I am glad to have the opportunity, along with my colleagues from neighbouring constituencies, to raise the issue of Royal Air Force low flying over rural communities. I admire enormously the skill and courage of RAF staff in the work that they undertake and, like most of my constituents, recognise that they have a vital job to do. They have skills to develop and keep in the best condition, and that requires training. Although most of my constituents recognise that, widespread concern exists about the heavy numbers of low-flying aircraft.

The Northumberland area, low flying area 12, takes a large share—nearly three times the national average—of the fixed-wing jet low-level flying that takes place in this country. I am not concerned primarily about helicopter low flying or the transport flights occasionally made by Hercules aircraft because those flights do not raise the greatest concern, and, of course, the RAF search and rescue operation conducted from RAF Boulmer is enormously appreciated. Concern about other aircraft comes from the collision risk, rather than any other problem that low flying might present, so jet low flying causes the real concern.

In 1997–98, we experienced an 11 per cent. increase in low flying when other areas experienced a reduction. Rural communities are mainly affected; bigger towns with a population of more than 10,000 are, supposedly, subject to avoidance. That does not entirely apply, however, as low-flying jets fly over Berwick, which is a town of more than 10,000 people. Larger conurbations tend to have civil airfields, which are subject to wide areas of exclusion. I would not prefer to be in the flight path of a civilian airport—especially in the case of somewhere like Heathrow, where several planes come over every minute—in contrast to the periodic low-flying exercises to which I refer. Conurbation exclusions do not mean that people have an easier life, as heavy civilian flights cause a great deal of disturbance and lead to a concentration of low flying over rural communities.

Low-flying jets create a disturbance of a very sudden nature. One does not normally know that a jet is coming; suddenly it is there, and one is aware of an aircraft immediately overhead. Among those who are disturbed are those who are also greatly impressed by the flying and, in fact, enjoy seeing it. A large number of my constituents go to RAF Leuchars every year to see the air show and to watch the skills displayed there. In a week in which I had received a particularly large number of complaints about low flying, I remember attending an agricultural show at which a display of acrobatics by a single-engine propeller plane took place over the crowded show field. I wondered whether any of those who had written to me were among the crowd directly underneath the manoeuvring aircraft. For those who are concerned, there are those whose concern is outweighed by the sense that the RAF does a good job and who are impressed by its skills. However, that does not alter the disturbance.

People worry about disturbance over schools and to animals. From time to time, we request that the RAF avoid common ridings, for example, and events in our area that involve riding for the disabled. I am glad to say that several of those requests have been met. There is also concern about apparent targeting, when an aircraft can appear regularly to make for a particular building—perhaps a farmhouse, a row of cottages or a reservoir. That, too, can give rise to anxiety and to a feeling that the locality is getting more than its fair share of the low flying.

Road safety is another factor. Jets sometimes fly beside the road, or even below the road if it is on a hillside and the jet is flying along the bottom of the valley. That can be a major distraction to motorists, and it can present problems.

I suppose that the most significant problem for the majority of people is the fear of a crash and the risk involved if there is a lot of low flying. The RAF obviously goes out of its way to avoid accidents and crashes because aircrew can be lost, as happened in one of the incidents to which I shall refer, and every incident involves the loss of equipment, or even of aircraft costing tens of millions of pounds each. But crashes there are, and, unfortunately, they have been fairly frequent in the past two years.

In December 1998, a Harrier jet hit power lines and crashed at Barnard castle in County Durham. In July 1999, a Harrier crashed in my constituency, just east of Coldstream; the report into that crash was published recently, and I shall refer to it in a moment. In October 1999, a Tornado crashed at Kirkheaton, just beyond the southern boundary of my constituency, with the loss of two aircrew. An hour earlier, that jet had been involved in a near miss with a Boeing 737 passenger aircraft near Newcastle airport. There have been other near misses in that area. On 27 October 1999, a Hawk was lost when it hit trees at Shap in Cumbria. On 19 November 1999, a Tornado crashed into the sea near the Torness nuclear power station, just north of my constituency. On 18 October 2000, an Air Force Hawk crashed five miles west of Holy island, quite close to the village of Lowick; the crew ejected, but sustained minor injuries. On 29 October 2000, a Jaguar aircraft crashed near Lockerbie in Dumfriesshire.

On every occasion, people on the ground avoided injury or fatality. That is the happy side of an otherwise sad sequence of events, but people worry whether that will always be so. I know that aircrew are instructed to avoid that risk as much as possible and that, if an aircraft does go out of control, they often take courageous actions to try to ensure that it does not crash over a populated area.

What have we learned from the inquiry reports? I start with the Tornado that crashed at Kirkheaton in October 1999 and resulted in two fatalities. When confronted with deteriorating weather, the aircrew found themselves on a heading for Newcastle airport's controlled airspace. While turning to avoid that area, the aircraft went nose down and could not recover in the height available. The inquiry board found that four factors had contributed to the crash—the weather, what the board called "poor crew resource management", an incorrectly executed manoeuvre and the proximity of Newcastle airport's controlled airspace.

The board recommended a thorough review of low-level abort procedure, the action that aircrew need to take when required to make a sudden change of direction at low level. It also recommended that a ground proximity warning system should be fitted to all aircraft. Recent correspondence from the Minister suggests that that has been done for some categories of aircraft but not all, and that there are some constraints—perhaps for reasons of cost—on how many aircraft will be fitted with the warning system. I hope that the Minister will tell us what progress has been made on that important recommendation.

I also have the report into the Harrier crash near Coldstream. That incident involved five Harriers, nine Tornado jets, three of which were supporting the Harriers and six of which were acting as the "enemy", and a Tucano aircraft that was on a completely different navigation exercise, presumably without the knowledge of any of the authorities involved. In turn, they did not seem to have knowledge of the low-flying activity that was taking place. One Harrier was lost when departing violently from its course to avoid collision with the Tucano.

The RAF board of inquiry's recommendations were that all military low-flying aircraft should have a collision warning system installed, and that a study should be carried out into aircraft data links, whereby proximity can be displayed in aircraft to reduce collision risk. The inquiry also recommended a review of the handling advice for Harrier aircraft on high-speed departure avoidance. Will the Minister tell us what is being done about those firm recommendations?

It would also be useful to know what has been done about the near misses. In October 1999 there were three near misses in an hour on the day of the Kirkheaton crash to which I referred earlier. One or two of them involved the aircraft that was eventually lost, and another involved a near miss of 100 ft with a helicopter. There were seven reported cases in the past year. I hope that something has been learned from them.

The concern in the border areas has led local authorities to work together in approaching the RAF. That is generally helpful to the RAF, as it does not have to make presentations to many individual local authorities. The RAF took a full and valuable part in a conference that I chaired in Annan in March 1999 at which there were good papers from various groups. A lot of good was achieved by our discussions, but several issues were left in the air about which I want to see more progress.

At the time of that conference, Gulf war activity was still taking place, which led to questions about the operational requirement for low flying. In several recent conflicts, low flying has not been the chosen method of attack, which has led many people to question its future utility. I am in no position to provide an answer. So long as the RAF can make a convincing case for the operational need for low flying, we as a community have to accept our share in ensuring that we have the capacity for it. From time to time, Ministers need to satisfy me that that requirement is kept under review and that its essential nature is being checked out in the light of experience in recent conflicts.

Questions on the amount of low flying concentrated in certain areas were raised at that conference. Much reference was made to the extensive scientific literature on problems that can be caused by noise and disturbance from low flying. A specific and positive suggestion that emerged was the idea of a charter for low flying, to set out clearly some of the responsibilities of the Ministry of Defence in policing low flying and dealing with the community, and some of the citizens' rights to pursue their complaints and receive information. Most of us thought that that was a good concept, and it is disappointing that more has not been made of it in the interim. It had attractions for the RAF as well as for the communities involved, as it would have set out what the RAF does already in terms of providing information and responding to complaints. It would also have given citizens some assurance of what they were entitled to if they had a complaint about low flying.

I want to return to the issue of distribution and its effects in Northumberland. So long as the operational requirement for low flying clearly remains, I remain firm in my view that we must take our share of the necessary burden, but that it should be fair. As well as being in the heavily used LFA 12, we are part of the Cheviot low-level training area known as LOTAC, one of the busiest low-level operating training areas. A wide range of manoeuvres, measures and risks are taken in those defined areas. Are they and their uses being reviewed?

What other measures would help? One that constituents frequently suggest to me, perhaps in rather broader terms than I shall use, would be a reduction in reciprocal flights in our territory by the air forces of other countries. I would limit my plea to one that we should not have to accept non-reciprocal low-flying training over Northumberland. We have arrangements with some countries, which provide reciprocal benefit in our ability to use their territory. That benefits my constituents and others. If there is no reciprocal benefit, flying by other countries could surely be reduced.

Some of the low flying that affects my area is generated by traffic on route to the Spadeadam range—both our own and that of other countries' air forces. The Spadeadam range is a valuable resource and is marketed. Its facilities are made available to other air forces for payment. I see nothing wrong in that, with this qualification: I am advised that it is often not necessary on the way to use the range to fly in at low level over LFA 12. The main operational requirement involves using the Spadeadam range. Given the amount of low flying that we experience it should, I suggest, be made clear, particularly to those from overseas, that low flying is to take place over the range and not over the approach to it through LFA 12.

It would help significantly if the targeting, to a disturbing extent, of properties, buildings and features, could be avoided. Instructions to aircrew should involve keeping that under review. Although that practice is not the main issue, the intensity of low flying in a locality seems greater if a feature is so attractive to pilots that they continually home in on it. It creates a sense that part of the area is under an even greater burden of low flying.

I hope that the Minister will tell us about what hopes there are for a reduction in low flying. What is his current view of the operational requirement for low flying and for the pattern of low flying over the next few years? What efforts is he prepared to make to secure a fairer and more even distribution of low flying in the large number of areas where low flying is considered necessary and appropriate? Previous Ministers in the Department have been able from time to time to reduce low flying over Northumberland. The present Minister, who has not been in the post for long, could rise to the challenge and bring about some benefit for my constituents. The vast majority of those people greatly respect the RAF, realise that it has a vital job to do and accept that they have to play a part in accepting the burden involved—but they want their share to be a fair one.

rose—

Order. I lack guidance from the Liberal Democrats as to who is their Front-Bench spokesman. If no hon. Member is intending to wind up at the end of the debate, I shall simply call hon. Members as ordinary Back Benchers.

No one is here as a Front-Bench spokesman. In the best tradition of the newly created Westminster Hall we are all here to raise constituency concerns. However, my hon. Friend the Member for Roxburgh and Berwickshire (Mr. Kirkwood) has made it known that he is willing to be the last called from our Benches.

The absence of a Front-Bench spokesman for the Liberal Democrats must be a unique occurrence. I call Mr. Kirkwood.

rose—

Order. I beg the hon. Gentleman's pardon. I was confused. The hon. Gentleman intends to speak last for his party. Perhaps he will forgive me; I shall call one of his hon. Friends.

I apologise for any confusion that has arisen. We like to think of ours as a team effort, which we have, I hope, demonstrated beyond reasonable doubt this morning.

I congratulate my right hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith) on securing this debate. I welcome the opportunity to discuss the important matter of low flying and the RAF's role. Like my right hon. Friend, my constituents and I believe that the RAF's position in the armed forces is very important. We can all proudly proclaim that its pilots are the best trained and the finest in the world. We recognise that the training that underpins that must be done somewhere, and that low-flying training, whether during the day or the night, is an important part of the process. Because of our beautiful landscape and the thin population spread across many hundreds of square miles, we must also accept that the areas north and south of the border are a prime area for low flying. We have heard the statistics about the extent to which that is the case.

We accept all that, and would never seek to diminish the RAF's role or its ability to undertake low-flying training in our part of the world, but important issues need to be tackled. We hope that the Ministry of Defence in particular will have listened sympathetically to the points raised by my right hon. Friend—I am sure that other hon. Members will echo them—about ensuring that a balance is struck between the RAF's needs and the rights and sensitivities of those who live in the areas involved.

The RAF has recognised over many years that a proper public debate about its role, and dialogue with local people, must be in its interest and in all our interests. I pay tribute to the work of individuals such as the south of Scotland liaison officer, who has regularly been quick to deal with any complaints from my constituents and me.

Over the past two or three years, the RAF has made many attempts to make its case to my constituents. I recall attending a slick presentation in the volunteer hall in Galashiels not too long ago, at which a good crew demonstrated the RAF's role in the armed forces and in NATO, and the need for low flying. Any sceptics would have been won over by the end of that presentation. We were impressed that the RAF took the time to visit us and go into a great deal of detail. Incidentally, the presentation was almost too slick. As the commanding officer answered questions at the end of the presentation, his squad had appropriate slides and captions appear on the screen behind him, and someone alleged that that was a fix. I was happy to check that out and was confident that it was not. I thought that we should be grateful if the skills that keep our pilots in the air also allow them to move slides quickly through a presentation.

In addition to public presentations and the like, we have benefited from and appreciated regular briefings from the RAF, as have many right hon. and hon. Members. My colleagues and I paid a fruitful visit to RAF Spadeadam just over a year ago and were impressed by the extent of its facilities and the commitment of the ground crew, officers and all those in the surrounding area to the work being carried out there. We had a proper, open and professional tour of the site and a good opportunity to raise many of the concerns that we are raising here.

We all recognise the RAF's need for low-flying training, but we frequently worry about the manner in which it is carried out. We want to stress again the need for a great deal of sensitivity. I shall focus on two sensitive locations in my constituency. First, the Borders general hospital, situated in the lee of the Eildon hills, which are a beautiful and stunning landmark, standing out for miles around, and are consequently a useful visual target for RAF crews using the area, in fast jets or transport aircraft. There is an exclusion zone around the hospital, but I get many complaints from people who say that, although the aircraft have not flown over the hospital, they have come close to it. Residents in Melrose, the adjoining town, are concerned about how close the aircraft come to the hospital, which is the major acute hospital for all three constituencies in the border area. I ask the Minister and his colleagues in the Ministry of Defence to look again at the use of the Eildons as a target area. It is important to consider the matter sensitively.

The second place that I want to highlight is St. Mary's loch. The area is thinly populated but the issue is none the less important for residents and farmers. I have held annual autumn community advice surgeries in its community hall, Cappercleuch—a beautiful little hall that one would drive by and ignore if one did not realise that it was the focal point for a vast surrounding rural area. It is one of the better attended of the community advice surgeries that I hold. Apart from such issues as roads, which are always of concern, low flying is a big problem. I have witnessed the aircraft while in the area. It is a false impression, but one feels sometimes that one could wave to or touch the pilots as they pass. That is all very well on a beautiful clear autumn day; it is more alarming when it occurs regularly at night or at other times of the year. I again appeal for some sensitivity to be shown towards that area; it is an easy visual target for passing aircrew but a balance needs to be struck on how often the area is targeted.

As my right hon. Friend said, apart from sensitive locations, many sensitive events—such as the common ridings—take place over the Borders summer. The common ridings are important to the towns and communities that hold them. As many as 300 horsemen and horsewomen often gather to ride over the moors and the hills. Selkirk common riding is one of the larger ones: I choose my words carefully because it does not do to decide what is better or worse in my constituency. It is one of the larger gatherings of riders and one of the longest established common ridings in the area. In each of the past two years, I have had to ring the Ministry of Defence while on top of a hill watching the horses because, despite exclusion orders having been issued for the day, low-flowing aircraft were buzzing the area. I am sure that the Minister and his colleagues in the Ministry of Defence appreciate the sensitivity of a situation in which there are so many horses, people and visiting tourists and understand the importance of making a real attempt to ensure that low-flying aircraft are well clear of the area on such days.

I appreciate that mistakes will be made. It is in the nature of fast-moving, low-flying objects that a small change of direction can quickly have a huge impact on distance and location. What matters is the level of monitoring carried out by the RAF of such flying. One of the issues that we raised at RAF Spadeadam a year ago was the nature of the flight plans that are filed by pilots before their trips. We were encouraged to find how thorough they are and just how serious are the briefings given to individual pilots as they head out on their sorties. We were alarmed to discover, however, that there is no monitoring after the event to check where pilots flew. There may be an informal debriefing but there did not appear to be anything near the serious levels of debriefing needed to ensure that pilots did what they were intended to do or that if, for understandable reasons, there were deviations from the plan, those were explained and understood.

What impressed us at RAF Spadeadam was the Skyguard facility, the mobile radar that ensures that low flying can be policed Skyguard must be proactively and regularly used. It appeared from my correspondence with the Minister that it is used only intermittently and often in response to specific concerns raised after a particular incident. There is little sanction against pilots if they do not think that there is much chance of being caught when they have flown too low or too fast through an area. Is there a defined programme of monitoring using Skyguard, and what reporting procedure is there? To what level within the RAF does that report go?

We do not ask to understand the outcomes—for obvious reasons, we recognise that the Ministry of Defence and the RAF need to maintain that for themselves—but there would be no harm in the public knowing how often Skyguard is used and getting an idea of the types of measures and lessons that have been learned from it. We have come a long way in recent years. There is a great deal more openness now than ever before. I hope that that can be encouraged to go further.

My constituents are wholehearted supporters of the RAF and fully appreciate the need to have training facilities. We hope, in return, that the MOD and the RAF recognise the sensitivity of our part of the world.

Order. Before I call the hon. Member for Somerton and Frome (Mr. Heath), it might be for the convenience of hon. Members to know that I am not one of the listed Deputy Speakers and therefore it is correct to address me as Mr. Maxton.

Thank you, Mr. Maxton. We are beginning to learn the revised rules of this place.

May I, too, congratulate my right hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith) on securing this timely debate? I notice that my hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Mr. Moore) indicated that this was a team affair. Not for the first time, I do not seem to have been included in the team, as I will speak from a rather different stance.

First, I shall speak about another area of the country, Somerset, rather than the borders. Secondly, I shall concentrate on rotary-wing rather than fixed-wing aircraft. Thirdly, and I hope that I will not be ruled out of order, hon. Members will be aware that the principal airfield in my constituency is the royal naval air station at Yeovilton, although in these days of jointery, there is no fixed distinction between services that fly from that base. Hon. Members who have heard me speak over the years will know that I am a great supporter of Yeovilton airfield. I believe in the work that it does and I want it to be developed. In previous years, the Ministry of Defence has put in considerable investment, but I worry that there are plans to close it. I hope that it will continue to be used.

Like my right hon. Friend, on making my customary tour of villages in my constituency this summer, I discovered that the recurring complaint, particularly from those living on the levels in the Yeovilton area, was of noise from helicopters that use the base. Curiously enough, the problem is caused by helicopters that use the Merrifield satellite station at Ilton, rather than Yeovilton.

Of course, fixed-wing jet aircraft such as the Harrier, which we have lived with for a long time, are leaving Yeovilton. We have recognised their value and taken considerable pride in them over the years, but there is now a greater emphasis on helicopter traffic. In the tiny communities such as Isle Brewers, Isle Abbotts, Beercrocombe and Curry Mallet—they are not much more than specks on the map—that fringe the air stations, people consistently complain about the considerable disruption caused by helicopters. In fact, many say that helicopters are more disruptive than jet aircraft because they hover rather than pass in an instant.

I should point out that, in terms of liaison, RNAS Yeovilton is first class. Mr. Richard Seymour, the liaison officer, does a terrific job. He talks to local parish councils and investigates individual complaints. Air station open days attract many people and allow them to see exactly what goes on there. Mr. Seymour works closely with Commodore Clapp, for whose attitude to complaints I also have nothing but praise. However, the fact remains that the low-level exercises that helicopters inevitably need to carry out cause disruption in the area. Although it is impossible to eliminate that disruption, we must consider how to minimise it for the greater good of the local community. With that in mind I shall make a few brief points.

First, liaison is desperately important. As I have said, although the existing systems are extremely good, I should hate them to wither away because it is important that the community understands what is being done and why.

Secondly, we must develop as far as possible family-friendly practice among pilots and those who plan their exercises. That can be achieved, for example, through the design of the exercises. Of course military exigencies might require flights at unusual times such as weekends. Nevertheless, much of what is done is carefully planned. Such low-flying exercises and other events should as far as possible avoid disrupting local communities.

It is questionable whether pilots stick rigidly to their guidance when out of visual range of the airfields. I cannot prove that—it is based purely on circumstantial evidence and hearsay. However, challenges from members of the community—for example, they may complain that there is a helicopter just above their church—are too often refuted by the air station. If the area is in visual range of the control tower, the air control people can prove that the helicopter is not there, but the systems that are in place at Yeovilton may not be sufficiently accurate—they are rather antiquated—to be able precisely to identify the position and altitude of a helicopter that is out of visual range. Perhaps the Minister can persuade me otherwise.

Thirdly, I turn to the interplay between current and future use of the airfields and planning processes. Many planning decisions depend on the way in which the airfields will be used. A process is under way to establish a flight path footprint for Harriers at Yeovilton, within which planning permissions will not be granted, or there will be a presumption against doing so. That will affect the value of property and people's legitimate wish to develop it. It makes sense not to put new houses under the flight path of a jet, but the position must be constantly monitored to ensure that it is consistent with current and future use of the airfield.

The crucial question that everybody in the area is asking is, "What will the future uses of Yeovilton and Merrifield be once the Harriers have finally departed?" I know that that is a big question and that careful consideration is being given to a wide range of options, which may involve much greater use of Yeovilton. Many aspects of those discussions are welcome and I look forward to the final decision being taken.

One consequence of the change may be that the satellite station becomes redundant. Merrifield's purpose has been to facilitate helicopter traffic when the Harriers are monopolising the main airfield, so it may become surplus to requirements when the fixed-wing aircraft depart and there is purely helicopter traffic. I assume that the Department has not yet made that decision. Rumours go around the local community that it is about to be disposed of for commercial use. People find that alarming because they feel that they will not have similar liaison with a commercial user. Commodore Clapp and others have said that they know of no such plans.

I would be grateful if the Minister provided some enlightenment, although, given that the prime subject of the debate is jet aircraft in Berwickshire, I accept that he has probably not come equipped to talk about helicopters in Somerset. My local community would like to know as soon as possible about the plans for airfields in Somerset. They want to know that jobs are secure and that the well-established relationship with the fleet air arm will continue. They also want to know about potential effects on the environment of the local area. For example, if twin-rotor Sikorskys come to the airfield, that will make a significant difference to the surroundings.

Will the Minister write to me with any information that he has and assure me that I will be made aware of any decision as soon as it is made, so that I can inform the people whom I represent?

I am pleased to be able to take part in this short but important debate, and I congratulate my right hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith) on securing it.

This subject has been a key part of my constituency casework since I was elected in 1983. Every year, with almost inevitable regularity, we get a new Defence Under-Secretary. We last saw the Minister's predecessor in December last year and—this may concern the Minister—a few weeks after that, he resigned because the job was too much for him.

I am made of sterner stuff.

Well, we look forward to that being reflected in debate. I join my hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Mr. Moore) in the great reservoir of support for our active servicemen—brave young pilots who fly at high speeds at low levels in the interests of national security. I also share my hon. Friend's estimation of the work of the RAF. RAF Spadeadam, which we visited, is an impressive place where dedicated professionals perform what they consider to be an important role for the nation. I understand the Minister's attitude, that there is nothing new to have prompted this debate, but it is incumbent on the Ministry of Defence to argue month in, month out, year in, year out, why low-level tactical training is necessary.

In the old days, when I was first elected, the cold war was in its latter stages and people in my constituency were willing to accept the strategic need to fly heavy jets at low levels, because they understood the perceived threat from the Soviet Union. That was how our forces were configured, and one did not have to be a military strategist to recognise that there was perhaps a need, in extremis, to attack deep into Russia. During the late 1970s and early 1980s, the need for low flying was much clearer than it is now. One of the biggest difficulties that I have with my constituents is trying to argue the circumstances in which such flying would be practised in a live theatre of war. There may be an argument about taking out airfields in Iraq, but it would help me if the Minister would take a minute in his response to stand back and justify the strategy. There may be elements of strategy that the Ministry of Defence has to keep up its sleeve to protect national security and secure its ability to respond to perceived risks. However, we are responsible people and I would not breach national security. What are the perceived military risks to which tactical low flying is a response? I am often asked that question.

Constituents telephone me because slates have just been taken off their roof or their stock has been disrupted or damaged by low overflights. They are hot with rage and want nothing more to do with low flying. I calm them, arrange to see them and talk them through it. During that process, I often come to the most difficult question: why on earth are we asking our young pilots to do this? What are the costs involved, not only in terms of the risk to life and limb? We know that young servicemen regularly put themselves at risk and some of them tragically lose their lives. A further, less substantial, consideration is the huge attritional cost to equipment. We are concerned not only with the cost of the damage, disruption and disturbance that our constituents encounter in an environmental context as a result of low flying but with the totality of the costs incurred by the Ministry of Defence. The Minister may say that we go through the same issue year in, year out, but I believe that the Ministry of Defence is obliged to keep winning the argument, year in, year out. Otherwise, in my experience, the game becomes almost impossible to defend.

I will add a couple of points to those already made eloquently by my two colleagues. I would like the Minister to tell us about some of the more recent crashes and what caused them. I am encountering concerns that equipment failure is not the prima facie cause, but rather a loss of control by the crew. That is a cause for concern. Can he reassure us on the matter? I am also increasingly concerned about the implications of manoeuvring and interceptions as causes of crashes.

On the volume of low flying, can the Minister bring us up to date about the four Tornado squadrons that have, I believe, been redeployed from Germany? The implication is that they have nowhere else to train. They used to train in West Germany, and in LFA 13, LFA 16 and LFA 12. That is a prima facie cause for concern, because if more jets are flying, even more of them will be flying over our constituencies. We need to know more about that issue.

I am sure that the Minister will wonder what all the fuss is about, because at 100,000 or 110,000 a year, the volume of flights is decreasing. That may be true in terms of fixed-wing heavy jets, but with the new deployments of Apache helicopters and of Tornado GR4s and Jaguars with night-flying capability, which are being used for night training, there is concern that new helicopter and Hercules activity is now becoming a problem. Although there may be a decrease in the level of flying undertaken by heavy fast jets, the Minister must bear it in mind that a reduction in some types of activity is being counterbalanced by an increase in other types.

In passing, I concur with my right hon. Friend about the use of foreign crews. It would be useful to know the current trends in the use of Spadeadam by foreign crews. That is a difficult issue to deal with when responding to constituents' complaints, when they read in the papers of incidents involving crews from overseas who are training there. The ALFENS—automated low flying enquiry notification system—computerised booking system was still being considered a year ago as a way of tracking low-flying sorties over some of the tactical training areas. If no ALFENS system is currently being considered for deployment, we cannot reassure constituents that there will be a fair distribution of flights. Quite frankly, the Ministry does not know where the jets are going, because pilots have a free hand over the route that their sorties take.

Technical difficulties or cost-efficiency savings may have caused the abandonment of the system, but the Minister previously founded his argument on the fact that a tracking device would be available, to track the flight paths of the aeroplanes. That would give us the confidence to go back to our constituents and say, "Here is the pattern. This is what is going on and we can assure you that we are not getting more than our fair share." As my right hon. Friend said, that is by far the biggest complaint. I should be pleased to have an update on the ALFENS system, if it is still on anyone's radar screen—if that is not an inappropriate metaphor.

Skyguard is another common feature of discussions that have been going on since I was elected in 1983. In spite of the fact that it is deployed professionally—there was a demonstration at RAF Spadeadam, and it is an impressive piece of kit—there is scepticism in the public mind about it. I cannot believe that in the debriefing room or in the lavatory back at base the crews do not share the news that there might be a Skyguard unit deployed in Duns, Dumfries or anywhere else. That must be so, because the results show that it does not pick up any breaches in regulations. The Minister's body language seems to say, "QED: there is no breach of the regulations," but that is in flat contradiction of the evidence of my constituents, some of whom have been in the RAF. I cannot believe that they are all wrong; there must be some breaches in the regulations that the Skyguard system does not pick up. If the Ministry had been notified of recent convictions for speeding track offences and one or two pilots were brought to book, it would, in a perverse way, reassure people that the Skyguard was working because it had picked up pilots flying outwith the regulations.

Landmarks are an issue in every constituency. Although I appreciate the Ministry's difficulties, if it dealt more sympathetically with one or two hotspots it might find its general case easier to argue across the board. Berwickshire high school in my constituency is one such hotspot. No one in the town of Duns can be persuaded that the school is not a target. There may be technical reasons for that: it may be in a corridor for planes coming in off the North sea and going north. It may not be the technical target of a toss and dive attack, but it suffers from overflights, sometimes in the middle of examinations. There are enough problems with the marking of examinations in Scotiand without the poor pupils being overflown for two or three days in the middle of highers and certificates.

There should be more sensitivity to specific complaints. I accept that the Minister may say that Berwickshire high school is not a target and that, in any case, if there are too many exclusion areas it sets precedents, but if specific complaints are not dealt with sensitively, people think that their legitimate complaints are not taken seriously. In this case, the schoolmaster and members of the school board are making the complaints, and they are not disruptive people. If the Ministry was more sensitive in dealing with one or two areas with a relatively high intensity of low overflights, and if it took a more sensitive approach to hotspot landmark targets, it would find it easier to win the argument that low flying is a positive thing that is necessary in the long-term public interest.

I agree with my hon. Friend the Member for Tweeddale, Ettrick and Lauderdale that the liaison officer works hard; continuing consultation is needed all day and every day to win the argument. The Select Committee on Defence carried out a thorough and useful full-scale inquiry into low flying in the early 1990s. Opposition Members want the Ministry to tackle the issues raised this morning as a matter of urgency, or our next port of call might be to say to the Chairman of the Select Committee that, after 10 years, it is time to have another go. In the not-too-distant future, it might be persuaded, if it thinks that the Minister is not addressing the issues properly, to attack the question again and consider what improvements or changes are necessary and how the issues have evolved.

I hope that the Minister will accept that the debate is not meant to attack the good faith of the RAF or any of the professionals involved. It is an attempt to make representations positively on behalf of constituents who are constantly in touch with us and who are genuinely concerned about what is a real public issue in our rural areas.

I congratulate the right hon. Member for Berwick-upon-Tweed (Mr. Beith) on securing this debate. He and his hon. Friends all seem to represent particularly beautiful parts of the kingdom, some of which I know quite well, especially the constituency of the hon. Member for Tweeddale, Ettrick and Lauderdale (Mr. Moore). The Borders general hospital, to which he referred, is the only general hospital to which I have been admitted as an in-patient. I was enormously impressed by the professional thoroughness with which I was treated. If I ever have to return to a general hospital—I hope that I do not—I would love to go to that one. Although no one knew what I did for a living when I was admitted, I was there for several days, and it came out. The staff therefore talked to me quite a lot about public issues in the area, but no one mentioned low flying as a problem.

I speak not only on behalf of the Conservative party but as a Lincolnshire Member. No part of the country has a greater concentration of RAF stations. I would be surprised if Lincolnshire experienced less low flying than the areas represented by the Liberal Democrat Members present. I was amused to hear about people who persuade themselves that their houses or schools are targets for low-flying operations, because the Davies family has been persuaded for a very long time that our house in Lincolnshire is a target of the same kind. There is a great deal of low flying in our part of the world, and the family dog always howls at low-flying aircraft, which is a technique that she is persuaded works well, as they end up going away. She has been defending the family against such intrusions for many years in that very effective fashion.

As a Lincolnshire constituency Member, I have often heard complaints about low flying but have never complained on my own behalf, and only rarely, on two exceptional occasions during the past 13 years, have I raised the issue of low flying with the Ministry of Defence. The only occasion on which I mentioned the subject previously was during my first Parliament as a Member, when I accused a lot of the complainants of being whingers and whiners, which landed me in the tabloid press. I am happy to repeat that phrase today, as many such complaints should not be taken seriously, and certainly not in the context of the enormous seriousness of having effectively trained RAF crews who can handle their aircraft, operationally, in the whole range of situations in which they might be required to fly. That is absolutely vital.

The hon. Member for Somerton and Frome (Mr. Heath) displayed a characteristic and, if I may say so, Liberal propensity to pick up whatever populist issue happens to be hanging around, and to recite the usual litany of the politically correct brigade about family-friendly policies. Is he proposing family-friendly low-flying policies? What rubbish! Another typical Liberal proposal is to have a charter—again, what rubbish! The need for flexibility in conducting low-flying exercises is an absolute imperative. It is vital for national security.

Will the hon. Gentleman give way?

No, if the right hon. Gentleman will forgive me, I will not, because I do not want to take too much of the Minister's time.

Frit.

Well, if the right hon. Gentleman insists and is brief, I will take one intervention.

I wonder whether the hon. Gentleman's criticisms extend to the hon. Member for Hexham (Mr. Atkinson), his Conservative colleague, who said:

The whole issue must be properly investigated. We put up with a lot of low flying in Northumberland and most people do that because they recognise that the RAF needs to do it.

He went on to argue that low flying needed to be properly controlled and that recent crashes needed thorough investigation.

Clearly, the right hon. Gentleman would not expect me to disagree with the latter proposition, that crashes should be properly investigated by the RAF, as I believe they always are. The procedures are thorough, and we shall hear shortly some of the conclusions from the reports that have been undertaken.

Some hon. Members have got their priorities fundamentally wrong in the emphasis that they place on this matter. The right hon. Member for Berwick-upon-Tweed made some reasonable points, however, and I sympathised with his proposal that ground proximity warning systems should be installed in all aircraft, as should collision warning systems. I have often taken the Government to task for not equipping the RAF with the appropriate, up-to-date avionic equipment; recently I have taken them to task on the matter of secure communications. The area to which the right hon. Gentleman refers may be another on which the Government have let down the RAF by failing to install equipment that would bring a significant reduction in the risk of collisions and would save lives. There is force his criticisms in that respect, and I fully endorse that aspect of his argument.

It is important that I do not take up too much of the Minister's time, because we want to hear his response to these matters. I hope that my contribution may cause him to take a more robust stand against some of the more unreasonable whingeing that we have heard this morning. I make a practical suggestion to him. Thanks to him, his colleagues and the Ministry, I visited the Falkland Islands earlier this year, which was a fascinating experience. I came back with many conclusions—most of them are not relevant to this subject, but one of them is. We do not use the Falklands efficiently for low flying and live firing operations. There is no public resistance among the islanders to such operations. The area has magnificent scope for training, with the endless seas, mountains and other interesting landscape features. Four F3 Tornadoes—a pretty good minimum—are based at Mount Pleasant air base, which has every possible facility and is well organised. I hope that, if the Minister thinks my suggestion worth pursuing, he will pursue it irrespective of the fact that it was made by a Conservative Front-Bench spokesman. I would like to think that it could be considered on its merits.

Conservative Members totally support the necessity for the RAF to continue to conduct low-flying training. It is absurd to say that those skills are no longer necessary because we have not used low-flying techniques in recent military operations. Equally absurd is the suggestion made by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) that we do not need those skills any more because the cold war has ended. We live in a world of great uncertainty and it is more difficult now than it was during the cold war to predict the circumstances of the next armed conflict or peacekeeping mission in which we might unfortunately be involved. The tactics that we adopt must make sense in terms of the threat that we face—ground-based air defence systems, the characteristics of the enemy radar, and so forth. It is vital in this uncertain world, in which we have to train for a much wider scope of potential military tasks, that no flexibility is lost in the skills in which our aircrews are trained.

In the interests of giving the Minister at least 28 minutes to respond, I conclude my remarks.

I congratulate the right hon. Member for Berwick-upon-Tweed (Mr. Beith) on securing this debate and particularly on securing an hour and a half, as that gives us all ample time in which to make our points. In case I do not reach the end of my carefully prepared text, I shall give the right hon. Gentleman some good news now. In the training year April 1999 to March 2000, booked low flying reduced by 7,388 hours—15 per cent.—across the United Kingdom, compared with 1998. In low-flying area 12, there was a 25 per cent. reduction. I am sure that the right hon. Gentleman will be happy to take that good news back to his constituents. I sincerely hope that the next complete year will also show a satisfactory reduction, although there are bound to be fluctuations at times.

If the hon. Member for Grantham and Stamford (Mr. Davies) painted a nice large white cross on his roof, it would make it much easier for us to target him. I hasten to add that that was a joke, although there is an apocryphal tale about someone who painted a white cross on his roof because he thought that the RAF had targeted his remote farm a number of times.

I was in no way suggesting that the Davies family were volunteering to take part in live-firing operations in Lincolnshire.

I had better move on.

I propose to answer as many individual queries as possible and I will go over my prepared statement if I have time to do so. On several points, I will have to write to hon. Members, as I do not have the full information available. In the nature of things, we cannot cover every eventuality, and I do not want to give inaccurate answers.

We realise that low-flying military aircraft can distract drivers. Aircrews avoid carrying out prolonged or unusual activity near major roads, but a typical fast-jet sortie may cover a distance of 500 to 600 miles. It is, therefore, impracticable to avoid all major roads at all times, particularly in valleys, although we do our best. Of course, the highway code states that a driver must be in control of his vehicle at all times, and one or two of my constituents have written to me in the past after finding that distraction is no defence for an accident.

The overall number of accidents for all types of RAF flying has approximately halved over the 10 years between 1988 and 1998, but fluctuations in the trend will occur. In 1999, the RAF lost 12 aircraft and, I am sorry to say, five aircrew. An Italian air force pilot training in the UK was also killed. Our target remains to achieve the lowest possible accident rate, and we make constant efforts to reach that goal. Aircrew always do whatever is humanly possible to pilot a stricken aircraft away from any remotely populated area, as happened in the Jaguar incident on 27 October this year.

The investigations into the full circumstances of the Hawk crash near Lowick on 18 October 2000 and the Jaguar incident on 27 October are still proceeding, and we will release their findings in due course. I think that the Hawk incident at Shap on 22 October 1999 was also mentioned. I expect to be able to release the military aircraft accident summary to Parliament early in the new year. Boards of inquiry not only determine the cause of an accident, but try to establish what can be done to prevent such accidents from happening in future.

The Tornado crash on 14 October 1999 tragically killed both crew members. The finding was that, during a low-level abort, the aircraft was manoeuvred into a position from which recovery could not be effected in the height available. Those who have read the report will know that the board identified a number of factors that might have contributed to the accident, including poor weather in the operating area. It was impossible for us to identify which factor played the largest part.

Flight safety is clearly a high priority for us, and the highest in training. All aspects of flight safety are kept under continual review, and there are many continuing initiatives. We strive for open and honest reporting of incidents, and a system of confidential reporting enables individuals to raise issues anonymously if they prefer. We do our utmost to ensure that as much information as possible is given to us about any aspect of flight safety, without people feeling obliged to conform to some real or imagined code of practice.

We are pleased at the high level of co-operation between military and civil aviation communities. Regular civil and military air safety days are held, usually at RAF stations, to provide a direct safety link to the general aviation community. Military and civil air traffic controllers are closely integrated to try to ensure the highest safety standards.

Development work on a collision warning system for the Tornado GR4 is making progress. The requirements deal with the mitigation of mid-air collision risks relating to various types of civil and other military aircraft. The Civil Aviation Authority has been directly involved and is happy that the programme is consistent with developments in civil air safety policy. We expect the collision warning system to be introduced as part of a scheduled refit programme beginning in 2004. The technical solution for the GR4 may be able to be used on other types of aircraft, and we will keep that possibility in mind.

The programme to fit ground proximity warning systems to all fast jet aircraft except the Hawk continues, and I shall write to the right hon. Member for Berwick-upon-Tweed with an update. He mentioned a charter, but we have no proposals to set one up. The RAF works within a clearly defined set of regulations that are strictly enforced. The public are well informed through annual statements on low-flying training, our Department's website and written and video material which is freely available. Local newspapers also pick up such material, especially in the borders where the issue is so important.

Use of our low-flying airspace by non-UK based foreign aircraft is a sensitive subject, and all such use of the system requires approval by officials. The principle of reciprocity is a key consideration, and approval is generally given only when British aircraft are afforded the opportunity to train at low levels in the countries concerned. Other factors must be considered, including the rather less tangible mutual benefit that UK and allied forces may receive from such training, as well as the wider defence interest.

My Department views exercises and squadron exchanges with other nations as excellent training opportunities to develop the capabilities that are increasingly employed in multinational responses to emerging crises. When foreign use of our low-flying system is approved, the aircrew will be fully briefed beforehand on the requirements of the system. They are subject to stringent flying regulations that are the same as or stricter than those that apply to our services. During the last year for which I have full data, foreign aircraft took part in less than 0.5 per cent, of the total sorties booked in the UK low-flying system, so such exercises are small in number.

The Spadeadam range is a designated facility for the North Atlantic Treaty Organisation, and is available to it on a repayment basis. Low flying by non-UK based foreign aircraft using the range is generally restricted to LFA 13, with transit flying to and from it conducted at medium level. There is an exception, as Italian aircraft are permitted to conduct their transits to and from the range at 1,000 ft. That dispensation continues in recognition of the assistance provided to our forces supporting the NATO operations in the former Yugoslavia from Italian air bases.

One does not have to be an active conspiracy theorist to imagine that there might be collusion on skyguard. On the days when it is deployed inconveniently, everyone knows about it. That is not our practice—just as we do not warn units when we are about to carry out random drug tests, a fact borne out by the numbers who regularly fail them. I am sorry to say that the fact that skyguard virtually never picks up evidence of irregular activity shows that what bothers people is normal activity by low-flying aircraft. I fully accept that normal low-flying activity is highly intrusive and annoying. I have experienced it over many years—not, I hasten to add, where I live, but certainly when fishing. Few more disconcerting things can happen, when one is standing waist deep in a fairly fast flowing river, than to have a Tornado fly overhead.

The MOD knows where the hon. Gentleman goes on holiday.

Yes, one could almost imagine that one was being targeted by those aircraft. I have had the experience only once this year, so perhaps I have been lucky.

Skyguard is a covert programme. I intend to observe it in the new year in an area that I shall, of course, not mention. If any right hon. or hon. Members want to see it in operation I should be happy for them to go out for a day to see what will be done in the area in question. As they will know, there are usually about 12 deployments a year, of three or four days. On the last occasion, in the constituency of the right hon. Member for Berwick-upon-Tweed, when monitoring was carried out at locations around Alnwick and Morpeth, between 7 and 9 November, 37 military aircraft were tracked. I am happy to say that none was in breach of regulations. The equipment was put on public display in Alnwick on Friday 10 November, and 56 members of the public visited it. It is not deployed solely in response to accidents. We try to implement a constant random programme as well. We should hope to cover all relevant areas of the country in a year.

On the point about Newcastle airspace, the MOD employs a three-nautical-mile buffer zone to protect Newcastle airport's airspace during exercises. Military aircrew are stationed in the tower during exercises. Regular consultation takes place with Newcastle airport managers. In fact, a meeting took place last week. An airspace users conference is proposed for Newcastle in May, to be led by the RAF's inspector of flight safety.

The hon. Member for Tweeddale, Ettrick and Lauderdale (Mr. Moore) spoke about the avoidance of sensitive sites, including the Borders general hospital. I am of course highly sympathetic when there is any allegation of disturbance to a hospital. In general we are always willing to consider requests for temporary avoidances. I want to make it clear that the hospital is excluded from low-flying activity—that is our official policy. As to ride outs, we avoid them in general provided that we receive notification. I shall see that that advice is strongly reinforced this year.

We do not target farmhouses or other places of human habitation during exercises—apart from the home of the hon. Member for Grantham and Stamford, of course. There are turning points in exercises, which are flown to predictable, pre-set patterns. Of course, hills are often used as aids to navigation. It is our policy to try never to use turning points in built-up areas, or where avoidances are in place. There is constant rotation, so that one area is not disproportionately penalised. We are happy to investigate specific allegations.

On the matter of Yeovilton and rotary-wing aircraft, I am sympathetic about disturbances from helicopter activity. Low-flying techniques require regular and realistic practice. Helicopters are often authorised down to 50 ft or even sometimes ground level. We would always try to seek permission from landowners when landing on private property.

I will probably have to write to the hon. Member for Somerton and Frome (Mr. Heath) about the future use of Yeovilton. I cannot find the note that I have made on the subject in my pile of papers.

On the automatic low-flying booking and control scheme, I am sorry to say that parts of the project have been the subject of litigation between the contractor and my Department. I take it that I do not need to expand further. Negotiations are at an advanced stage. I expect to be able to write to the Chairman of the Select Committee on Defence early in the new year. I will place a copy of my letter in the Library. I do not believe that flight safety has been compromised at any stage by difficulties with the project.

Skyguard was deployed to the Duns area earlier this year in order to determine whether Berwickshire high school was seeing an unreasonable amount of low-flying activity. I believe that I wrote to the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) about it. I will keep these matters under review.

I have now found the note about Yeovilton. The hon. Member for Somerton and Frome will be delighted to know that the study is on-going. He is well aware of that as I can remember signing the letter to him recently. I regret to say that the study is still on-going and that is unlikely to change before next summer, when I will be happy to write to him again.

The hon. Member for Roxburgh and Berwickshire asked why low-flying training was necessary. Our pilots are not always required to use their low-flying skills, as was the case in Kosovo last year. However, as a nation we continue to demand and expect well-trained armed forces, ready to defend our interests and those of our allies at short notice, anywhere in the world and often in unstable and unpredictable conditions. With those expectations, we must ensure that when we send them to deal with the unexpected, our armed forces have the ability to achieve their objectives, which includes taking control of airspace at the earliest opportunity.

Kosovo does not provide the only template for future conflicts. Our armed forces must be ready to go anywhere at any time. Sierra Leone is a case in point, where low flying by Harrier aircraft was a factor in ensuring that our mission objectives were achieved. As right hon. and hon. Members are aware, considerable use of low flying was made in the Gulf war where low-level missions by RAF Tornados made an important contribution to coalition air operations.

Low flying remains a vital element in our armoury of tactics to enable aircrew to penetrate and reconnoitre hostile airspace with minimum risk to themselves. Our aircrew must be able to reduce the effectiveness of an enemy's air and ground defences when required to do so. They therefore need to train to be able to do that. Low flying is a specialised skill and like many other skills, it requires regular practice. The warning time to prepare for the type of operations to which our forces deploy, does not allow, in the main, for the acquisition of new or unfamiliar flying skills. So, rigorous training in a realistic environment is essential to preserve professional skills.

I can assure the House that maximum use is made of simulators, but they complement, and do not replace, low flying. We continue to monitor carefully advances in simulator technology to assess the scope for their future use, but for the foreseeable future at least, simulators will be an aid to and not a substitute for low-flying training. The UK low-flying system, as right hon. and hon. Members are well aware as they represent a large chunk of it, comprises the open airspace of the whole of the UK and the surrounding overseas areas from the surface up to 2,000 ft above ground level. Helicopters are permitted to train down to ground level, but 250 ft is the lower limit for fixed-wing aircraft undertaking routine low-flying training, although on occasions lower sorties down to 100 ft are permitted in the three specially designated tactical areas.

My Department remains committed to exploring and exploiting all opportunities for low flying overseas. Over the last year, our forces have participated in exercises that involved low flying in north America, Europe, Africa, the middle east, Asia and Australia. Our aircraft have flown down to the national limits in many countries and have been cleared to fly down to 100 ft in the United States, Canada, Oman, Egypt, Poland and Sweden.

We take constituents' complaints seriously. We do everything in our power to mitigate the effect of low flying, but we cannot stop it.

Before Mr. Kidney rises, it may be for the convenience of those hon. Members who were not here earlier if I inform them that, as I am not one of the designated Deputy Speakers, I should be referred to as Mr. Maxton, not as Mr. Deputy Speaker.

It is a great pleasure to open this important debate. It is timely for several reasons. First, it is a welcome opportunity for us to debate the Government's strategic plan, the White Paper entitled, "Modernising NHS Dentistry: Implementing the NHS Plan", which was published in September. Secondly, this week saw the publication of the report of the Review Body on Doctors' and Dentists' Remuneration and the Government's announcement of increases in fees and salaries for dentists from next April. Thirdly, the university of York recently published its study review on fluoride in drinking water, a matter that is of some interest to the residents of Stafford. I hope that the Chamber agrees that we have plenty to discuss.

My reason for asking for the debate is the recent decline in access to NHS dentistry in Stafford and in other parts of the country, a matter that is frequently raised by hon. Members at Question Time and in correspondence with Ministers. The Government's strategic plan charts that decline back to a change in the general dental services contract in 1990 and its effect on the attitude of dentists to NHS dental services, as opposed to their attitude to private services. In Stafford, dentists have voted with their feet by closing their NHS patient lists and refusing to take new NHS patients. The result has been that people have had difficulty finding an NHS dentist.

Looking back on the history of dentistry, I agree with much of what the hon. Gentleman says, but is it not the case that the new contract that was introduced in 1990 produced an increase in the amount of NHS work? It was in 1992, when the fees were cut, that we started to see a decrease in the amount of NHS work.

Ironically, the strategic plan charts the rise in the number of dentists since 1990. It shows that there are more dentists today than there were in 1990, but that the proportion of NHS work that they undertake has decreased. I cannot agree with or contradict the hon. Gentleman's suggestion that the decline started in 1992. I observe simply that the Government's strategic plan points to the change in the contracts in 1990 as the start of the problem.

The phenomenon affected Stafford for the whole of the 1990s. It is a problem because it affects the level of oral health that the public can achieve. People such as I want to go to the dentist regularly, as part of a whole-care approach to keeping ourselves healthy. We like to have our oral health checked, to receive the dentist's advice and to benefit from the complementary contribution that the dentist can make to our efforts to ensure our general health. We do not want NHS dentists to deal only with emergencies, although emergency treatment is an important aspect of dental treatment.

Since 1997, the Government have made efforts to improve access to NHS dentistry. A welcome and early addition to NHS dentistry funding was the investing in dentistry initiative, which started in 1997. Money is made available each year to help health authorities to improve the number and quality of NHS dentistry practices.

I acknowledge the contribution of South Staffordshire health authority in using that initiative to improve access to NHS dentistry. The authority prepared four different bids for money from that initiative, but only one of the bids was successful. On the other occasions there were difficulties with identifying suitable premises, or a suitable person to undertake NHS dentistry under the scheme. In the end, one scheme was agreed and one new NHS dental practice opened at Castlefields in Stafford, to which residents came in a great rush to register. To add to Stafford's woes, as soon as the period of restriction to allow concentration on NHS dentistry ended, that dentist announced that he was closing his NHS list for new patients—an event that was demoralising for people in Stafford.

The new plan is welcome and necessary and approaches the issues of oral health and equality in health treatment comprehensively, promising to act to end the unfairness that exists. The first of the important reforms is to make NHS Direct call centres the gateway to NHS dentistry. From anywhere in the country, people will be able to ring NHS Direct, ask where the nearest NHS dentist is and be directed there. That is a good addition to the NHS's overall services.

From next April, the country can have confidence in that scheme, but, already in Stafford, people can ring NHS Direct to get that information. It is pleasing to be able to tell the Chamber that there is an NHS Direct call centre in Stafford, based at Stafford hospital. It opened in October, created more than 100 new local jobs and serves more than 3 million residents in the west midlands.

That is all wonderful news but, on its own, it is not good enough. The health authority has a duty to advise callers where their nearest NHS dentist is and, at present, callers in Stafford will be told that the nearest dentist is in Rugely or Cannock, both of which are some 10 miles from Stafford.

There must be further reforms. The next welcome reform that is mentioned in the strategic plan is the introduction of dental access centres, at which people can receive treatment when they need it. A dental access surgery opened in Stafford in November—again, it is a great benefit to Stafford. People who cannot register with an NHS dentist can go there and receive dental treatment. That is deeply reassuring for my constituents but, without other improvements, it is not good enough.

Recently, after I had already requested this debate and learned that I had been given it, I received a letter—there is no question that the letter was the reason why I asked for the debate. Mrs. Hales, my constituent, was inquisitive about the new dental access centre and visited it. She found that treatment was available on the NHS for what she described as toothache and discomfort. She writes:

The clinic will not follow up patients, they will only issue them with contact numbers for dentists in Cannock or Rugely who are accepting NHS patients. There are therefore no NHS facilities for dental follow up in Stafford unless you are under 18 or over 70 years of age. I think this is a disgraceful situation.

The Minister should understand that the people of Stafford are responsible people in all sorts of ways. For example, they look after their health and access NHS services to do so. My purpose in securing the debate was to examine how people such as Mrs. Hales could be supported in maintaining their oral health.

To complete the picture, will the hon. Gentleman tell us how long Mrs. Hales and other good folk of Stafford must wait for an appointment at the access centre?

Yes. When I said that Mrs. Hales was inquisitive and visited the centre, I meant that she could do that on the day that she chose, without having to wait in a queue. In fairness to the hon. Gentleman, I should make it clear that the centre opened only a month ago. It is a new and welcome facility in Stafford.

Therefore, we have NHS Direct and the dental access centres. What else is needed? As the British Dental Association points out, pay and conditions in general dental services are important factors. The Government's strategic plan recognises that and to some extent deals with it. More money has been allocated for NHS dentists through commitment payments. More money has been given to surgeries and to improve the NHS dental service generally. There is more emphasis on professional training and development. As I said earlier, we have had the news of next year's settlement for fees and salaries: an average increase of 3.9 per cent., with no staging, above inflation. That is all good news. The British Dental Association says, not unexpectedly, that that settlement will not be enough on its own, but interestingly the report of the Review Body on Doctors' and Dentists' Remuneration contains useful recommendations about the proposed commitment payments, to which I hope the Government will give serious attention.

The debate between the British Dental Association and the Government will continue. The Government have the right ideas for encouraging more dentists to devote more time to NHS dentistry. I hope that the Minister will comment on the anticipated improvements in access to NHS dentistry in places such as Stafford and on their likely time scale.

There are many other good elements of the strategic plan on which I do not intend to concentrate. However, I welcome those proposals, which give greater flexibility for health authorities and for delivering NHS dentistry. I also welcome the greater integration of community health dentistry with primary care providers. The discussion about better access to urgent out-of-hours treatment—there is a gap in the system in places such as Stafford—is helpful.

The fluoride debate rages hotly in the town of Stafford, where, generally speaking, the water does not contain fluoride. Most health professionals believe that it should, while a determined group of residents believe that it should not. I am somewhere between those positions. However, I have always put my cards on the table. My general view is the same as that of the Government. I believe that adding fluoride to drinking water at the optimum level, which most people accept is one part per million, improves dental health without harmful side effects.

Because the debate rages so hotly in Stafford and so many people refuse to accept that as a reasonable view, I was pleased when the Government announced the York review, which I hoped would produce authoritative conclusions that everybody accepted. Sadly, it did not. I was surprised that it found that the benefits were not as great as I had thought and that the incidence of the mottling of teeth, fluorosis, was higher than I had thought. Most significantly, the review team drew attention to the poor quality of some of the research. I quote from its conclusions:

Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken.

It warns:

The evidence of a benefit of a reduction in caries should be considered together with the increased prevalence of dental fluorisis. The research evidence is of insufficient quality to allow confident statements about other potential harms or whether there is an impact on social inequalities.

As a result of reading those conclusions, I asked a parliamentary question about the Government's response. In an answer that I received at the beginning of the week from the Minister of State, Department of Health, my hon. Friend Member for Southampton, Itchen (Mr. Denham), I was told that the Government recognised that the report identified the need for more good-quality research. The Government have asked the Medical Research Council to advise on whether further research is required. I am obviously not the scientist advising the Government, but I would say that further research was required.

The Government tell me in their answer that they are consulting the water industry. Will the Under-Secretary of State confirm that no legislative action is expected for some time while those deliberations go on and while any research that is recommended by the Medical Research Council is carried out?

My concern is for oral health, especially among children. The Government have a good general health programme for improving health education, promoting healthy living and healthy diet, and reducing health inequalities. The assurance on fluoride that I seek from the Under-Secretary of State is that fluoridation is not seen as the one big idea to solve all the problems of oral health. I expect her to be able to give that assurance easily, bearing in mind the content of the fifth chapter of the strategic plan.

I want the Government to say that they are committed to education, advice and the reduction of inequalities in oral health. I want sufficient numbers of NHS dentists throughout the country to enable the profession and the public to play a full part in that agenda. The Government's plan contains all the right elements to achieve my aims and I look forward to hearing the Under-Secretary of State express her determination to put all the elements of the plan into practice.

I am pleased to take part in the debate. Before the general election in 1997, national health service dentistry was one of the biggest issues raised with me on the streets and it has continued to be since. One reason why was that the situation in my constituency was especially bad. In 1997 under the Conservatives, no dentist in Swindon would take new NHS adults. Telephone lines received thousands of calls from people who wanted to register with an NHS dentist, but no one in Swindon would accept them.

The hon. Lady emphasised that, in 1997 under the Conservative Government, no dentist in Swindon accepted NHS patients. Has not the hon. Member for Stafford (Mr. Kidney) told us that, in 2000, under this Government, no dentist in Stafford will take NHS patients?

The hon. Gentleman is referring to the continuing problems in NHS dentistry, but it is clear that, under this Government, there has been huge enthusiasm and a huge initiative to restore NHS dentistry. There was no such plan under the Conservatives. Nothing took place to put the situation right. Before he intervened, I was about to say that it was good that I received an encouraging response as soon as I was elected and started to push the issue with Ministers.

I have been pleased that we have seen a huge change in NHS dentistry under this Government. That has happened through the Government investment in dentistry initiatives, the work of Wiltshire health authority and some individual dentists who have made proposals. There are four new practices, so we now have up to 19,000 places for NHS patients. I am delighted with the sea change in NHS dentistry in Swindon. Ministers do not receive enough thanks, so I want to thank them for their support for the people in Swindon. It is much appreciated. I regularly see constituents who are delighted that we now have NHS dentistry again in Swindon.

We have not only NHS dentists, but an emergency clinic. Before the hon. Member for Runnymede and Weybridge (Mr. Hammond) asks how long people have to wait to be treated there, I shall tell him that they do not have to wait. It has been open for several months. If people are in pain and in urgent need of help with their teeth, they get it. The clinic then encourages them to register with an NHS practice, or a private practice if they so wish, so that their teeth receive regular care and attention.

It is important to experiment with different ways of providing NHS dentistry because people fear dentists much more than they fear doctors, although I do not know why. Something in our psychology prevents a section of the population from registering with a dentist, although they would automatically register with a general practitioner. Those people keep taking the tablets and trying to put the pain out of their mind until things get desperate. Several of my friends avoid dentists until they have no alternative but to visit them. For that reason, experiments such as the emergency clinic are worth while and well worth spending funds on.

There has been a sea change in attitude, which has much to do with the Govt's constructive relationship with the British Dental Association and others. Shortly after I was elected, I spoke to a number of organisations and I was shocked by what I heard about the appalling relationship between the previous Government and dentists. I had never come across such a bad relationship between a professional organisation and the Government and I wondered whether it was reparable. I am pleased that some good work this summer produced the Government's new plan to modernise dentistry. There will always be complaints from individual dentists and it is the job of professional organisations to push the agenda forward, but the Government are developing the constructive relationship with the profession that is essential if dentist services are to be further developed.

Dentistry is of great concern to my constituents and I have done much work on the matter. I was surprised at the reaction of the British Dental Association to some of the Government initiatives, but we should remember where people are coming from. Only a couple of years ago, Members of Parliament were bombarded with BDA briefings that prompted fears that patients would be deregistered, which would be disastrous for them and for the dental profession. It was only when I raised the matter with the Minister that I learned that the problem could easily be solved by the dentists themselves. They had only to agree to re-register their patients and to encourage them to come back for more treatment and there would be no problem. Our constituents would stay on their dentists' books and the dentists would be funded for seeing their patients. We should always check what is really happening when we hear scare stories.

Dentistry fits well into the Government's public health agenda. Inequalities in people's dental health are only too visible. I have been in politics for some time. When I was a county councillor, I represented a ward with different socio-economic groups. The children in the relatively well-off part of the ward had bright, sparkling teeth and no problems, unlike the children in the working-class estate across the road. It shocked me that just crossing a road made such a huge difference because the two communities were served by the same health authority and dentists. The Government's agenda to tackle those inequalities is worth while.

I congratulate the Government on their agenda to modernise NHS dentistry and I urge them to continue to improve it. We must be able to assure constituents that they are receiving quality care. There have been worries about general practitioners, especially those who work in single practices. Some dentists also work in single practices, so there are fewer possible ways in which to pick up problems. However, whether a practice is single-dentist or multi-dentist, constituents need to know that quality checks are carried out to ensure a high-quality service. There have been some scandalous press reports about certain practices and that is a cause for concern among constituents. Therefore, I hope that the Minister will comment on how action taken through the modernising NHS dentistry initiative will ensure the quality of NHS dentistry that we deserve.

The bureaucracy behind NHS dentistry has built up over the years. Can steps be taken to simplify paperwork and payments to dentists, so that more practice money can be spent on quality checks and on looking after people's teeth, and less on paperwork and associated checks?

The question of fluoride always comes up in such debates. We have spent years and years looking at that issue, but most of the evidence that I have seen supports taking action on water fluoridation. Not everyone will agree, but the British Dental Association has made clear its support for adjustment of the water supply in certain areas, so that at least 25 per cent. of the population can receive fluoridated water.

I have listened to the hon. Lady's comments on fluoridation. She has acknowledged that certain people have strong objections to what is, in essence, compulsory medication. Does she agree that there are other ways to deliver fluoride to the population, particularly children? Will she join me in urging the Minister fully to investigate such alternative methods of ensuring that vulnerable people get adequate doses of fluoride, without resorting to compulsory water fluoridation?

I accept that, in theory, there are other ways to give appropriate doses of fluoride. However, I am unsure whether they would in practice deliver fluoride to everyone, and I particularly doubt whether they would tackle the inequality agenda. It is clear that that issue must be looked at, but my wish is that we get on with matters. We could debate for ever which route to pursue. Meanwhile, children do not get fluoride. We will never reach agreement, but some action needs to be taken.

I have two final brief points, the first of which concerns the funding, income and relative wealth of dentists. A question that always arises in such debates is whether dentists are poor people, working hard for no reward, or whether they are wealthy, have an easy life and therefore need no further support. I admit that I find it difficult to make my way through that maze. It is clear that some dentists who perform 100 per cent. or 95 per cent. of their work for the NHS have adequate incomes and provide a marvellous service. That is why it is sometimes said that it is housing costs in certain parts of the country that cause an NHS dentist to become a dentist in poverty. However, that is not the explanation. Some who do 95 per cent. of their work for the NHS and do the work to a good standard survive perfectly well on an adequate income with a good life style, but others say that it is impossible to support their families if they do NHS dentistry. I would welcome the Minister's comments on how to find our way through that maze, so that we can establish the reasonable level at which to support NHS dentists.

Although it seems to be kept hush-hush, most people in the dental sector agree that twice-yearly checks—on which the Government spend a lot of money—do not represent the best use of NHS resources. People do not like to say that, but most believe it to be so. We should be more open and face up to the fact that, if there is a more effective way of spending NHS resources to improve everybody's oral health, we must consider making the necessary changes.

I want to see throughout the country what we already have in Swindon: good NHS dentistry. We need more, but I am delighted with what we already have. I thank the Minister and the Government for delivering that to Swindon. It has made a big difference. I look forward to even greater improvements in NHS dentistry.

I am glad that we shall have adequate time to concentrate on the Minister's reply.

I congratulate the hon. Member for Stafford (Mr. Kidney) on initiating the debate. It is just over 12 months since we last discussed NHS dentistry in this Chamber, and this is a timely opportunity to revisit the subject—especially as we now have the Government's reply to last year's debate in the form of their document, "Modernising NHS Dentistry: Implementing the NHS Plan".

Am I mistaken, or was that document promised us in April 1998 for the autumn of that year, which somewhat predates the debate that took place 12 months ago?

I am not one to pick holes in promises—they cannot always be delivered to the desired time scale. One of the points that I wish to make this morning is that the Government's document is not a very substantive answer to the questions that we raised last year.

I find the plan a little complacent. It refers to increasing improvements in the oral health of the population, yet much of the evidence that it quotes is out of date. Measuring effectiveness in dental intervention through the number of remaining teeth in people over 65 or the amount of fillings and extractions in five-year-olds has a long tale to it. The evidence from my constituency, where we have undertaken regular surveys of schoolchildren, suggests that dental health is still deteriorating, not improving. From a purely public health point of view, it is important not to become complacent about the level of dentistry and dental health.

Two big issues are a cause for concern—outcomes, as in the dental health of the population, and the way in which people access NHS dentistry. In last year's debate, I asked the Minister to be more clear and honest about the direction that the Government are taking in delivering dental care to the population. They can do that in two ways—first, the traditional pattern of delivering care through the general dental practitioner service and, secondly, delivering care through a directly employed Government-organised dental service. The Government's paper refers to both of those methods, but does not emphasise which they are most trying to encourage. If we believe in the public health function of NHS dentistry, the access centres—the phone-and-go centres—that concentrate on dental pain and disasters are not the best way to serve the population.

The hon. Member for South Swindon (Ms Drown) said that there is a fear of dentists. There is not so much a fear of dentists—dentists are just as nice as doctors—as a fear of what they do. If dentists only drill holes and pull teeth out, that will not encourage the population to see them as relevant to their general health. As the hon. Lady correctly said, dentists solve acute problems that one sits on for as long as possible, hoping that they will go away. The result is traumatic intervention that literally leaves one spitting blood, and that is not the best way to encourage adults, let alone children or families, to consider dental health. As far as the NHS is concerned, contracts with general dental practitioners have not reflected that fear.

Dentistry has evolved away from the image of the clever manipulator who uses tools to pull teeth, to thinking people who look not only at the mouth but at the whole person, to see how they can help to maintain dental health in a healthy life style. As in medicine, it is no longer the prima donna big boss who does the manipulations, but a whole team that get involved: receptionists advise on access, toothbrushes and gadgets; dental hygienists have developed an enormous range of skills; dental nurse practitioners are invaluable people; of course, there are also dentists themselves. Encouraging access to that service is important, and the Government should be clear about the direction that they want to take. We have two-track access into dentistry, which means the Government can almost manipulate which track will come out on top. If the contract with the general dental practitioner does not allow the dental team to provide the service that they believe is right for national health service patients, they will not accept the deal that the Government offer.

I am not quite clear whether the hon. Gentleman is posing an unfair choice for the Government by suggesting that they must choose one track or the other. Is it not true that both are relevant? Some people want to see their dentist regularly to receive the kind of advice that he mentioned, and I welcome that warmly. Other people do not want to see the dentist and do not want to be registered, but they would like the reassurance that treatment is available when they might need it.

That is a valid point. Of course that treatment should be available, but it should be available, even for those people who do not want to commit themselves, through a general dental practitioner. When people visit the dentist in emergency, they are most receptive to the message about preventative work. If they have a positive experience during an emergency—if that is possible—one may be able to persuade them to return. If emergency treatment is delivered through a separate agency, there is no support between preventive, maintenance and emergency work. That is why I find the direction that we are taking problematic.

I was talking about dentists moving away from NHS services. I do not think that that is primarily a matter of income. In some cases it is, but dentists can, by restricting what they do, by dealing in large numbers and by not concentrating on some of the time-consuming preventive and educational activity that a good dentist engages in, make an extremely good living in the national health service. Many dentists earn a great deal of money providing adequate service and good, acute interventionist services, but are failing the overall dental health of the population that they serve, because they have not engaged with the broader remit that should belong to a good dentist.

The people who are moving away are those who want to engage in a more holistic approach—if I can use that term about dentistry—and who feel that they cannot do so under the current NHS regulations. The real challenge for the Government is not to entice them back with money provided as a sort of loyalty bonus. That is artificial and would probably be restricted to a small number of dentists—most likely those who are stuck grinding away at teeth anyway, and who are unlikely to change. We need to attract the modern-thinking, up-and-coming practitioners, and provide a deal for them that makes NHS dentistry not only financially rewarding but exciting and professionally fulfilling.

As we have the time, I should be interested, given that the hon. Gentleman feels that our strategy lacks ambition and is a two-tier plan, if he would describe his vision of perfect national health service dentistry.

I am grateful for the opportunity to do that. The national health service should learn from good practice, whether abroad, in the private sector or in areas of the national health service. I do not doubt that a great deal of good practice is found in this country, but I am afraid that, with respect to primary care, preventive work and the full use of the dental team, most of it is in the private sector. Interestingly enough, however, many of the dentists doing that work, because they are ambitious, skilled and concerned people, also do a great deal of work within the secondary care sector for the national health service.

Can the hon. Gentleman clarify whether what he is getting at, in his vision of holistic dentistry and wider use of the dental team, is relaxing the professional boundaries between dental auxiliaries, dental nurses and dentists, and the idea that assessing what each group can do might result in better care for patients and better use of NHS resources?

That is a valid point. Of course all members of the team should be recognised for their expertise. They should be enabled to fit in and should be adequately rewarded as team members. However, my real concern is that, in their discussions with the British Dental Association, the Government are too concerned with the manipulations that are carried out, instead of with the outcomes that are achieved. We can learn from some of the private sector insurers, who tend to think in terms of a package of care. They make an assessment and a payment is made. Irrespective of the amount of manipulation or the procedures that are carried out, a service is provided that suits the circumstances and the patient.

It might be possible for the national health service to learn from the way that that funding can be structured. The present system, which is bob-a-job stuff, is open to manipulation and abuse. There is evidence that many more fillings are done than are necessary. It encourages sloppy thinking and over-intervention, rather than prevention, which is more important.

Other than looking at the contract, and encouraging good-quality general dentistry within the NHS, the Government should consider access to NHS dentists. I am a great fan of NHS Direct, but it cannot deal with people's dental problems. It can only refer people to dentists if they exist. A national helpline is not very helpful if it refers people to a clinic some 20 miles away, so that a visit involves an expensive two-hour bus journey. Local solutions are much better and we should have some imaginative schemes during the interim period.

I am a great optimist, and I hope that the Government will get this matter sorted in the fullness of time. I hope that people will be able to use the dentists who are available. Some help with bus fares might be useful. My elderly constituents or those on low incomes would find it extremely difficult to get to a dentist now if it cost £8 or £10 in bus fares. Again, that is a great disincentive to a service that we want to encourage people to use.

As the hon. Member for South Swindon pointed out, dentistry, or the state of dentition, is probably one of the best measures of social disparity. If the social exclusion unit, which should have been called the social inclusion unit, took its job seriously, it could use it to measure almost directly how well off or connected a population is with the general welfare of the rest of the community. It is extremely sad to see four or five-year-olds with little black stumps and their parents not even concerned about the state of their teeth. They believe that that is how they should be, as they have always been like that.

It was not like that 15 years ago; we have gone downhill. That is not due only to non-access to dentistry, it is due also to diet. Sadly, the only way that people now clean their teeth is to soak them in Coca-Cola, which dissolves their teeth at the same time. We must recognise that because special efforts are needed to find a dentist, to get there and to pay the bus fare, people tend not to visit dentists. They see their general practitioner who, on the whole, is pretty inadequate at dealing with oral problems.

That brings me to a further point, which is access to check-ups. The point is well made. Six-monthly check-ups for most people are irrelevant. There are some people who need three-monthly check-ups with a hygienist to ensure that they do not lose more of their teeth as they have gum disease. It is then part of a course of treatment as well as checking up. We correctly spend millions of pounds on taking cervical smears to avoid cervical cancers. Concomitantly, those tests pick up genitourinary problems; it is a useful way of finding chlamydia and other such diseases. However, we ignore the opportunities presented by having regular, free-access dental check-ups. More people die of oral cancers each year than now die of cancer of the cervix. We have a priority problem. We are abandoning the proper identification of some curable diseases because of a distrust—I do not know what motivates it—of the dental profession and of how it functions in the high street.

I usually think of the Government as wonderful people, but they semi still to have a dogmatic fear of what private contractors might get up to with Government money. At some stage, they will have to overcome that distrust. The Minister may be able to do just that.

I know that dentists are wonderful people, but before the hon. Gentleman goes too far in making comparisons between cervical cancer and oral cancer, he may like to tell the House a little more about the improvements in treatment and prevention that might result from early diagnosis. He suggests that screening for oral cancer could be as successful as screening for cervical cancer. Such a direct comparison may not stand up to analysis.

The Minister is testing my medical skills beyond what should be expected of the average general practitioner. However, she has the resources to answer that relevant question. We all know that the outcome for cancers that are diagnosed early are better than the outcome for cancers that have already presented symptoms. As a general rule, my argument stands. It would be extremely helpful if the Minister were to ask her officials and scientists to do some work on it. It would allow some evidence-based government, of which we are always in favour.

The hon. Member for Stafford made a good case for re-evaluating fluoridation. It is not clear-cut. The arguments for and against are both selective. The anti-fluoride lobby comes up with the most extraordinary bits of research—for instance, that wells in India are poisoned with natural fluoride. The pro-fluoride lobby tends draw on historical patterns of what has happened in two adjoining districts. However, those arguments may not be relevant to the debate.

I have no doubt that some dental decay, especially that seen in children in non-fluoridised areas, is the result of people not having access to fluoride supplements, access that is available to those who are better off, or who are at least better motivated. Those who do not own a toothbrush are unlikely to use fluoride toothpaste. We should consider other ways of delivering fluoride supplements—perhaps with school milk. It would be strange if the Government kept ducking the issue. There should be equity of access to such treatments if they are known to be helpful. At the moment, there is no equity.

I gave my own opinion to show that I am not sitting on the fence, but is there a Liberal Democrat party policy on fluoride in drinking water? If not, does the hon. Gentleman have a personal opinion on the matter?

The party policy as expressed through party conferences is probably against standard fluoridisation. The health team in Parliament is in favour of it, on good public health grounds. As with embryology, abortion and hunting—which will be debated this afternoon—I suspect that we shall have a free vote with an indicative Whip. We do not go in for rigid regimentation; we believe that Members of Parliament ought to have their own view, and I hope that it is an informed view. The Government's job is to ensure that information is available in an accessible and balanced form.

I think that I have filled up enough time and raised a number of issues to which I hope that the Minister can respond. Her Department's document, though helpful, is not a sufficiently strong pointer towards the Government's thinking. We must know whether they are going for direct services, such as the directly employed fire fighting and emergency services, or whether the direct access centres will be expanded to take a more holistic approach. That would be an alternative way of achieving what I think that we all want to see. There could be meaningful discussions with dentists, although not necessarily directly concerned with conditions of service and remuneration. The BDA is perhaps most concerned with those in the Committees with which the Minister deals. There is broader thinking to be done.

I am delighted to be in this Chamber for the first time since its reorganisation. I prefer it as it is now, because I like to see the whites of the Minister's eyes when I am speaking to her. I always found the former arrangement somewhat confusing because of the culture at Westminster. However, if the hon. Member for Isle of Wight (Dr. Brand) really thinks that the Government are wonderful people most of the time, he might like to sit in the corner next time, rather than so close to me.

They are like dentists, who are wonderful people, although I do not always approve of what they do to me. Some Ministers are also delightful, but I do not necessarily approve of everything that they do.

I am sure that we all find the Minister personally delightful. Whether we approve of what she does may be another question. I am grateful to the hon. Member for Isle of Wight for saving us from the embarrassment of an early end to the debate by helpfully padding out its middle area.

I congratulate the hon. Member for Stafford (Mr. Kidney) on giving a balanced analysis of the problems facing NHS dentistry. In a measured way, he suggested some issues that the Minister might want to consider in taking the debate forward.

The hon. Member for South Swindon (Ms Drown) said that there were no initiatives in NHS dentistry under the previous Conservative Administration. I can understand the temptation to try to make this a party political issue, but she is not quite correct in saying that. For better or worse, there were initiatives under the previous Administration. In 1990, the new general dental services contract was introduced. Many of the issues that we are discussing and that the Government will want to address in future flow from that contract.

Will the hon. Gentleman acknowledge that insufficient piloting of the contracts resulted in a considerable deficit, which was part of the problem that we needed to address when we took office in 1997? There were initiatives, but does the hon. Gentleman think, with hindsight, that they were good initiatives?

I have already said that the problem of declining NHS participation by dentists stems from the fee cut in 1992, rather than the contract itself. If I may, I shall say something later about what I think is the appropriate balance between capitation-based payments and fee-for-service-based payments, and how we might expect NHS dentistry to develop in future.

The hon. Member for South Swindon also talked about the Government's commitment to restoring NHS dentistry, and explained the baseline for that assessment. Whatever that commitment might be, it is not, however, to restore the general dental service model. In constant terms, spending on general dental services will be lower this year than in 1992–93. Of course, I acknowledge that there are additional expenditure items outside general dental services, and I shall return in a moment to the balance between GDS and other methods of providing NHS dentistry.

I should clarify that I was saying that the Tories did nothing to deliver NHS dentistry in Swindon. Does the hon. Gentleman agree that the reality for Swindon is that there is now a Government who support the reintroduction of general dental services to the NHS? Project after project in Swindon has been supported, and I do not expect that such support will be limited. I hope that he agrees that it is in such circumstances that the Government want to see a return to NHS dentistry.

I am grateful to the hon. Lady for making that point. I am no expert on what is happening in Swindon, and I am not familiar with the balance there between GDS and other forms of delivering NHS dentistry. The hon. Member for Isle of Wight touched on that point, and I shall ask the Minister about it in a moment.

I hope that this is not simply a sterile, party political issue. There are different ways in which to deliver NHS dental services, and to a significant extent, the jury is still out on some of the newer forms of providing access. The hon. Member for Isle of Wight noted that the Government's newer initiatives appear to focus on remedial, rather than preventive, work. As the hon. Member for Stafford suggested, they perhaps lack the facility for patient follow-up that was offered by traditional GDS methods. Here, there is a wider issue that relates to the way in which NHS services are delivered. Similar initiatives exist in respect of delivering primary medical care. The Government are experimenting with ways of delivering such care that differ from the traditional, general medical services model for general practitioners.

I am glad that the hon. Member for Isle of Wight also made the important point about the role of dental practitioners in the wider health care of the population. The majority of oral cancers are diagnosed by dental surgeons, and from that point of view, anything that reduces the number of people who routinely visit a dental practitioner must be bad.

I am unsure whether the comments of the hon. Member for Isle of Wight on the dental health of children bear detailed scrutiny. My understanding is that one of the bright lights in the NHS dentistry picture is that children's overall dental health is in fact robust, if not improving. That much, at least, we can grasp.

The hon. Gentleman drew the distinction between general dental services and other methods of delivering NHS dentistry. Clearly, the Government's commitment to dentistry—whatever it may be—is not focused on restoring the traditional pattern of general dental services to enable them to deliver the percentage of NHS treatment that they did in the past. In 1992, 93 per cent. of treatment delivered through dental surgeons was NHS treatment. Now, the figure is 65 per cent. The Minister will correct me if I am wrong, but apparently the Government's stated commitment to increase access to NHS dentistry should not be read as a commitment to increase access to NHS dentistry through general dental services.

Why is that? Why have the Government determined, in relation to both GDS and general medical services, that it is more sensible to plough substantial sums of money into replicating facilities and infrastructure that already exist to provide stand-alone NHS-only facilities for patient access? Perhaps the Minister can point to a robust cost-benefit analysis suggesting that investing a large sum of money in new buildings where buildings already exist is more effective than using that same sum of money to persuade private dentists with mixed practices—both NHS and private work—to include a greater proportion of NHS work in the mix.

Creating a sort of dental apartheid, whereby people in some areas who need access to NHS dentists have to go to dental access centres or get their treatment through personal dental service schemes, is not the best way forward for patients or for the dental profession as a whole. It would probably be more cost-effective, and certainly more socially beneficial, to encourage by financial incentive dentists who are already largely engaged in mixed practice to take more NHS patients into their overall patient mix.

I would be interested to hear the hon. Gentleman's reaction to the Government's allocation of £28 million towards rewarding dentists' commitment to the NHS and £35 million towards modernising GDS practices, as well as improving access dental care and clinical governance. We are not only doing what he is asking, but doing more of it than his party would do were it to regain power—if we live that long.

I shall ignore the last part of the Minister's remarks. As it is nearly Christmas, I allow her that little indulgence.

As the hon. Member for Isle of Wight said, the commitment payments to which the Minister referred are available only to dental practitioners who are already doing a large proportion of NHS work and have been doing so for some time. That gives the impression that the money is a reward for those who have "stayed loyal" to the NHS. The Minister is nodding, but I suggest that she should be trying instead to incentivise those who have not stayed loyal to the NHS to return and start to provide more treatment to NHS patients.

If we are to be pragmatic, we should use the limited amount of money that is available for NHS dentistry—we all accept that those resources are and always will be limited—in the way that best delivers access to NHS dental care. On what basis have the Government decided that dental access centres and personal dental services are the best use of those limited available resources, given that they both involve fairly substantial sums to duplicate infrastructure that is already available among dentists who provide general dental services? As the hon. Member for Stafford told us, the problem is not that there are no dentists, or that they do not have the premises, the staff or the equipment, but that they are not opening their lists to NHS patients. Relatively modest adjustments at the margin would surely change the economic balance for those dentists in mixed practice.

Will the Minister tell the House about the Government's view of mixed practice? Are they committed to maintaining a model of mixed practice in the future? Do they accept that it is beneficial for the service to maximise the choice of patients, so long as there is adequate access for NHS patients? Do they accept that it is for the good of everyone if NHS patients and private patients can be treated alongside each other in mixed practices? As some people might conclude from the focus on dental access centres, do the Government prefer to see the future model of the service as one of dedicated NHS facilities staffed by salaried dentists and technicians?

The problem with increasing the proportion of dental care delivered by salaried people—those employed by the NHS rather than through general dental services—is that it does not increase the number of dentists, or necessarily the number of dental man hours available. One discovers from talking to dentists in mixed practice, including the many with NHS patients who no longer seek to expand their NHS patient lists, that the principle reason for the closure of lists is not that the dentists are greedy, but that they feel unable to deliver adequate standards of care to NHS patients within the NHS remuneration structure. The hon. Member for Isle of Wight made that point.

Such dentists feel that they are being asked to run ever faster up an escalator going in the opposite direction. It is only by limiting the proportion of NHS patients in lists that dentists feel able to deliver something like an adequate service to them. Will the Minister tell us frankly whether there is a future for general dental services in the NHS, or do the Government see them as an historic aberration that they expect to fade away over time?

Is the Minister minded to think that, within the general dental services, the balance of emphasis between capitation payments and fees for item of service should be changed? Several hon. Members mentioned the perverse incentives that face dentists who are almost entirely dependent on fees per item of service. In some personal dental service pilots—I have the Ellesmere Port pilot in mind—the emphasis is on capitation payments, so that the dentists involved have an incentive to look after the overall oral health of their patients, rather than to treat in order to be paid.

I have three other specific questions for the Minister. Will she consider the problem of NHS patients finding that dentists willing to take them on make them suffer a long waiting time for a first appointment? Several people who have experienced that have suggested that it is somehow related to the way in which capitation payments work and are made. Many people think about signing on with a dentist only when they have an immediate problem. That system militates against patients registering with general dental practitioners because if they have to wait when they have a problem, they will probably consider going to one of the emergency centres or a dental access centre and then fail to register.

Will the Minister confirm that the Government want to increase the percentage of the population that is registered with a dental practitioner? Does she have any proposals to deal with the salary differential between dentists employed in delivering personal dental services and the community dental service, which the recent pay review body award has done nothing to address?

Finally, recognising that to some extent the root of the problem is the number of dental surgeons available—and we would all agree that our qualified manpower must be used to the best advantage of patients—what are the Government's plans for the registration of supplementary dental professionals, such as clinical dental technicians and dental therapists? How does she see the future development of the broader dental health team as a support to the limited number of dentists available to provide dental care?

I welcome you to the Chair, Mr. McWilliam. It has been an interesting and wide-ranging debate. I will try to draw it together a little. Should I inadvertently fail to address any points, I will be happy to get back to hon. Members.

I congratulate my hon. Friend the Member for Stafford (Mr. Kidney) on raising what is an important issue. We do not enjoy visiting dentists. It is not because of who they are, but because of what they do to us. For many years, NHS dentistry was almost a national pain service, rather than an integrated dental service. The question is: what are we doing about it? It is genuinely one of those cases where we have done a lot, but we recognise that there is a lot more to do. Duplicating past systems is not the way forward.

"Modernising NHS Dentistry: Implementing the NHS Plan" is a significant title. We have made dentistry a key element of the NHS again and we are modernising it. There have been big advances in practice. Dentistry was mentioned in the NHS plan in order to enshrine it there. The strategy comes with considerable amounts of money. It offers up to £100 million of new funding over this financial year and the next and concentrates on three major issues: improving access to NHS dentistry, improving the quality of services and improving oral health. I hope that that deals with the concerns of the hon. Member for Isle of Wight (Dr. Brand), who felt that the focus was not there and that we lacked ambition.

I reassure my hon. Friend the Member for Stafford that, after publishing the strategy and supporting it with money, we have every intention of driving its implementation forward. He mentioned the case of one of his constituents who asked for a check-up at an access centre. That should not have been refused. Something has gone wrong and we will take the matter up with the health authority.

Let us be clear. My constituent Mrs. Hales did not say that the centre refused to check her teeth. She said that it could deal with toothache or discomfort, but could not sign her up for follow-up treatment.

I thank my hon. Friend for that intervention.

The hon. Member for Runnymede and Weybridge (Mr. Hammond) questions whether our commitment to access is good value for money. I wonder what he will think about dental access centres after the next round of bidding; there is already one in Woking and there may be some near his constituency. I do not know whether he will welcome them or say that the money would be better spent on something else.

I was not trying to be confrontational. I was merely asking the Minister whether the decision to go for dental access centres rather than to reinforce general dental services was based on a robust cost-benefit analysis, or was part of the Government's instinct to do things differently.

The Government considered all the problems, one of which is access and the various means of getting people to dentists. I was struck by the suggestion that our proposals would mean the end of general dental services. Would we have invested £35 million on modernising GDS practices if that were so? The strategy must be seen as a combination of improving the quality of the service and the access to it. It is not a matter of the Government saying yet again that they have inherited a problem. In this case, we really have inherited a problem.

When the Government came to office, about 2 million people who wanted NHS care could not get it. In what other modern, primary care service would that have been possible or acceptable? That is the reason for our strategy. It is not just a question of the number of dentists. The hon. Member for Runnymede and Weybridge seemed to imply that we could increase access by increasing the number of dentists, but the number of dentists has gone up. What has gone down is their commitment to the NHS. More dentists are working in general dental services than ever before—about 18,000 are working in GDS, an increase of more than 1,600 since 1997.

The real problem is that some dentists worked under the 1990 contract system, which was introduced without being properly piloted. That system had significant drawbacks for oral health, NHS dentistry and expenditure. It resulted in an overspend of about £200 million, which eventually had to be written off. The contract was based on unsound activity forecasts and resulted in a 7 per cent. fee cut, which left many dentists increasing their commitment to the private sector. The problems started with the 1990 contract, which led to the 1992 changes to try to remedy those problems.

The Minister said that the number of dentists has gone up. Will she confirm that, under this Government, the intake of pre-clinical students to United Kingdom dental schools has fallen from 937 in 1996–97 to 877 in 1999–2000?

I can check the figures, but the problem is not one of capacity, if the hon. Gentleman is suggesting that we do not have enough dentists. The problem involves the focus on NHS work. In some areas where there is a shortage, the problem may be the skill mix, rather than registration.

I am merely responding to the Prime Minister's commitment that, by September 2001, anyone who wants access to NHS dentistry will get it. The BDA said that at least 1,000 additional dentists would be required to deliver that commitment. It is the BDA's suggestion, not mine.

We must make it more attractive for dentists to make a commitment to NHS work. The problem is that, for the past 10 years, dentists have shifted to doing more private work, and the number of dentists working part-time has increased. That is the reason for most of the access problems that we still have today. What are we doing to change that?

The investing in dentistry scheme, which ran from 1997 to 1999, offered dentists grants, so that they could expand their practices and treat more NHS patients. The scheme is still bearing fruit. The £10 million in grants that has been approved is expected to generate up to two thirds of a million more patient registrations with dentists.

The scheme was moderately successful in south Staffordshire. Patients in a number of locations were once again able to receive NHS treatment. I know that there were problems of recruitment to the Stafford practice. It had been offered funds to expand, but the expansion could not go ahead, which meant that the practice did not receive the funding. In general, however, health authorities' contracts with dentists include specific repayment clauses in the event of the terms on which the grant was awarded not being fulfilled.

The hon. Member for Isle of Wight was concerned about the relationship of the personal dental service to public health. He may want to study the pilot schemes that took place under the personal dental service programme because they dealt in a focused way with the situation that he described. The East London and the City health authority personal dental service not only uses dental therapy in general practice, but, because it has low dental manpower and, more important, a socially deprived, mobile and ethnically diverse population, aims to improve access and to deal with inequalities in oral health provision, with an emphasis on improving the oral health of children. In the Warwickshire health authority area, particularly in Rugby, primary dental care is designed to encourage dentists to work within the NHS and to encourage the registration and treatment of new adult patients. The PDS model is responding to real needs and idiosyncrasies.

Can we be assured that those exciting pilot projects will be evaluated and could form the basis for a more flexible contract with general dental services providers? Does the Under-Secretary of State not recognise that the direct access, clinics may be undermining some of the efforts that are being made in those projects?

Of course the projects will be evaluated. More important—it is horses for courses—we should consider the needs of an area and then deal with them. There is not one model that is right for every area. The hon. Gentleman mentioned the treatment of oral cancer and cervical cancer. There is no clear evidence that the early detection of oral cancer leads to a significantly better outcome, but he may be delighted to hear that setting up a screening programme for oral cancer, particularly for the over-40 higher risk group, is under active consideration by the UK national screening committee. We are not ignoring the matter, but giving it careful consideration.

I need to say something about fluoridisation, particularly as my daytime job is as a fellow west midlands Member of Parliament. The question of what the Government should do is hotly debated and tempers can get terribly frayed. The evidence from the York study was not as clear as people would have liked. We have therefore asked the Medical Research Council to do some more studies. However, it is clear that no area will decide one way or the other without careful consultation, because dental health can be improved in other ways, particularly for children. Fluoridisation may not be the chosen route, but that chapter is not closed.

Hon. Members queried our commitment to ensuring oral health, particularly for children, but the issue goes much wider than dentistry. Our work with health action zones and health living centres in education is the way forward. I hope that hon. Members will realise that we have recognised the problem, particularly with respect to achieving equity. We have begun to deal with that in many, I hope, innovative ways, including increasing physical access and introducing more flexible structures, but there is still some way to go.

I want to discuss the regional distribution of lottery grants. The debate is, I suppose, timely given the current news, but I do not want to go into the matter of who is to run the national lottery. That is a debate for another day.

I am delighted to be introducing the debate. I met the Minister in the summer to discuss my concerns about the distribution of lottery grants. The fact that I wanted this debate is by no means a sad reflection on that meeting: it is intended to move matters on, as we had a very interesting discussion. She was helpful, and I am grateful for her attendance today.

The national lottery was started six years ago, in November 1994. The principal reason was to try to provide funding for undertakings that were not covered by general taxation and therefore to provide benefits to certain areas and opportunities for organisations and projects that might not otherwise be afforded them. It appeared to be an exciting prospect and I dare say that it has often proved beneficial. There are many opportunities for use of the money, such as the opportunity to regenerate certain areas. However, that approach should not be concentrated just on towns or inner cities. There are perhaps better ways to regenerate those places—such as by getting people to live in them again, and by building there rather than in the countryside. The point is that rural areas also have projects and organisations that need help.

Rural communities are under threat. Farming is going through a difficult period. There is a threat to some rural post offices, shops and pubs. The price of petrol is high, and that is a threat to livelihoods in the countryside. Today, the hunting debate will pose a further threat. I look forward to joining the Minister in the same Lobby later. In addition to aiming to help rural areas, we should aim to create sustainable communities. I hope—although I am not sure about this—that the criteria for allocating lottery funds extend to the creation of sustainable communities, rather than just to building houses. A load of houses is not a community. I should have thought that such an objective was suitable for the national lottery.

It is difficult to ascertain the criteria by which each board of the national lottery makes decisions about giving, but I know that that sphere of activity is the largest part of the Minister's jurisdiction and responsibility in respect of the national lottery. I am not suggesting that she is responsible for the grants that are given or refused, but she is responsible for setting the parameters, and perhaps she will provide more detail on that.

The south-west region is a loser in many respects. It does not have terribly good rail links, although I suppose most people would say that about their region at present. It also receives relatively low funding for education, health, policing and local government. I am afraid that it does not do very well from lottery funding. According to figures that I have been given by the House of Commons Library—all the figures that I shall give are from that source—the south-west received £113 per capita, which is 20 per cent. below the national figure of £140 per capita. That puts the south-west eighth out of 12 regions. The figures for Wales, Scotland and Northern Ireland are £150, £156 and £157 respectively. Some parts of the south-west can claim to be as remote and to have similar difficulties to Wales, Scotland and Northern Ireland, yet there is that huge difference in lottery funding. Indeed, there is a wide range of difference in the regional figures. Only £76 per capita of lottery money finds its way to the eastern region, whereas £162 per capita goes to the north-east, which is 43 per cent. more than the figure for the south-west. Is that difference justified?

To break the distribution down within the region—as the Minister knows, I have much concern about the money that is coming, or not coming, to my constituency—Tewkesbury receives only 2.58 per cent. of all the lottery money coming to Gloucestershire, which is a total of £1.86 million out of £72.2 million. Neighbouring Gloucester received about £22 million, and even the beautiful Cotswold constituency received a total of £16 million. I have nothing against the other constituencies in Gloucestershire—good luck to them for securing that funding, and I hope that they continue to do so—but, on a strictly proportional basis, Tewkesbury has about 17 per cent. of the population, so why do we receive only 2.58 per cent. of the money coming to the county?

There may be reasons, and if so, I would like to uncover and confront them. One might ask whether institutions in Tewkesbury are applying for the money. Of all applications made by the county, 15 per cent. come from Tewkesbury. Are they asking for enough money? Of all the money asked for by organisations in the county, 14 per cent. comes from organisations in Tewkesbury. So our organisations are making the applications and are asking for sufficient money. Why then do they receive only 8 per cent. of the funds that they ask for, when organisations throughout the country receive 44 per cent. of the funds that they ask for?

The hon. Gentleman makes a powerful case. A further problem concerns the advice received by organisations. To give two examples, Ken Hitchings, who represents Kingshill house in Dursley, and Bob Ludlow of Woodchester village hall would allege that the advice that they received concerning their request for lottery money has not been good and has caused confusion. They failed to get not only the money but the right advice about how they should go about getting it.

I am grateful to the hon. Gentleman. I hope that he is successful in catching your eye again later, Mr. Deputy Speaker. What he says worries me, and I hope that the Minister will respond to it.

The hon. Gentleman's intervention was timely, because I was just coming on to ask whether the shortfall in funding was due to an unprofessional approach in Tewkesbury. I do not think that it is. Is it a lack of support from the council? That is clearly not the case. I would like to cite two examples to demonstrate my point. I declare an interest in relation to the first. My wife is a director and trustee of Rose's theatre, so I know a little about its application, which was professionally submitted and received financial support from Tewkesbury borough council; the theatre also put in some of its own money. When it was submitted, Rose's theatre was told by the director of capital services at the Arts Council:

Your application was assessed against the published criteria and was recognised to have some merit.

Yet it was turned down.

A second project, for a swimming baths Churchdown village in my constituency, was also professionally prepared. I have a copy here, and hon. Members will notice the size of it. We would need much more time than we have available to go through it all. It goes into minute detail. Again, the application was well supported by the local borough council. Churchdown is one of the largest villages in England, with a population of just over 10,000—quite a big area. It is not terribly prosperous and has few facilities, but its bid was turned down. The senior case manager at Sport England said that it was turned down

primarily because the proposed facility would fall within a 20 minute drive time of a number of other swimming pools.

When I raised that response with the Minister, she said that it was nonsense, and she was right for three reasons. First, children cannot drive; secondly, we are supposed to be trying to reduce car journeys; and thirdly, we need to build sustainable communities, and if people have to drive out of their communities to enjoy facilities, we are not doing that—we are simply building loads of houses on green fields, which does not constitute a community.

Other bids from my constituency have also been turned down, including those for playing fields in Bishop's Cleeve, a jet age museum at Staverton and a heritage centre at Tewkesbury. The battle of Tewkesbury took place in 1471 as part of the wars of the roses. Although the Yorkists won that battle, they did not win the war. Like Churchdown and the rest of the south-west region, Tewkesbury is not a particularly prosperous area. The regional distribution of lottery funding is unfair, and the distribution within the region, certainly as it applies to Tewkesbury, is unfair as well.

I ask the Minister to look into Tewkesbury's funding in great detail. Will she review the giving criteria and ensure that sensible criteria are adhered to? Will she monitor the regional distribution of lottery funds and donations within the region? I also ask her to assess the reasons for refusals.

There will be repercussions from what is happening in my area and perhaps in the rest of the south-west. If organisations feel that they have little likelihood of success, they will become dispirited and give up. People such as Councillor Brian Jones, who was involved in both the bids to which I have referred—Rose's theatre and the Churchdown swimming pool—put so much into the community and should not be treated as they have been. Money will not reach the areas that it should unless there is fairer distribution of lottery funds. Organisations in Tewkesbury could be forgiven for asking what on earth they have to do. They receive only 2.58 per cent. of the money that goes to the county, which is unacceptable. People in Tewkesbury play the lottery just as much as people in any other part of the county and should benefit from it equally.

In my intervention, I raised two issues. There are several other issues, but I shall not dwell on them now; I shall simply make two points about the process. First, it seems that Kingshill house was uniquely badly advised about the route to take in seeking funding and therefore wasted much time and effort. Disillusionment has set in as a result. Will the Minister say how the advice about which route to pursue can be improved? I know that it is difficult to do that, because there is almost always an understanding that an organisation will receive the money if it receives a lot of advice, and that clearly cannot follow.

The second issue is debriefing people from an organisation after they have heard that they will not receive the money. There is almost a belief that they cannot be told why they will not receive it. Again, I know that there are problems about speaking to so many organisations and how much assistance can be offered, but when people have invested an awful lot of time, effort and money in pursuing a bid, it is only right and proper that they should receive greater clarification. If not, they might go through the process again and again, which could lead to upset—I put it no more strongly than that.

I congratulate the hon. Member for Tewkesbury (Mr. Robertson) on securing this debate. I also congratulate him on his persistence in relation to this issue over the past few months. He is right to remind me that we met. I thought that we had a useful conversation. Unfortunately, much as I would like to, I do not sit in my office with a cheque book, and I do not decide who receives lottery grants. However, he raised several issues that were useful to hear about. I am also glad that my hon. Friend the Member for Stroud (Mr. Drew) was able to say a few words I shall try to cover some of his points.

Clearly, areas such as Tewkesbury and Stroud have had real problems in getting what they feel is a fair share of the lottery money. As the hon. Member for Tewkesbury pointed out, it is not a question of their not applying, as, in spite of submitting 14 per cent. of all applications made in the county—and asking for 14 per cent. of the money requested—Tewkesbury received only 2.6 per cent. of the money allocated to organisations in the county. Clearly, that is difficult to accept. It is annoying, because we can all think of instances, in some parts of the country, in which people complain and moan but have not done the work or put in the applications. Clearly, Tewkesbury is not in that category. It makes the effort and submits the applications, but for some reason it does not seem to be paying off. Why have constituencies such as Tewkesbury and Stroud lost out, and what can we as a Government do about it?

Clearly, the lottery reforms that we introduced were initially based on the idea that, first and foremost, lottery distributors are independent and take their decisions on individual awards without interference from Government. We all accept that we do not want that to happen and that it would put Ministers in an invidious position if we were making the decisions. Government can and should influence the broad framework within which the distributors operate, through legislation and policy directions.

In our White Paper in 1997, we published an assessment of how the lottery should change. We said that we would like the benefits of lottery money to be more widely spread, and that there should be greater confidence that money was allocated fairly across the country and to different groups in our society. We wanted money to be spent according to a strategy that takes account of assessed needs, and we wanted decisions on individual grants to be taken closer to the grass roots and the area where the money would be spent. Those objectives are reflected in the National Lottery Act 1998 and in the new policy directions to lottery grant distributors. Clearly, some of that—and, in certain cases, all of it—has not yet permeated through to the grass roots.

In many ways, Tewkesbury is disappointing. The reality is that, if they have lost out on funding at the beginning, it will take several years before such constituencies reach what is regarded as the average level. It is important to remind hon. Members that in the early days of the lottery there was an almost exclusive emphasis on capital funding. In the first full year of its operation, 97 per cent. of the total money distributed was spent on capital projects. That inevitably favoured certain areas of the country—large towns and cities and, indeed, London—because they had a wide range of facilities in need of refurbishment or because they could easily provide, in the first year, the visitor numbers necessary to justify new building.

We changed that with the new policy directions for distributors, which shift the focus from bricks and mortar to people, activities and access. By this year, funding for capital projects had fallen to 42 per cent., while the number of small grants under £5,000 had more than doubled to more than 24,000. The hon. Gentleman will know that, of the 85 awards that Tewkesbury received since the lottery started in 1994, more than half were made in the two years since the lottery reforms were introduced. The effect of the capital revenue shift is to bring many more groups into the net, and, I hope, to spread the benefits of the lottery more widely. The effect of the capital revenue shift is to bring many more groups into the net, and I hope to spread the benefits of the lottery more widely. The statistics for each area will remain imbalanced for some time as a result of the early capital awards, some of which were, by today's standards, very large.

Vauxhall—my constituency—has received a huge amount of lottery money, much of it for huge capital projects. Although local people may have benefited from them, they have been of national benefit. However, just because my constituency has received more than a lot of others, I do not think that my local community has benefited unfairly. Although that does not help the people of Tewkesbury, it helps to show that, although some constituencies receive more money, more people use facilities in the capital, so the money has actually been more evenly spread across the country.

Another important effect of the legislation was to allow distributors to delegate decisions to regional and local level. There must be controls on how the money is spent, but it is not ideal for somebody in London to be making decisions about a drama group or theatre in Tewkesbury. It is therefore encouraging that the Arts Council has now devolved decision making on applications of up to £100,000 to the regional arts boards, and that national lottery regional awards committees are being given powers to award grants of up to £1 million. The awards for all schemes for small grants is going from strength to strength, and is set to continue until at least March 2002. I hope that this delegation will help to make a lasting impact on how lottery money is spread throughout the country.

Originally, lottery funding could occur only on a reactive basis, which meant that lottery distributors were busy dealing with a large number of applications from well-organised groups soon after their establishment. In those circumstances, it was difficult to pay attention to the fact that the number and value of awards varied considerably between different parts of the country. That has now changed. The distributors are now asked to produce plans that specifically address the needs of their sectors. They can now actively encourage applications from certain groups or areas, and solicit applications if they do not appear spontaneously. That is why lottery distributors are increasingly targeting their funds on areas of need.

If funds are to be targeted, it must be done wisely and on the basis of information. That is why the monitoring exercise is important and why debates such as this, in which individual hon. Members raise their concerns, provide crucial feedback. We must also be clear about why areas such as Tewkesbury are losing out.

To find out more, as hon. Members know, my Department and the lottery distributors commissioned research from Sheffield Hallam university into the problem of areas of low take-up, which showed that various types of area were losing out, such as the coalfields and mixed rural and urban areas. Both the hon. Member for Tewkesbury and my hon. Friend the Member for Stroud have large rural areas with pockets of urban areas in their constituencies, as well as resort and retirement towns. The research identified several problems, including the size and complexity of application forms, which place a heavy burden on many community and voluntary groups unfamiliar with the language required to complete them. The practical advice and assistance needed to steer people through the process was often not available.

I take the point made by my hon. Friend the Member for Stroud regarding bad advice. It is unacceptable that people's hard work and effort is wasted because wrong advice is given. Within the Sports Council, I am trying to ensure that we use the two-stage process, in which a group should be told early if its application is clearly not going to get support, so that it does not spend the money, waste its efforts, or become disillusioned.

That is an extremely important point. I used to work in charity fundraising and I know the importance of getting an early indication of the refusal of an application. One application in my constituency took two years to prepare, and was turned down. It was probably obvious in retrospect that that would happen, but it resulted in two years' wasted work.

Absolutely. Clearly, money will never be available for every single application, so there will be disappointments. We must, in a sense, manage those disappointments, so that the people who are turned down are turned down early on or directed to a different approach. Feedback is crucial, too; I cannot understand why we cannot be open and transparent about the reasons for turning down an application, and I make a point of finding out such information as regards sport applications. Sometimes, there is a good reason.

The example of the swimming pool raises the question of how we can create good facilities in rural areas, while recognising that it is impossible to give every little village a swimming pool. I want swimming's governing bodies to state their aims and work closely with the regions and local communities.

The village whose swimming pool application was turned down has a population of at least 10,000. Although I accept that a village of 150 people cannot necessarily expect a lottery grant for a swimming pool, that particular area, parts of which are deprived and which has a fairly large population, should have been considered more seriously.

I assure the hon. Gentleman that I will look into that swimming pool application to discover what we can learn from it.

The cross-distributor group was established to consider the problems raised in the report and explore ways in which to ease the burden. I hope that Tewkesbury, along with Stroud, will be involved in that process and will benefit from it. QUEST was commissioned by the Secretary of State to investigate the cost of applications for lottery funding. The results of that first phase were published in August. Distributors welcomed the report and are working hard to simplify the process, especially for small community groups.

Application forms are already smaller, shorter and simpler. Previously, there were applications that were too large to fit on one's desk. The application referred to by the hon. Gentleman is not too bad in that respect—I have seen some that are 10 times bigger. The heritage lottery fund and the Arts Council have been awarded the Plain English Campaign's crystal mark for application packs produced this year. That simplification will make life easier for groups that formerly had to struggle to fill out pages and pages.

A joint national helpline has been introduced that will make a difference in co-ordinating bodies so that a group does not fall between one lottery distributor and another. That will ensure that the buck is not passed and that no distributor will be able to say, "It's nothing to do with me, go and ask the other one." If all distributors cooperate, community facilities used for both art and sports may have a heritage involvement. It is important that there is much more—in that awful phrase—joined-up thinking between lottery distributors.

Local authorities can clearly do more. A huge range of intermediary groups can provide support to help with applications. The Chief Leisure Officers Association has recently worked with the Local Government Association and my Department to produce guidance for local authorities, telling them how they can help more and have a phased strategy for working with distributors.

Although my response in this respect may not answer the specific points made by hon. Members, I want to convey the sense of change that is taking place across the country in how the lottery funds are distributed. I understand the frustration expressed in towns such as Tewkesbury and Stroud, in which people have worked hard on good applications with comparatively little success. I say comparatively, because there have been successes: the new clubhouse for Tewkesbury rugby club, the Tewkesbury after-school care scheme and the new minibus for the Tewkesbury and District Wheelchair Bus Association.

Those are all awards to be proud of, but more should be done to spread the money fairly throughout the country, and the Government are committed to that. I will continue to monitor what is happening in the region and in the constituencies of Tewkesbury and Stroud, to ensure that the changes that we have predicted come about. I am grateful to both my hon. Friend the Member for Stroud and, especially, to the hon. Member for Tewkesbury for raising the matter and giving us the opportunity to discuss it.

I would have preferred not to have to secure this debate. The serious matters to which I will refer are complex and cover a lengthy time scale. I must apologise for the tortuous events that I shall describe, but I must put them on record because there are serious failings in the system of investigating complaints about clinicians and managers in the NHS.

My involvement began at the end of October 1998, when my hon. Friend the Member for Cannock Chase (Dr. Wright) passed on some correspondence he had received from Dr. Imad Soryal, who is a consultant in rehabilitation medicine, about clinical practice at Hillcrest ward 3 unit at Moseley Hall hospital in my constituency. The documents included eight-month-old correspondence from the then clinical director of the unit, Dr. Steve Sturman, which was addressed to the unit's clinical manager. There was also an account of an incident on 2 October in which a patient, Peter Collins, was subject to degrading and inhumane treatment, including being denied bowel care for six and a half hours. I undertook to pursue the serious issues raised in those documents.

Although I was familiar with Moseley Hall hospital, I did not have any specific knowledge about the service provision at Hillcrest ward 3. My initial response to the correspondence was to make an unannounced visit on 9 November 1998. I found nothing untoward during the short time that I was there, although I noted that there were a number of empty beds. I subsequently received a letter from the general manager, John Wells, inviting me to meet him and Dr. Jim Unsworth, who had taken over as clinical director.

While the meeting was being arranged, I phoned Dr. Soryal to inform him that his correspondence had been passed to me and to question him about its contents. I particularly wanted to clarify the relationship between Dr. Sturman and Dr. Unsworth, and I was told that Dr. Sturman had given up his role as clinical director because there had been insufficient progress in taking up his suggestions to improve matters that he had raised with management. Dr. Soryal also explained what happened when he became involved as on-call consultant in the case of Peter Collins, a patient who had had a large brain tumour removed.

I wrote to Dr. Sturman to inform him that I had seen a copy of his letter. I asked him what response he had received to it, and whether he was satisfied that his concerns had been appropriately and adequately addressed. I also contacted South Birmingham community health council to ask what it knew about the unit. I was sent a note prepared by its then chair, which seemed to support the concerns expressed by Dr. Soryal and Dr. Sturman. The note stated:

95% of patients have no therapy. They spend time eating, sitting, sleeping and boredom is a constant complaint.

The community health council had raised its concerns at a meeting with Birmingham health authority on 21 September 1998, when it was promised that it would be sent a copy of the service specification. In fact, that document was never sent. I finally got hold of a copy in April 1999, and passed it on to the community health council. Subsequent events demonstrated that the service specification was not being met.

I took up the invitation to meet Dr. Unsworth and John Wells, the general manager, and Dr. Unsworth explained the work of the unit, which provided care for adults under 65 who suffered from degenerative conditions such as multiple sclerosis, acquired impairment and traumatic and non-traumatic brain injury. They both denied that bed occupancy was low and Dr. Unsworth dismissed clinical psychology and other issues that Dr. Sturman had identified as important. I was informed that in relation to the incident involving Mr. Collins, there had been an internal inquiry and that the main issue had been the professional conduct of one member of staff, who turned out to be Dr. Soryal, although he was not mentioned by name. Dr. Unsworth informed me that he knew where I had obtained my information and that he also knew that staff who had left the unit bore grudges. Dr. Unsworth and Mr. Wells suggested that I contact the clinical manager, who later turned out not to be clinically qualified, with various other queries, so I immediately wrote to her requesting information in advance of our planned meeting, which I had arranged but later cancelled after no information was forthcoming.

After it became known that I had visited Hillcrest ward 3, a member of staff on the wards, who was anxious that her identity should not be revealed, contacted me. She gave me a copy of an anonymous letter that had been sent to the former chief executive of the Southern Birmingham Community Health NHS trust in 1995. The main grievance was the imposition of 24-hour contracts that would make it difficult for nurses to plan family life. It was also stated that in the staff's view the way in which the changes had been implemented would make it difficult for them to voice their grievances or identify a member of the management structure to whom they could express their concerns.

Management abused their authority by unilaterally imposing on the organisation a major change that caused some members of staff to fear victimisation if they expressed their opinions. Loss of staff morale was mentioned, as was their ability to care effectively for patients. Concern was also expressed about inadequate cover by trained staff on duty between 9.15 pm and 7.45 am. I was given the names of former staff who might discuss with me their experiences on the unit that indicated intimidation of staff and patients. I should make it clear that it was not the person who gave me the anonymous note who provided those names.

Copies of complaints from former patients were also given to me, including one that referred to poor treatment, racism and an attempt by Dr. Unsworth to undermine Dr. Sturman. Those events occurred long before Dr. Soryal appeared on the scene. I also received two replies from Dr. Sturman which made it clear that he never received a written response to the detailed concerns expressed in the letter that was included in the bundle given to me by my hon. Friend the Member for Cannock Chase. Dr. Sturman said that he had been disappointed to be told—presumably by the clinical manager—that an early meeting to discuss his letter would not be possible, although he added that he was able to conduct a few training sessions for nursing and therapy staff. Dr. Sturman said that he was saddened not to have been able to make more progress during his time as clinical director.

I obtained a copy of the investigation of the incident of 2 October involving Mr. Collins to which Dr. Unsworth had, referred. The investigation was conducted by Dr. Alistair Main, clinical director of services for the elderly, and a senior personnel officer. The acting chief executive wrote to tell me that he had discussed the report with the director of personnel, and with Dr. Unsworth in his capacity as medical director of the trust—a post that he held in addition to those of clinical director of Hillcrest and medical director of the regional rehabilitation unit. After seeking legal advice, the approval of the chairman of the trust was obtained to institute intermediate procedures for the discipline of consultant medical staff and the consultant in question was to be Dr. Soryal. Dr. Main concluded that the way in which the matter was handled by the nurse manager, whose conduct Dr. Soryal had complained about, could not be criticised, but Dr. Soryal was criticised for poor professional judgment.

Dr. Main's report proved to be extremely one-sided. He did not interview Mr. Collins or his wife. By that time, Dr. Unswortn had moved Mr. Collins, without notice, to a local nursing home. He subsequently received proper treatment at Rivermead rehabilitation unit in Oxford. Dr. Unsworth's judgment of Mrs. Collins suggested that she refused to believe that her husband was cognitively impaired, or that he had shouted and used abusive language. Her supposed lack of acceptance of his cognitive and frontal lobe defects was the crucial factor in events leading to the breakdown in confidence between the nursing staff, Dr. Unsworth and Mr. and Mrs. Collins. It was those events that led Mr. and Mrs. Collins to make complaints. It was also suggested that Mr. Collins bore responsibility for not accepting bowel care early in the morning.

I have not discussed the details of Mr. and Mrs. Collins' complaint because it is subject to a separate and on-going complaints procedure. I have read Mrs. Collins' formal complaint, and Dr. Main's interpretation is a travesty of the views expressed in it. Mrs. Collins, who is a graduate psychologist, in fact demonstrates rather greater insight into her husband's condition than the professionals who were supposed to be caring for him. She offered to assist ward staff, as she was trained in lifting and handling, but her offer was rebuffed.

It subsequently became clear that the evidence given by the nurses and the registrar was heavily influenced by behind-the-scenes intimidatory pressure. Nevertheless, despite its inadequacy, Dr. Main's report offered some interesting insights into the running of Hillcrest ward 3. The nurse manager, who was on G grade, was able to select which patients were accepted on to Hillcrest on the basis not of clinical need, but of her perception of their suitability for the unit. She was able to transfer a patient from one ward to another without consulting his consultant or family and was able to control the information that was given to certain consultants. She had advised Dr. Sturman not to talk to the family. The clinical manager, who had a background in occupational therapy, was able to influence the psychology services that people needed, which seemed to be none at all, despite the views of the former director, Dr. Sturman, to the contrary. Those views were ignored.

Alistair Main took no steps to help staff who felt intimidated to come forward and give evidence confidentially, although he was aware of the anonymous letter, which he dismissed. He said that he had no time for staff who made such accusations but who wished to remain anonymous for fear of losing their jobs. No attempt was made to investigate tile grievances that were raised, yet that could have been done had there been the will to do so. On the positive side, Dr. Main did at least request a non-punitive and constructive inquiry into the unit by an individual or team from a similar specialist rehabilitation unit and a list of sensible issues to be reviewed. To cut a long story short, I pressed for such an inquiry, which was eventually agreed to.

I must add that at no point was I acting on behalf of Dr. Soryal, who was being advised by his BMA representative. My concerns were solely about the services offered to patients. I have kept the documents that were sent to me and were confidential in relation to other people who contacted me.

The independent inquiry was a model of good practice. All senior and middle grades of staff on the unit were interviewed, as well as 50 per cent. of the junior staff—who were randomly chosen—and interviews took place away from the unit. I began to receive feedback that staff were pleased at the way in which the inquiry was being conducted and felt confident enough to express themselves.

During the inquiry, which was chaired by Professor McLellan of Southampton general hospital, members of the panel were so worried abut the possible maltreatment of staff and patients that they felt obliged to tell the chief executive of their most acute concerns. As a result of that information, the G grade nurse manager was suspended. In its full report, the inquiry team recommended that the nurse manager's suspension should be confirmed and that she should be formally investigated for oppressive and unprofessional practices. The team also recommended that the post of clinical manager should be discontinued and that Dr. Jim Unsworth should be replaced as clinical director of the unit, while continuing in his role as director of the West Midlands Centre for Rehabilitation, of which the unit is a key component. As a result, two female staff were suspended from work and Dr. Unsworth was suspended from his role as clinical director. Formal disciplinary inquiries were then instituted using internal trust procedures.

Contrary to the view that my hon. Friend the Minister expressed in a letter to me—I am not sure where she obtained the information—I had no criticisms of the independent inquiry or its conclusions. The McLellan report exposed the inadequacy and bias of the earlier Main report. That is an important point, to which I shall return.

I was approached with further allegations about inappropriate behaviour on the part of Dr. Unsworth, but this time the complaint was um elated to Hillcrest ward 3. The complainant was an orthotist, Alan Drew. He had already submitted a formal complaint about Dr. Unsworth to the General Medical Council, but it was unsuccessful because the allegations did not impinge on Dr. Unsworth's competence to practise as a doctor. I add that that has never been in question. I advised Mr. Drew to put his concerns in writing and contact his Member of Parliament to request that they be investigated. Mr. Drew did so and sent me a copy of his correspondence.

On 21 February, I wrote to the outgoing chair of the former trust, to inform her that I had received feedback to suggest that some more senior staff—whose evidence would be crucial in the disciplinary process that would follow the inquiry—might feel that silence would be the best policy if their career progression was not to be damaged. I also sent a copy of a letter dictated by Dr. Sturman in February to Dr. Unsworth, which enclosed a copy of his letter to the clinical manager, to which I referred earlier. Dr. Sturman stated that, because of his overcommitment, he felt unable to provide a safe or adequate service to his patients, adding that he was prepared to carry on with the clinical director's brief for a little longer.

Dr. Sturman stated, however, that if there was little positive response to the letter to the clinical manager, he would have to conclude that she and her colleagues did not want to work with the clinical director structure, and that there was little point in carrying on. He was looking for evidence of change within two weeks, and would then stop using the service because, he said, it was clearly morally wrong to use it when there were such grave concerns about its efficacy and organisation. That judgment was vindicated by the McLellan report. Dr. Sturman also told Dr. Unsworth that any complaint or legal action would be indefensible, yet no action was taken in relation to Dr. Sturman's concerns.

I enclosed the correspondence from Alan Drew with my letter. On second thoughts, I felt that it needed further investigation and should be taken into account before any conclusions were drawn about the possibility of disciplinary investigation into Dr. Unsworth's conduct. I copied the correspondence to my noble Friend Lord Hunt of Kings Heath at the Department of Health, and to the chair of Birmingham health authority.

The chair advised me in response that Dr. Sturman had discussed his letter of 23 February during his interview with the team investigating what disciplinary action might be justified. The internal audit service was to investigate financial allegations made by Mr. Drew, and there would be an investigation into other allegations. I subsequently learned that the investigation was to be carried out by none other than Dr. Alistair Main. Despite misgivings, I accepted assurances that the outcome of the independent inquiry had resulted in Dr. Main reappraising his earlier efforts. I was reassured by the acting chief executive that the inquiry would be open and objective—but I should have known better.

When it was eventually announced that disciplinary action was felt appropriate against two members of staff, but not Dr. Unsworth, I was surprised. Sylvia Fry, who conducted the investigating interviews, told me that Dr. Sturman and Dr. Unsworth had said that the concerns in the 1998 correspondence had been tackled. I did not feel that to be credible, considering the contents of the McLellan report and the appalling treatment to which we know that Mr. Collins was subsequently subjected.

I had also had access to three of the statements collected by Sylvia Fry and had spoken to another individual who had not yet been interviewed. Also, of course, there was the Alan Drew complaint, which was completely separate. I was told that his allegations had been thoroughly investigated, but how could the investigation have been complete when he was not even interviewed? I have gained evidence that that inquiry, again conducted by Alistair Main, was far from thorough.

I think it important to read a copy of the letter that Alistair Main sent to one of the witnesses. It states:

I have been asked to investigate a recent complaint by your colleague Alan Drew, made in a letter to his MP with the encouragement of Lynne Jones. I have been asked specifically to look at documentary evidence around Alan Drew's association with the RRC—

the regional rehabilitation centre—

over a number of years, to ask for the views of those working most closely with him…to make a judgement about whether there is a case to answer. In a sense this is raking over old coals following Drew's submission to the GMC in 1998 against Jim. The GMC decided to take no action but the recent letter to the MP…has been circulated in high places and the Chairman of BHA—

Birmingham health authority—

is taking a keen interest in the matter.

I would value your written comments… about anything you consider to be relevant to Alan Drew's relationship with colleagues at the RRC, and specifically around the Coventry issues contained in the attached extract of Drew's letter to the MP. I can say that the RRC's managers' views of events are in stark contrast to Drew's.

Despite the leading nature of that letter, I know that the response that was received confirmed some of Drew's allegations and concluded that there might be some substance to the complaint, and that it might need to be investigated. Cynthia Bower, the new chief executive of the new Birminghamwide trust, which replaced the old community trust, tried to assure me that the investigation was thorough. To be as charitable as possible, I can conclude only that what she said must have been based on assurances that she did not bother to check.

I have been very concerned about the behaviour of Cynthia Bower since she took on the job of chief executive of the new Birminghamwide trust. Her behaviour seemed to lack insight into the situation that she had, unfortunately, inherited. For example, on her first visit to Hillcrest ward 3 on taking up her position as chief executive, she was accompanied by Dr. Unsworth, despite the continuing disciplinary inquiry. Dr. Unsworth was seen to be influencing the manner in which the trust implemented the McLellan recommendations on the future of the unit, even though McLellan had recommended that he should not have a role. Cynthia Bower's memorandum to staff included the information that she and Jim Unsworth would begin work to redefine the new director post, thus implying that he still had a hands-on role in relation to the future of rehabilitation services. Other consultants felt excluded from the process.

Cynthia Bower seems also to have been unaware of the impact of Dr. Unsworth's announcement in March that he would be leaving the trust—an announcement that was mentioned in the trust board's April minutes and in her circulars to staff—while failing to submit his resignation. That did not come until September. He was not then required to work out his three months' notice and he received full pay. Dr. Unsworth is seen to be close to the chief executive, who is a close friend of his partner. In view of this, I believe that the chief executive should have taken greater care to dissociate Dr. Unsworth from any future developments at Hillcrest ward 3.

I wrote to Cynthia Bower informing her that I found it remarkable that the investigation should have found sufficient evidence for action to be taken against the nurse manager and the clinical manager but not enough to justify action against Dr. Unsworth. I told her that all the feedback that I had received would suggest that he was more than aware of the way in which those two individuals ran the ward. I had received accounts from independent sources of how they would collectively humiliate Dr. Sturman. We know that Dr. Unsworth was fully aware of he contents of Dr. Sturman's letter of 23 February 1998 and his grave concerns about practice on the unit. All the evidence suggests that no action was taken to deal with those concerns.

I quoted the McLellan report, which stated:

A few of the consult ants felt that they were often undermined inappropriately by the Clinical Manager and the Senior Nurse Manager.

It also said:

Junior medical staff felt ward and nurse managers treated them poorly and they…felt humiliated by the way the Nurse Manager and the Clinical Manager treated them.

It added that those staff felt they

did not get any support from Dr. Unsworth.

Another extract that I quoted noted that

Staff did not feel able to challenge bullying of individuals by Ms Millman because Dr. Unsworth and Ms Colbear would always support Pat Millman.

I mentioned that, according to the report,

Staff complained to the enquiry that Dr. Unsworth—

and the physiotherapist partner to the nurse manager—

had arraigned and threatened nursing and medical staff for having given testimony

that was responsible for the nurse manager's suspension. In addition, I included the following passage, stating that the nurse manager

could not have established such an effective regime for suppression of innovation and taken it to such extremes without the unwavering and ill-judged support of Dr. Unsworth and the clinical manager.

The report also stated:

Our interpretation of the evidence available to us is that Dr. Unsworth's management style is direct, confrontational and inflexible.

Order. I hope that the hon. Lady realises that only seven minutes remain in which the Minister may contribute. This is supposed to be a debate.

I am drawing to a close, but I must put this matter on record. The report that I quoted mentioned

medical staff in rehabilitation medicine, who despite their professional autonomy would, in practice, have great difficulty in undertaking any significant activity of which Dr Unsworth disapproved.

It was further remarked:

Staff in the unit rarely used the internal mechanisms…because they did not believe they would be implemented fairly.

The final quotation from the McLellan report was that

there could well be attempts in the future by some members of staff to identify the sources of some of the evidence of the Inquiry, using the same kind of intimidation that has been such a feature of current difficulties. Indeed at the time of writing reports were reaching the Panel that senior staff were already attempting to do this.

I subsequently learned that that member of the senior staff was Dr. Unsworth, who organised a meeting for staff at which he accused them of being responsible for the nurse manager's suspension and said that they were likely to be sued for their efforts.

The report continued:

We recognise that this behaviour may be difficult to control and recommend that the trust should take all reasonable steps to prevent it.

I also reread Alistair Main's internal report, in which Dr. Unsworth takes complete responsibility for the staff under him, notably the clinical manager and the nurse manager. That report shows a discrepancy between the information given by Dr. Sturman to Dr. Main and that which he gave to Sylvia Fry, as reported to me. My main concern is about the impartiality of the internal inquiries in the Southern Birmingham Community Health NHS trust and subsequently the Birmingham Specialist Community Health NHS trust.

I sought a meeting with my hon. Friend the Minister to discuss my on-going concerns, as well as with the regional director of public health, who has still not replied, despite a letter dated 9 November apologising for not being able to get back to me until Monday 4 December. The Minister was reluctant to meet me. I had several telephone conversations with her office and I was asked to put my request for a meeting in writing. I subsequently received a copy of a letter from her colleague, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), to Dr. Unsworth, addressed to "Dear Jim", and ending:

I note your comments in regard to Lynne Jones, MP. You will appreciate that it is not appropriate for me to comment on the views expressed by Dr. Jones. However, I will pass a copy of my correspondence to Dr. Jones so that she can be aware that we consider the investigation into this matter to have been concluded and no further action is planned.

At that time, I was seeking a meeting with the Minister for Public Health, and the letter was inappropriate.

I apologise for having gone on at length. There is more that I wanted to say and It am sorry that the Minister has so little time to respond.

I congratulate the hon. Member for Birmingham, Selly Oak (Dr. Jones) on securing the debate, although I have only three minutes to reply to it, which is wholly inappropriate when so many allegations have been made and anxieties raised. I shall try to respond as rapidly as I can, but it will be difficult in the circumstances.

Concerns first arose about the in-patient unit of the rehabilitation service of the Birmingham Specialist Community Health NHS trust in September 1998 when a patient's formal complaint about the standards of care was received. As a result of investigations into that complaint and other concerns raised by consultants at the rehabilitation service, an internal investigation was ordered by the acting chief executive. That led soon afterwards to arrangements being made early the following year to put together a multidisciplinary review panel under the chairmanship of Professor Lindsay McLellan, which examined, as part of an independent inquiry, all the issues involved.

On the basis of emerging evidence, the senior nurse manager at the in-patient unit was suspended in October. Later that year, when the McLellan panel reported to the trust, the board accepted the recommendations and proceeded with disciplinary investigations. At that point, the clinical manager, line manager to the senior nurse manager, and the director of the regional rehabilitation service were suspended.

The disciplinary action was carried out under the proper procedures and according to employment law. That disciplinary action has now concluded; the senior nurse manager has been dismissed and the line manager has been disciplined. No disciplinary action was taken against the director of the regional rehabilitation unit. He was not appointed as medical director of the new trust and I am advised that those disciplinary procedures followed all the proper procedures and that the trust acted correctly on the basis of the available evidence under employment law.

There remain two outstanding issues: the completion of an investigation into the patient's complaint that triggered the McLellan investigation, which was put on hold while disciplinary procedures were implemented, and the on-going investigation into grievances between senior clinicians and the previous trust management at the regional rehabilitation centre. That review has not yet been completed, and it is being conducted in accordance with annexe E of HSC (90) procedures. I do not think that there is evidence to justify a repeat inquiry when there has already been an independent inquiry and a disciplinary inquiry has been carried out according to proper procedures, and when a grievance inquiry and a complaints inquiry have not yet been resolved. In addition, substantial changes have taken place in the unit since the new trust was established, and I am informed that there have been considerable improvements.

I want to address some issues regarding the future of magistrates courts in rural areas of Wales, and focus in particular on my constituency of Ceredigion. I am afraid that my colleague the hon. Member for Meirionnydd Nant Conwy (Mr. Llwyd) also wants to squeeze his speech into the next half an hour, so I hope that the Parliamentary Secretary will be allowed adequate time to respond.

I want to concentrate on two main issues—the first is the future of Lampeter magistrates court, and the second is the withdrawal of the Narey cases from Cardigan to Aberystwyth and the effect of that on the delivery of justice in Ceredigion. Currently, there are three magistrates courts in Ceredigion—Aberystwyth, Cardigan and Lampeter. However, there is at least a suggestion—I can put it no more strongly—that, in time, we will have only one magistrates court in Ceredigion. It was stated at the meeting of the Dyfed Powys magistrates courts committee on 27 September this year that the long-term strategy may be to have no more than one court complex in Pembrokeshire, one in Ceredigion, two in Powys, and two in Camarthenshire. I accept that that is merely a suggestion, but the possibility of a decrease from three magistrates courts to one has caused great concern in my constituency.

What is certain is that the Lampeter court has no listings from 1 January 2001 and that a threat of closure hangs over it. I am grateful to Clive Williams, a solicitor, for providing me with details that outline how that has happened. He says that the reduction of cases at Lampeter started earlier this year, to the extent that a meeting was organised on 2 August between the chairman and chief executive of the magistrates court committee, with town councillors and local solicitors. An assurance was given that there were no current plans to close Lampeter. We have heard the phrase "no current plans" before, and we know what it often means—that the plans are just around the corner. Sure enough, by 28 September the Dyfed Powys magistrates court committee had met and issued its strategic plan, in which it clearly states that the magistrates court committee does not believe that it can retain a third courthouse, and that it would therefore cease using Lampeter courthouse. That was implemented by the short-term proposal to stop listing cases at Lampeter from 1 January.

Many cynics may feel that, by taking Lampeter court out of use, if not actually closing it, the magistrates courts have prevented Ceredigion county council from appealing. That may be a cynics' view, but, unfortunately, it is borne out by the minutes of the meeting of the magistrates court committee on 27 September, in which it is stated that the suggestion was made to close Lampeter courthouse. It was also stated that the chief executive explained the difference between closure of courthouses and taking out of use. We know what that difference is—one can be appealed against, whereas the other cannot. I wonder what will be the likelihood of success when Lampeter is eventually closed, as a long period of disuse will have occurred. I am sure that the Parliamentary Secretary will tell us the success rate of closures of magistrates courts in Wales, which I think is rather low.

A further meeting took place in Lampeter on 31 October, at which Ceredigion county council made its support for Lampeter clear. It also made the reasonable point that it could not invest in improvements at Lampeter unless it had an assurance on the long-term future of the magistrates court from the magistrates court committee. I met a cabinet of the county council on 6 November to discuss those matters, and its willingness to fund improvements or alternative accommodation way confirmed. I would accept, and no doubt the Parliamentary Secretary will tell me, that Lampeter courthouse is inadequate, but alternative provisions are being discussed—perhaps in the local school. The magistrates court committee does not propose reaching any decision based only on the Disability Discrimination Act 1995 until a code of practice is available but that Act is one of the obstacles in Lampeter's case. However, funding is at the heart of the issue.

At the same time, there are worrying signs of downgrading at Cardigan, because it has been proposed that Narey cases should be transferred from there to Aberystwyth. Narey cases are designed to speed up the administration of justice by encouraging defendants to enter a guilty plea at the first hearing. Guilty pleas often mean that cases car be dealt with there and then, but a plea of not guilty means that the case is adjourned. However, that complicates matters still further, because the adjourned case goes back to Cardigan. Many defendants will therefore be going to and fro.

When I raised those matters with the Parliamentary Secretary, the hon. Member for Liverpool, Wavertree (Jane Kennedy), she stated that no decision had been made to transfer Narey cases from Cardigan magistrates court. However, she admitted that a consultation exercise was under way. Once again, I have to tell her that, although no decision has been made, not one Narey case has been listed in Cardigan since 1 January. The management board of the Dyfed Powys magistrates court committee took the decision on 21 September 2000 to move Narey courts to Aberystwyth. That decision shows that a firm proposal to transfer the Narey courts has been made. Jointly or severally, those two decisions will lead to a severe diminution in access to justice in rural west and mid-Wales. I am sure that my hon. Friend the Member for Meirionnydd Nant Conwy would agree.

I wonder what is driving those decisions. I believe that it is a cost-cutting measure. A new funding formula from the Lord Chancellor's Department comes into force in the next financial year. The Parliamentary Secretary may say that the magistrates courts committee makes its own decisions, but I believe that the Lord Chancellor's Department pulls the strings and calls the tune. An explanation of some of those funding issues would help. Funding is given to magistrates courts on the basis of each unit of work load. That is weighted in Wales to account for the use of the Welsh language, which is appropriate, and in rural areas, including Dyfed Powys, for what is called a super-sparsity factor. We do not have a sparse population; we are super-sparse. It is one of the seven most sparsely populated areas in England and Wales.

Is that super-sparsity factor based on the English settlement made by the Department of the Environment, Transport and the Regions or on the new Welsh local government settlement, which is rather different? The answer to that question may reveal why the super-sparsity factor has not helped Dyfed Powys. I believe that it is being reviewed by the National Assembly to the slight favour of sparse rural areas. I do not know whether the English or the Welsh formula is used for Welsh magistrates courts. However, its effect on Dyfed Powys will be an undoubted cut of at least 2.1 per cent. in the next financial year and as much as 6.9 per cent. if the full cuts come into force. I appreciate that a damping scheme may be in place, but the Minister will no doubt say that resources are generally up by as much as 3.75 per cent., but because Dyfed Powys carries only 86 per cent. of the average work load of magistrates courts, due to the sparsity factor, it seems that it has been penalised for being rural in nature and in funding.

In addition, Dyfed Powys magistrates court committee has had a stand-still budget—it is the equivalent of the budget set in 1998–99—yet its salary and accommodation costs are up. The Lord Chancellor's Department also sets targets for the administration of justice, which are difficult to meet in rural areas. One of those targets is specifically to reduce courtroom overcapacity by 10 per cent. by March 2002. It is difficult to see how that can be achieved in rural areas without closing rural magistrates courts. Those proposals are implemented locally, but I believe that they are made in Westminster. The effect is highly injurious. I shall outline the case put to me by solicitors showing how this may affect the delivery of justice in Ceredigion and, I am sure, in other hon. Members' areas.

First, defendants face an additional 80-mile journey if they travel from Cardiff to Aberystwyth, which could involve up to two hours on public transport in a rural area, where public transport is difficult to come by. There may be additional costs for child minding for defendants, too, and for the police. It is difficult to imagine an unemployed defendant it Cardigan reaching Aberystwyth magistrates court by the start of play by means of public transport. What will happen if that defendant fails to make it to the court on time? Will the police issue a warrant for the arrest of that person?

The public and the press are important in this matter. I wonder what will happen when justice is not seen to be done locally in places such as Cardigan and Lampeter. Despite its being a sparse rural area, at least three local newspapers cover the various courts, all concentrating on different court cases. I hardly think that the local press will report cases of Cardigan crime when they are dealt with in Aberystwyth. That raises a question about the openness of the justice system.

The victim, who is of course the most important person to consider, and the victim's gamily will have the additional burden of travelling. In respect of Narey cases, they may have to travel from Cardigan to Aberystwyth, which may take as much as four hours altogether, to find that the case is adjourned back to Cardigan. That would be a waste of their time and an additional penalty or burden on victims and their families. Although solicitors and lawyers may not be doing that travelling for free, they will also have an additional time burden. Many cases are dealt with through legal aid, on which there will be additional costs. Someone is picking up the tab for the court closures—not the Lord Chancellor's Department, perhaps, but the public, the solicitors and others.

I appreciate that the information I am about to give the hon. Gentleman may be new to him, but I do not want him to take a false point. Is he aware that, on 11 December, the magistrates courts committee of Dyfed Powys decided not to transfer Narey cases from Cardigan to Aberystwyth? No doubt that was, in part, a result of his strenuous representations on behalf of his constituents.

I accept that that is the present position. I am sure that it is due not to my advocacy, but to that of the solicitors in Cardigan. Nevertheless, a long-term proposal for the kind of measure that I described is on the table, and that is the concern that I raise today.

Whether or not we accept that the Narey case change is temporarily postponed, a question mark hangs over Lampeter court and over the long-term future of Narey cases in Cardigan. I hope that the Parliamentary Secretary will deal with a couple of issues. First, how will the sparsity funding issue relate to Dyfed and will a Welsh or English formula be used? Secondly, how much weight will be placed by the Lord Chancellor's Department on the need to deliver justice in rural areas? New guidelines for the closures were announced yesterday, at column 200 in Hansard. I would like to know a little more about how those closures will relate to Lampeter court. Will it be possible to put off the closure of Lampeter court until the guidelines have been considered, especially given that funding exists until April in that regard?

Finally, will the Parliamentary Secretary agree to receive a deputation from my constituency, from Lampeter town council, Ceredigion county council and solicitors involved in cases at Lampeter Crown court? Those groups are keen to meet the Parliamentary Secretary or another person from his Department to express their concerns about the future of Lampeter and the administration of justice in west Wales.

I congratulate my hon. Friend on securing this important debate. The question of sitting days to which he referred is a way to close magistrates courts by stealth. Unfortunately, we are seeing the wholesale closure of rural magistrates courts. When I first started as a lawyer in Meirionnydd, there were six magistrates courts. We are now down to the last one, in the second largest constituency in Wales, for 100 miles north, south, east and west.

Under the previous Government, I appealed, along with the local council, against the closure of Blaenau Ffestiniog magistrates court, and was given a sympathetic hearing by the hon. Member for South-West Devon (Mr. Streeter). The general election intervened, and we were given a meeting with the Secretary of State for Defence who, patently, did not want to listen to our appeal, and it was turned down with virtually no discussion.

The Government are now presiding over the wholesale destruction of the magistrates courts network. I was told on 31 October 2000 that in 1995

there were 516 magistrates courts in England and Wales. In 1999 there were 436—[Official Report, 31 October 2000; Vol. 355, c. 416W.]

Of the 17 appeals lodged in 1997, two were successful. In 1998, of 26 appeals, one was successful, and in 1999, of nine appeals, one was successful. With respect—and I do respect the Parliamentary Secretary—it is no use saying that it is a matter for local magistrates committees, that they know best, and that it falls under the provisions of the Justice of the Peace Act 1997. That is simply not true.

The downward pressure on magistrates courts that comes from the Lord Chancellor's Department, and the bonuses offered to clerks to rationalise, militated against any form of local justice. The Department is the appellate body for appeals from magistrates courts, and I have already referred to the appallingly low rates of success that appeals attract. The closures are politically driven from the Treasury. There is no point in the Government saying that access to justice is important. With changes in the legal aid service, the Legal Services Commission, solicitors moving away from doing criminal work altogether so that experienced people are being lost to the profession, and the withdrawal of legal aid for personal injury, there is less access to justice, and magistrates courts are being closed down wholesale.

According to justices of the peace to whom I speak, whom I have known for many years and who are apolitical—or certainly not of my persuasion—the subtext is that stipendiary magistrates are seen to be the flavour of the month. As a practising lawyer, I would much prefer to appear before a lay Bench. The problem is that the Government will not listen to appeals. With respect, the appeal procedure is virtually a waste of time. There is no point in saying that it is up to the local authority and local magistrates to decide. They are being pressurised into making cuts, and the sooner the Government reverse their policy, the better.

I congratulate the hon. Member for Ceredigion (Mr. Thomas) on securing the debate on what is a very busy day for him—he also has the first question at Prime Minister's questions.

I assure hon. Members that magistrates courts are managed by locally based magistrates courts committees. As the hon. Member for Meirionnydd Nant Conwy (Mr. Llwyd) reminded us, under the Justice of the Peace Act 1997, each of those committees is responsible for the efficient and effective administration of the magistrates courts in their area. Dyfed Powys MCC, in which the hon. Member's constituency falls, has yet to finalise the accommodation strategy for the entire area. It is for the MCC, in consultation with the relevant paying authority, to determine how many courthouses are needed, whether urban or rural, and what other accommodation is needed locally.

It is worth reiterating that the reviews are perfectly sensible and rational. We expect no less of the MCCs in fulfilling their responsibilities. They must decide the most efficient way to discharge their statutory duty. That matter is, rightly, solely within the responsibility of local magistrates and MCCs. Clearly, when resources are tight, it is for the local committee to manage within them.

The hon. Gentleman asked about the grant application formula and suggested that it was to be changed from next year, and that changes that took place this year in magistrates courts provision in his constituency were in some sense driven by the funding formula changes that were due to come into force.

I can assure the hon. Gentleman that we consulted on changes to the magistrates formula but, as I am sure he would accept, it is a complex matter. The results of the consultation were, on balance, unfavourable. Therefore my noble Friend the Lord Chancellor decided not to implement the current proposals for changes to the formula, mainly because the work load information on which they are based is too unreliable to secure the confidence of the service as a whole. I hope that he will welcome that.

Work will be taken forward in 2001 to obtain more reliable information. The revenue allocation for the magistrates courts committees in Wales as a whole is rising by 6.7 per cent. next year. In Dyfed Powys it is rising from £3.1 million to £3.3 million, a rise of 6.45 per cent. I hope that the hon. Gentleman will welcome those revenue allocations and will realise that expecting cuts year on year is not the Government's approach and that revenue is available to ensure that the magistrates courts committees can do their job locally in the way that they consider most effective.

I accept the Minister's point, but I was trying to make the point that the magistrates courts committee had put together a strategy based on what it expected the funding formula to be. It is pursuing that strategy and, at present, it looks likely to lead to the closure of magistrates courts in Ceredigion.

That is a fair point. The strategy has been consulted upon.

On Lampeter, the hon. Gentleman is right that the magistrates courts committee intends to take Lampeter out of use from 1 January 2001. There are various reasons for not using it. First, as there are no usable cells, custody cases cannot be taken there. Secondly, the building has major problems meeting the impending requirements of the Disability Discrimination Act 1995. That problem is not unique to Wales; it applies to small magistrates courts throughout England and Wales. It is important that they service the needs of all constituents and the requirements of the Disability Discrimination Act must be faced. If there is no disabled access and if there are problems with disability rights, we must deal with those problems fairly.

Thirdly, security for the magistrates and staff is poor at Lampeter. There is no separate access to the building for magistrates, who have to retire from the bench through the public waiting area. There are not even separate toilet facilities. Cases that magistrates hear are often serious and bitterly contested. It is important that these volunteers—I am committed to the lay magistracy—are properly protected, can do their work in the right environment and deliver their service to the public in appropriate conditions. At present that is not possible in the Lampeter courthouse.

Does the Minister agree that the Disability Discrimination Act 1995 was never intended to cause the closure of those vital local magistrates courts? As he has, by implication, supported the principle of local magistrates provision, will he be sympathetic to proposals that come from Montgomeryshire and elsewhere if local lawyers can find sensible, cost-effective proposals to reinstate that provision?

If the magistrates courts committee wanted to improve facilities, it could submit a bid for capital funding from my Department. In Dyfed Powys, in the last financial year, there were bids from the magistrates courts committee for improvements that amounted to £183,467. It is not as if the Department were not investing in magistrates courts. A considerable amount of investment is available, but it is up to the magistrates courts committee to decide what is feasible and practical and then to submit its bids. At present, no bids have been submitted to improve facilities at Lampeter. I welcome the fact that the hon. Gentleman is in discussions with the council. If there are alternatives to providing appropriate facilities in Lampeter, that matter must initially be put to and pursued with the magistrates courts committee. It is responsible for delivering justice in its area.

The essential feature of local justice is that magistrates live or work in the locality; it is not simply about the local delivery of justice. It is not an essential feature of local justice for every community to have its own courthouse. MCCs must balance the need for a locally delivered service with the need to improve the quality of that service with the resources available to them. I have referred to the resources that will be available next year. MCCs are mindful of the Government's aim to reduce delay by providing the optimum number of courtrooms in their area, permitting flexible listing of cases.

Courtroom utilisation figures for last year show that, overall, the magistrates courts committees in Wales use courtrooms for about 44 per cent. of the time. That is significantly below the national aver age of 57 per cent. For Dyfed Powys, the utilisation figure is 45 per cent., which is substantially below the national average.

The Lord Chancellor is committed to making better use of the court estate, which includes magistrates, Crown and county courts. There is considerable scope for better joint use of courthouses to create justice centres where hearings of different types of cases can be conducted. Magistrates courts committees and local court service managers have been asked to draw up plans for their areas. That might include other judicial users such as coroners courts, the Immigration Appellate Authority or local tribunals. We must ensure that we make the best use of the Crown estate and our courtrooms for the maximum amount of time. Using them for less than half the time, as happens at present, is not a sensible use of the investment that the public have made in those buildings.

Surely the point is that we are dealing with large but sparsely populated hinterlands and rural areas. Inevitably, courthouses in such places will never be as busy as a city-centre courthouse. That is as plain as a pikestaff. With respect, the figures quoted do not reflect that problem.

I understand the hon. Gentleman's point and accept it to some extent. However, we have provided £3.4 million to carry out 60 projects to improve courthouses in Wales. Security has been improved at a number of courts. Work to improve disabled facilities, for example, by the provision of hearing loop systems and the installation of automatic entrance doors has been approved, and further works will be carried out. We must balance the local communities' need to have justice within a reasonable distance with the need to ensure that the centres where justice is delivered are of a reasonable standard. That is a difficult balance to strike and must, in the first instance, be a matter for the local magistrates courts committees, rather than the Government.

The hon. Member for Ceredigion asked whether I or the Parliamentary Secretary, Lord Chancellor's Department, my hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy), would be prepared to meet a delegation. In the first instance, the delegation should go to the magistrates courts committee, because we are talking about decisions taken locally. It is not right for Ministers to seek to usurp its jurisdiction or discretion. If the hon. Gentleman is not happy with final decisions taken by magistrates courts committees, I am sure that my ministerial colleague or I would be prepared to meet him to discuss his concerns. In the first instance, the accommodation strategy—which has not yet been finalized—is a matter for the local magistrates courts committee.

The hon. Gentleman also mentioned the new guidelines on closures. In the House yesterday, my ministerial colleague said that they would be published shortly. I will ensure that the hon. Gentleman is sent a copy of them. I am afraid that I cannot tell him in advance what they are likely to contain, but I entirely accept his legitimate point about the difference between closing a court where there is an appeal by the paying authority and merely not listing cases at a court. At present, there is no appeal.

It being Two o'clock, the motion for the Adjournment of the sitting lapsed, without Question put.