious. Indeed, in a carefully considered paper, issued just before the election, Mr. Terence Duffy, consultant to Electoral Reform International Services, said:

Currently, Peru does possess a vigorous and extensive (if socially limited) culture of political debate expressed in some of the cable television channels such as Canal N, in the weekly magazine Caretas, and in newspapers such as El Comercio and La Republica. Regrettably, these media possess rather limited audiences, totalling no more than a few hundred thousand people, which is a gross imbalance in relation to the scale of the total Peruvian population. The Peruvian media are therefore heavily Lima-centric and possess an audience which is solely located in the highest socio-economic sectors. Regrettably, economic considerations would prevent the extensive dissemination of these media to the wider Peruvian public.

In conclusion, I thank the Minister warmly for his vigilance on these matters and ask the Government to take the initiative in ensuring European Union monitoring next time around. Even then, delivering a timely democratic election will not be easy. However, such representation and the expressed will of the international community can go a long way to achieving fair play. Never again should the election observation mission feel the need to use the expression "a culture of fear." Instead, let us hope that we can see a country with limitless potential achieve that potential in a democratic way, as I believe Peru will do.

Before I call the hon. Member for East Londonderry (Mr. Ross), will the right hon. Member for Coatbridge and Chryston (Mr. Clarke) confirm that the hon. Gentleman has his consent and that of the Minister to intervene?

Yes.

It is a pleasure to take part in the debate, brief though it is. However, I would have preferred to have the opportunity for a much longer debate so that we could have explored the matter in depth. It was a pleasure to share the visit with the right hon. Member for Coatbridge and Chryston (Mr. Clarke). We did not know each other very well before we went, but we returned as firm friends. Although we did not know much about Peru before we went, we knew a fair bit about elections and we now know about Peru as a result of our visit.

We were made aware before we left of the serious problems that Peru has faced in recent years. At one stage, it had over 7,000 per cent. inflation per annum, and the country suffered from terrorism and cocaine. The last was more of a problem that Peru was exporting to the rest of the world than an internal problem, because I understand that, at one stage, it produced over 50 per cent. of the world's cocaine.

The right hon. Gentleman and I returned with a kaleidoscope of impressions, for we found a land of great contrasts the very wealthy, the very poor, heartbreaking street children, shanty towns, unemployment and modern bustling towns and cities. The people were friendly, helpful and, in many cases, very outspoken: their opinions were made plain to us from every level of society.

The right hon. Gentleman and I visited one shanty town, with a policeman or two in tow, and went into one of the huts there: they can be described in no other way. The lady of the house said that she had voted for Fujimori. Her son stated openly that he had voted for Toledo. Therefore, the people had a measure of free speech that they were not afraid to exercise, even in the presence of the police. Some of the meetings in which we took part were valuable in clarifying the conditions in the country. Given the way in which the population exercised free speech, we are both hopeful that Peru will overcome not only its economic and social problems, but its political difficulties. I want to deal now with the political problems to which my right hon. Friend referred.

It was evident to us that President Fujimori enjoys a great deal of electoral support; it would be wrong to give any other impression. People recall how desperate the nation's plight was when he first took office. He defeated, or at least suppressed, terrorism, by means that we in this country could never find acceptable, but which he and his Government considered necessary; he stopped inflation, which is now between 3 and 4 per cent. per annum; he did quite a lot on the drugs front, and is commended by the United States Government for that; he reached agreement with Chile and Ecuador on long-festering border disputes; and he has built many schools and roads, which benefit the poorest sections of society. It is a formidable list of successes, which even his most vociferous critics commended. We found only one person who was prepared to condemn him at every turn. The downside is that when he took office, he could serve only one term of five years.

President Fujimori changed the constitution to allow two terms, and is now claiming the next term as his second, if he wins, as it is under the new constitution and his first term does not count, as it was under the old one. That was at the root of much of the opposition to him, for he is perceived by many as breaking his word and violating the constitution.

It was made plain to us that he had used doubtful methods to achieve his goal of running again and then attempting to secure election. The allegations seemed to us to be valid. Some are the ones that the right hon. Gentleman referred to; others are slightly different. The first is that the campaign against the other principal candidates was an utterly ruthless and vicious programme of vilification, which succeeded in destroying them one after the other. Mr. Toledo was a late-emerging candidate.

We were told that $3,000 made certain that any one of the tabloid newspapers published the stories, which were personally written with the headlines, the story and the editorial and then read on the street corners. The cost of television propaganda for opposition candidates was set so high that they could not afford it, and the stations that were willing to be even-handed ran into difficulties over advertising revenue from Government and other sources and increasing demands for unpaid tax.

Opposition rallies in other towns were disrupted by power cuts, land-line breakdowns, power failures to mobile phones and the closure of access roads on one pretext or another, so that folk could not get to the rallies. In addition, the poor who supported Fujimori got food aid, and 800,000 people have been promised a plot of land on which to build a house. All those are powerful inducements.

It was also made clear to us that many judges had been sacked and replaced by provisional judges; there were other official bodies where the membership simply screamed "rigging". There were questions about the accuracy of the electoral register. We were unhappy about all that and believed that it was not possible for the president to win on the first ballot, and that a second round would eventually become necessary. There is no guarantee that Fujimori would lose in the second round. He might win, even in an honest ballot, and every hon. Member knows that elections are difficult to predict.

Time does not permit me to continue, except to say that Peru is a wonderful country, full of men and women with high hopes. We wish them well and hope that the bright future that beckons will be achieved. They seem to have created a formidable array of institutions, procedures and documentation to ensure that fraud could not occur, but they left gaping holes in the process into which votes disappear and do not emerge in the same form.

Finally, I thank our ambassador and staff who were admirable in every way and looked after us very well indeed. I thank also the ambassadors of Belgium and the Netherlands, and their parliamentary representatives, whose company we enjoyed and whose report on their experiences we are happy to accept.

It is customary to congratulate the hon. Member who secures an Adjournment debate. In this case, more than congratulations are in order.I do not know how an Adjournment debate is secured in Peru—

Order. I hope that the Minister is not implying that the systems in the House echo those in Peru in any way.

I suggest that the efficiency with which we can communicate speaks volumes.

The debate is timely, as it keeps the spotlight on the situation in Peru and keeps up the pressure. That is precisely what Adjournment debates should do and I congratulate my right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke) and the hon. Member for East Londonderry (Mr. Ross) on bringing the matter to our attention while it is alive.

I congratulate them both on their valuable contribution to the IPU election monitoring mission to Peru. The telegrams that we received from our ambassador reflected the fact that they were a credit to Britain. Their work and the way in which they participated enhanced our parliamentary reputation, which is the purpose of the IPU. It was impressive to receive the feedback from the embassy as the situation unfolded. Monitoring should allow a snapshot to be taken to assess how the process is doing. The reports were on my desk during the process and they were important to enable us to react and to make a contribution to the process.

I am also grateful to my right hon. Friend and the hon. Gentleman for their kind words about our ambassador and his staff. The system was working at its best and the job was well done.

Outside the Chamber in Westminster Hall there is an exhibition on parliamentary work and elections. It reminds all of us why we are here and that, despite our 2,500 years of history, parliamentary democracy is not as advanced as it should be. Of the 30 elections taking place in the world this year, 16 are taking place in countries that have never had any form of democratic election. The process is relatively new and it is important that in places such as Peru, which has had democratic elections since 1980, we strengthen the process and ensure that it is not undermined. The work of my right hon. Friend and the hon. Gentleman as observers was crucial.

Throughout the Peruvian election process, the United Kingdom played a leading role in calling for free, fair and transparent elections. We financed two visits to Peru by representatives of Electoral International Reform Services. Reports of those visits highlighted worrying deficiencies in the electoral process at that time. In particular, the reports drew attention to the misuse of state resources, including food aid for party political purposes and manipulation of the media, to which reference has been made. We gave copies of those reports to the Peruvian Government and to members of the IPU delegation in Peru, and circulated them widely at international level. The spotlight was turned on events, so that matters could be improved.

We supported the activities of the office of the Peruvian ombudsman, Mr. Santistevan, in the election campaign. Our Government contributed some £20,000 to his election-monitoring mission. Since March 1998, we have contributed more than £140,000 to the cost of important work and research conducted by his office. He visited me just before the election, and we discussed that process. He expressed certain fears and spoke of the need to keep the spotlight on the election process to ensure a fair outcome. We will continue to support his activities in the run up to the second round of voting.

Last week, I met members of the inter-agency group on Peru, with whom we have strong and established ties. The group consists of a number of non-governmental organisations, including the Peru support group and Oxfam. The meeting followed an earlier exchange between members of that group and officials from the Foreign and Commonwealth Office's Latin American and Caribbean department. In other words, consultation with people who were familiar with events on the ground has been vital throughout this process.

Last week's discussion, in which I outlined our concerns about irregularities highlighted by independent observers, proved useful. As a result of that meeting and information received from those observers, I released a statement that expressed those concerns and underlined our view that a second round of voting was desirable and sensible. A copy of that statement was given to the Peruvian authorities by the British ambassador in Lima.

On the morning of 12 April, Jose Portillo, the head of the official electoral authority of the national office of electoral processes, announced that, with 97.68 per cent. of votes counted, Fujimori had 49.84 per cent. and Toledo had 40.31 per cent. He added that, with so few votes remaining, the "50 per cent. plus one" target for an outright first round victory could not be attained by any one candidate, so there would have to be a second round play-off. He explained that his office would not be able to deliver a final report on 100 per cent. of the results until official vote registration documents from polling stations abroad were received. Although a similar system operates in this country, receipt of those reports has been subject to considerable delay.

The head of the official electoral authority suggested that the national election board would have to resolve pending challenges to certain results registered in official vote registration documents. Again, such challenges occur in our elections. If there are squabbles over spoilt ballot papers and so on, agents sort them out there and then. The problem should not take long to resolve but, following the interim result of 12 April, there has been no official announcement of the final result, so a date has yet to be set for the second round. I share the concerns of my right hon. Friend and the hon. Gentleman about that. Although I am confident that a second round will take place, I have instructed our ambassador to raise our concerns with the Peruvian authorities and the national office for electoral processes. In other words, the ambassador will advise them to get on with it.

We played a leading role in preparing European Union statements that expressed concern about the election campaign and developments on polling day. Prior to the elections, we helped to draw up the statement by the European Commission of Human Rights in Geneva on 24 March. It stated:

The EU continues to be disturbed by the decline in Peru of the rule of law and democratic institutions, including deterioration in the electoral process.

That reflects precisely the impressions that the hon. Member for East Londonderry outlined during the debate.

We also took the lead in issuing an EU statement condemning the withdrawal of Peru from the Inter-American Court of Human Rights last year. We made it clear that we did not think that that withdrawal was a good move. On 15 February, EU ambassadors, including the British ambassador in Lima, issued a public statement calling on the Peruvian authorities to take the measures necessary to implement important recommendations set out in the independent reports on the electoral process. We also initiated an EU statement on 7 April, expressing our deep concern over aspects of the election campaign and calling for procedures on polling day to be free and fair and to conform to international standards.

In the preliminary work leading up to the day of the election, we endeavoured, through the EU, to keep the international spotlight focused on the process to ensure that it was carried out correctly. It has worked imperfectly at best, but we must move on. We shall continue to work with our EU colleagues to impress on the Peruvian authorities the need to meet international standards as the second round of voting approaches. They now have an opportunity to get it right.

The Peruvian elections were discussed at the EU Latin America working party meeting on 17 April. I was asked earlier whether we could take the initiative, and I am happy to confirm to my right hon. Friend the Member for Coatbridge and Chryston that it was agreed at that meeting that the EU will be sending an observer mission. As part of that, the United Kingdom again plans to send observers, and I hope that my right hon. Friend and the hon. Gentleman will once more be able to contribute in some way. It is important that we should keep up the good work.

The hon. Member for East Londonderry suggested that it would be better to have a wider debate on the economic, social and political context of development in Peru. I, too, would welcome that. In the short time available to us today, we have had to focus on the election process. That will be an on-going state of affairs until the second round, and we must keep a critical eye on it.

In relation to drugs, the Government are committed to tackling the global drug trafficking problem. Last week, we met President Pastrana of Colombia for an in-depth discussion about working more closely together to tackle international drug trafficking. That is a shared responsibility between producer and consumer countries. We have work to do on the streets and in the clinics here, as well as trying to eliminate production by finding alternative crops to coca and heroin.

We welcome Peru's commitment to its national drugs plan, and we are actively involved in bilateral and multilateral counter-drugs projects. In January 2000, I announced a further £500,000 contribution to a UN programme to monitor coca leaf production in Peru. Its aim is to discover the extent of production and to encourage a shift to alternative crops, providing peasant farmers with a livelihood while removing the potential for the cocaine trade.

We also keep a close eye on human rights in Peru. We continue to monitor closely the human rights situation and to raise human rights issues with the Peruvian Government whenever suitable opportunities arise. We press them whenever we consider that they are not adhering to their international obligations. For example, when they withdrew from the jurisdiction of the Inter-American Court of Human Rights, we joined our European Union partners in pressing them to rejoin. In March this year, at the 56th session of the United Nations Commission on Human Rights, we joined our EU partners in issuing a statement expressing concern at the decline in the rule of law and democratic institutions in Peru, including the deterioration in the electoral process.

In conclusion, democratic politics is a project. We try to deepen participation in democracy. As the posters outside in Westminster Hall demonstrate, there is a history to the development of democracy. Not long ago, only men could vote in Britain, and the franchise was extended to women only relatively recently. We must look for new ways of deepening our democracy, and increase the extent to which popular participation is built up from the base in all societies. We have a history of democracy dating back hundreds of years. I am proud of the fact that my colleagues have been to Peru to participate as monitors in its election process. Their work has been exemplary, and it stands as part of the tradition of campaigning to deepen democracy.

We share a common concern that, in Peru, democracy is very new and needs underpinning, supporting and encouraging; it does not need undermining. If we feel that it has been undermined, we have a duty to point that out. We look forward to the second round of voting, and we shall continue to monitor developments very closely during the electoral campaign. We shall encourage the Peruvian authorities to ensure that the conditions are in place for free, fair and transparent elections that are dominated not by fear but by the free decisions of the people participating in them. It is important for Peru to move forward democratically, not backwards. We shall continue to play a full diplomatic role in ensuring that that happens, and we are grateful to our colleagues for their work during the past few weeks.

The events that I am about to describe go from the bizarre to the outrageous. Anyone who did not know that what I am about to say is entirely factual could be forgiven for thinking that they were listening to the plot of a John Grisham novel. It is a story about how a small west country business has been ripped off by one of the world's largest computer companies, while others pitch in at the same time.

Before I go into detail, I should say that the story includes the all-too-familiar tale of anti-competitive behaviour, of which the Microsoft case is the best-known current example. On this occasion, however, the behaviour is aimed against a United Kingdom company. As if that were not enough, the story also includes an almost incredible example of procrastination by the United States judiciary, which damages existing and future UK innovation at the expense of the British taxpayer. As a result, a west country company, which should now be a multi-million-pound operation pouring money into further innovations and creating wealth for the entire UK, is struggling for its existence.

AllVoice Computing plc develops computerised speech recognition products. Computer speech recognition allows a person to dictate into a microphone connected to a computer, with the result that the recognised words appear on the computer screen. No less a figure than Bill Gates has said that

speech recognition is not just the future of Windows: it is the future of computers.

AllVoice did not invent speech recognition any more than Trevor Baylis, who is famous for inventing the clockwork radio, invented the radio or clockwork. However, it made the application of voice recognition a practical reality.

IBM and Dragon Systems Inc. dominate the relevant market. Dragon is a US company founded and owned by two long-serving IBM employees. When it first produced speech recognition—a facility for converting speech to text—there was no option to play back the audio on a word processor or through any other standard computer application. In effect, the dictator had no choice but to try to remember what was said in order to make corrections. Consequently, users had to interrupt their dictation and train of thought. Dragon's system required more time and effort than using a traditional dictating machine. In effect, it had invented a car that could never move out of first gear.

AllVoice's crucial innovation was to invent an error correction capability. That was done by linking the original spoken words to the text in the user's word processor, which meant that the user could freely dictate without pausing to correct the errors that inevitably occur. Furthermore, the provision of an option for storing the text with its linked audio meant that users could delegate the entire correction process if they preferred to do so. AllVoice also offered users an ability to record an audio note to accompany a delegated or deferred correction document. In 1996, the company received a prestigious Confederation of British Industry award for those inventions. Following the release of its inventions, AllVoice's sales rose dramatically and further sales and development staff were employed.

In January 1996, IBM informed AllVoice that it was seriously considering incorporating AllVoice technology into its products under a worldwide agreement. IBM urgently requested AllVoice to submit the software, including unreleased features, to IBM's speech research and development groups in Vienna and Florida. In February 1996, AllVoice was invited to Florida, at IBM's expense, to discuss the arrangements. Of course, promises of confidentiality were made, and IBM insisted that it had no intention of writing similar software. There was an understanding that should the evaluation of the products be satisfactory, some form of partnership would be entered into. Instead, in April 1996, after a satisfactory evaluation, IBM wrote to say that it was now working on the same functions. Over the next few weeks, IBM also tried unsuccessfully to trick AllVoice into signing away its intellectual property rights.

In June 1996, having clearly decided to exploit AllVoice's products for itself, IBM announced to the world that it would be delivering a new product with similar features in the following November. Pre-announcing a product is a well-known tactic of predators, which is designed to undermine competitors who would otherwise sell competing products in the time between the announcement and the release of the predator's product.

IBM slipped up temporarily in January 1997 by introducing a low-price product that had all AllVoice's features missing, no doubt thinking by then that AllVoice would be dead in the water. AllVoice responded by adding its features back in and then undercutting IBM's more expensive version by nearly 30 per cent. Once again, AllVoice's sales climbed dramatically, so in retaliation IBM resorted to anticompetitive actions against AllVoice. As the anticompetitive actions increased, AllVoice eventually filed a formal complaint with the European Court in December 1997—case No. IV/36 824. AllVoice is waiting on the European Court to take action.

In 1996 AllVoice decided to try to produce a complete British speech system by involving unique developments in natural speech from the University of Cambridge. AllVoice had by then discovered that it could apply for patents in the United States for some of its crucial features that had been pirated. UK patents were also applied for on previously undisclosed innovations and were obtained in May 1997.

Dragon Systems also invited AllVoice to the United States to discuss collaboration and was made aware of the imminent announcement of UK patents and applications for US and worldwide patents. Dragon wanted AllVoice to disclose all its details, without a confidentiality agreement, which of course AllVoice declined. However, Dragon by then had access to the UK patent public disclosures less than one month later, and its next version included the audio playback features previously missing from all its earlier products. Needless to say, that was in clear breach of patent, but having a right of action is one thing and successfully prosecuting it through the American judicial system is something else entirely.

AllVoice was awarded its first US patent on 25 August 1998. By then, its products were being pirated on a grand scale. I understand that it is a feature of American business practices that if a little guy has a patent that he is in all probability not in a position to enforce, all the big guys get in on the act. Therefore, all attempts by AllVoice, short of litigation, to stop the breach of its patent had no effect at all. Reluctantly, AllVoice had to resort to litigation in the United States. As an official complaint is currently outstanding against IBM, a patent infringement suit was filed in Boston on 12 February 1999 in the US District Court of Massachusetts against Dragon Systems. The court case number is CA No.99-CV-10436, and the judge allocated is the honourable Douglas P. Woodlock.

At this stage, as might be expected, AllVoice filed a motion for preliminary injunction against Dragon Systems. The purpose of a preliminary injunction is to prevent further harm from being done to the patent holder until the case can be dealt with. In any judicial system where injunctive relief is available, it is the very essence of the matter that the hearing be held swiftly. AllVoice's injunction hearing was held on 26 May 1999 and, incredibly, that is where matters rest. The judge has reserved to himself whether he will grant immediate relief—immediate relief after nearly a year. I am told that even AllVoice's American lawyers, practised as they are in the vagaries of their own litigation procedures, are stunned by the delay. All attempts to get the judge to move on it have failed. It is, frankly, bizarre.

Normally such motions are decided within a month. After a month had passed without a decision, AllVoice's US attorney, Sullivan and Worcester, started to make telephone calls to the court, to inquire about the status of the opinion. After six months of such contacts and still without a decision, Sullivan and Worcester wrote formally to the court in November 1999, pointing out that the inaction was an implicit endorsement of Dragon's patent infringement and urging the court's attention to the case. When that correspondence received no response, a motion was filed the following month for a status conference. The judge denied the motion on the same day, saying that it was "unnecessary".

That is where matters rest, except that AllVoice has had to scale down its operations in an attempt to stay in business, while Dragon includes AllVoice's patented features at no extra cost. The attorneys are analysing whether other companies include the same features. That cuts out any realistic possibility of AllVoice making sales; yet it has to fund the entire litigation because, subject to what I shall say in a moment, no Government help appears to be available to it.

Lest anyone thinks that this extraordinary inactivity by the American judicial system affects only a private company and not the taxpayer, let me disabuse them at once. In 1996, AllVoice received a Department of Trade and Industry SPUR award to assist with the development of natural speech recognition systems. That project cost nearly £200,000, of which the DTI funded 30 per cent. Indeed, part of the funding has been invested in taking forward intellectual property protection through US and UK patenting.

It is difficult to describe in a few words the magnitude of what has been done to AllVoice or, indeed, the advantages that the United Kingdom would have gained had AllVoice been able to proceed. I have reminded the Chamber what Bill Gates said about speech recognition. Every computer has a keyboard, which is a cumbersome barrier for most users. Speech control and dictation is increasingly being used as a better alternative. As more innovations are made, the keyboard will, almost certainly, disappear. AllVoice's invention can, therefore, be applied to virtually every computer. The value of the speech recognition market has been estimated at £2.1 billion for this year alone. Speech recognition packages, mostly with AllVoice features, have been among the top-selling software packages in the world since January 1998. Obviously, IBM is one of the bestsellers, but even Dragon's product is said to be the 10th best-selling software application of all time.

To date, AllVoice has spent more than £275,000 on outside intellectual property costs, including patent filing fees, patent attorneys, legal counsel in the United Kingdom and the United States and, probably, other US associates. That is more than the current reduced turnover of the entire company. Patent fees continue to mount up, as do the company's legal costs. On top of that, AllVoice's has had to devote daily resources to litigation for lengthy periods, at great additional cost.

The sickening thing is that we have seen it all before. James Dyson, inventor of the bag less vacuum cleaner, has been involved in patent litigation with numerous American corporations. He has spoken of being "shafted" by the Americans, in their efforts to put him out of business. They nearly succeeded. He was saved from a considerable debt for legal fees by a fortuitous Japanese licensing arrangement. Dyson is a major UK success story, but only after going through American litigation, with the help of Japanese funds.

Even closer to home, as it were, is the case of Rodime, a Scottish-based company that made a quantum leap forward by inventing a smaller computer disc drive, which was wiped out in US patent litigation. Six hundred and twenty jobs were lost in the fight against the two main protagonists, IBM and Seagate Technology. Seagate's name will be familiar to those involved in these matters, and well it might—Seagate is Dragon's main outside investor. After years of litigation, including revelations of attempts to interfere with the US Patent Office and anti-competitive behaviour, Rodime had to settle for just $45 million gross from Seagate, a mere fraction of what it would have got if it had received a proper percentage of all the disc drives that use its invention.

The way in which American industry has rallied round to carve up AllVoice makes a pack of sharks look like a convention of nuns. It is an utter disgrace. For reasons that are impossible to fathom, the American judicial system, instead of protecting the innocent, has played into the hands of the guilty.

The Minister, as a fair-minded person, will, I am sure, be as concerned as I am. Knowing how such things go, I can predict that her civil servants are already preparing to advise her that she has no standing in the American judicial process. I hope that, if she receives that advice, she will reject it. If the big battalions, in the form of Her Majesty's Government, will not intervene on AllVoice's behalf, who will? The Government should make an approach to the US Government at the highest level-and I mean the highest level-and say that the injunctive procedures should be brought to a conclusion at once. Indeed, given the large sums of taxpayers' money that the Government have already put into AllVoice, I would like them to go further, by helping to fund the litigation that will still have to take place.

After all, Her Majesty's Government are not entirely powerless. The taxpayer helps to fund many of the manufacturing plants opened by US corporations as UK subsidiaries in areas of regional assistance. I assume that it is no coincidence that IBM has a manufacturing plant and call centre at Greenock in Scotland. Before continuing with those subsidies, or agreeing to new ones, we should insist that those corporations declare all existing official disputes publicly, as well as declaring all new ones, as they occur. The Government could make it a condition of assistance that litigation be conducted responsibly, rather than in a predatory fashion. I say that because I believe in solutions, as well as problems. The Government are better placed than I am to work out what steps they could take. What they should not do is wash their hands of the issue and say that it is all down to the American courts.

The Government should look specifically at the activities of IBM and Dragon in the United Kingdom and at how they relate to the United States. Despite the dramatic growth in the emerging speech recognition market, a number of UK firms that have invested heavily in added-value sales with IBM or Dragon speech technology have been forced out of existence. AllVoice has just completed. a project part-funded by the DTI involving automatic speech recognition over the telephone. One Department, which has seen the prototype, has calculated that AllVoice's innovation could save it more than £3 million a year. Unfortunately, the US litigation has deprived AllVoice of the funds that it should have had to turn a finished piece of development into a marketable product range. The Government must ensure that that innovation, and the savings that the UK Government could make, are not lost through US behaviour.

The Minister has an opportunity today to stand foursquare by British innovation and excellence and by our sense of decency and fair play. That is what the public would expect of the Government. I cannot imagine for one moment that the Minister will not have considerable sympathy with the matter that I have described to the Chamber today.

I thank the hon. Member for Teignbridge (Mr. Nicholls) for raising this issue, which is clearly of enormous concern to AllVoice and to the hon. Gentleman, who is the relevant constituency Member of Parliament. I congratulate him on giving such a full account of the company's concerns.

The hon. Gentleman rightly acknowledged that I cannot comment on the details of an individual court case—it would be improper of me to do so, regardless of the jurisdiction in which the case was being heard. I also cannot give details of the contact and support that the Department of Trade and Industry offered to the company, because that is a matter of commercial confidentiality. None the less, I hope that I can help the hon. Gentleman and the company.

The hon. Gentleman discussed possible delays in proceedings in America. I have no standing whatsoever in the American judicial system. I shall ask our officials in the British embassy in Washington to establish the full details of the case and, perhaps, to seek legal advice about taking further action. I shall also ask to be given a personal report on the result of those inquiries.

It might help if I confirm that AllVoice was the beneficiary of two grants from my Department relating to speech recognition technology. In December 1996, it was awarded a grant under the SPUR-support for products under research-scheme, which has been replaced by the small firms merit award for research and technology. In November 1998, the company received a second SMART award. I understand, and the hon. Gentleman confirmed, that significant provision was made in both grants to cover the cost of protecting intellectual property rights.

Since then, Government officials have been in regular contact with the company-indeed, we have been in touch over the past few days. We are aware of the pressures that are on the company, which the hon. Gentleman described, and we have been flexible about its undertaking to exploit the research that we supported. The possibility of a further joint university project was kept open-that would involve the company in the further development of speech recognition technology.

The case that the hon. Gentleman described raises issues that are becoming increasingly important as our economy is transformed by information and communications technology. One of the most striking features of the impact of the new technologies on the economy is the speed of innovation. The Department of Trade and Industry and, more broadly, the Government are determined to ensure that industries in this country contribute fully to the development and exploitation of those new technologies. That will allow the United Kingdom to generate new companies, jobs, products and services and, ultimately, a better quality and standard of life for everyone. As part of that strategy, we support the development of ground-breaking technologies that could contribute to economic growth.

The hon. Gentleman rightly began by saying that speech recognition technology is hugely important to the development of computer technology. In particular, it opens up the possibility of creating a friendlier and more effective interface between the user and computer technology. All of us know, as users, that the current and earlier generations of computers are not easy or intuitive to use.

The United Kingdom is a leader in wireless technology. Indeed, we are currently holding the world's first auction for third generation mobile spectrum. Voice recognition technology will be critical in catching the next wave of wireless technology and ensuring that we build on our competitive edge in wireless technology to develop new businesses, new jobs and new wealth creation.

As part of that strategy we have sought to maximise the support available for UK-based firms from the European Union and we work with our European partners at the leading edge of information society developments—for instance through the European fifth framework programme. That programme, which is funded by all member state Governments, offers a budget of about half a billion pounds each year, from which I am glad to say that last year the UK industry received some £50 million. We are helping firms to take part in that programme to ensure, not least, that they exploit the immediate funding available and then continue to benefit from it.

Through that, through the SMART programme and through EUREKA and so on, we can support not just AllVoice but many innovative, high-technology companies in the United Kingdom. However, I am pleased to say that United Kingdom firms working in speech recognition and language technology won more than £750 million from the European fifth framework programme last year. Those firms and their European partners will work on a series of projects to extend the potential of spoken human language technology for mass market e-commerce, so that users can compare and buy services and products in their own language and in the form that they prefer. The firms will also develop multilingual delivery of information from a single source, tailored to highly personalised requirements with improved quality of speech synthesis. Therefore, with our European partners, we are making significant investments to try to sustain and build further competitive advantage for the United Kingdom.

In this fast-moving and highly competitive technical environment, intellectual property rights become hugely important. The more I talk to companies at the leading edge of the knowledge-driven economy, the more I hear from them that intellectual property rights and related issues around patenting, trademark, copyright and so on are at the top of the agenda for Governments and policymakers. Certainly the episode that the hon. Gentleman has highlighted underlines the need for leading-edge companies to establish a clear and well-directed intellectual property strategy from the outset. It is not always easy, and it certainly is not cheap, to obtain the necessary specialist advice. None the less, as the hon. Gentleman rightly said, the risks of not securing protection for intellectual property are enormous and the returns, therefore, from investing in the protection of successful innovation are very large.

There are huge complexities as laws on copyright—generally on intellectual property—are translated from the older economy to the new. It is not always easy for lawyers and courts to see how concepts that were developed for a different world and a different set of technologies translate into the new world. I make that as a general observation and in no sense as a comment on the specific case that the hon. Gentleman raised.

I am grateful to the Minister for the way in which she is responding. What she has said, particularly at the outset, is helpful, but will she comment on this proposition? In the case to which I referred the protection is already in place and has had to be referred to the American courts. Clearly neither she nor I can contemplate what the outcome of that litigation will be: that is a matter for the courts. We are not discussing the result of the injunction, because it may be refused, but is she as concerned as I am that injunctive relief is outstanding and has not been decided after 10 months? Will she tell her commercial officials that such matters concern her? I refer not to the decision but to the fact that no decision has been made. That must concern her, given the existence of patents.

I have already said that I shall ask commercial officials at the embassy to investigate the matter. I have also asked DTI officials to look into the general issues raised by the case specifically to determine whether the United States is complying fully with its obligation to enforce patents and other intellectual property rights that are set out in the World Trade Organisation agreement on the trade-related aspects of intellectual property. That is the global framework for intellectual property issues and it is essential that all Governments who have signed the agreement abide by it.

It is also important to seek greater international harmonisation of intellectual property rights, because laws differ. They differ between the United States and the United Kingdom. The Government are playing an active role in seeking globalised norms to provide a more appropriate framework for what is increasingly a global and not a national or even regional knowledge-driven economy. We shall participate in the diplomatic conference for the adoption of a patent law treaty being held in Geneva next month. If we can obtain a successful outcome to that diplomatic conference, it will establish international harmonised standards for the procedures to be followed in patent formalities. A number of cases in different parts of the world have raised concerns about the nature of patents and whether they are granted too easily in some cases and not readily enough in others. We need some harmonisation of the procedures involved in patent formalities, which, in turn, will pave the way for more substantive issues of patent law.

The wider issue, which will not be resolved simply through harmonised legal substance or even improved legal procedures, is that, because information and communications technology is moving so fast and because of the intense competitive pressures on companies to innovate quickly, there is a danger that the brilliant idea or innovation of one company or individual will be taken over by a larger, better established, more powerful company. In the end, the answer is not simply to seek proper legal protection for the innovation and the intellectual property that resides in it, but to give away as little as possible and then to maintain constant innovation and investment in research and development. There is no guarantee in such a fast-moving world that a successful innovator will stay ahead of the game. The successful innovator might be lucky and remain ahead of the competition for 18 months or two years, but will then be taken over unless a new wave of innovation is introduced. The danger is that, unless the innovator keeps moving forward, someone else might take the idea or concept and engineer an application solution without having known how the innovator had done that in the first place. That may be done better, or it may not, but the person who gets to the market first will have the advantage. That is a general observation; it is not a specific observation of the AllVoice situation.

That is a problem particularly for small companies and individual innovators who might not even have created a company or taken the idea to market. The problem is how to protect an innovation and secure intellectual property rights, and then how to introduce them and maintain the competitive advantage.

I am grateful to the hon. Member for Teignbridge for raising this important issue.