I have been trying to secure this debate for two months, partly because of the recent newspaper headlines about Nissan and the future of Corus, and partly because I am passionate about manufacturing and strongly believe that it is the only sound way to success for our economy,

In our region, manufacturing is bigger than merely Nissan and Corus, important though they are to Wearside and Teesside. The north-east was built on manufacturing. Our existing technical strengths are built on the historic foundations of shipbuilding, iron and steel making, heavy chemicals, mining technology and bridge building, but the world has changed and our region along with it. Change often means an uphill struggle, and we are having such a struggle at the moment. As the commentator William Keegan said in The Observer last Sunday:

Manufacturing in 1999 was a mere 2.2 per cent. above 1995. That is not healthy for a serious economy.

Our region is still heavily dependent on manufacturing, because it makes up a larger part of our economic base than it does in other regions and involves a larger percentage of the labour force than in any other region of the United Kingdom—174,000 people in all, which is a fifth of all people employed in the region—and also because most of our manufacturing firms are in specific sectors with specific skill needs.

What are those sectors? Mechanical engineering employs about 45,000 people. It includes the steel industry, which is centred on Teesside and Hartlepool, and the shipbuilding and offshore yards along the Tyne, Wear and Tees. We have the automotive industry, which, as I said, is more than Nissan—the sector is made up of some 235 firms employing up to 40,000 workers. Nissan is obviously the focus, but it is not generally realised that the north-east has a large automotive products industry selling throughout the UK and the globe.

We also have the chemical industry, which is primarily located in my area of Teesside and employs about 18,000 people, who were once mainly employed by ICI, but who now work for a large number of chemical multinationals, many of them household names such as DuPont, BASF and Dow, which bought into the divested ICI bulk businesses. We also have electronics, which employed 15,000 people in the mid-1990s. Since then, employment has increased, despite the loss of Siemens and Fujitsu. Much of that increase has been in mass production and assembly functions. A number of Pacific rim companies have also located in the north-east. All those sectors have managers and workers with skill, talent and initiative.

We need to take account of certain factors when we consider long-term plans to improve manufacturing competitiveness. Studies of mechanical engineering show that that area of technology is divided into two broad sub-sectors. One is based on knowledge-intensive, high-technology processes and applications, which feed into global supply chains. That group is characterised by the steel industry and the more advanced engineering companies. The other is based on a large number of smaller, less-advanced employers that undertake fabrication, mechanical engineering and associated installation and plant services. The north is home to both sub-sectors, but the second is the bigger employer.

The biggest threat is to our steel industry, and I speak with passion as I was a British Steel employee before I came to Parliament. We have no clear knowledge of the intentions of Corus, but the omens for both south Wales and Teesside are not good. There has been speculation in the newspapers that as many as 7,000 steel worker redundancies will be announced in the next week. I urge the Minister and the Government to do everything possible to assist in minimising the number of redundancies. They could leave a devastating hole in the economy of Teesside, as well as heaping pain and misery on the individuals affected and their families. It has been estimated that redundancies would also result in a loss of gross domestic product to the area, at a cost of £28,000 per annum for each job lost, plus £8,150 per annum per job lost as a result of loss of tax and payment of benefits. There are also the massive costs of cleaning up and decontaminating such heavily used sites, which have seen nearly a century of steel making.

I recognise that the Government, and certainly the Secretary of State for Trade and Industry, have given us support and help on Teesside when we needed it—when job losses were announced last year—through the setting up of a rapid reaction taskforce that embraces the local authority, the Department of Trade and Industry and the Department for Education and Employment, and agencies such as the Employment Service and the local training and enterprise council. As a Member of Parliament, I am also involved.

What a contrast that is with the world before 1997, when the previous Government were utterly indifferent as millions of jobs were lost throughout the country—[Interruption.] The hon. Member for South-West Hertfordshire (Mr. Page) laughs.

I have to laugh because the hon. Member is giving us the propaganda rather than the facts. If he studies manufacturing industry in this country, he will find that from 1993 to 1997 the numbers employed increased, year after year, for the first time in decades. It is only since 1997 that they have started to go down again. If the hon. Gentleman is referring to the 1980s, his argument may have some validity, but if he is talking about the 1990s, he has got it wrong.

I merely refer the hon. Gentleman to what William Keegan said, which is that the manufacturing sector has gone up by 2.2 per cent. He is a well-respected commentator.

The threats still remain to jobs in manufacturing—in mining, shipbuilding, engineering and car making. Manufacturing is vital to the working of a modern economy and must be viewed by the Government as such. It is too vital to become merely the plaything of City institutions and day traders looking for easy profits.

The automotive industry arose on the back of the original Nissan investment. The presence of that world-class employer on our doorstep has meant that suppliers know what quality is required of them. However, the movement of motor manufacturing across European borders, the loss of critical customers such as Ford and Vauxhall and the slimming down of Longbridge and Cowley will mean that competition will be tougher for their former suppliers.

I know from my experience as the chairman of the all-party industry group that the chemical industry is also in a period of rapid change. It is not a sunset industry: it powers material manufacture, backs up the pharmaceuticals industry and is vital to the manufacture of food and drink. Issues such as higher energy costs, less-developed logistics and a fragmented world market with different systems of regulation mean that traditional bulk production is under pressure. Chemical companies also have to face new competition from new facilities in southeast Asia and Latin America, which can draw on a pool of low-cost labour.

The electronics sector is also under intense pressure. The mass-market industries, especially those manufacturing domestic goods, are extremely sensitive to new products, innovation, price and marketing strategies. In order to remain competitive, plants must undertake continual reinvestment, retooling and retraining.

The north-east electronics industry is still a branch of plant operation, which means that most companies have few engineers, technologists, managers and other professionals—people able to develop new ideas and innovation into world-beating products that could be made in the north-east. The market factors with which northern manufacturers now have to cope are increasingly severe. That on its own would be enough, but northern manufacturers have other worries. They are concerned about a growing north-south divide in manufacturing with high-tech sectors increasingly investing in the south of England, and the north being seen as lagging behind when it comes to high-tech investment. Figures from the northern TUC are sobering. They show that the south-east gained 6,000 manufacturing jobs between 1998 and 2000, whereas the north-east lost 1,500 similar jobs over the same period.

How are we in the north-east going to reverse this decline? How much of the solution is in our hands and within our power, and how much is within the power of central Government? I recognise that central and regional government will have to co-operate to get the best deals for our communities and for our local businesses.

I applaud the establishment of the regional development agency, One NorthEast, which is the most integrated approach to industrial reinvigoration that we have seen. I applaud the formation of regional and sub-regional structures to integrate the planning, transportation and development functions essential to greater competitiveness and growth. That has led to a world that is much changed since 1997. There are more people in work than ever before. Unlike the previous Government's training schemes, the new deal is more than a revolving door for unemployed people. New public spending measures have pump-primed our schools and our colleges, and have helped universities to produce better-qualified people to meet the needs of industries that are having to compete on a global footing.

However, the scale of the downturn in manufacturing employment is such that other solutions have to be devised with the blessing and backing of central Government. There should be no shame in that. It is not a matter of reversing pledges, but merely of recognising that the world has changed and that we have to adapt policies to meet new circumstances. Above all, we must recognise the changing balance of trade with mainland Europe—the biggest export area of our manufacturing firms.

There is no time in this debate to discuss our entry into the euro. The need to ensure that we have some price comparability in selling finished goods on the European mainland has to be recognised. We must enter into the single currency zone as soon as possible. I fully support the Government's commitment to a referendum, only after the key economic tests have been satisfied. We must also take heed of the doctor's test of the good health on our manufacturing industry. At present, that test will prove that it is suffering from a rapidly worsening attack of economic anaemia.

Other measures are needed. I am aware from reports that my right hon. Friend the Prime Minister is contemplating a post-election shake-up of the Cabinet structures. One reform that could be instituted quickly is the designation of a Minister for Manufacturing, who could champion manufacturing, just as small businesses, universities and farmers have ministerial champions—a minister whose role should be to ensure that a framework of incentives and rewards is developed to encourage entrepreneurs and to ensure that the technologies developed can be exploited with incentives. That suggestion came from Sir Ken Jackson, the general secretary of my own trade union, the Amalgamated Engineering and Electrical Union, whose knowledge of manufacturing should not be underestimated. He is someone who should be listened to, and I know that the Prime Minister takes his views on board.

We also need a domestic policy for growth that recognises that manufacturing can be successful only if there is a customer base for its products. The state itself is one of those customers. When we examine the matrix of economic indicators available to us, we should pay attention to the power of the state as an agency that can create growth. That can be done in many ways: by infrastructure projects, such as new road and new mass transit schemes, an example of which is the metro extension to Sunderland; by considering carefully the procurement budgets for individual spending Departments; by speeding up the reclamation of derelict industrial sites that still disfigure too many parts of the north-east; by working with the oil and gas industry to try to speed up the opening of new oil and gas field developments in the North sea and Atlantic shelf: and by helping with a programme of scrapping older, less environmentally friendly North sea platforms at the end of their working life.

New private sector infrastructure projects could be speeded up by a more targeted use of state aid, and by speeding up the planning system, so that a project deemed to be of national or regional significance could have a quicker planning route. We could even look to climate change as a vehicle for helping manufacturing. Flood defences work often needs the civil engineering skills associated with building North sea structures. We could examine how to create a water grid of pipelines linking the saturated north with the drier south, which would provide a massive fillip for the north-east steel industry.

We must begin to put flesh on the bones of the cluster concept. Clusters are rapidly assuming a new status as a way of encouraging upskilling, investment and a virtuous circle of improvement and partnership. Partnership leads to greater growth, productivity and wealth creation. Our RDA has championed the idea of clusters, which I welcome. Clusters should be encouraged in certain areas to allow the free flow of collaboration between companies engaged in the same area of business and on joint marketing, research and development, blue sky research and training. The establishment of clusters in specific areas, such as chemicals, food and drink and marine technology, is well advanced. Indeed, I attended a debate in Westminster Hall only a few months ago on a chemical cluster for Teesside.

The Government must make an explicit commitment to clusters, especially to the chemical cluster, by providing physical incentives, by the fine tuning of the national and regional grant regime, and by underwriting partnerships between manufacturers and universities. I recognise that the new Learning and Skills Council and the Small Business Service will play an important part in that, and I should be interested to know whether the Minister can give us any information on progress so far.

The north-east has great potential, and the opportunities are limitless. Therefore, I merely say the obvious—that manufacturing is very important for our region.

I congratulate my hon. Friend the Member for Middlesbrough, South and Cleveland, East (Mr. Kumar) on securing the debate. The subject of manufacturing industry in the north-east is close to his heart, and he has spoken—both inside and outside this Chamber—passionately and consistently on that matter since he was elected in 1997. My hon. Friend displays considerable courage in doing so, because we would rather not hear critical remarks that need to be made about our Government.

Over the past four years, the Government have made enormous progress in pursuing their macro and micro-policies on manufacturing. The emphasis has been on research and development, innovation and the spin-off from universities acting together as a knowledge base—jobs can be created in university engineering departments and high technology departments—and that is all now beginning to come together. Universities in the north-east are outstanding, and are now acting together far more effectively than in the past. In the next decade, we anticipate even more spin-off into our manufacturing industry.

Many people say that the north-east does not have the skills to cope with modern developments. That may, sadly, be true in that we still have the poorest educational performance of any English region at all levels. That has been the case for the 30 years that I have been involved in politics, despite the efforts of all Governments to rectify it. Part of the problem is that not enough jobs are available, so there is no incentive for people to acquire skills at the higher educational level. Economic growth and the development of talent must go hand in hand. With mass unemployment, people's skills and employability are all too quickly dissipated. Growth and skills must run in tandem. I congratulate the Government on recognising that and doing something about it.

The north-east is proud of its manufactories, some of which have had to struggle for years against adverse circumstances, and we have some fine examples of global players. My own constituency, for example, includes Black & Decker, Thorn Lighting and Electrolux—all those outstanding companies are within half a mile of each other in Spennymoor ward. Glaxo Smith Kline, as it is now called, employs 1,500 people at Barnard castle—it is a global player.

The north-east has always had a long tail of uncompetitive smaller companies. Our great problem is how best to dissipate best practice from the global players throughout the whole chain. We may take complaints from some of the less efficient and less competitive manufacturers with a pinch of salt—it is always possible to find staggering ways of improving competitiveness. However, when the global players complain, we know that other measures should be taken.

Recently, we have heard complaints about the high value of the pound or the low value of the euro, which led to a 30 per cent. reduction in competitiveness, most of which took place under the previous Administration. Although it may be possible for companies that are already global players to improve their competitiveness by 5, 6 or 7.5 per cent. per annum, it certainly is not possible quickly to improve competitiveness by 30 per cent., especially when the majority of our manufactures go to Europe. Companies who send their manufactures to the United States have done quite well, because the exchange rate has not been a problem, whereas those who have sent most of their manufactures to Europe have experienced enormous problems because of the high value of the pound, and that even includes the global players.

The economic cognoscenti believe that there is very little that can be done about that problem. That is why the Government have preferred not to mention it too often, because the next question they are asked is what they intend to do about it. For some people, the easy answer would be to join the euro. I have been pro-European for 40 years—I was a lonely voice in the Labour party in the early years—but I have always been cautious about the single currency, and remain so. I would love us to join the euro at a rate that we could live with and at which we could prosper. If that were possible, we would do it tomorrow, and I would accept everything else in its wake. However, that will be hard to achieve, so we must remain cautious about that whole agenda for the time being.

The trouble with being cautious is that it gives manufacturing industry very little hope that the situation will improve. Does the right hon. Gentleman think that the Prime Minister may have been rather less cautious in his conversations with Nissan, and may have wanted to stress to them that there is a prospect of Britain joining the single currency in a reasonably short time?

There may have been a window of opportunity immediately after the 1997 election to have a referendum. If we had gone into the euro at that stage, we may have avoided some of the problems that we are discussing this morning. That window was open for only a short time, and as we have lost that opportunity, entering the single currency will be one of most delicate negotiations that any future Government will face.

I am glad that mention was made of Nissan because I am enormously proud of what it has achieved. I was on the Tyne and Wear metropolitan county council in the mid 1970s when we reserved the Usworth airport for the big one. The big one was not going to be anything to do with the motor industry—that was the last thing on our minds. We did not want the motor industry to come to Tyne and Wear, but the arrival of Nissan not only created a large number of jobs, both direct and indirect, but tuned the quality of management throughout manufacturing in the north-east.

People in the north-east are ready to embrace the future and are keen to continue the improvements in productivity and quality. However, just as we begin to run the race effectively, we have to run harder to stand on the spot. That always seems to be the problem in the north-east. We have restructured our economy continually throughout the past 30 years, but we have always needed to do more and more to remain on the spot.

Does my right hon. Friend agree that one of the problems for the whole of the north is the relative absence of investment in high technologies? Is he aware that a number of the universities and businesses in the north-west have come together, as he advocated earlier, and have proposed the Casim project on the Daresbury laboratory site, which is currently being considered by the Department of Trade and Industry? Would he support that project, as he does for similar projects in the north-east?

Yes, of course. Bringing together research and development is crucial for the future of our regions. I am enormously keen for information and communication technology companies to come to the north-east, so it is rather depressing that most are going to London and the south-east and to parts of the southwest. Therefore, the north-east is falling further behind in the new economy.

I say kindly to my hon. Friend that although the Government rightly emphasise that the future largely depends on the new economy, the unintended message to manufacturing industry in the north-east is that it does not really matter, and that investment will go into ICT. The suggestion is that the future is with information communication technology, as if that had nothing to do with traditional manufacturing. The future for traditional manufacturing lies in the application of all these new technologies to each of their processes, so it is divisive to talk about the new economy as if we could dispense with the old economy.

I associate that view not so much with the Department of Trade and Industry, but with the Treasury—and not necessarily Treasury Ministers. I have been a Treasury watcher for 40 years, and it has always been keen on a strong pound, whatever the consequences to manufacturing industry, and has always believed that manufacturing is old hat—that view reached its peak in the days of Lord Lawson. The belief that manufacturing is of no great consequence to the nation arises from the coalition between senior Treasury officials, the Bank of England and the City, as they see all new investment going in other directions. We in the north-east want our share of ICT design and artistic developments. We want the new rapidly growing industries to come to the north-east. Part of our problem is that we can never get our share of those rapidly growing industries.

I advise my hon. Friend the Member for Middlesborough, South and Cleveland, East to resist any pressure from the Treasury suggesting that manufacturing industry is of declining importance to the nation, that its effect on our gross domestic product is diminishing and 1h it employment in that industry is reducing. We do not need to be concerned about that. Employment in manufacturing industry is reducing because of its more efficient use of labour.

We could talk about this subject for the next three or four hours, but I shall close my remarks by urging my colleagues at the DTI to resist pressures from the financial authorities that manufacturing does not matter. It does matter. It is crucial, and we cannot prosper without it. No matter how we restructure our economy, manufacturing is important, and we want the Minister to understand that.

I am grateful for the opportunity to speak in this debate, which was successfully obtained by my hon. Friend the Member for Middlesbrough, South and Cleveland, East (Dr. Kumar). My hon. Friend has a great passion for his constituency and works tirelessly on behalf of the people whom he represents. My area resembles his, in that Easington was founded on coal. Nothing was ever developed on the Usworth site because we required coal miners. One of my predecessors, Mannie Shinwell, once said that as long as there was coal, we could forget about modern engineering plants of any size in the north-east. Mrs. Thatcher put paid to all that. An area that once had 14 coal mines no longer has any. The region has suffered a creeping paralysis over a period of about 35 years. Fortunately, the corner has been turned and that paralysis is now on hold.

There are lessons to be learned from the past, one of which is that the great strength of our area—mining and heavy engineering—was also our great weakness.

Virtually with a stroke of a pen, 9,000 coal mining jobs were lost overnight. Coal mines will not come back and we must look to the future. That is being achieved through superb partnerships between industry, district councils, county councils, One NorthEast and the Government office for the north east, which have achieved a great deal and which are providing the necessary infrastructure in my constituency to attract future inward investors. Existing industrialists—such as Caterpillar, NSK Ball Bearings and the GT group, under the dynamic leadership of Geoff Turnbull—have given a practical expression of their faith in the area by remaining in it. They rely on the strengths of a work force who are willing to learn, re-skill, adapt and travel. My thanks go to all the industrialists in the area who have remained, through thick and thin—and there have been some very difficult times.

To attract manufacturing to the area, we need to have something on offer. That has been accomplished with the establishment of enterprise zones at Fox Cover and Dawdon, the new development on Dalton Flatts of a £37 million retail park, the reclamation of the Hawthorn mine and the new Glebe centre in Murton, which was opened on Friday by the Prime Minister. All the pieces of the jigsaw have finally been put together. It is a ringing example of what can be achieved for coalfield areas through partnership and Government initiatives.

However, while much has been accomplished, we find ourselves at a standstill. The textile industry is moving into Slovakia. NSK, which is a superb, model employer, now has a plant in Poland. The shipbuilding industry, which lies to the north of Easington, finds itself disadvantaged because hidden subsidies have allegedly been granted to foreign shipyards. In Italy, for example, shipyards are owned by municipalities, which means free rent for shipbuilding and repair.

I am not sure whether the civil servants in the Department of Trade and Industry are as assiduous as they should be in watching developments in Europe. They may wish to apply themselves to the situation in France, for example. Why do we never get French ships for repair in Britain? Why do Italians constantly undercut us? There is more to the situation than meets the eye. The DTI should follow that issue in some depth, to discover whether we are being deliberately disadvantaged.

If shipbuilding is not already in crisis, it shortly will be. The problem lies with the work force, whose average age is between 50 and 55. They are looking towards retirement. Where will we find the skills base to provide the work force, should we be successful in once again embarking on shipbuilding and continuing ship repair?

To attract industrialists and manufacturers into an area, money must be expended in rather different directions than the provision of an infrastructure and an enterprise zone. We need more money in my area to tackle deprivation. It has been recognised by the Government as the area of the greatest deprivation in the country. I do not want to talk the area down; I have never done that. I want to talk it up. But the areas of deprivation cannot be ignored. We must ultimately attract industrialists to the area. We need more than the brand new and exciting business parks such as Peterlee and Bracken hill, where several thousand jobs have been relocated into the call centre industry. There is an ideal opportunity for high-tech industry to move into the exciting new units adjacent to the A19. However, more money must be expended in the surrounding colliery villages, with their run-down and dilapidated housing.

We must increase funding for our schools. My right hon. Friend the Member for Bishop Auckland (Mr. Foster) mentioned the low standards of education. There are also low standards of health. The Government have recognised that, but we are still waiting for further funds to flow into the area. How on earth is it that gap funding is to be removed at perhaps the most critical time in the north-east, in the middle of the largest regeneration project? It beggars belief. Have civil servants and Ministers fought tenaciously enough to retain gap funding?

My basic message is that five years ago there was a feeling of helplessness and hopelessness in the area. We were still reeling from the loss of more than 9,000 jobs. Well, we have virtually pulled ourselves together, but in order to help ourselves, we must receive help from the Government. It should be looked upon not as a handout, but as an investment for the future—a true, gilt-edged, solid investment. Those are the messages that I want the Minister to take back to the Department and his officials. All is not lost. I am not painting a rosy picture. An immense amount has been achieved over the last three years, but much more is to be achieved, provided the Government direct the correct stimulus and resources into the area.

I am glad that we are having this debate. I congratulate the hon. Member for Middlesbrough, South and Cleveland, East (Dr. Kumar) on introducing it so thoroughly and covering so many topics. The hon. Member for Easington (Mr. Cummings) made a heartfelt plea, and I echo much of what he said as, like him, I represent an area that had many coal mines—it still has one—and it shares some of the same problems. The right hon. Member for Bishop Auckland (Mr. Foster) also made some interesting points. As one would expect, Labour Members, although constructively supporting the Government, wish to draw attention to what needs to be done to help our region.

There are advantages for manufacturing industry in the region and scope for further development. There is space for sites, and it is an attractive area in which to live. We have good labour relations and low labour costs—that is the other side of the low-wages coin—and low housing costs. There are abundant water supplies. As the right hon. Member for Bishop Auckland said, there are numerous universities, most of which have a long tradition of working closely with manufacturing industry. Some of the universities were founded on their association with manufacturing industry.

However, there are some serious weaknesses, or the figures would not appear so alarming. The gross domestic product per head is 15 per cent. below the United Kingdom mean; the density of businesses by population is 40 per cent. below the UK mean; new VAT registrations by population are 50 per cent. below the UK figure; employment in high-tech business is 10 per cent. below the UK figure; the business spend on research and development by regional GDP is 33 per cent. below that in the UK; average earnings for full-time employees are 11 per cent. below the UK mean; and the proportion of graduates in the work force is 32 per cent. below the UK mean.

Those are worrying figures. Admittedly, they are 1997 statistics, but the Government do not claim that there has been a substantial change in the interim, and yet manufacturing is crucial to the north-east. It provides 21.3 per cent. of employment in the region, compared with 16 per cent. in the country as a whole. Despite the decline, it is still a much larger element in the jobs of our region than in those in other parts of the country. It includes major international companies, such as Proctor and Gamble, Nissan and Alcan, and smaller specialised exporters, such as the House of Hardy in my constituency, which exports the highest quality fishing tackle all over the world.

However, only two of the top 10 manufacturers who provide 10 per cent. of all manufacturing jobs in the region have their headquarters in the area, and the threat of losing those companies whose headquarters are elsewhere is pretty frightening. My constituency lost Pringles, the knitwear manufacturer, and Polychrome—both companies with headquarters outside the region that decided to move their manufacturing activities elsewhere.

The small and medium-size business sector is most important, as the Government acknowledge. The right hon. Member for Bishop Auckland expressed his anxiety about the availability of skills, resources, and expertise to sharpen competitiveness. A great many people have achieved an enormous amount in our smaller businesses by innovation and sheer hard work, but they often need help in keeping up with the increase in competitiveness that is necessary even to cope with the exchange rate problem. Business organisations have drawn my attention to that problem.

A very good organisation called Manufacturing Challenge, which brings together large and small business to explore relevant issues, was started in the region by my constituent Mr. Karl Watkin. It has drawn attention to the shortage of resources and expertise to promote competitiveness in the SME sector.

I quote the business view of major international companies:

The decision makers, whether in America, Europe, Asia or London can look at a map and see that we are on the peripheral fringes of Europe. They can see that we are not connected to the UK motorway network, unlike nearly everywhere in western Europe.

They refer to the "blue lines on the atlas" position; manufacturers can see that the lines showing the motorways do not extend into our region. They continue:

They see that there are no regular business connections except to London, Brussels and Amsterdam by air, and that the cost of transporting freight is also high.

The retention of international businesses is crucial to the regional economy. Infrastructure is of fundamental importance to the continuance of manufacturing industry in our region, and action is needed. If the region had more power to decide how resources are used, it would help us to tackle those infrastructure problems. We are strongly committed to a regional assembly, and we want the Government to keep moving on that. We do not want just a talking shop but a body, like the Scottish Parliament, that has the capacity to make resource decisions within the region in the light of the needs of regional industry and business. That is why fairer funding is important.

It is no accident that several local authorities in the region are among those worst hit by the standard spending assessment system with regard to educational spending. It is increasingly recognised that the absence of a mechanism like the Barnett formula, which has helped Scotland so much, means that the region does not have the public expenditure per head to improve infrastructure to the same level as in similar parts of Scotland with similar problems.

The exchange rate problem, and the uncertainty over Britain's future position on the euro, is of crucial importance to manufacturing industry in its exports to Europe. Our region depends on the manufacturing industry, so it is disproportionately affected. International companies, such as Corus and, crucially, Nissan, are affected by those problems and that uncertainty. Will the right hon. Member for Bishop Auckland tell me what he thinks that the Prime Minister really said to Nissan—in addition to the discussion of regional aid—about Britain's future in the euro? Every car that Nissan exports to Europe from Sunderland is exported at a loss, because of the exchange rate problem and the sheer unpredictability of the exchange rate—not because the company is not an efficient producer. In fact, the company has set such a good example that it has brought great efficiency throughout the region.

Does the right hon. Gentleman think that the Prime Minister should have told Nissan that we would lock on to the euro at the prevailing exchange rates?

I am sure that the Prime Minister did not say that. I suspect that he told Nissan that, if he were reelected as Prime Minister, there would be an early referendum, and that the Government would try to reach the position in which we could join.

Given that discounting takes place in international markets, one of the factors at play is whether people believe that Britain is likely to join the euro. A commitment not to join the euro for the next five years—the duration of the next Parliament—would not help to get our currency closer in exchange rate terms or give industry the confidence to continue to develop manufacturing in our region. Nevertheless, that is the position taken by the Conservative party, although it is is a little cagier about the matter in the region. I received a leaflet through my door that said that the Conservative party's position, unlike that of the Liberal Democrats, was that we should join the euro only when it was in Britain's interests to do so. I entirely agree with that—I sign up to that statement. However, if we can get to an exchange rate level that is sustainable for us in the euro, it will certainly be in Britain's interests to join, and very much against them to rule out membership, as the Conservative party has done.

The Conservative party may say that we should never join the euro out of principle, but it must realise what a big sacrifice our region would have to make. Anyone who has the interests of the region's industry at heart must realise how important it is, and that we should attempt to reach a point at which Britain can enter the euro zone so as to give our industry a chance to compete and ensure that international industry remains within our region.

Smaller and medium-sized enterprises depend to a larger extent than the biggest businesses on support systems. Business men have sometimes expressed their dissatisfaction to me about the support systems for smaller business. Between 1997 and 1999, approximately £80 million—one third of the region's total allocation of European structural funds—was directed towards the business support community to provide innovation and technology services. In addition, the training and enterprise councils and business links, co-funded by European regional development fund cash, spent a further £4.5 million. Some £100 million has been spent on publicly funded innovation and technology support. That is a lot of money, so it is perhaps surprising that there has been so much criticism about the outcome.

The figures suggest that that funding is not achieving the desired results. When I ask why, business men tell me that too many programmes and projects have focused on the transmission of technology rather than preparing the ground for its reception and absorption. Too much emphasis has been placed on inward investment from other countries and external businesses, with little attention paid to the growth and retention of the existing stock of businesses. It is largely left to service providers to determine the detail of what services are needed by industry.

The perception in business is that the cash is used to look after the providers, not the people whom they are supposed to be supporting—that is, those in business. The providers are not driven by the needs of business. That is the view of many people who want to use the support facilities. Business representatives often express that point of view forcefully to me and to the other Members who represent Northumberland constituencies.

Clearly, the debate has revealed that much should be done to strengthen manufacturing industry in the north—a region that depends on it. The Government must recognise the vital significance of manufacturing—the hon. Member for Middlesbrough, South and Cleveland, East suggested that there should be a Minister with responsibility for manufacturing, which is an idea that is worth exploring. The Government must give the regions more power to make decisions that can benefit manufacturing industry and close the infrastructure gap through fairer funding. If we are to get a skilled and adaptable labour force, they must also tackle the inequalities in education. They must listen to what business representatives say about the support mechanisms for business and respond to those views and be clear about Britain's need to enter the euro as soon as we can get terms and an exchange rate that makes it right and sustainable to do so—they should take action to achieve that outcome.

I add my congratulations to the hon. Member for Middlesbrough, South and Cleveland, East (Dr. Kumar) on initiating this debate—the more the merrier, because in many ways this debate adds to one in this Chamber two weeks ago on the same subject. It does no harm for us to hammer home the message that manufacturing matters, and I shall develop that theme.

I agree with much of what the hon. Member for Middlesbrough, South and Cleveland, East says, and I know of his enthusiasm and support for manufacturing. He has been a member of the all-party group on the chemical industry throughout the years that he has been a Member of Parliament.

This debate presages the one that will take place this afternoon in the main Chamber. I do not know whether the Minister will be replying for the Government this afternoon. If he is, he will have two speeches for the price of one. If not, he can hand it to his colleague who is winding up this afternoon's debate.

I will delicately twit the hon. Member for Middlesbrough, South and Cleveland, East. I will not call it a diatribe, but he gave us a mantra about the declining numbers employed in manufacturing industry, and said that it was all the fault of the Conservative party. I freely admit that in the 1980s the number of people employed in manufacturing fell dramatically. On the other hand, the restructuring of so many of our nationalised industries—

Will the hon. Gentleman give way?

After I finish my set piece I will welcome whatever the right hon. Gentleman has to say.

Nationalised industries were being run under the lunchtime directive—politicians thought that they could run businesses better than those who had spent a lifetime doing so. I am surprised that there was not an even greater shake-up.

Will the hon. Gentleman confirm that in the early 1980s, during what was dubbed the deepest recession since the war, employment did not merely fall—we lost a third of all manufacturing jobs in the north-east? In the 1990s, when we were beginning to recover, we entered the longest recession since the war and lost a further tranche. Numbers did not merely go down under the Tories, they fell dramatically.

I said that in the 1980s numbers went down dramatically. It is amazing that they did not go down more. To refresh the right hon. Gentleman's memory, at the start of the 1980s, the nationalised industries in the sector were costing the taxpayer £50 million every week. After the restructuring, that sector was making contributions of £50 million a week in company and corporation tax, which was a huge turnaround and a basis on which to grow, work and develop. From 1993 to 1997, the numbers went up.

Does the hon. Gentleman recall that when the Conservative Prime Minister, Mrs. Thatcher, visited the north-east and unemployment was mentioned, she said that people were moaning minnies? Does he agree with her that we were moaning minnies asking for jobs?

Any Conservative Member of Parliament who says anything derogatory about a previous Conservative Prime Minister or Government treads dangerously. People always tend to ask for handouts rather than practical recovery programmes. I shall say no more.

In the United Kingdom today, we must look to the future, not over our shoulders. I am remarkably grateful to the Labour party. If inflation had not been at 26 per cent. in 1976—stagflation—with the whole country going to pieces and regarded as the sick man of Europe, I should not have been successful in a by-election in Workington, which is not exactly the home territory of the Conservative party. That shows the disillusionment that existed. Let us put all that behind us and see how to progress in future.

The present Government have been in power for nearly four years and they had 17 years in opposition to prepare for office, yet we have a serious problem of job losses in manufacturing. If necessary, I can cite the various figures that have been produced by the TUC. Mr. Edmonds said that he thought that 96,000 manufacturing jobs were lost last year. John Monks, the general secretary of the TUC, reckons that the losses this year will be in the region of 10,000 each month. I cannot see anything happening to reverse that. The Government seem almost paralysed—fixed into some jelly from which they cannot break out to develop a positive programme to move manufacturing forward.

Talk of a north-south divide is growing daily, as the facts are emerging. Total unemployment—not merely in manufacturing—in the north-west has increased for the past four months. All Confederation of British Industry surveys show a loss of confidence in industry in the northern regions.

I agree with what the hon. Member for Middlesbrough, South and Cleveland, East said about critical masses. If there is no critical mass in a sector, the consequences down the line for small businesses are serious. He said that about 235 firms in the north depended on the car industry. Which Government were responsible for introducing the Nissans and Toyotas into the north, to provide the critical mass—the cluster—and thus to provide jobs? The right hon. Gentleman made a remark about a previous Prime Minister, but she was one of the drivers for a practical solution to overcome the problems in manufacturing in the north-east. Like all right hon. and hon. Members in this Chamber, I want the critical mass and the clusters to work and to be successful.

Of course, critical mass can go the wrong way. If it gets too small, the problems are greater. It is a virtuous circle if it goes one way, and a disaster if it goes the other. One worry about Corus and our steel industry arises in the light of the actions of Ford and Vauxhall. Let us hope and pray that Nissan decides to stay in the country. Our steel consumption has decreased by about 10 per cent. in the past few years—an example of the downward spiral mentioned earlier. More steel is being used, but it is being imported from abroad in manufactured items. Once in a downward spiral, more jobs will be lost in the steel industry.

I regret that every report that I see adds another 500 or 1,000 to the number of steel workers who may lose their jobs. Before Christmas, there was talk of around 4,000. The last figure that I saw was over 6,000. Let us pray that the figure will be lower.

Like the hon. Gentleman, I do not underestimate the power of prayer, although I do not think that working politicians are necessarily the best people to refer to that. With regard to Nissan, does he think that the Government aid package, which has now been approved by the European Commission as consistent with its rules, is enough, not enough or too much?

The hon. Gentleman puts the question in the manner of the old shaving advertisement, "Is there too much foam on my mouth, or is it just right?"

An analogy with shaving is not really appropriate in my case.

No, it is not. I was pleased that the aid package was processed, pushed and developed by the DTI much more effectively and efficiently than the Rover package. I am glad that it is in place and I hope that it will encourage the Nissan management to make that decision. Of course, we all know about the ownership of Nissan and where it may go. The aid package is a sign of the importance that the country attaches to retaining Nissan and that critical mass.

The right hon. Member for Berwick-upon-Tweed (Mr. Beith) referred to the price differential on every product that goes abroad. We know that about 7:5 per cent. of Nissan vehicles are exported and that the company has a turnover of about £1.2 billion. Nissan is losing about 20 per cent. on every vehicle because of the exchange rate. Therefore, no sum of money will be big enough to enable it to trade against the euro at the present rate. The package is an expression of support and confidence. Let us hope that we can run our economy with a greater and more comfortable relationship with the euro. I will return to that subject if time permits.

I agree with much that the right hon. Member for Bishop Auckland (Mr. Foster) said. He made an interesting contribution, and he is a living example of the old political adage that if one has political views and stands still long enough, the wheel will turn and eventually one will be in the mainstream thinking of one's party. There he is, right in the forefront today.

I agree with the right hon. Gentleman's comments on education. There is a story about a schoolteacher who took a class round a factory shop floor. When they got into the coach to go home, he turned to them and said "There, if you do not pass your exams, that is where you will end up working " That shows a mental attitude that I find extremely worrying—and I went to school, passed all my exams, got the standard 3 'A' levels, but decided not to go to university. I took an industrial apprenticeship and did four years as an indentured, manufacturing apprentice, so I know the importance of manufacturing. That lesson has remained with me all my life. Therefore, I am a firm and committed supporter of the importance of manufacturing to this country.

Hon. Members may find this difficult to grasp, but I welcomed some of the Government announcements this morning. An election is coming and it is not fashionable to agree with anything that is being announced by another party, but I agreed with the Secretary of State for Education and Employment on the establishment of school courses—leading to qualifications—on manufacturing and industry. That would be a valuable lesson for school children on the importance of manufacturing, rather than the more esoteric and theoretical subjects.

I disagree with the hon. Member for Middlesbrough, South and Cleveland, East about having a Minister for Manufacturing—I thought that that was the Secretary of State for Trade and Industry. If the hon. Gentleman is calling for his right hon. Friend's removal and replacement by a Minister who will do the job properly, then we are as one, but I would say no to someone doing that job in addition to the Secretary of State.

The hon. Member for Easington (Mr. Cummings) mentioned the importance of education. He spoke about the mining industry and the necessity for change. His message is that we are not clockwork mice, who are wound up with one education or training and set loose, but when that spring winds down we do nothing else. Today, we have to be able to retrain several times because of our career structures and the fact that technology moves on—the ability to make wagon wheels today may be superfluous tomorrow.

The hon. Gentlemen briefly and quietly touched on a disaster area that is almost regarded as a secret—the textile industry. For the past few years, we have been losing thousands of jobs every year in that industry. The figure is now well over 100,000 and has been exacerbated by the decision of Marks and Spencer to start sourcing abroad. That brings me back—a slight variation on a theme—to the importance of clusters and critical masses of sources on which all small businesses can run.

As I said in this Chamber a couple of weeks ago, I find the Government guilty on manufacturing—not of persecuting the sector directly, but of indifference and of abandoning it. Three or four hammer blows are hurting manufacturing. The first is the climate change levy, which is going to hit the sector hard. I will not ask the hon. Member for Middlesbrough, South and Cleveland, East, who instigated this debate, to comment on that subject because I know his views only too well. When the Conservative party sweeps to power in a few weeks at the next election, we will abandon that levy. We will take that burden from manufacturing to give it a chance to grow.

The right hon. Member for Berwick-upon-Tweed mentioned the price differential between the pound and the euro, and how it feeds through and hurts our industry. Frankly, while the fiscal policy of our Chancellor of the Exchequer is to spend more money than we are earning, I cannot see how the Monetary Policy Committee can do anything but keep interest rates higher than they need to be. As a result, we cannot get anywhere near parity with the euro to take the burdens and pressures off our manufacturers, who are trying to sell their products but suffer from the huge differential due to the exchange rate.

The Government came to power saying that they would do much to remove the pressure and pain of regulation, yet over the years we have had record numbers of statutory instruments. Regulations pile up year on year. In 1999, we broke the record with 3,700 plus, and I am told that last year we went through even that barrier.

I congratulate the hon. Member for Middlesbrough, South and Cleveland, East on introducing this debate on manufacturing. It does matter, and we must keep on raising the issue until the burdens are removed and our manufacturers are given the proverbial level playing field on which to compete.

I, too, apply for membership of the appreciation society for my hon. Friend the Member for Middlesbrough, South and Cleveland, East (Dr. Kumar), who has been a tireless campaigner on behalf of his constituents and the chemical and steel industries. This has been an important and excellent debate. There will probably be more blood and thunder this afternoon, but thoughtful contributions have been made in this debate, and the tone set by my hon. Friend in his opening speech will generate a lot more light, if not as much heat, in the debate generally.

I am pleased that hon. Members who represent the north-east are present, reflecting the importance of the issue in that region. My hon. Friends the Members for Liverpool, Riverside (Mrs. Ellman), for Newcastle upon Tyne, Central (Mr. Cousins) and for Hamilton, South (Mr. Tynan)—whose constituency could be described as being in the north, rather than the north-east—have also been present. In the short time available, I shall do my best to respond to individual contributions.

The hon. Member for South-West Hertfordshire (Mr. Page) was right. On 10 January we had a debate in this Chamber on the steel industry. This is a wider debate, but as I said in the previous debate on the Government's behalf, manufacturing matters. Hon. Members on both sides of the Chamber are right to say that manufacturers want to hear that message continually from Government. I do not think that we can say it often enough. This debate helps to reinforce the fact that manufacturing is a key part of the economy. It makes up about one fifth of our national income and directly employs about 4 million people.

The Foresight manufacturing report was commissioned and funded by the Department of Trade and Industry to look at manufacturing in 20 years' time. It was published last month and concluded that manufacturing would remain of major importance to the United Kingdom. The report also acknowledges that much remains to be done to secure the UK's position in what will be a European manufacturing competition, but that the UK can succeed.

Hon. Members have raised many crucial issues that we need to address. I am not here to say that the Government have done everything that we need to do on manufacturing in the last three and a half years, and everything is hunky-dory. There are problems that need to be addressed, but I have serious disagreements with the hon. Member for South-West Hertfordshire, which I shall deal with in a moment.

This is a period of major business change and restructuring. All sectors must adapt, and UK manufacturers have a crucial role to play in the knowledge-driven economy. My right hon. Friend the Member for Bishop Auckland (Mr. Foster) emphasised the point that this country does not have two types of economy: the new economy and the old, metal-bashing economy. We in government talk all the time about the knowledge-driven economy. I organised a conference on behalf of my right hon. Friend the Prime Minister last February to make that point. It is a matter of harnessing new developments and technologies to traditional industries such as steel, chemicals and the automotive industry. Anyone who walks round a steel plant can see that the knowledge-driven economy is as much about steel as it is about any other industry. We must support manufacturing by providing a stable macro-economic framework.

There has been a lot of talk this morning about the contribution of trade unions. In my time as a Minister with responsibility for an industry with which I had not traditionally been involved, I have been constantly impressed by the constructive approach of trade unions—particularly the Amalgamated Engineering and Electrical Union, the Manufacturing Science and Finance Union and the Transport and General Workers Union—in every sector of manufacturing.

What is the business world saying? In its December report on manufacturing, the Confederation of British Industry said:

The macro-economic policies pursued by the Government have succeeded in delivering a stable and favourable economic environment.

That is the prime responsibility of any Government. We also need to support manufacturing by investing in education and skills, investing in Britain's knowledge base, ensuring a decent infrastructure, and helping business to boost productivity and secure effective competition. We need to support business by creating a culture in which enterprise can flourish. All those points have been touched on by hon. Members in this debate.

The manufacturing sector has faced—and is still facing—serious challenges. Some parts of the sector are in the middle of a period of great uncertainty, primarily as a consequence of the march of globalisation. Many sectors of manufacturing are undergoing major restructuring. Nowhere is that more apparent than in the steel, automotive and textile industries.

My hon. Friend the Member for Middlesbrough, South and Cleveland, East is unfortunately only too well aware of the massive problems facing the steel industry—which are of particular concern at this time. That issue was discussed in detail a few weeks ago. The Government were deeply concerned about the redundancies announced by Corus last year, but we are playing our part in helping those workers affected. We await further announcements from Corus, following their statement on 5 December, but I can assure hon. Members that DTI Ministers and the National Assembly for Wales have, almost daily, met representatives from Corus at every level to establish whether the Government can help the situation, and ensure a constructive outcome to the current review.

Some companies in the automotive sector have experienced serious problems in the past few months. The most prominent company mentioned in the debate was Nissan, which is central to the north-east, and the most productive car plant in Europe. We wait in the hope that the plant will receive the go-ahead to produce the next generation Micra. I know that it has been well publicised, especially in the north-east, that the Government have offered up to £40 million of regional selective assistance. I am pleased that the European Union, having carefully considered the terms of the offer, has given it the go-ahead. It is now a matter for the Nissan board, and we await their decision, which I think is imminent.

It is beyond question that the numbers employed in manufacturing have fallen in this country, but there has been a similar decline in all other G7 countries. We estimate that, since 1997, 250,000 jobs have been lost in manufacturing. By comparison, under the previous Administration, from 1979 to 1997 the figure was 150,000 jobs lost each year in manufacturing. That was not decimation—decimation is one in 10. As my right hon. Friend the Member for Bishop Auckland said, that was far worse than decimation.

Overall unemployment is falling in all parts of the country. Indeed, the most recent figures confirm that not only is unemployment falling nationally, it is falling noticeably in the north-east. The hon. Member for South-West Hertfordshire mentioned the north-west. I do not have the figures available—I doubt the accuracy of his figures—but we will look into the point that he raised. In the north-east, the number of unemployed is dropping, and the number in employment is rising. According to the figures, for the first time, the north-east is closing the earnings gap and the gap in employment prospects with the rest of the country.

The Secretary of State for Trade and Industry made an important announcement yesterday on the regional innovation fund. That fund plays a small part in helping the process of restructuring. Regions undergoing manufacturing restructuring will particularly benefit from the new fund. Previously, it was calculated on a flat rate across the country, but it is now being calculated so as to put more resources into areas such as the northeast and my own region of Yorkshire and Humberside.

It is impossible to talk about manufacturing without making reference to the strength of the economy. We recognise the problem that the weak euro causes some exporters, but things have picked up recently as the euro has strengthened against the pound. This is a genuine issue of debate between us and the Liberal Democrats, although not the Conservatives. Many companies, such as Nissan and Toyota are keen to know that the options are being kept open for membership of the single currency.

The hon. Member for South-West Hertfordshire represents a party that would close those options and see significant investment in this country disappear overnight. We believe that the best contribution that the Government can make is to secure long-term economic stability based on low inflation and sound finances. We have had a growth record of 2.7 per cent. since the election compared with only 2 per cent. between 1979 and 1997. Under the previous Government, we had the worst record on economic growth of any member country of the Organisation for Economic Co-operation and Development since the second world war.

The period 1999–2000 was outstanding for attracting inward investment. The right hon. Member for Berwick-upon-Tweed referred to the problems that overseas countries face when they look at a map of the UK. We are beating the world on inward investment. We attracted 757 inward investment projects in 1999–2000, 40 per cent. of which were in the manufacturing sector and they created 52,700 new jobs.

Those are the points that I need to make on behalf of the Government about the macro-economic climate. I turn now to the individual problems and points raised in the debate. I shall return to the chemicals sector if I have a few minutes at the end. My hon. Friend the Member for Middlesbrough, South and Cleveland, East warned a Minister for Manufacturing. I could describe myself as that, but the Foresight report proposed something slightly different. It suggested:

A Chief Manufacturing Adviser should be appointed from industry for a limited period to catalyse the necessary culture change across the government and to provide a focus for manufacturing issues within the DTI.

The Government are considering that proposal, but we have already set up the ministerial group on manufacturing, and its first meeting is due shortly. It was initiated by my right hon. Friend the Secretary of State and will involve Ministers from every Department, including the Treasury and the devolved Administrations. That development may meet my hon. Friend's request.

My right hon. Friend the Member for Bishop Auckland, with the benefit of his wide and long experience, was right to stress the point about the new economy and the old economy and the need to invest in research and development, innovation, skills and training and the infrastructure. I entirely agree with that.

My hon. Friend the Member for Easington made some interesting points about the background of areas such as the north-east. I know from my own experience in the fishing industry in Hull how that affects education in the city. When large numbers of jobs were available for which no qualifications were necessary, the whole education system tended to be of secondary importance. That must now be built up. A lot more work is needed in the north-east, Yorkshire and Humberside. My hon. Friend also mentioned the textile industry, and made a specific point about shipbuilding, ship repair and hidden subsidies. We are considering those issues closely. I remind hon. Members that, for the first time in the history of this maritime nation, we have brought the industry, the unions and the Government together in the shipbuilding forum, which is doing much good work.

I had much to say about chemicals, which was a specific problem that my hon. Friend the Member for Middlesbrough, South and Cleveland, East raised, and about the clusters initiative, which is being taken forward. Perhaps I can talk to him outside the Chamber on that. I congratulate him on instigating an important, intelligent and constructive debate. Over the coming weeks and months, the Government will consider carefully the points that he raised, and those of other right hon. and hon. Members.

I regard it as a great honour to be able to introduce this debate on the issues surrounding complementary and alternative medicine, based on the findings of the House of Lords Science and Technology Select Committee's recent report.

When I last addressed the subject, the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), said that he admired the persistence and imagination with which I raised the issue at every turn; a compliment for which I was very grateful. I have been involved in the field of complementary and alternative medicine since my election in 1987, so it should be no surprise that I am again raising the issue.

If we were in Beijing or Hong Kong, we would have much to celebrate, as it is the Chinese new year today. Many across the world would say that this is a most auspicious day to debate this House of Lords report, paper no. 123. Soon after my election, I wrote a paper, as treasurer of the parliamentary group for alternative and complementary medicine, in which I argued that complementary and alternative medicine should be integrated into mainstream health care. At the time, that was thought to be a somewhat revolutionary approach.

Over the intervening years, such medicine has grown in people's estimation. The demand for it has increased dramatically in the United Kingdom; one in five people now use complementary and alternative medicine and the budget for treatments is approximately £350 million per annum.

Perhaps it is not so surprising that, recently, 160 Members of Parliament signed early-day motion 3 in my name, which broadly supported the findings of the Select Committee. When I was collecting the signatures, approximately a third of all colleagues said to me that they had direct experience of complementary and alternative medicine.

Therapies such as osteopathy and chiropractic, which were once treated with disdain by the orthodox medical profession, are now regulated by Acts of Parliament and considered almost mainstream by the orthodox profession.

Does the hon. Gentleman accept that many Members signed the early-day motion because it urged the House to look at the House of Lords report, which is quite specific about some of the values—and, indeed, some of the non-proven aspects about alternative medicine? The hon. Gentleman must be very careful not to attribute motives to people supporting the motion. Members of Parliament signed to support the House of Lords report, and not necessarily the hon. Gentleman's views.

I did say that the motion was broadly supportive of the report, and I did not go as far as to say that those who signed supported my views. The motion urged the Government to take notice of the report and it was supported across the House. I expect that the hon. Gentleman will expand on that later if he so desires.

Last June, the Under-Secretary of State for Health said in Committee:

Services that were considered outlandish several years ago are now almost considered to be part of conventional health care.— [Official Report, Standing Committee G, 6 June 2000; c. 81.]

We should view the report in that context. Many disciplines hitherto not considered to be part of medicine at all have moved through the spectrum of complementary medicine and are now firmly integrated into the health service.

As the longstanding treasurer of the all-party group on complementary and alternative medicine, I support the findings of the Select Committee and I congratulate their Lordships on having worked so long and hard to produce this report. It marks the defining moment in the use of complementary health care in this country.

The report was commissioned largely on account of the huge increase in the use of complementary and alternative medicine not just in Britain but across the developed world. As the report states, it

raises significant issues in public health policy

such as whether regulations to protect the public are in place, how the evidence base has been accumulated and research conducted and whether the information sources on the subject and practitioners' training are adequate. The report also deals with the prospects for this form of medicine in the context of NHS provision of treatments.

The report makes five key recommendations, on: regulation; professional training and education; research; the information required by the public; and the delivery of complementary medicine in the national health service. The key objective of the Government, following the publication of the report, should be further integration of complementary and alternative medicine into the NHS.

The report provides a logical, safe and sensible way forward. Paragraph 4.37 says:

If a therapy… does gain sufficient evidence to support its efficacy, then the NHS and the medical profession should ensure that the public have access to it and its potential benefits.

The report divides the therapies broadly viewed as complementary and alternative medicine into four groupings—groups 1, 2, 3a and 3b. We should examine each group, which attracted specific recommendations, in turn.

The first group is the so-called big five, which are already and increasingly provided on the national health service. These five—acupuncture, chiropractic, herbal medicine, homeopathy and osteopathy—are professionally organised disciplines with their own diagnostic approach and scientific evidence of effectiveness. Osteopathy and chiropractic are now regulated by Acts of Parliament and I was a member of the Committees—in previous Parliaments—that scrutinised the Bills concerned. Homeopathic doctors are regulated as doctors.

The report stated that regulation by statute might be appropriate for therapies such as acupuncture and herbal medicine and for the non-doctor homeopaths in the future. I would not disagree. For both, pre-existing voluntary regulation is in place and there is a credible evidence base. Following the inquiry, the Government should take action to make the big five widely available on the NHS to circumvent the patchy distribution of services, for which there can be no excuse.

The second group are, as the report puts it, the therapies most often used to complement conventional medicine. Some are already provided on the NHS, but more work is needed on regulatory structures and to increase confidence and provision. They are: the Alexander technique; aromatherapy; Bach flower remedies; bodywork therapies; counselling for stress; healing; hypnotherapy; maharishi ayurvedic medicine; meditation; nutritional medicine; reflexology; shiatsu; and yoga.

The challenge for the Government with regard to the second group is to determine regulatory structures and the proof of efficacy necessary for further integration in the health service.

I turn to the third group, which, as I have said, is really two groups. The report says:

While the question of efficacy was not included in our initial terms of reference, in the absence of a credible evidence base it is our opinion that the therapies listed in our Group 3 cannot be supported unless and until convincing research evidence of efficacy,

—I would like colleagues to bear that last phrase in mind—

based upon the results of well designed trials can be produced. Such evidence must be capable of showing that the effects of any therapeutic discipline are superior to those of the placebo effect. It is our view that for those therapies in our Group 3, no such evidence base exists at present.

That is where I part company with their Lordships. Despite the length of the inquiry, perhaps it would have been better if they had waited until after Christmas and possibly given a little further consideration to those therapies listed in group 3. Most of those listed in group 3 should either be in groups 1 or 2. The group 3 listing of alternative disciplines, which offer diagnostic information as well as treatment but for which the Committee did not find convincing evidence of efficacy, include: Chinese herbal medicine, traditional Chinese medicine and ayurvedic medicine. That is hard to understand. I have been dealing with the Chinese medical institute and register in London, which is closely linked with Peking university and runs postgraduate courses for western medical doctors in collaboration with Peking university on Chinese medicine pharmacology. In fact, I will be speaking at the presentation of diplomas for doctors at the Chinese medical institute and register on 3 February.

Western doctors learn Chinese medicine and go on to treat using Chinese medicines. There is one such doctor in my constituency and I have met others practising in London. I cannot understand how it can be said that the evidence is not available. Professor Mei, the chairman of the Chinese medical institute and register, is trying to explain to the Medicines Control Agency how the safety mechanisms of Chinese medicine work. There is a fundamental problem of misunderstanding the classification of group 3. I suggest to the Minister that the evidence base exists, but that an interface with the western regulatory structure is required.

Another organisation in London, the Asante academy of Chinese medicine, is the first Chinese academy to be affiliated to a university in the U.K.— Middlesex university. The opening of the affiliated teaching and research centre, which I intend to attend, will be on 31 January. The evidence base is there, but it has not been understood. I have used traditional Chinese medicine and acupuncture on several occasions. Certainly, there are strong structures in place, including Peking university and now at Middlesex university, and we need to investigate how they can be extended into other groupings.

I referred to ayurvedic medicine and that is also in group 3a, despite the fact that maharishi ayurvedic is in group 2. Again, these should be in group 1. They should be available because the Indian system of ayurvedic medicine has been around for 3,000 years. At the time of Homer, the ancient Greeks travelled across land to India. I once said that they went round the Cape, but I am not sure that they were capable of doing that in those days. However, they certainly went to India and learned Chinese medicine. Eighty per cent. of the population of India and Sri Lanka use Chinese medicine, and recently the first ayurvedic hospital was opened in the United Kingdom. We cannot say that there is no evidence; the problem is that we are unable to interpret it.

It was said that for group 3b—other alternative disciplines—there was no evidence. That may be the case and it is another argument for Government help to obtain better evidence. All the therapies are valid; I have experience of them all. One of the first is listed as crystal therapy. Crystals seem to work crystal radio sets. If that energy can create a radio signal, it is likely to be able to do other things. It has long been held that crystals have energies that contribute to health and well being. Many therapists who massage use crystals under their massage beds. They may not tell their patients, but they believe that the crystals enhance the energies that they are using to help to repair the body.

There is also a British Dowsing Association; I have been with those involved in the west country and watched them at work. Dowsing can be used to find water. At Charing Cross station, there are illustrations of mediaeval woodcuts that illustrate dowsing. We should not dismiss it.

Iridology is a newer science involving looking into the eyes to discover medical problems. I recently attended an exhibition at which an iridologist, who was a qualified medical practitioner, asked 20 members of the audience to go up on stage. He looked into the eyes of each person and told them what their main medical complaints were. Seventy per cent. of them said that he had got it right. I went on to the stage and he got it broadly right for me; I have problems with muscles and tendons. I talked to him about his work. He said that the advantage of iridology was that he could look into someone's eyes and tell them which internal organs were not functioning properly. Not only that, he could tell them, for example, whether it was the right or left kidney. Why go for expensive endoscopies and goodness knows what else? If there is a failing in the modern health service, it is that we rely too much on expensive equipment. The Minister is trying to balance his budget. A little basic research on doctors who use iridology will show that they find a cheaper way to treat people.

Kinesiology has to do with muscle testing. If anyone holds something poisonous, such as carbolic, and then sees whether their arm has any strength, they will find that their muscles have little; if they hold an apple, which is harmonious with the body, the arm will have more strength. We have had demonstrations in the House, and it is a way of testing for allergies. Diets and allergies are an important part of health care in Britain today.

The final topic is so-called radionics, which is difficult for science to test using current conditions. In layman's terms, black box radionics involves the transmission of a signal that sends a healing process to someone remotely. I was talking to someone yesterday whose teenage children were in the far east; both had contracted a foot problem and had sores that would not heal. One child had nothing to do with radionics, while the other was given radionics treatment. The latter was healed, but the former had to go to Australia for treatment.

The Minister's mind should not be closed to such treatments. He should be aware that other treatments that are not the subject of the report are over the horizon, and are concerned with, for example, sick building syndrome. That is linked to the Chinese art of Feng Shui, which seeks to achieve well being through the modification of layout and orientation of workplaces. Feng Shui is concerned about "cutting Chi". I shall not talk about that today, but it is often used when a building is misplaced and is alleged to send bad energies that can cause problems in another building.

I referred to the Chinese new year. That is not set arbitrarily; the Chinese believe that, on a certain date, the energies in the sky above are very poisitve better. I was interested to find a report in a newspaper last month that stated that science has worked out that pregnancy, hangovers and visits to one's GP may be affected by the awesome power of the moon. The article stated:

Arson attacks increase by 100 per cent. during a full moon,

and added that hospital units see 10 per cent. more patients and alcohol consumption rises. If science has discovered those facts, the Government will have to address them. If so, we may see the reunification of astronomy and astrology, which split in the 16th century. I do not suggest that the Minister needs to address the matters now, but if I were to make a speech at the end of the next Parliament, they might have come into the fold. I alert him to that.

I said that those in group 1—osteopaths, chiropractors, homeopaths, those who practise herbal medicine and acupuncturists—should immediately become more uniformly available throughout the United Kingdom. That is essential, and the Minister can achieve it right away. He needs to address the difficulties of efficacy with group 2 that are highlighted in the report. The problem is that too many organisations represent complementary and alternative medicine; there are about 150 in Britain.

When professional organisations within an individual therapy or profession join forces or work more closely together, quicker developments in self-regulatory structures, improved standards of training and greater recognition follow; that has happened for example, in acupuncture, aromatherapy, healing, herbal medicine and homeopathy. With not a lot of money, the Minister can help such groups to join together, especially aromatherapy and hypnotherapy, which have done well. There is great scope for the Government to intervene.

The report also recommended that in order to protect the public, professions with more than one regulatory body should make a concerted effort to bring the various bodies together and to develop a clear professional structure. A minority in the complementary movement say that there should be one regulatory badge for all approved complementary practitioners. That is not the way forward. It would be more satisfactory for each discipline to develop its own regulatory structure. Nothing that encompasses every discipline will have the credibility that it needs.

The report also deals with training for health care professionals. It proposes better training for doctors in CAM disciplines and highlights the need for other statutorily regulated health care professionals to develop clear guidelines. That is important and I hope that the Minister will refer to it. Another issue is the availability of information about CAM. There is a clear need for more effective guidance for the public about what works and what is not safe in CAM. We need a central register of information and, as the report states, central resources should be directed either through the Government or in partnership with a neutral body.

Research and development is a major topic that is covered by the report. We need to create measures that effectively evaluate the benefits experienced by users of complementary therapies and consider different ways to test them. The normal method of double-blind trials is not necessarily the best way to check their effectiveness. As highlighted in the report, one thing is certain; there is not enough research. Time and time again, complementary therapists say, "We haven't got the time to produce trials. We are up against it making a living, so how can we offer the convincing proof that is required? We get on with our job: we teach people and heal them." The Government should set up proper trials, such as that which was set up recently at Glasgow university into the effectiveness of homeopathy in treating allergies. That scientific trial found that, on average, the homeopathic patients were 22 per cent. better and the placebo group were 2.5 per cent. better. The report refers to the need to distinguish between placebo effects and medicines, and this is a good example of how that can be done. It is the kind of research that we need.

The report also recommended a central mechanism for co-ordinating and advising on CAM research and for making available research and training opportunities with resourcing from the Government. The Minister may wish to respond. There is a recommendation that the NHS, the directorate and the Medicines Research Council should pump-prime this area with dedicated research funding to develop a few centres of excellence for conducting CAM research on appropriate disciplines.

Centres of excellence will make a huge difference; look at the science park at Cambridge, for example. If we put experts together, they will produce something very special. This will not cost the Government a lot of money; in fact, it is one of the best opportunities for any Government, as I argued with the last Government. It is such a cheap way of getting new health care into the system. If we can get the assurances of efficiency that we need in some of the other disciplines that are in group 2—not the mainstream ones such as acupuncture, herbal medicine and homeopathy, which are in group 1— we can take things forward.

The last point that I want to cover is delivery in the national health service, which I have to say is patchy or non-existent. I spoke to Leicestershire health authority yesterday; it has a policy of not intervening, which, generally speaking, is the policy of the Department. I have been in three Parliaments and I have never found advisers to the Department of Health to be particularly sympathetic to complementary medicine. The Minister should look around and see who can advise him on creating a health service that does not discriminate in the provision of those disciplines in group one.

The primary care system has failed to expand the delivery of complementary and alternative medicine. Since GP fundholding was abolished, the amount of provision of complementary health care in the NHS has fallen and I have sent letters to the Department about the failings. I received a letter from the Anglo-European College of Chiropractic in August, saying that demand had fallen off due to the new primary care group arrangements. I received another letter, from Christchurch in Dorset, about the problems that those involved there are facing. The letter said:

Funding for chiropractic services will be withdrawn from 1st of October 2000.

Those are just two examples.

I would like to finish by giving an illustration of how complementary and alternatives medicine can work in practice and how people use complementary medicine to best effect. Recently, a constituent wrote:

I've been on the sick since March and my mother's got carpal tunnel syndrome and has been waiting for an operation for a very long time.

I was asked what I, as a Member of Parliament, would do about it. I am not a physician, but I have had carpal tunnel syndrome myself—a condition where the cartilage round the wrist grips the nerve and, in my case, there is extreme pain in the second and third fingers. I went to see a doctor who at first did not pick up the problem. Subsequently, I saw the doctor's colleague who did pick it up but, in the intervening period, I visited an osteopath. That did not work, and so I went to a cranial osteopath, with limited success.

Then, I received the proper diagnosis and was told that I needed an operation, which would take a year on the NHS. I could go privately; anybody can if they have and want to spend the money. My constituent, who is on benefit, cannot afford to do so. I then went to my homeopathic doctor, who prescribed something that I think gave me relief. I have also used acupuncture, which stimulated the kidney and liver meridians to make sure that the flow of energy is better through the body to my hands. I have also used aromatherapy oils. I do not know which of those therapies has affected me; all I know is that I am better. I do not need an operation or to be a burden on the health service. I have done it all myself, and that is a good illustration of how complementary and alternative medicine works. Often, people like to move around therapies for treatment; some go to a healer, of whom there are around 20,000 in Britain.

To conclude, complementary and alternative medicine offers hope to people who have perhaps lost hope, sometimes when conventional doctors feel they have nothing else to offer. The House of Lords Select Committee report has drawn attention to many issues that need to be addressed if complementary medicine is to play its full role in the provision of health care in the UK. I urge the Government not only to take those recommendations on board but to act on them.

The therapies in group 2 meet the Lords' criteria for being suitable for the NHS. There are 50,000 complementary therapists in the UK, and perhaps 10,000 health care professionals. Thirty thousand of those 50,000 therapists fall into the category of being suitable for the NHS. The Government should act now to make greater use of those therapists, who are an under-utilised resource. The therapists could provide comfort and relief to millions of people and bring about considerable cost savings to the Government. I rest my case.

I congratulate the hon. Member for Bosworth (Mr. Tredinnick) on securing the debate, and on highlighting the valuable contribution made by the House of Lords Select Committee on Science and Technology. As he pointed out, we may not be dealing with a mainstream medical activity, but we are certainly dealing with a mainstream commercial and patient activity; a turnover of some £350 million and 50,000 therapists are significant.

I supported the hon. Gentleman's early-day motion because the House of Lords clearly recognised that there was a need to evaluate what was going on within the market, and to draw up some criteria, if only for consumer protection. As a conventionally trained allopathic doctor, I am aware that there is a great deal of uncertainty in medicine. Many conventional therapies are first brought out on the basis of a theory. Hopefully, the evidence follows. Certainly within my clinical lifetime, effective drugs have been introduced. However, the theory of how drugs work has probably changed three or four times in 10 years. Therefore, one must not necessarily say that because we do not understand a process, it has no value.

One has to protect people and be rigorous in the evaluation of the process, potential side-effects and outcomes in so far as one can. I have problems with the hon. Member for Bosworth's claim that the evidence is there, but we do not understand it. Scientific evaluation is exactly the same whether we are talking about the effects of food, aromatherapy or anti-cancer medication. We look at what we do to someone and the outcome, test that against another group of people who are not having that intervention and look at the results to see whether one group fairs better than another.

I was thinking mainly of traditional Chinese medicine, which, after all, treats between a quarter and a third of the world's population.

There are so many universities in China that it seems strange that anyone should say that there is no evidence that those therapies work. I feel that that is due to a misunderstanding.

I did not say that there was no evidence; I merely objected to the contention that the evidence was not understood. Simply because something has been done for a few thousand years does not mean that it is useful. The health outcomes in China are not especially good; nor are those in India. That type of medicine may be the only resource available to those populations, but their morbidity and mortality rates are far worse than they are in this country.

I have a problem, too, with the description of iridology as a new science; it is a new practice, but it cannot be called a science until it has been evaluated. One does not want to pick holes, but I also have problems with kinesiology and the idea that holding carbolic does something to one's muscles. I will have to change my soap, as I did not realise that carbolic could have such a dangerous effect on my well being.

The issue is serious, however. The House of Lords has done us a great service in considering the various complementary therapies and making an attempt to classify those that, although we may not understand them, are shown to be of value and—more important—not to do harm, and those about which we are uncertain. It is important that the consumer and patient are protected in this bewildering market. I have a problem with the enthusiastic proponents of alternative medicine because they seem to turn it into a quasi-religion. One has to accept a belief system and an entire philosophy before accepting treatment from a particular regime. That puts tremendous pressure on vulnerable people whose symptoms have not been relieved by traditional medical intervention.

I am not saying that we should never treat people because we cannot find an origin for their pain or misery, or that we should use only treatments that have gone through the double-blind trial procedures. One can often improve the patient's sense of well being through alternative methods, which has a tremendous effect on the disease process. Dr. Balint showed clearly that the placebo effect could be important, and every doctor would recognise that a doctor—in him or herself—has a placebo effect that may be powerful, either positively or negatively.

We should not close our minds to the opportunities presented by alternative medicine, but we should temper that with a degree of science. Scepticism is the wrong word; I believe that we should temper it with a degree of care for patients and consumers, for whom the Government and Members of Parliament have a responsibility.

Research is important. I do not accept that alternative practitioners can use the excuse that they are too busy to evaluate what they do. If one sets oneself up as a professional in a therapeutic regime, one has a professional duty to evaluate what one does and consider the outcomes. It cannot be acceptable to claim that one is too busy to do that. There should be a mechanism by which those evaluations are supported and published, so that a peer review can take place and they can be tested.

When a new drug comes out, one is always told that it is the best thing since sliced bread. A doctor can examine the clinical trials, but his experience with the first six patients on whom he uses the drug will determine whether he will continue to use it. We are all a bit like that. We need the science base, under the research base, to inform our gut feeling, because we cannot run a health service on gut feeling alone. I am sure that the Minister would agree with that because, at the end of the day, it is his money that is being spent.

I want to refer briefly to the problems of access to these therapies through the national health service. The hon. Member for Bosworth said that fundholding had reduced access to complementary therapies. That is not my experience.

I had intended to say that primary care groups had seen a reduction of complementary provision, but that GP fundholding had helped.

I am glad that I have given the hon. Gentleman an opportunity to correct what he said by misadventure.

In my experience, fundholding created a blossoming of access to alternative medicine, for three reasons. First, the interventions on the whole were not harmful. Doctors are always minded that their first duty is not to do harm. Secondly, patients liked being referred to alternative practitioners. Thirdly, the interventions were, on the whole, very cheap. That may be a cynical point, but it is certainly advantageous to make significant savings on a prescribing budget by sending patients to a homeopathic practitioner or an acupuncturist, provided that one is not denying those patients more appropriate treatment.

Some of the more ideologically motivated complementary practitioners deliberately stand in the way of conventional medicine and significant treatment, believing that people must commit themselves to their philosophy of medical care. That is dangerous. Faith healers can also be dangerous in that way. There was a vicar in my village who did not believe in medicine; according to him, all cancers were caused by lack of faith, and church attendance was the solution to everyone's problems. When he tried to stop his mother-in-law taking her heart medication, I felt that I had to intervene. I was not sure whether he had done that because he did not like his mother-in-law, but I thought that his faith was being pushed on to a third individual, which was totally inappropriate. One sometimes sees instances of that; it shows that there is a need to protect the public from undue enthusiasts for such therapies.

Will the Minister do some work on the availability of complementary medicine since the establishment of primary care groups and trusts? In my own primary care group, we have reduced the access to complementary therapy. In my practice, we had access to an excellent acupuncturist and a homoeopathist, and found it valuable. The audits that we did on their interventions showed that they were helpful in about 30 per cent. of cases and extremely helpful in the 5 per cent. of cases that had not been helped by anything else. As I said, it was safe and cost-effective.

Our fundholding practice worked as a multi-fund, rather than an individual practice making individual decisions. We developed a menu from which individual fundholders could pick what they thought was most appropriate for their patients. Some patient groups therefore had access to alternative therapies; others did not because some doctors and patients were more enthusiastic than others about alternative medicine. That is appropriate; it is not for a central organisation to determine what is best for an individual patient within a locality.

Largely as a result of Government pressure, primary care groups now follow the doctrine of giving everyone equal access to every intervention, which has resulted in some people—depending on the membership of the groups making commissioning decisions—saying that the majority of GPs do not believe that therapies such as acupuncture or homeopathy have a place and that it would be inequitable for anyone to have access to them. That is not a positive way forward. It is more reasonable to have a fairly wide menu of interventions and then allow individual practitioners, in discussion with patients, to decide what is best for a particular patient within a particular practice.

If a GP has strong feelings that no one should be referred outside the conventional envelope, patients may still have access to the alternatives if they feel strongly that that is what they want. Will the Minister reflect on whether his laudable attempt to make access to medical intervention equitable around the country will stifle some of the more imaginative approaches that were taken in the past?

Some complementary medicines play a similar role to counselling and psychotherapy; they are a supportive mechanism, and if they make people feel better and are not disproportionately expensive, that is excellent. It is ridiculous that we have had to sack our acupuncturist, but can still obtain acupuncture by sending people to a consultant anaesthetist in a pain clinic—which is considerably more expensive than treatment from an in-house practitioner who was popular with our patient group.

The report is helpful and shows a way forward. The box system is extremely helpful. It is for those who think that they have been placed in the wrong group to make the case to become more part of the mainstream. I am also glad that recommendations have been made on professional accountability and insurance. I began practising medicine at a time when one could be struck off for referring someone to a non-medically qualified practitioner, on the grounds that we should not dabble with such people as osteopaths and chiropractors but should refer patients only to what were seen as subsidiary disciplines such as physiotherapy. I am very glad that that attitude has disappeared and that we now recognise professional expertise outside the strictly medical circle. We have an approach of teamwork, centred around the patient.

It is important to set up a system that enables alternative practitioners who want to join that team to take responsibility and to accept liability for their actions. The disciplines in group 1 have taken that on board, which is why the House of Lords found them much easier to deal with than those in group 3, who rely more on faith than on evidence.

I congratulate my hon. Friend the Member for Bosworth (Mr. Tredinnick) on securing the debate. It is good to have an opportunity to debate the House of Lords Select Committee on Science and Technology report on complementary and alternative medicine.

I pay tribute to the Select Committee's work; the report is comprehensive and most informative to those of us who are not familiar with the range of alternative and complementary therapies. I cannot comment on the efficacy of the diverse range of therapies and I would not attempt to do so. The Select Committee was the best forum in which to attempt the difficult task of categorising the different therapies.

The question that was paramount in the Select Committee's work was how best to protect the public. Anyone who visits a complementary therapist places himself or herself in a position of trust, in the same way as someone who visits a conventional practitioner does. It is a one-to-one relationship in which the patient's problem is discussed in privacy and with a degree of confidentiality, which people expect the therapist to respect. Recommendations are made and a solution may be suggested or treatment practised during that therapy session. We must seriously consider whether more protection should be afforded to people visiting the blossoming range of alternative therapists.

It is interesting that 40 per cent. of general practitioners refer their patients to practitioners of alternative and complementary therapies. I am not surprised by the statistic given by my hon. Friend that one third of Members of Parliament have direct, personal experience of alternative and complementary medicines. The public are prepared to pay individually to receive treatments in the belief that they will address their problems. Alternative and complementary medicine is expanding and playing a more important role, as the hon. Member for Isle of Wight (Dr. Brand) explained, and conventional practitioners are having to get their heads round the way in which these different medicines may work together with conventional medicine.

What can be done to protect the public is a topical question. Last night, there was a debate on the Floor of the House about the dreadful events that led to the murders of the patients of Dr. Shipman. God forbid that there should be a repetition of a Shipman situation, even on a minor scale, in alternative and complementary medicine. Some safeguards must be put in place.

We made an attempt to afford the public better protection during proceedings on the Care Standards Act 2000. My hon. Friends and I tabled a new clause, which would have enabled the Care Standards Commission to regulate complementary medicine by requiring it to maintain a register of alternative therapists. It would have given the Secretary of State important powers to protect the public in respect of the description of services, claims made in respect of services, and techniques that might be employed. Our constructive proposal was rebuffed on the grounds that, as the Select Committee was undertaking an inquiry, it was riot an appropriate moment to seize the legislation and make such a provision. We were told that we should wait to find out what came out of that inquiry and react accordingly.

We have all now read the Select Committee's report, which contains several recommendations. Do the Government accept that regulation of complementary and alternative medicine is necessary? If so, which of the two routes that the Select Committee considered under the Health Act 1999—a single body representing the entire profession applying for statutory regulation by order in the Privy Council, or a new health professions council—do the Government believe would be better? Will they say now, as they were not able to say when the Select Committee was taking evidence, what the advantages and disadvantages would be of those alternative routes to regulation?

The reason given for not responding at the time to the Select Committee's questions on that point was that one of the two options—the new health professions council—was subject to consultation. The consultation is now over, and the Department will have received all responses by the beginning of November at the latest. Did those responses raise questions about incorporating alternative and complementary medicine under the umbrella of the new health professions council, and if so, what is the Minister's view of those questions?

The Select Committee report also recommends that national studies should be commissioned to obtain more detailed quantitative information about the extent of complementary and alternative medicine in use in the United Kingdom. Our debate has revealed that, as legislators, we are operating in the dark on the matter. We are not sure how many practitioners are involved and where they are. The Government have a responsibility to keep tabs on developments in the blossoming field of alternative medicine. I should be interested to know whether they accept the recommendation that such studies should be undertaken.

We do not yet know the outcome of the consultation, but one of my anxieties about the Government's proposal to create a new health professions council relates to the slightly untidy arrangements that will result. Some of the professions allied to medicine are already regulated by statutory arrangements; indeed, osteopaths have their own Act. That has led to not a little local jealousy from some of the other professions, which are worried that, as they will not have a similar legislative basis for their regulation, they will suffer as a result of inferior regulatory arrangements. That problem is difficult to avoid, as the existing legislation is already in place. A problem might arise if one of the routes recommended by the Select Committee were taken. A range of alternative and complementary therapies are available. Will some be regulated by statutory order while others come under the umbrella of the health professions council? That presents some difficulty, and I should be genuinely interested to hear how the Minister suggests that we proceed, given those diverse arrangements.

The Department of Health plays an important role in signalling to the conventional medical community the areas in which research should be conducted. The Government send signals to research councils about areas of prioritisation that they would like to see pursued. Should the Department of Health send similar signals to research councils about promoting more of a research culture in complementary and alternative medicine?

What plans do the Government have for regulating the professions allied to medicine, either by statutory means or by the health professions council route? Does the Minister accept that regulating areas of conventional medicine would help to lay an important pathway for the recognition of qualifications and training in the new therapies? That would also enhance the standing of the new professions in complementary medicine. When we debated the new clause during the proceedings on the Care Standards Bill, it received a positive reaction from representatives from the complementary medicine professions, who saw in it an opportunity to establish received pathways to recognition as a qualified practitioner. Does the Minister accept that that would benefit the practitioners and their customers? Were we to place ourselves in the hands of an alternative therapist, we would receive some reassurance from knowing that that therapist had a recognised qualification for the skill that he was practising.

The Select Committee report on complementary and alternative medicine focused on the diversity of therapists and their skills and how they might be regulated, but it did not touch on the products used, which are an important part of the therapy. A homeopath might make use of very different products from those prescribed by the hon. Member for Isle of Wight, with his depth of experience. That is an important area.

The Minister is sure to be aware that the United Kingdom is currently in a difficult position. A new European directive to control products used by alternative and complementary therapists regards some of the well-established products sold in health food shops, such as vitamins and herbal remedies, as medicines. Practitioners are concerned that remedies hitherto widely used by the public might be restricted if subject to the kind of directives envisaged at a European level. Medicines should be vigorously tested—I am sure that we would all agree that the public should not be placed at risk because of a medicine that had been inadequately tested—but many remedies have been in use for many years.

Testing is an expensive process, and new, novel medicines often fall at the first fence because a company has insufficient resources to have them tested. The position of a number of established remedies may be precarious if they are caught in a rigorous new medicines directive. I know that a number of practitioners of complementary and alternative medicines would be interested to hear the Government's view on the proposed new directive.

I start by warmly congratulating the hon. Member for Bosworth (Mr. Tredinnick) on raising the subject of alternative and complementary medicines today. I congratulate him also on the depth of his knowledge of the subject, which is probably unrivalled in the House. My hon. Friend the Minister of State, Department of Health, the Member for Southampton, Itchen (Mr. Denham) has rightly praised the hon. Gentleman for his tireless devotion to those subjects. I should also like to pay tribute to his commitment to his cause.

The hon. Gentleman made an interesting reference to the impact that the full moon can sometimes have on our lives. I have no idea whether there is a full moon today or whether it has had any influence on our debate, but he certainly made some intriguing remarks about that, which gave everyone who heard them pause for thought.

I compliment also the hon. Member for Isle of Wight (Dr. Brand) on his thoughtful comments. He posed the issue in terms of public safety. I do not think that this is just about public safety; it goes much wider than that. I agree that public safety issues are important, but there is another issue to which he rightly referred. NHS doctors and patients must have the widest possible choice of available remedies. We must also ensure that NHS resources are used effectively. We must not just balance important issues of public safety; we must do all those things simultaneously. That is a difficult balancing act, as I am sure that the hon. Member for Bosworth would be the first to concede.

We are quite clear about the priorities on which we should focus at the moment. When we came into office, the NHS was under-doctored and under-nursed. Too many health care services were being delivered in Victorian buildings. Those are our priorities, in addition to dealing with the top clinical priorities that the NHS faces; the big killers such as cancer and coronary heart disease, where our survival rates are simply not acceptable and where more work has to be done to improve services.

A difficult set of choices has to be made by Governments of whatever party. We have tried to set out through the NHS plan and all our other work the key priorities behind our commitment to modernise and reform the NHS and to increase its capacity to meet the needs of our complex society in the 21st century. I want to refer to how alternative and complementary medicine can play a part in that in my response to the hon. Member for Bosworth's detailed and thought-provoking comments.

The hon. Member for Isle of Wight expressed his support for the Government's efforts to promote greater consistency of NHS provision across England. That is an important focus for our work, but he is wrong to conclude from his example that GPs were being required to fit themselves into a straitjacket of policy that would narrow the options available to them. That is not what we are doing.

I do not think that that is the perception of some of the primary care groups and primary care trusts on the ground. There is a risk of losing diversity of choice for the sake of equity of access.

I strongly believe that we can avoid, and have avoided, making that trade-off. We have always made it clear in relation to the reforms that we made to primary care that we want to level up the provision of services. The hon. Gentleman gave an example from his own practice. He said that access to complementary medicine had been narrowed down. I do not dispute that for a second, but that is a choice that he and his colleagues made locally—[Interruption.] The hon. Gentleman may want to correct me, but we believe that our reforms to primary care will improve the delivery of services. Our reforms will end—I must tell the hon. Member for Bosworth—the totally unacceptable state of affairs created by GP fundholding. Far from increasing choice, it effectively narrowed it for many patients. We are determined to put right that wholly unacceptable change to the NHS. The hon. Member for Meriden (Mrs. Spelman) asked about professional regulation and research and asked what signal the Department would send to the complementary alternative sector about the importance of research. I have a simple message; research is very important. A strong, research-based culture would be beneficial to complementary and alternative medicine, and we would welcome it; as would, I am sure, the hon. Member for Bosworth.

Debate has rightly focused on the House of Lords report into complementary and alternative medicines. The report represents the first-ever comprehensive inquiry into complementary medicine in the United Kingdom by any parliamentary Select Committee. Written evidence was submitted by 180 individuals and organisations, 46 of whom were subsequently called to give oral evidence. That testifies to the thoroughness with which the Committee approached its task. My hon. Friend the Minister for Public Health also appeared before the Committee towards the end of its deliberations.

We are debating the issue today before the Government have published our response to their Lordships' report. The hon. Member for Bosworth will accept that I cannot anticipate the Government's full response here, although it will be published in the near future. The response will, of course, be published and presented to Parliament as a command paper. In the normal run of events, there would be a debate in the Lords, but that is a matter for the Committee itself to determine.

In recent years, we have seen increased public interest in and use of complementary medicine. It is a thriving feature of the private health care sector. Some forms of complementary medicine are also provided in the NHS on the basis of clinical need, usually as an adjunct to orthodox treatment and sometimes practised by members of the orthodox health professions. The Government are aware that many people have found complementary medicine helpful and that it has some powerful advocates, including some from the world of orthodox medicine.

Today's debate has touched on the main themes in the report—regulation, training, research, information and NHS use. Reference has also been made to how the report has introduced some structure to the world of complementary and alternative medicine by classifying therapies into three primary groups.

The first group embraces what the Committee refers to as the "principal disciplines"; osteopathy, chiropractic, acupuncture, herbal medicine and homeopathy. The second contains the therapies most often used to complement conventional medicine, such as aromatherapy, massage and reflexology. The third consists of disciplines that, in the view of the Committee, adopt a philosophical approach very different to the scientific principles of conventional medicine. Some of these are long-established, traditional forms of health care, such as traditional Chinese and ayurvedic medicine. Others are therapies that the Committee viewed as lacking a credible evidence base, such as crystal therapy and iridology—both mentioned by the hon. Member for Bosworth.

I recognise the difficulty of generalising about such a diverse range of therapies, but it is important that we begin to introduce more structure into the complementary medicine world, not least to help patients and the general public better understand what they are dealing with. Not every therapy will fit exactly into the wide definitions suggested in the report, but I recognise the potential value of adopting sensible working definitions as a foundation for making real progress in future.

Among other things, the structure and definitions in the report provide a useful template for developing the regulation of complementary and alternative medicine therapies. As the report has suggested, some therapies have reached the stage where they ought seriously to consider preparing for regulation on a statutory basis. Other therapies need to progress to the point where they have their own recognisable voluntary regulatory bodies. In time, some of them may also become suitable candidates for some form of statutory regulation. One thing is sure. If complementary and alternative medicine is to be recognised as a respected member of the caring professions, it must put in place a proper regulatory framework that will raise standards and protect patients.

In giving evidence to the Committee in October, my hon. Friend the Minister for Public Health said that effective regulation of complementary and alternative medicine practitioners was important to ensure proper protection and support for patients. She also made clear the Government's view that without effective regulation, it was hard to promote greater uptake of complementary medicine in the NHS.

The Chief Medical Officer, Professor Liam Donaldson, who also gave evidence to the Committee, made it clear that he thought it important that as professions formed themselves into recognisable professional bodies, they were brought forward into the right statutory framework.

In this respect, Department of Health officials have already held exploratory meetings with representatives of the two professions that the Committee considered could be early candidates for statutory regulation; herbalism and acupuncture. These discussions have focused on the steps that each profession needs to take in preparation for statutory regulations.

The scope and nature of any future statutory regulation of these professions needs to be discussed more widely and there will need to be full consultation. Among other things, consultation could explore the feasibility of including aspects of the practice of traditional Chinese medicine, ayurveda and other forms of traditional medicine based on herbs in the arrangements made to regulate herbalists as a whole. This could offer a way forward to some of the disciplines, which the Committee has chosen to categorise as group 3 therapies.

In relation to other professions, we have stated our support for the work being done by the Foundation for Integrated Medicine to help establish and improve voluntary, regulatory schemes. The foundation will be holding a conference next week, to which it has invited a wide range of regulatory and professional bodies from complementary medicine. The aim of this conference is to encourage constructive debate about taking forward the recommendations in the report. An open forum of this sort will give the various professional groups an ideal opportunity to discuss what the Committee has recommended in relation to regulation and professional standards and to consider how they will respond.

We do not, of course, view complementary and alternative medicine in isolation. We are currently working hard to raise standards across the NHS and the private sector in patient-centred care, in better equipped, better trained and better regulated professions. The higher standards that we are setting for the NHS will provide a yardstick against which complementary and alternative medicine should be measuring itself, whether it is practised in the private sector or the NHS and whether it is provided by doctors and nurses or by complementary medicine therapists.

Regulation of products is important and the hon. Member for Meriden referred to this. Following extensive consultation with UK interest groups, we are now working with our partners in Europe on proposals for a directive in traditional medicines. The aim is to provide a framework for the effective regulation of traditional herbal remedies, balancing public safety and consumer choice. The hon. Lady will be aware that the Commission has produced a first draft of that directive and the Medicines Control Agency has produced some initial responses. I am very happy to let the hon. Lady see the response of the Medicines Control Agency; it may be in the Library.

There is significant concern in the UK at the moment about the way in which these issues are being dealt with. There are about 500 licensed herbal medicines available on the UK market and many more are sold under section 12 exemptions. The difficulty with the existing arrangements is that whereas the normal licensing arrangement provides strong protection for the public, they have been perceived by some as limiting public choice. The section 12 herbal exemptions offer the public greater choice, but do not always provide adequate protection. There is every opportunity that this work can be taken forward successfully with our colleagues in Europe and that is the best place for this type of work to be done.

An important function of professional regulation is setting standards for training and education. I accept that there is a lot of work to be done in this area in training health care practitioners who aspire to practise complementary medicine and providing more undergraduate doctors and nurses with some familiarisation with complementary medicine. The important thing will be for the professional bodies involved to set clear standards and to work closely together in doing so.

We will continue to encourage complementary medicine regulatory bodies to set clear and consistent professional standards for their registrants and to work with education and training institutions to ensure that these institutions offer qualifications that meet these standards. As I said, there is much work to be done. Officials from the Department have discussed the report's recommendations with the Department of Education and Employment, the Qualifications and Curriculum Authority and the Quality Assurance Agency. Once the Government's response to the report has been published, I am sure that wider consultation is likely to follow.

The Minister said earlier that there would be a Government response in the very near future. Does that mean this month or next month? It would be reassuring to hear that it did. I have not yet heard him say anything about the issuing of guidance to health authorities on complementary and alternative medicine, so perhaps he could address that point. Does he intend to set up a register of practitioners?

The hon. Gentleman need not worry; I will deal with all his points.

Hon. Members have talked about the need for more research into complementary and alternative medicine. Complementary medicine needs better research, not just more research. The most popular therapies, at least, need to be underpinned by more definitive, high-quality research evidence. Everyone recognises that it will take time to produce such evidence, but opportunities exist for researchers to train in the techniques that they will require and the academic expertise is beginning to come together to help to co-ordinate research efforts. My Department welcomes applications to fund complementary medicine research projects, provided that they offer a clear link to one of the NHS priority areas.

In the meantime, I fully accept that information on complementary and alternative medicine, such as it is, needs to be carefully synthesised and made available in a much more user-friendly way both to the wider public and to health professionals. The provision of better information for patients is a key feature of the NHS plan, and work is in hand to include complementary medicine in the information that will be made available more widely to the public.

Better information on complementary medicine will be in patients' interests twice over. First, it will help them to decide which therapies could be appropriate for them and where to go for treatment. Secondly, it will inform them of the professional standards to expect. When the public expect and demand high standards of complementary medicine practitioners, the complementary medicine professions will have even more incentive to put high standards in place and to live up to them.

We have given the Foundation for Integrated Medicine a grant to create a database of information, which will enable it to advise anyone who wants more information on regulatory bodies and the codes of conduct that they follow. Regulatory bodies must be the repository of more detailed information about registered practitioners, the appropriateness of their treatments, likely costs and complaints procedures. Information on the nature of treatments is also available from a wide range of other reputable sources. NHS Direct will be able to expand the information that it provides when authoritative evidence of safety and effectiveness becomes available and proper regulatory systems are in place.

It is important for both complementary and orthodox medical practitioners to share information with one another about their treatments. In fact, there is considerable scope for the two sides of medicine to work together more collaboratively. I am not sure whether the hon. Member for Bosworth saw the leading article in last week's British Medical Journal that argued for much greater integration of complementary and orthodox medicine. He referred to that approach, and I strongly believe that there is much to commend it.

The hon. Gentleman was anxious for me to talk about NHS provision. Complementary medicine can, and often does, play a part in treating NHS patients. An informal survey carried out on behalf of the Department of Health a year ago found that 58 per cent. of primary care groups were providing patients with access to some form of complementary medicine. We continue to keep a watchful eye on the extent to which primary care groups make complementary medicine services available.

As part of an on-going work programme, we have commissioned Sheffield university's medical care research unit to undertake a detailed study into the impact that primary care groups have had on access to complementary medicine through NHS primary care. The study will be completed at the end of 2001 and will help to inform our future policy.

We have collaborated with others to produce a basic information pack for primary care groups on complementary medicine. The pack was built on the results of the informal survey previously carried out for the Department of Health and focused on the therapies that that study had shown to be most commonly encountered in primary care; chiropractic, osteopathy, acupuncture, homeopathy and aromatherapy. As well as offering information about the nature of each therapy and the conditions that were most likely to benefit from them, the pack discussed the regulatory status of practitioners and provided sources of further information. Several examples were included of how those therapies had been adopted in primary care.

We circulated that pack to primary care groups and sent a shorter companion booklet to all GPs in England in July. The feedback that we received suggested that many people found it helpful. As my hon. Friend the Minister for Public Health mentioned to the House of Lords Select Committee, we hope to produce a new version of the pack for patients.

We obviously need to be careful with the use of public money for the provision of health care. Could he assure me that what is provided for the NHS is based on evidence, and not just on popularity? There needs to be a proper evidence base behind the provision of complementary and alternative medicine on the NHS; the fact that a therapy has been made available because it is popular is not quite the same thing.

I agree with the hon. Lady, and that was the point made by my hon. Friend the Minister for Public Health in her evidence to the Committee; popularity is never enough, and there has to be an evidence base of effectiveness. Towards the end of this year, the National Institute for Clinical Excellence will be publishing evidence-based guidance to the NHS on supportive and palliative care for cancer patients. The guidance will aim to improve patients' experience of cancer care and, in doing so, improve the quality of life for all those affected by cancer.

The hon. Member for Bosworth might be interested to know that one of the issues that NICE is considering, as it prepares its guidance, is the potential benefit that cancer patients derive from complementary services. As I said earlier, if complementary medicine aspires to be equal with other forms of NHS treatment, it must meet the same standards. It must be clear and realistic about the contributions that it can make, and it should work in an integrated way with other forms of treatment. Effective regulation of practitioners is important, as is an appropriate evidence base for the treatments that they offer.

The report sets an authoritative agenda for change. Some of the complementary and alternative medicine professions have begun making the improvements that they need to secure a more lasting place in public affections. They must now drive forward these changes more decisively, and the professions that have still to put those changes in hand must do so more urgently.

Before he finishes, will the Minister state what "in the very near future" means in terms of the Government response?

I am glad that the hon. Gentleman reminded me of that. I think that it will be published in the next few weeks, although I cannot go much further than that, other than to say that the Government certainly welcome the report and will be setting out a full response in the near future.

Part of my constituency is an island and it is known as the Isle of Sheppey. Islanders throughout the world feel that they are unique, and even if they are not, that is their perception of themselves. Of course, that does not apply to my islanders, because they are unique.

The Isle of Sheppey has never been permanently linked to the mainland of Britain, but that is due to end soon. As part of the Labour Government's commitment to the community that I represent, they are to build a new bridge, which I hope will be called the Queensferry bridge, and which was part of our 1998 roads review scheme. It is due to start in 2003, for completion in 2005. The Highways Agency is not known for its transparency, so I urge it to confirm that timetable as soon as possible—this afternoon would do.

The way in which the previous Tory Government went about the island's planning issues and the way in which they understood difficult words such as "infrastructure" and "funding" has been a joy to behold. It is like a bad dream—housing and more housing. There is housing everywhere. But every time that the building of a new school is in the plan, Tory-controlled Kent county council always reneges on its promises to build one.

In my short life I have found that housing tends to be occupied by people, and that they need professional back-up if the quality of their life is to be maintained. They immediately need roads to travel on, as well as a bus service. They need water companies that do not have failed pumping stations, or perpetual sewage flooding their brand new gardens or sidewalks, especially in the summer. They need doctors' surgeries to be included in these plans at the micro level, and they need to know that at the macro level the Government have planned for an adequate number of new general practitioner recruits to enter the system. They need a local community hospital.

Minister, you need to come and minister to Minster, on the Isle of Sheppey, because at Minster we have a building that doubles as a hospital. It is in a dreadful state of repair. The staff do a marvellous job, almost despite the system. I hope that they will get their due rewards in heaven. They are our public servants and public heroes. They are not the fancy, unaccountable consultants who, one by one, have found excuses not to continue their clinics there, or the myriad faceless administrators who have to fight our corner.

Those nurses, cleaners, cooks, ambulance drivers and doctors are the glue that keep the national health service working—in some cases, barely working—on an island not yet connected to the mainland, where the nearest accident and emergency department is 20 miles away. When the trains are running and the buses turn up, it takes about two hours on public transport to travel from Warden bay or Leysdown on the east of Sheppey to Medway Maritime hospital and two hours to get back. It is tiring, expensive and often frustrating, especially when one arrives to find that one's notes are missing or that the appointment has been cancelled by mistake. One would be forgiven for thinking that we were talking about a third world country.

For those reasons, my island has not had a healthy respect for past Tory Governments. It would be fair to say that it is also running out of patience with the current Labour Government.

When I was on the hustings in April and May 1997, my Tory predecessor was fond of telling us that a new £10 million private finance initiative-funded spanking new community hospital, albeit smaller than was originally planned, was almost signed off. Four years on, it is not signed off and we have no idea when it will be.

My community is very angry, and it is justified in being so, for many reasons. Although I have toiled away trying to make Sir William Wells take some decisive action over the sheer incompetence of the administration of which he is the chief executive officer, I have failed. There is little public respect left for the administrators of the NHS in my patch.

All that we want is a small community hospital. The funding is minuscule. It is about £11 million: a snip. In the two years when we said that we would abide by the Tory spending plans—1997–98 and 1998–1999—the total spending for West Kent health authority was £479.9 million in the first year and £501.4 million in the second. We have done better than that. We increased the budget by 11.6 per cent. in 1999–2000 and by a further 13 per cent. in 2000–01. Next year the initial allocation, which at this time does not include further sums that are still to be debated and agreed, has increased by at least 8 per cent. My constituents understand that expenditure tends to increase year on year anyway, because wages and salary costs must be taken into consideration, but the figures that I have quoted, whose source was the acting finance director at West Kent health authority, are in real terms. Therefore, £11 million is still a snip.

Instead, we have had a series of dreadful decisions. The first was the Tory love affair with private finance initiatives. Although the Tories introduced PFIs in 1992, not one PFI hospital was signed off by 1997—and that from a party that was supposed to be close to the City and business. Thankfully, under the Labour Government 38 major hospitals across the United Kingdom, worth £4.1 billion, have been given approval to proceed under the PFI since 1 May 1997. That is the biggest hospital-building programme since 1945. Alas, for some reason we have not been able to find a mere £11 million for Sheppey: a snip.

There we were in May 1997, months away from that snip of a hospital. Of course, as with the new bridge, which was one of 500 road schemes with no Treasury bills attached, we took most of our first year setting down some rules and regulations about how PFIs should work, and not just in the NHS. That was good and sensible government. What none of us can understand—perhaps the Minister will enlighten us—is who took the decision in her Department to move the goalposts so that our snip of a PFI suddenly had to embrace four other small community hospitals. I have given the Minister some notice of that question, and I look forward to her response.

That decision was wrong. It was seriously flawed. Five health authorities were obliged to pay out five sets of legal and consultancy bills. Surely that was not in the rules that we laid down in 1997 and 1998. Thames Gateway NHS trust has spent nearly £1 million in costs to sustain a £11 million snip of a community hospital. Which chief executive officer gave approval for that amount of money to be spent when we still do not have a decision on a hospital?

Thus our snip of a community hospital became a larger snip, and we waited and waited for a decision about the future of Sheppey community hospital. I even had a visitation from the chief executives of West Kent health authority and Thames Gateway NHS trust in my office in the House of Commons. They told me that all was well. I was told that it would happen in 1998, then 1999, then 2000—and now we do not have a clue.

Throughout all this time, the old hospital at Minster has deteriorated further. The clinics have decreased. The beds have been reduced. The service that the islanders receive is well below the level of the service provided to those of my constituents who live in Sittingbourne, who have the wonderful services of Sittingbourne memorial hospital. I thought that we were supposed to want an end to postcode health care. I also thought that we were supposed to favour our poorer communities. We just want the community hospital to he given the go-ahead.

The Treasury rightly turned down the PFI. Why, if it was that obvious, was a marginal business case made for it in the first place? At what stage did the Minister become aware in her Department that there was a case for trying to justify the unjustifiable?

Enough. My community wants its community hospital. We have been waiting for over a decade. We want the Government to release the money. As my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), then Secretary of State, said to me in the House of Commons at Question Time:

The people of Sheppey are entitled to a decent community hospital, and that is what we are determined to provide—one way or another.—[Official Report, 8 June lo99; Vol. 332, c.456].

As the Minister knows, on 4 April 2000 I wrote to the Prime Minister, pleading for the hospital. Will the Minister please announce, in her response, the funding solution and the day that we can expect the first brick to be laid?

I congratulate my hon. Friend the Member for Sittingbourne and Sheppey (Mr. Wyatt) on securing this debate on the Sheppey community hospital and I pay tribute to his vociferous and unceasing commitment to placing his constituents' case on the record. Every Health Minister, and even the Prime Minister, must be aware of his concerns. I fully understand and endorse the commitment of my hon. Friend the Member for Sittingbourne and Sheppey to ensuring that all his constituents receive the best possible health care services. He kindly gave notice of some of his major concerns, and I hope to be able to address his very specific questions. Should I inadvertently leave anything out, we will write to him.

I shall respond very specifically to one comment. My hon. Friend refers to "faceless administrators", but he pays tribute to the people who work in the national health service locally, and to the nurses and doctors whom he encounters. Although I fully accept that he may not often see the administrators, I assure him that they care just as much about the NHS as the more visible people. Moreover, I can reassure him that that commitment to a better NHS is not just on the front line. However, I support him in saying thank you to all those in his constituency who work to make the NHS better for the patients.

I am also aware that the decision not to proceed with the proposed private finance initiative scheme for Sheppey has caused considerable uncertainty to the local community. The cancellation of the various projects has further compounded that uncertainty, not least because this is not the first Adjournment debate that I have been part of in relation to that issue, and I am probably more familiar with the details than I would always like to be.

I know that my hon. Friend has been in close contact with Ministers and that he has met the Minister of State, my right hon. Friend the Member for Southampton, Itchen (Mr. Denham), to set out his concerns in more detail. Today, I should like clarify the current position and say what the next steps will be. I hope that this will end any uncertainty and reassure my hon. Friend the Member for Sittingbourne and Sheppey that his constituents' needs will be addressed. Moreover, I hope that, after the debate, my hon. Friend will be left in no doubt that the Government are dedicated to ensuring that his constituents receive first-class health services in a new community hospital.

With my hon. Friend's permission, I should like to begin by reiterating the Government's support for PFI and take the opportunity to remind him of the key principles behind PFI and the key factors that need to be taken into account when approving any PFI case. It is important to do so, to make it clear why we decided that the PFI scheme proposed for Sheppey was not the right way forward. I know that my hon. Friend has been involved in business and knows that the path of good decision making is sometimes to say, "On this particular occasion, we do not proceed". That does not undermine the whole process or the whole case.

When the Government came to power in 1997, the NHS was crying out for the biggest building programme in its history. There had been chronic underinvestment for far too long and the private finance initiative is key, because it will provide extra resources for the NHS building programme. The initiative transfers many capital investment risks to the private sector and ultimately results in better care for patients and best value for money for the taxpayer. The process is designed to allow the NHS and the private sector to work together effectively, to build new hospitals or provide information technology services.

I know that my hon. Friend is extremely keen on using new technology and would not argue with me for a moment that the private sector is a very useful source to complement Government action, not only with capital but also with ideas. However, PFI also deals with support services or the supply and maintenance of equipment, and it provides an opportunity for the NHS and the private sector to liaise and provide fruitful results that are beneficial to both parties. Within our commitment to expansion of the NHS, there is increasing support from the PFI initiative, leading to improved facilities nationwide.

My hon. Friend mentioned the postcode lottery. We are aware that one of the biggest problems that we still face in the NHS is huge differences in performance between both institutions and areas, but also sometimes within institutions. We strongly feel that the way to deal with the situation is in terms of capacity. In a sense, money is no longer the real problem, as the money is there, but we must ensure that the money comes with the right price tag. The right price tag is that we change the way in which we deliver the service, but also use it with best value.

I return to the PFI projects. Thirty-four major hospital developments, worth over £3.7 billion, have been given approval to proceed on the PFI since 1 May 1997. My hon. Friend is right when he draws attention to the fact that although the previous Government showed in their rhetoric that they were determined to use PFI, they did not make it work. Not a single new hospital was built under the PFI scheme. We have already completed some of these hospitals, and have seen that it works.

The NHS plan that we published in July 2000 included a number of PFI commitments: to set up 18 more schemes in 2001 and 2002, to provide at least 40 more medium-sized hospitals by 2010, to provide 20 new diagnostic and treatment centres by 2004 and to invest up to £1 billion in primary care facilities. PFI does work and we have seen it work. We are committed to developing new forms of public-private partnership that work better and protect the interests of the NHS. The bottom line is that it works better for the NHS.

PFI does have a future, but that does not mean that it is always the best solution, and in the case of Sheppey it was not the best solution. My hon. Friend has referred several times to £11 million as a snip. I can see why he may think that it is a snip in terms of the entire NHS budget, but we still have to be very careful that £11 million is used in a right and proper way.

Factors that need careful consideration before PFI schemes can be approved include the following: overall value for money, the need for proposals to represent best value, and whether a scheme would be better value for the NHS and the taxpayer under PFI than it would be under the equivalent NHS alternative. Proposals must also be affordable, and local health authorities and those that commission services must be able to afford the overall cost of a proposed scheme.

I am sure that my hon. Friend recognises that hospitals are complex buildings and take considerable effort to design. That is why all PFI schemes in the NHS are subject to review before they are approved. The results of the national beds inquiry have led us to look at a number of larger projects to ensure that those big designs fit the requirements of the community. It is a complex jigsaw.

I know that there is considerable frustration about the time that the process can take, and I do acknowledge the concerns that my hon. Friend has raised about that today. The process is lengthy and detailed, even if the PFI scheme succeeds. When there is a situation like the one in Sheppey, there comes a point when it is clearly recognised that the PFI is not the way forward. That causes a further delay, and I fully acknowledge that, but I hope that it is understood that we are taking the constituents' best interests to heart and will ensure that we can deliver. However, it is vital that all critical factors have been accounted for and are properly tested. Reviews must ensure that schemes represent a good deal for the public, and that can take time. If schemes fail to meet these criteria, they do not proceed. Sadly, the Sheppey PFI proposal failed on the two criteria: value for money and affordability.

My hon. Friend has raised a number of detailed issues concerning the responsibilities for procurement decision making. I would like to confirm that for all the schemes referred to, the trusts received NHS Executive approval for their outline business cases prior to commencing procurement.

No decision was taken to procure the schemes as one PFI scheme. However, a decision was taken to try to expedite the development process by agreeing a framework contract on one scheme, Sheppey, that could then be used as a template for the others. In a sense, although a number of schemes were going on that appeared to be going forward as one package, it was an umbrella package. It was not the case that suddenly Sheppey, with its snippet demand for £11 million, was thrown into a much bigger pot. That decision was reached by the trusts in liaison with their legal advisers and the NHS Executive. The decision did not require Treasury or ministerial approval.

The trusts pursued negotiations with the Investors in Health consortium to develop a value-for-money solution, in accordance with NHS Executive guidance. When it became clear that, despite the intensive efforts of the trusts and the NHS Executive, a value-for-money solution could not be agreed, the Minister of State, my right hon. Friend the Member for Itchen, was informed and agreed that further work should be terminated. However unfortunate it may be when such decisions have to be taken, if that is the right decision, we have to take it.

I can confirm that all the trusts involved followed established practice and Treasury and NHS Executive guidance throughout the procurement process. I recognise that money has been spent during the development of these schemes. However, that money was invested to ensure that the schemes would be approved only if they provided value for money. That investment is more cost-effective in the long run than proceeding with a scheme that is not economically sound. It is one of those paradoxes that we have to face. If we have to invest, sometimes in schemes that will not be proceeded with, the important issue is to ensure that we learn what made each scheme inappropriate. We are continuously fine-tuning that process.

What matters now is how we are moving forward and what we are doing to ensure that the health care needs of the people of Sheppey are met. I am sure that at some stage my hon. Friend the Member for Sittingbourne and Sheppey will be back on the stump in his election hustings. I would be extremely surprised if his constituents were to ask him which funding groups were used for the provision of the health care. They will want to know whether they will get the health care that they need on the island.

Once it was decided, in November, not to proceed with the PFI option, Ministers stressed how important it was for all parties concerned to move forward as quickly as possible with alternative arrangements to ensure that the health care needs of the local people were met. A review process was immediately initiated to appraise alternative options for provision of the new hospital, and concurrently to reaffirm the service model and functional requirements of the new facility. A priority has been to consider the proposal put forward by the Isle of Sheppey healthcare charity for funding and provision of the new hospital, which my hon. Friend mentioned today. Should that option prove not to be viable, the review will also consider the potential for public funding of the scheme.

The review has been fully supported by the south-east regional office of the NHS Executive. The views and opinions of the local stakeholders have been taken into account, as have those that my hon. Friend raised in correspondence and conversations with the Minister of State, my right hon. Friend the Member for Itchen. The review is close to completion and I am sure that my hon. Friend the Member for Sittingbourne and Sheppey appreciates that it would be inappropriate for me to speculate on its outcome now. An announcement will be made in early February and I will ensure that my hon. Friend is informed of the decision personally.

Although I cannot speculate on the outcome of the review, I assure my hon. Friend that the people of Sheppey will get their community hospital. The scheme is a high priority for the south-east region and I guarantee that public capital will be made available for the scheme if it is required. It is important for everyone to be confident that effective primary and community services are in place in Sheppey before the new hospital opens, and they do exist. Recent innovations include a nurse-led assessment centre operating from the leisure centres in Sittingbourne and Sheerness, enabling GP referrals for subsidised access for coronary heart disease patients; and recuperative care developments in partnership with social services in Sheerness, initially developing two, then three recuperative beds for short-term rehabilitation for elderly people who are unable to go straight home from hospital. The increase in practice and administrative staff in 25 per cent. of GP practices brings the lowest-staffed practices closer to the West Kent average; GPs are making good use of informal networks, with consultants visiting for out-patient clinics, which, for example, allows them to get specialist advice without making referrals.

In addition, considerable work has taken place over recent months to ensure that the health economy can cope this winter. Many of my hon. Friend's colleagues raised their concerns within the West Kent region about how that would be done, not just within the NHS but in the social services. I have met representatives of the various stakeholders in order to ensure that there is a comprehensive service. Judging by the feedback that we received, there is a tremendous commitment. The planning has paid off. However, that requires money and West Kent health authority received an extra £1 million, some of which was targeted at Sheppey residents, to help with the work. For example, four additional recuperative beds at Sheppey hospital will free up acute beds and there will be additional medical staffing at Sheppey to allow more dependent patients to be cared for in the community hospital. That includes additional staff-grade locum cover for annual and sick leave, increased clinical assistant hours from local GPs to cover beds under the care of a consultant on a GP ward—including out-of-hours cover—and increased nursing on De Shurland rehabilitation ward to enable more dependent patients to be admitted.

I appreciate my hon. Friend's concerns; it is only right that he and his constituents should question how local health services will be provided in future. The doubts about PFI schemes are legitimate. PFI's history as a solution to problems extends over 10 years, but it did not work under the Tory Administration. There was a reduction in the number of beds, and no work was done on intermediate care. We inherited a model of private and public finance working together but not making things work. We recognise that some of the underlying structural trends in the NHS were wrong, which increased delay. We must get it right.

The Government are clearly committed to a publicly funded NHS, as my hon. Friend will see if he finds a moment to look at the NHS plan. Its interesting chapter on the funding of the NHS restates the Government's commitment that the NHS is a public funded service. We will not go down the route of private medical insurance or charge people for GP visits, but we will work with the private sector on capital investment because that is in the best interests of taxpayers and my hon. Friend's constituents.

I know that my hon. Friend and his constituents are frustrated by the time that the project in Sheppey is taking, but we must get it right because I am sure that that package is right for the NHS. Although the proposed PFI scheme in Sheppey has undoubtedly caused anxiety, we will bring the matter to a swift conclusion. I well understand my hon. Friend's cynicism in saying that he has heard such things before, but I say confidently that if the consultation reveals that PFI or other projects are not the right option, we will find the public money to fund the project.

I hope that my hon. Friend will leave in the knowledge that his constituents will get a new community hospital and will receive high-quality health care and modern facilities, and that public funding will be made available if required. I was struck by the opening of his speech; displaying his usual way with words, he asked the Minister to minister to the people of Minster. He will no doubt be in touch with my private office to find a suitable slot in the diary. One reason why I am happy to accept his invitation is that it will give Ministers an opportunity to thank people in the NHS who have sometimes had to work in conditions that are less than perfect, but who always put patients' interests first. I hope that they agree that we in the Government also do that.

I am delighted that the Department of the Environment, Transport and the Regions seems to be tackling the issue of the bridge so that those people on the island who, as my hon. Friend powerfully illustrated, have not been connected will have easier access. I hope that my hon. Friend is reassured that something is happening in the interests of his constituents, and that the right thing is being done.

This short debate allows me to raise an issue in which I have long taken an interest in the House. I spoke on defence medical services when we had six military hospitals. I expressed concern and alarm when, under the previous Government, that number was reduced to three, as I did when "Defence Cost Study 15" decided that there should be only one military hospital, the Royal Hospital Haslar in my constituency.

I wish now to articulate the anger and distress caused not just in my constituency and the locality but to all who have an interest in defence medical services and in defence generally by the fact that the Government chose to announce that the Royal Hospital Haslar would close, as they originally said, not before 2002. That crass and incompetent decision had to be reversed almost immediately when the Government realised that it would be impossible to close the hospital without finding alternative medical care in the locality, and that the proposed expansion—through a PFI bid—of the Queen Alexandra hospital, Cosham could not be completed in less than five to seven years.

For those reasons, almost immediately after the initial statement that Haslar would not close before 2002, an announcement had to be made that it would stay open for five to seven years. That original decision caused such consternation that almost irreparable damage has been done to defence medical services—I say "almost" because I believe that there is a way ahead and I hope that the Minister will take note of it.

This is not a simple plea against a hospital closure or for hospital development. I listened to the end of the debate that was instituted by the hon. Member for Sittingbourne and Sheppey (Mr. Wyatt), talking about his local hospital. Haslar is the local hospital in my constituency. This is a more important, national issue, because Haslar is a military hospital. As one would expect, the United States has many military hospitals. France has 15, but the United Kingdom has only one, which is Haslar. It was selected under "Defence Cost Study 15" to be the single military hospital. The plan was never fully implemented. It was to expand Haslar from 180 beds to 350 or 320. If it had been implemented, we would have had strong medical services. It was not implemented, and the number of beds remains at about 180. As a result, a great deal of damage has been done to defence medical services and to medical care in the locality.

The special feature of Haslar is that the throughput of patients, to provide sufficient throughput for the practice of doctors and nurses and other medical staff, needs to be both civilian and military. To that extent, Haslar is unique. Military staff have front-line duties that may need priority from time to time; to that extent, too, Haslar is unique. The medical staff who are training and practising there must be accredited by the royal colleges, who have strict rules about the amount of training that is required of trainee doctors and the maintenance of training by existing doctors. That imposes a breadth of experience and training on all at Haslar and in other hospitals and, to some extent, a requirement for split-site working to which the royal colleges have been reluctant to agree. They are now content with the manner in which Haslar is operating, but it was always going to be difficult to maintain a military hospital.

If there is a cadre—a corps—of individuals whose first responsibility is in the front line of battle and they are taken from their civilian milieu, it will obviously be necessary to have a reserve somewhere in the United Kingdom. We knew that it would be difficult to cope with defence medical services. There is no satisfactory accountant's answer, no cost-efficient response: we must have a reserve of doctors and nurses.

Those who saw the decision in "Defence Cost Study 15" in 1995 that the Royal Air Force hospital at Wroughton and the Cambridge hospital at Aldershot were to be closed, may reluctantly have decided that their future careers lay in the Gosport area of south Hampshire. When they, their families and children moved to south Hampshire, although they may have been reluctant initially, they found it an agreeable place to live and would not willingly move again to Birmingham. The Government's proposal to establish a centre for defence medicine in Birmingham will not be popular. The Government—who have no Defence Minister who has served in the armed forces—have misread the motivation of defence medical services.

Recruitment has turned up a little in the past year or two. That is not surprising, because the armed forces give excellent training, to trainee doctors and good pay during training; the way of life is attractive and the experience varied and exciting. One can imagine why many younger people find it attractive to join defence medical services for their training during their first 10 or 15 years of medical experience. When fully qualified, however—at consultant level—their motivation is different. They no longer wish to be deployed at short notice to the Falkland islands or to Kosovo and on return to be told that they are going back again. No; they need to be retained by a different motivation. They want greater stability, they want to be sure that their career plans are working their way through and they want to be fully and sensibly employed for the skill that they have. If, as is happening now, they are more frequently deployed overseas because of shortages, that will make them less willing to remain in the armed forces. They will not be retained by the Ministry of Defence hospital units.

These units, previously at Derriford, Frimley and Peterborough—now at Northallerton—do provide the medical experience and the training that doctors require. I would not fault them on that. What they do not provide is the ethos, the services' camaraderie—the reasons why people join defence medical services rather than qualify in the national health service as civilians.

I have raised this issue previously with Ministers and responsible individuals in the MOD and they say that they are satisfied with MOD hospital units. They must be talking to people other than those whom the Select Committee on Defence talked to when it visited Frimley and Peterborough. During our visits we were told, by all those to whom we spoke—every single service man and woman—that the MOD hospital units were satisfactory, in their way, and that they were providing a level of medical experience but that it was "not what we had joined for".

indicated assent.

I see that my hon. Friend agrees with that point. He has visited MOD hospital units and has visited the Royal Hospital Haslar with me, and has taken a keen interest in the subject. I am grateful to him for his interest, and for the fact that he is present to show support for my submission today.

If doctors are not going to be retained by the MOD hospital units, are they going to be retained through the attractions of the centre for defence medicine at Birmingham? There were high hopes for the centre for defence medicine; we thought that it would provide the clear, leading light to guide medical defence services.

Then we discovered that initially, the centre for defence medicine would he a ward of 32 beds. That will not be the compass that will lead defence medical services out of its present difficulties. I recognise that the centre for defence medicine, as it is based in the University Hospital Birmingham NHS trust, is intended to provide an academic link to the defence medical services and give them an intellectual edge—that is attractive. A 32-bed unit will not be an incentive for individual consultants to remain in defence medical services. They will not be retained by the University Hospital Birmingham NHS trust.

What is happening in defence medical services at the moment? A week ago, the permanent under-secretary at the Ministry of Defence appeared before the Select Committee on Defence. He admitted that defence medical services were arguably the area of greatest concern to the MOD at the moment—as they should be. I am certain that when the Minister responds to this speech, he will say that recruitment is going better than it has for a few years. That is true for junior doctors, but the crucial question is, how many deployable consultants are there in the key areas? The key areas, which the services must excel at if they are to have proper medical cover, are anaesthesia, general medicine and general and orthopaedic surgery.

What are the numbers? The requirement for anaesthetists is 120 and the MOD has 29: a 76 per cent. shortfall. The requirement for general physicians is 51. We have 19: a 45 per cent. shortfall. The requirement for general surgeons is 44. We have 18: a 52 per cent. shortfall. The requirement for orthopaedic surgeons is 28. We have 8: a 71 per cent. shortfall.

There are even worse statistics. For accident and emergency, which one might think is one of the prime requirements for the Ministry of Defence armed forces, the requirement is for 23 consultants, and we have three: a shortfall of 87 per cent. The situation is critical, facing collapse. What is it doing to those serving in the armed forces?

We have more deeply worrying numbers. The number of personnel in the Army who are downgraded for more than a month is 9,144, which is 9.5 per cent. of establishment. The Army is of course also 5,000 under strength, so it is 14,000 people short of full fitness. The comparable figures for medically downgraded personnel in the Royal Navy and the Royal Air Force are around 2,500 and 3,796 respectively.

Those are critical figures, and the Minister cannot be complacent. He cannot say, in the face of such a shortfall of doctors and nurses, and the danger to the armed forces' health, that there is no problem that he should address. Perhaps as a result of a parliamentary question that I tabled about the fitness of service personnel, there seems to have been a desperate attempt to rectify the situation by sending service men to private hospitals. In response, the Minister told me that he could not give details of those arrangements, as they are commercially confidential. If he cannot tell me anything about the arrangements, I will tell him.

The Ministry of Defence is being charged £95 for a consultation at a private hospital, and if that leads to an operation, the Ministry buys that specific item without medical back-up. In other words, if a soldier, sailor or airman goes to a consultation, the doctor advises tonsillectomy and the operation is authorised in a private hospital, the patient will of course get the tonsillectomy and come out. There is no aftercare or general care through the private arrangements that have been made by the Ministry of Defence. Should anything go wrong, the patient will have to have aftercare elsewhere.

Let me take an example. A service man had a varicose veins operation in a private hospital that went wrong. There was no follow-up and he developed sepsis and pulmonary emboli. He had to be admitted to Haslar hospital as an in-patient. There are other examples. Patients have been sent privately for magnetic resonance imaging scans, for ear, nose and throat surgery and for general surgery, when in each of those cases there is virtually no waiting time at Haslar hospital and it would have been possible to perform the operations there. Obviously, all is not well.

I have said little about the civilian need for Haslar hospital, and I am conscious that the Minister is responsible for the Ministry of Defence medical services, not civilian medical care. However, I will say that Gosport, although a peninsula with a tidal flow of traffic, is fully accessible for most of the day, and Haslar is available to those outside the Gosport peninsula. It is intended that the Queen Alexandra hospital will be rebuilt, as I mentioned, under a private finance initiative. However, the Queen Alexandra hospital has had problems recently with its sterilisation plant and for some weeks it was not possible to carry out cold surgery there at all. It has also had management problems. It has unfortunately lost its chief executive and its chairman in the last year.

Much has been done at Haslar to rectify the situation from a civilian and a military point of view. There is at Haslar an accident treatment centre, which seems to be working well. The health authority has agreed a plan whereby the number of out-patients seen at Haslar will be increased from 55,000 to 60,000 a year. May I put it to the Minister that we have a way ahead? I recognise that the Ministry of Defence has signed an agreement with Birmingham to create a centre for defence medicine at the University Hospital Birmingham NHS trust. That is a mouse of an agreement, providing only 32 beds, but I would be seeking to push water uphill if I tried to persuade the Minister to go back on that agreement, which I believe is not being put in hand.

A contract has been signed between the Ministry of Defence and the Portsmouth Hospitals NHS trust to provide a Ministry of Defence hospital unit in south Hampshire. It is needed because of the large number of service personnel in that area.

However, the private finance initiative at Queen Alexandra hospital at Cosham is not likely to go ahead with the military element. There are already problems with the PFI bid at the hospital. There are also planning issues, which may be insuperable. There will certainly be considerable hostility from the local authority over the full PFI bid if it includes the military element. I have already mentioned the management issues and problems at the Portsmouth Hospitals NHS trust and Queen Alexandra hospital.

I maintain that the only way to retain defence medical staff is to provide them with a focus of service interest. They will need that if they are to get the two 200-bed hospital ships in due course. Where better to place that massive commitment—which would imply a significant swing in favour of ship-provided hospital care—and moor those hospital ships than the Portsmouth area? From where should they be supported but. Haslar?

I press the Minister to say that he would not object to the MOD hospital unit's remaining at Haslar after the national health service takes over management responsibility for clinical services on 2 April 2001. There is no other way to provide the framework for the defence medical services—their spirit, loyalty, spiritual home and centre. The MODHUs will not provide it; nor will Birmingham. Without it, the decline in the number of doctors and nurses will continue. It would take 25 years to get the defence medical services in proper order again. I said to a senior individual who is responsible in this area that it would take 25 years to rectify the damage, and he smiled thinly and said, "Well, perhaps 15." This is a serious problem, and I urge the Minister to take note of it and respond.

I congratulate the hon. Member for Gosport (Mr. Viggers) on securing this debate on the important subject of defence medical services. As the House recognises, he continues to take a close interest in defence medical matters. He has been particularly assiduous in pressing the interests of his constituents, who are concerned about our plans to close the Royal Hospital Haslar.

I reiterate my previous assurances that Haslar will not close until our new Ministry of Defence hospital unit opens at the Queen Alexandra hospital, Cosham. The Portsmouth Hospitals NHS trust plans to develop that hospital on a private finance initiative basis. The timing of the final closure of Haslar and the opening of the new MOD hospital unit therefore depends on the progress made on the redevelopment project. The hon. Gentleman can be assured that we are working closely with both local and central NHS authorities to ensure the appropriate provision of health care services in the Gosport area during the transition to the new arrangements.

Following a visit to the Haslar hospital at Gosport earlier this year, I said that we would certainly be sympathetic to discussions held with a view to the long-term provision of care within the Gosport peninsula, although not based on the full provision at Haslar, which, if the MOD hospital unit goes ahead, will be moved to Cosham. I am certainly sympathetic to the needs of the hon. Gentleman's constituents. In the long term, we try to do what we can within the constraints on us. I hope that he has been assured that the closure of Haslar does depend on the opening of the new unit; it will not take place in its absence in the short term. I can guarantee that today. The two are interdependent and will remain so.

I am pleased to say that our plans for close integration with the Portsmouth Hospitals NHS trust are progressing satisfactorily. As part of the plans, the trust will take over the management of clinical services on 1 April this year. The arrangements will be similar to those in our existing Ministry of Defence hospital units, with military personnel integrated with NHS staff. However, we will remain responsible for the infrastructure and support of the Haslar site. As in any other MODHU, the Portsmouth Hospitals NHS trust will pay my Department for service personnel employed in the trust, and we will in turn pay the trust for treating service patients.

We have also reached agreement with the Department of Health on the transfer of funding to compensate for the costs that the health authority will incur during the transitional period for NHS patients who were hitherto treated at Haslar at no cost.

The hon. Member for Gosport expressed concern that current manpower shortages in the defence medical services will affect our ability to meet staffing commitments at Haslar and at the new centre for defence medicine that we are establishing in Birmingham. I can assure him that manpower plans for that centre take account of other medical manpower commitments, and any moves of staff from Haslar will occur only on a carefully planned basis. Our plans for the centre also assume a gradual growth over a number of years in which we expect overall staff levels in the defence medical services to improve. He referred to the provision of a ward it Birmingham as part of a Ministry of Defence hospital unit. In the long term, I anticipate that unit growing substantially. The initial provision is just that: a means of getting the unit started and having our own particular unit attached to the hospital in Birmingham. Over seven to 10 years, the MODHU component in Birmingham would increase in line with the number of staff.

The hon. Member for Gosport rightly expressed concern about the current personnel shortages, to which I have frequently referred in debates over the past year. He doubts our ability to achieve improvements. With hindsight, the cuts made during "Defence Cost Study 15" were obviously too severe, and morale in the defence medical services undoubtedly suffered as a consequence. When consultants are lost, it takes a long time to train replacements. We have given a high priority to trying to restore the operational capability of the defence medical services. The strategic defence review provided for extra money over the four years to 2002 for additional medical manpower and equipment. Our plans for the procurement of medical equipment are on target. Making good manpower shortfalls is much more difficult, because it takes time to train the personnel—eight to 10 years for a doctor to qualify as a consultant. Nevertheless, I can say with confidence that manning levels are stabilising, and overall numbers have increased by 74 between June 1999 and July 2000. Although that figure is out of date, medical staff tell me that the trend is encouraging.

Levels of recruitment into training are satisfactory. The number of medical cadetships and nurse training places has increased, and we are making progress in meeting the higher figures. The medium to long-term outlook is happier than at this time last year. However, to make a significant impact on manning levels in the short term, we need to recruit more direct-entry, qualified medical personnel, particularly doctors. Recruitment of such personnel has proved difficult in the past, and we are undertaking a considerable amount of work to identify and deal with the barriers that have previously limited our success in that area. We shall shortly be able to put in place arrangements that will encourage already trained and qualified staff to join the defence medical services, and so contribute directly and quickly to easing manning pressures. I shall keep the hon. Member for Gosport and the House informed of progress in that area.

We also recognise the need to improve the retention of experienced medical personnel if we are to achieve a significant improvement in manning levels. We are still losing more people than we would wish through early retirement, although the situation is better than a few years ago. We are, therefore, also undertaking work on a range of measures to improve the retention of staff.

The centre for defence medicine will play an important part in attracting and retaining personnel in the defence medical services. I am pleased to say that this project, which is a core element of our strategy for the defence medical services and which will include academic, teaching and clinical roles, is going very well. We are on track to open the centre formally on 2 April. Many defence medical personnel have shown a keen interest in serving at the centre. The first group were posted there last September. They have been warmly welcomed by their civilian colleagues, and are enjoying working there. By the time of the formal opening on 2 April, some 80 of our people will be serving at the centre, with one ward managed exclusively by military personnel. The centre will then, as I said, build up progressively, especially in its academic and teaching roles, to its full strength over a period of five to 10 years. I believe that it offers exciting prospects as a professional focus for the defence medical services and a facility for promoting excellence in military medicine.

The hon. Member for Gosport rightly referred to the importance of fostering a military ethos among defence medical services personnel and the part that that plays in sustaining high morale in the service. It is especially important that those serving at MODHUs should have access to military facilities and be able to participate in military training and exercises. That also applies to those who will be serving at the centre for defence medicine. I assure him that every effort is made to ensure that personnel at our units are released for military training, exercises and adventurous training whenever possible and that they have access to facilities at local military units, all of which helps to foster a military ethos.

We are working on plans for the development of separate domestic accommodation for military personnel at the new MODHU in Portsmouth, and at the centre for defence medicine. That accommodation will include the usual service mess facilities, which will help military personnel maintain their distinctive identity.

Having visited Derriford and Northallerton in the past six to eight months, my experience, having spoken to medical colleagues about their experiences, is different from that of the hon. Member for Gosport. There is no doubt that teething troubles were experienced when the units were first set up, but I believe that those troubles have been largely overcome. Certainly at Northallerton, the experience gained from the units set up earlier seems to have paid dividends, and staff seem to have adjusted quickly to conditions there, which differ from the conditions where they were formerly. However, we shall keep a close eye on the matter, because it is important to maintain high morale and a military ethos among the staff serving there.

The hon. Member for Gosport also said that, as a result of manpower shortages in the defence medical services, service patients are now waiting longer for treatment. He referred to two aspects; the number of medically downgraded personnel and our use of private facilities in trying to reduce treatment. I am a wee bit sorry to be criticised for taking an initiative that I thought would help. Not many options are available in the short term to make dramatic inroads on waiting lists, and I believe that we have shown an imaginative attitude towards the problem. If the hon. Gentleman wants to bring any individual cases to my attention, I promise him that they will be carefully investigated to find out whether more can be done than is being done at present.

Although we are worried about the downgrading of personnel, it covers a wide range of circumstances. Many—indeed most—such personnel can be deployed on military operations, although not necessarily in the front line. A considerable amount of work is being done to improve our understanding of the cause of downgrading and on the action that can be taken to ameliorate the circumstances. Numbers awaiting medical treatment are only part of the problem. They include personnel who are permanently medically downgraded and have been retained in the armed forces with limited employability because we feel an obligation to people who have given us sterling service in the past.

I am happy to say, in passing, that I have experienced at first hand what is being done in Edinburgh for recruits who become injured. Many acute downgradings are due to skeletal injuries sustained during training. I am cautious about what I say, because it is only too easy to make dramatic claims for medical advances that are not borne out in the long term. However, the initial impression seems to be that the extent of medical downgrading and the length of time for which people are downgraded are dramatically reduced through early interventions such as intensive physiotherapy and access to consultant treatment. I hope that we shall be able to generalise on that experience in the rest of the services over the next year or two to ensure that people who suffer injuries to their knees, ankles or backs return to service as quickly as possible.

The debate has shown once again the importance that hon. Members, and in particular the hon. Member for Gosport, rightly attach to the defence medical services. Before concluding, I reiterate the Government's commitment to restoring the capability of such services. It is essential that the armed forces have the level of medical support that they need on deployed operations. Despite the current manpower shortages, defence medical services continue to meet their operational commitments. Those whom I have met have impressed me with their motivation and professionalism; that applies to reservists, as well as full-time staff. Morale is generally good, although people are anxious about numbers, just as we are. Personnel are beginning to see that there are grounds for optimism about the future of the defence medical services.

The closure of military hospitals over the past decade has been a source of disappointment.

Order. Time is up.

I am pleased to have the opportunity to debate such an important issue. Shipley, my constituency, is one of five in the Bradford district. There are no general hospitals within its boundaries, but it is served by Bradford royal infirmary and St. Luke's, based in the city, and by Airedale general hospital in Steeton near Keighley.

Of the five Members of Parliament for Bradford, my hon. Friend the Member for Keighley (Mrs. Cryer) unfortunately cannot be here today, although I understand that she will shortly visit Airedale hospital. My hon. Friend the Member for Bradford, West (Mr. Singh) has taken a long interest in the Bradford royal infirmary site, which is in his constituency. I know that he looks forward to the Minister's visit in the near future. My hon. Friend the Member for Bradford, South (Mr. Sutcliffe), who sits beside me here as a Whip, is prevented from speaking in the debate. However, I assure the world at large that he strongly supports hospital services in the district and takes a close and long-standing interest in new investment and developments. I hope that my hon. Friend the Member for Bradford, North (Mr. Rooney) will say a few words later.

Nearly half a million people reside in the Bradford district. The area ranges from relatively well-off communities in the commuter belt to a fairly large area of deprived neighbourhoods with deep-rooted poverty and poor health. Bradford is recognised as the most deprived health authority area in the whole of northern Yorkshire, where more than one third of the population is classed as deprived. Patients, especially those from black and Asian communities, suffer high rates of heart disease, strokes and diabetes.

There are several good facilities in the area, but they need to be improved. St. Luke's hospital typifies the most pressing difficulties that we have in the national health service locally. Most of its site is contained in a series of unconnected 19th-century blocks, between which patients and equipment must be transferred in the open air between buildings in all weather. That is obviously unsuitable for the 20th century, never mind the 21st century. Most of the Bradford royal infirmary buildings are 1930s blocks built in the old Nightingale ward tradition, as open wards. Although the hospital staff do sterling work given the conditions, there are great needs at those hospitals.

Despite those challenges, I am proud of the good NHS systems in Bradford. For example, South and West Bradford primary care group was PCG of the year in 1999. Bradford also won health authority of the year in 2000, an award given by The Health Service Journal. Bradford has received various NHS beacon awards for primary care and hospital care, and Bradford hospitals have won several other awards, including one for cancer care at Bradford royal infirmary.

The overall number of people in the Bradford district waiting for admissions between September 1998 and December 2000 has fallen by 20 per cent. In that same time, the figure of more than 500 people waiting for more than 12 months has been reduced to zero. We have successfully implemented winter plans; there have been no bed closures and there has been no adverse impact on casualty. We have some of the lowest rates of delay from discharge in the region, so there has been little bed blocking. There is, too, an increasingly healthy ethos among the NHS staff at Bradford; management is devolving decisions and letting go, allowing frontline staff to make decisions and to make a real difference.

I wanted to set the scene about hospital and health provision in the district, but I also wanted to talk about some of the recent advances that have taken place in the district. A number of those advances are unsung—they have had very little publicity or coverage—but I am immensely proud that, step by step, some investment has been applied and is making a difference. At the Bradford royal infirmary and at St. Luke's, there are a number of improvements.

The Bradford royal infirmary has a brand new accident and emergency department to treat a large number of patients—approximately 100,000 a year. That department is now four times the size of the former cramped facility. A year ago, I spent a Friday evening, up until midnight—one of the peak periods—in the old accident and emergency department, and it was like something from a 19th-century novel. To now have this much larger, better-equipped facility with an improved triage, a separate children's facility, a nine-bay resuscitation unit and improved security for staff makes a wonderful difference for the whole of the district.

This year, the hospital will have a £1 million cardiac catheter laboratory, aimed at more than doubling the number of angiograms that can be performed annually, from 400 to 1000. That will make a huge difference, and is thanks to some of the capital investment. I recently visited the new intensive care beds, which have been operational since December. There are now eight intensive care beds, supplemented by some new high-dependency beds, all of which increase the capacity to serve that large community.

The hospital has a new operating theatre in the ear, nose and throat block, helping to reduce waiting lists. An extra ophthalmologist has been employed to tackle cataract problems, among other ailments, and £1 million has now been approved for the centralisation of paediatric services. More than £500,000 has been made available to improve the out-patient facility at St. Luke's hospital. These are areas where we have great problems in terms of the buildings and services, so step by step, some of the more recent investment has begun to make a difference.

However, it would be remiss of me to fail to mention another great hospital in my district; Airedale general hospital, where I was born in 1972. The hospital was recently ranked as having the seventh-lowest mortality rate in the county on a like-for-like basis without deprivation indices. This is a great sign that the staff and that facility are not only extremely popular locally, but extremely effective. I understand that just this morning the hospital opened the newly refurbished accident and emergency department, where £3330,000 has been invested in new X-ray equipment and modern resuscitation facilities. It is coincidentally fortuitous that we are having this debate today to recognise that milestone being passed.

Also at Airedale, £500,000 was invested in upgrading the admissions and assessment ward that opened at the beginning of December 2000. There was an investment of £750,000 on angiography and mammography X-ray facilities, with extra high-dependency beds installed.

The list is much longer, and I could not possibly cover some of the extra advances that have taken place in the short time that we have for the debate. However, more investment is needed and there is much more to do. The reason for today's debate is to look at how we have been benefiting from new investment, how—before we achieve a truly modern NHS of the highest calibre—we plan for the future, and how we put our foot on the accelerator in terms of investment and hopefully bid for some even better, more radical advances. Bradford has embraced the NHS plan and we are keen to see the benefits of the proposed modernisation programme that it describes. Bradford, as much as anywhere, needs 21st-century buildings and equipment. The main hospital buildings at Bradford royal infirmary are antiquated and inappropriate for today's needs; there is a compelling and urgent case for massive new investment in Bradford's health services to bring acute services into the 21st century.

We want to be in the list of nationally approved new district general hospitals. The district's capital investment programme is being considered as an integrated programme and all the local agencies support it. A great partnership effort went into producing the strategic outline case submitted by the health service stakeholders in the district. It is ambitious and farsighted, but immensely achievable and affordable with the available new moneys.

The bid is for £70 million of new-build capital investment at the Bradford royal infirmary site and £30 million refurbishment works in addition. The aim is to preserve the best elements of the current Bradford royal infirmary facilities and add on new elements; for example, a new series of operating theatres, a radiology suite, short-stay and day-case units and a consolidated women's hospital at one site.

St. Luke's hospital would become the focus for rehabilitation and post-acute care and be the main outpatients centre. BRI would be the base for all acute work, from emergencies to elective in-patient activities. That would significantly reduce Bradford's split-site problems and help to reduce waiting times and waiting lists. The proposal would improve the working environment for staff and, for the first time, there may be health services in our district that are designed around the patient's needs, and not around the geography and typography of the site and the difficulties of getting round the city.

It is an exciting vision for Bradford district health care in the 21st century, which can come about only because of the extra priority given to investment. Public services are not seen as something that must be scaled down and cut back; there is a belief that the NHS is vital. Our constituents will get what they want: a growth in services and in investment. I know that we have had a lot of Government money, but I strongly hope that the Minister will consider the bid favourably and make the extra investment that we want in the future.

I thank my hon. Friend the Member for Shipley (Mr. Leslie) for securing the debate and the Minister for his commitment to Bradford. We appreciate the regular cheques that arrive; the current one just happens to be slightly larger than the others. We are arranging a party for the Minister next week.

I want to talk about the issues arising from the ageing condition of the Bradford hospitals and the split-site operation. There is a health community in Bradford; the partnerships between hospital trusts, primary care trusts, community health trusts and social services are a model for the health service nationally. They form a partnership of equals, which works exceptionally well.

There is a need to develop those links and to divest many more services from the hospitals. The problem is that because of the state and age of the buildings, many of the revenue costs—perhaps as much as several millions of pounds—are tied up in those decrepit buildings. With bright, modern facilities, money could be released into patient care and into preventative work, an issue about which I am very concerned.

As the Minister knows, there is a health action zone in Bradford, which has been outstandingly successful in treating diabetes. A stack of other innovative proposals is waiting to be developed, but people are reluctant to ask the Government for even more money than the bounteous sums that we are already getting. However, by improving the fabric of the district hospitals, millions of pounds could be released to develop the services.

It is virtually impossible to maintain the buildings to acceptable standards of cleanliness. I speak from personal experience because, a few years ago, my wife had secondary and third infections following an operation. They resulted from poor standards of cleanliness. I mean no disrespect to the cleaners, who do their best and are still suffering from the disastrous compulsory competitive tendering arrangements introduced by the previous Government. Their job is difficult because of the physical structure, appearance, style and texture of the buildings. An above average number of people have to come back to do the job again. There is dead money that nobody wants to spend, which could be invested to develop other services.

I have a particular interest in health concerns among the ethnic minority community. Life style, diet, ignorance and language barriers can all be a problem. Exciting proposals have been made to develop services at the community level rather than institution-based services. Once again, the resource element is holding us back. We do not need any more money; we can release it from the additional costs that we are incurring by maintaining these ancient buildings.

I hope that the Minister will be able to make some pleasing sounds this afternoon. I know of his commitment to Bradford and I enjoyed his visit last year. I hope to see him there again in future—hopefully to open the brand new hospital that I am sure he wants to promise us today.

I congratulate my hon. Friend the Member for Shipley (Mr. Leslie) on his success in securing the debate. I pay a personal tribute to his work in attempting to improve the national health service in his constituency. He has always spoken up for the NHS in Shipley and I know that he will continue to do so well into the future. Along with all my hon. Friends who represent Bradford, I want NHS services to continue to develop in that city. Under this Government, they will.

We have increased resources for Bradford year on year. This year, Bradford health authority received a cash increase on its budget of more than £30 million—6.7 per cent. over and above inflation, or a 9.3 per cent. increase in cash terms. Next year, there will be a real-terms increase of 6 per cent.—more than £27 million in cash terms.

The benefits of those extra resources can be seen in the number of patients treated. Last year, 5.7 per cent. more patients were seen in Bradford than in the previous year. Nationally, waiting lists have come down from the record levels inherited from the previous Government. Not only are fewer people waiting in Bradford, but those who do wait do not have to spend as long on the list. My hon. Friend referred to the progress made in that respect.

The number of patients treated is not the only important factor. As my hon. Friend said, we must also ensure that we have the most up-to-date facilities to treat patients. Bradford has seen significant new investment. Nationally, £115 million has been spent to modernise every accident and emergency department in England that needs it. The accident and emergency department of the Bradford royal infirmary has been modernised at a cost of £5 million. That development, which was completed in October, houses one of the most modern and technologically advanced accident and emergency facilities in the country.

The new unit is a dramatic improvement on the original inadequate facilities. We are gradually sweeping away old and outdated Victorian buildings and replacing them with an NHS fit for the new century. New purpose-built facilities will enable the hospital to assess patients much more quickly, minimise their wait and care for them in a more private and dignified environment.

The superb facility includes a dedicated children's accident and emergency department that provides separate waiting areas, with facilities geared more towards the needs of young people. In addition, the trust has received a further £700,000 from this year's modernisation fund further to improve and modernise its services. That has been spent on new nurse-led clinics, the introduction of booked admissions to allow earlier and more convenient hospital appointments for patients and studying how services can be better delivered for patients in primary care.

In Bradford district, we have invested more than £130 million to equip 130 general practitioners to provide secondary care. That has meant that a total of 20,605 non-hospital out-patient consultations will be undertaken by GPs this year in Bradford, as well as 11,500 procedures that would otherwise have been carried out in secondary care—a better service for patients that frees up hospital time.

We have also provided the Airedale trust with more than £700,000 from the modernisation fund for equipment and building alterations aimed at further reducing waiting times and providing additional equipment. Bradford trust has been given new and replacement trailers and X-ray equipment for the Pennine breast-screening programme from the new opportunities fund for cancer services. The Airedale trust, to which my hon. Friend was right to draw our attention, is proceeding with a £3 million procurement to replace radiological equipment.

I am aware that time is limited, but I shall quickly mention a number of other important investments that have taken place in Bradford. An additional £500,000 is to be provided to Bradford health authority to tackle coronary heart disease and my hon. Friend referred to the progress that we are making there. A further £500,000 is to provide 120 extra intermediate care beds, to improve the health and social care of older people. There will be £300,000 from the modernisation fund to enhance security measures for the accident and emergency department. We have made available two additional critical care beds for Bradford hospital and two high dependency beds for Airedale hospital, which have certainly improved care this winter.

Money and equipment is, of course, welcome, but the NHS also needs more doctors and nurses to provide the additional services that patients need. The past three years have seen an additional 340 nurses, midwives and health visitors in Bradford—an increase of nearly 15 per cent. that has been mirrored by increases in medical and dental staff at the hospitals. Significant new investment has taken place, but we can only deliver a more modern and dependable NHS through doctors and nurses delivering services that are better organised around patient's needs. I am pleased that Bradford has delivered on that too.

I was delighted to hear that The Health Service Journal awarded its health authority of the year accolade to Bradford health authority this year. As my hon. Friend is aware, these things do not happen by accident. In Bradford, much imaginative and pioneering work is being done to improve services to patients. My hon. Friend reminded us of my visit to Bradford last year, where some fantastic things are being done by people working in the NHS and their partners in local authorities to improve the health and social care needs of the local population.

My hon. Friend rightly referred to the fact that Bradford has been in the vanguard of establishing new primary care trusts—I think some of the first in the country were set up in his area. That has provided the freedom for local services to modernise much faster than might otherwise have been the case. For example, the Airedale primary care trust is building new primary care surgeries and using new technology to pioneer a shared patient information system.

Bradford City—not the football club, but the primary care trust—has managed to take on additional practice staff and work with partners on a new, assertive outreach mental health team. I was pleased to meet the team last year and find out how they were improving services for people with mental health problems in the city.

Bradford South and West primary care trust has used extensive patient involvement to improve services for patients with coronary heart disease, diabetes, cancer and mental health problems. North Bradford primary care trust has been impressive in its imaginative approach to reducing waiting lists and improving access to local services.

Those improvements and successes have been made against a backdrop of a population of almost 500,000, in a district with a wide range of social, geographical, ethnic and health variations. As my hon. Friend said, Bradford is the eighth most deprived district in Britain and one in which there have been wide inequalities in its health experience for many years—a factor that led to the district becoming one of the first health action zones to be established in England in April 1998.

As my hon. Friend the Member for Bradford, North (Mr. Rooney) said, Bradford health action zone continues to receive significant funding to tackle the major health problems in Bradford—this year, we allocated to Bradford more than £4.7 million. The focus has been on diabetes, as my hon. Friend said, as well as rehabilitation, improving health for minority ethnic groups and services in the inner city.

The health action zone continues to make significant progress in tackling inequalities and modernising services to improve health in the most deprived areas of the city. Health action zone initiatives, for example, ensured continuity of discharge arrangements through last winter and maintained waiting times despite increased admissions into hospital.

As my hon. Friends the Members for Shipley and for Bradford, North said, we have recently received a strategic outline case to invest more than £100 million in new acute services in Bradford. The Bradford hospitals NHS trust proposes to create a new hospital facility on the Bradford royal infirmary site to treat acute and emergency patients, as well as a post-acute rehabilitative and out-patient facility at St. Luke's hospital. That will permit the introduction of a patient-focused model of care to enable all acute in-patient activity to be undertaken on one site, and the essential re-engineering of clinical services. It involves a combination of substantial new build on both sites, with major refurbishment of existing 1930s accommodation on the Bradford royal infirmary site and demolition of the Victorian accommodation at St. Luke's hospital. The trust has submitted a strong and well-made case for that re-development. As my hon. Friend is aware, it is being actively considered by the Department of Health and we expect a decision in the next few weeks.

My hon. Friend the Member for Shipley will want to join me today in thanking everyone who works in the NHS and the Bradford district for their tremendous work, day in and day out. We are all committed to providing first-class treatment for every patient. We are replacing the old Victorian hospitals and mindsets and replacing them with a new, vibrant and modern national health service of which we can all be truly proud.

The NHS plan sets out our vision for the future of the health service. The money that we have put into the service in Bradford and the dedication of the staff in the city will ensure that the vision that we all share—all hon. Members who represent Bradford and the Government—will become a reality.

Question put and agreed to.

Adjourned accordingly at five minutes to Two o'clock.