I am delighted to have secured this debate so early in the new Parliament. I welcome the new Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), to her first outing in such circumstances. We will be gentle with her. I am pleased to see so many colleagues from West Sussex. They, too, have encountered the problems that I am about to recount; my comments will relate mostly to Worthing, but the problems are found throughout the two counties that comprise Sussex.

I hope that I do not gain a reputation for whinging on behalf of my constituents if I claim that we in Sussex—especially in Worthing—have special problems. I have initiated several Adjournment debates on the problems facing the elderly in West Sussex, the enormous pressures that are put on social services by the high population of elderly people, and the great pressures put on the health service generally in the county. Much of what I say will strike a chord with other hon. Members but, as they would expect me to say, the situation in Worthing is far more acute.

That severity is the result of a cocktail of contributory factors, not least the fact that the population of the borough of Worthing is the oldest in the entire country: 48 per cent. of the electorate in the constituency of my hon. Friend the Member for Worthing, West (Mr. Bottomley) are of pensionable age, making the population there by far the oldest in the country. The knock-on effect is felt in many of the other Sussex constituencies where the proportion of elderly in the population is nearly as high. That is why I broadened the debate to include the whole of Sussex, even though I shall concentrate on Worthing.

Worthing has more than double the national average of over-65s and more than treble the national average of over-85s. Of the 211 hospital trusts in England, Worthing hospital now has the ninth longest waiting times; they have been gradually worsening for the past four years. Hospitals with even longer waiting times include those of the neighbouring Mid Sussex national health service trust and the Royal Surrey County Hospital NHS trust, which is not far away. My hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) knows of that problem.

A great deal of work caring for patients who wait inordinately long times falls back on GPs. Patients whose operations are cancelled need some form of ameliorative treatment while they wait. The enormous pressure on social services—I introduced a debate on that subject some months ago—leads to significant problems of bed blocking. All those factors result in increased fallback on GPs, particularly in Worthing. One Worthing GP says,

"To be an average GP would be wonderful for us".

but in Worthing there is no such thing as an average GP.

I do not mean to be alarmist or scaremongering, and I am not trying to score party political points. What I am about to describe is based on facts and the experiences of several GPs in Worthing and elsewhere in my constituency who are at their wits' end.

We in Bognor Regis have the same problems. The Bognor Regis health centre has cut 1,000 patients from its list. This morning, I received a letter from a doctor saying that there is simply no leeway—he cannot accept more patients. Grove House in Pagham is full and not taking more patients, Maywood and West Meads surgeries are full, and Feltham and Middleton have recently discarded patients. The doctor points out that there might well be 2,000 patients in Bognor Regis who have no GP at all.

I thoroughly understand the problems in my hon. Friend's constituency, just along the coast from my own. The situation in Worthing is rather more alarming, although that does not improve the situation affecting him and his constituents.

My comments stem from a meeting that I had just before the election with a couple of dozen GPs, at their behest, and from a letter sent to patients of one surgery in Worthing that has had to close its list. Virtually all the GP surgeries in Worthing have now closed their lists to new patients. My argument also stems from the anger that that engenders in many patients, even though they understand the pressures that their doctors are under. Usually mild-mannered doctors have gone public to give details of their plight to patients, not least in a series of articles run by the Worthing Herald, a local paper to which I pay tribute for the work that it has done on the issue. In an article entitled "Why your doctor fears for your health", one doctor is quoted saying:

"I do a 12 hour day average. I have no lunch and it gets dangerous. We cannot deliver the quality of care patients want and deserve. We try to squeeze everybody in but it's impossible."

Another says:

"There's a massive danger of burn-out and an increasing risk of mistakes. The only thing that stops that is the sheer professionalism of doctors in this country… It is just killing us. I would not let my children go into medicine."

A letter from Shelley road surgery in the centre of Worthing—it lies in the constituency of my hon. Friend the Member for Worthing, West but caters for many of my constituents in East Worthing—informed patients that it was about to close its list. In it, the doctors stated:

"There is now no room for any more work without adversely affecting patient care and our own health. It is our firm belief that consequently it is dangerous for the Health Authority to continue to allocate patients to this practice until further notice."

Those professional doctors are not pulling any punches. They are responsible and experienced GPs who work hard in their patients' interests in increasingly difficult circumstances. Those doctors did not close their surgery on the doctors' day of action in May; instead, they made a responsible protest by informing their patients of the problems that they were experiencing.

I pay tribute to the doctors who, although they are working under enormous pressures, have, both on and off record, contributed to my speech. In particular, I thank the Shelley road surgery and Dr. Bruce Allen, who has taken the decision to speak out on behalf of his patients and colleagues because the local GP service is at breaking point. He sent me some comments for the debate, which I received yesterday; he apologised for having taken so long to get back to me after learning that I had secured the debate. His excuse—

His reason.

Indeed. His reason for taking so long was that on Thursday he had worked solidly between 8 am and 11.30 pm, on Friday he worked solidly between 8 am and 8 pm and on Saturday he worked solidly between 7 am and 10 pm. He typically works between 60 and 65 hours per week. It is not a question of being on call or waiting for something to happen—all the work involves intensive patient contact.

The surgery deals with 11,400 patients and has a full-time equivalent of 5.7 doctors, which means that each doctor has about 2,000 patients. Doctors live in fear of falling ill themselves because of the problems that that would cause in terms of getting cover for patients, and because of the pressure that it would put on other doctors in the practice. On top of those working hours, in the past few weeks Dr. Allen has had his face spat at, been threatened with violence and sworn at profusely, and has had paint stripper poured over his car; one of his partners has had two tyres slashed and another a knife scraped down the side of his car. That has happened in cushy, affluent, south-coast Worthing.

The statistics are clear. In Worthing, 14 per cent. of the patients on a typical GP list are aged over 75; that is more than double the national average of 6.9 per cent. On the list of one surgery in Worthing, 22 per cent. of patients are aged over 75; that proportion is thought to be the highest in the country. The proportion of over-85s on patient lists in Worthing is 5.1 per cent.—more than three times the national average of 1.6 per cent. Worthing primary care group has 30 nursing homes caring for 778 people and 78 residential homes caring for 1,515 people. The Shelley surgery has 125 nursing home patients and 190 residential home patients on its list. That works out at an average of 55 per GP, whereas the UK average is five per GP. That surgery copes with 11 times the national average of patients from care homes.

The British Medical Journal states that nursing home patients require just over two times the number of visits required by patients of equivalent age who live in their own home. The home visit rate for over-85s is double that for over-75s, and we know the additional requirements that over-75s bring. However, no additional capitation is available for over-85s. That problem is not unique to Worthing, but many people like to retire to Worthing and, because of the general niceness of the place, they tend to live a very long time. We are delighted that they do, but local GPs face an inordinate amount of extra pressure as a result.

There are many other factors involved. Many people in our town live alone, which is a known cause of increased demand on GP services. In the Central Worthing ward, 16 per cent. of the population are aged over 65 and live alone; the figure is more than 21 per cent. in another ward. That compares to only 5 per cent. of the population in "younger" Sussex towns. Despite those extra pressures, Worthing does not have more district nursing services available than any other area of Sussex.

We have a serious problem with nursing recruitment. There have been 70 vacancies at Worthing hospital for more than five years. There is a particular problem with recruiting practice nurses to help with the work load: they simply do not apply for the jobs. Worthing also has a serious shortage of health visitors to deal with the under-fours. The absence of those extra staff creates additional pressure that falls back on to GPs.

Worthing has more than its fair share of deprivation. Of 155 wards in West Sussex, Nos. 1, 11 and 16 in the rank of deprivation are in Worthing, but local GPs describe the deprivation payments that come within the national health budget as very inadequate. In addition, there are enormous pressures in the mental health sector. We have three homes in the centre of Worthing for long-term psychiatric patients. Many patients have recently moved to the Shelley road surgery area following the closure of Graylingwell psychiatric hospital further to the west: the capitation fee to the GP is much lower, but the patients' problems are not diminished. I remind hon. Members of the tragic case of Sarah Lawson, who was killed by her father while she was in a desperate mental state. He is a constituent of mine and the tragic incident took place in Worthing, although I am sure that the report on it will show that local GPs and the staff of the local care trust offered a great deal of support and performed very professionally.

Extra local pressure is caused by four homeless hostels that contain potentially high demand patients, including people with serious alcohol and drug misuse problems and are therefore susceptible to hepatitis and HIV. There are two local homes for disturbed children, including one for mentally disturbed adolescents from Southwark in London. It is cheaper to house them in Worthing than in London, but they are far removed from their social care workers. A doctor told me that a youngster from one of the homes recently ran amok through the streets of Worthing brandishing a knife. To section him, the doctor had to locate and contact the social worker and psychiatrist in London. In addition, the Shelley Road surgery runs fortnightly methadone clinics on a shoestring budget and meets demands from three local hostels for asylum seekers, with the extra pressure and costs that that involves.

Things are not easy in Worthing and the situation is getting worse. At the Shelley road surgery, each doctor sees an average of 58 patient contacts in a working day: that is one every 8.27 minutes, including home visits and telephone consultations. Those figures represent a 21 per cent. increase during the past six years. The doctors have also to deal with referrals, incoming paperwork, letters and test results that require action. They must also run practice premises, achieve national service framework targets, attend primary care group meetings and postgraduate education meetings, run audits, participate in local development schemes, hold weekly practice meetings, monitor prescribing patterns and keep within their budget.

An enormous extra work load has been placed on general practitioners across the country. They now must administer drugs to deal with cholesterol levels, monitor more blood pressures and achieve blood pressure reduction targets, which involves administering more drugs. Forty per cent. of patients being monitored for blood pressure typically require three drugs to achieve targets, and those drugs must be administered by the GP. They are also administering more antidepressants and treatments for osteoporosis. They, rather than hospital outpatient departments, now give prostate injections, and there have been further shifts from hospitals to primary care in dealing with routine diabetic care and coronary heart disease follow-ups. In addition, the closure of long-stay geriatric and psychiatric hospitals has given greater responsibilities to GPs. Those may be progressive developments, but they were usually made without consultation as to their likely impact on GPs and without proper additional resources accompanying the patients. As one Worthing GP puts it,

"ten years ago most people had never heard of cholesterol and osteoporosis—nobody worried about blood pressure. We now handle an enormous amount of things but have got no extra staff."

All that is without proper additional funding and, as I said, we have woefully inadequate extra capitation for the elderly.

The funding model for GP surgery staff is 30 years out of date. Many GPs have to subsidise from their own pocket the necessary extra staff. It has been estimated that GPs in West Sussex subsidise the staff model by between £750,000 and £1 million a year. There has been an alarming rise in resignations among practice staff: one surgery in Southwick in my constituency has lost five out of its 16 members of staff in the past six months. Losing experienced staff means that it will have to increase the number of new staff, if it can find and recruit them. As a consequence, the staff budget will be overspent by £20,000, which will cost each partner £4,000 from his or her own pocket. As one said,

"in effect, we are being penalised for trying to deliver 'the new NHS"'.

GPs are having to pay to move to new premises in Worthing because the old ones are bulging at the seams; they are not getting the necessary support from the local health authority. There should be sporadic reimbursement for computer equipment, but the total budget for computers in Worthing in the current financial year is, in effect, zero. How are surgeries supposed to modernise? New local development schemes, which the Minister might mention as bringing extra funding, provide only 20p per patient per annum, and practice development money amounts to only £1 per patient per annum—and both have been described as hopeless. Worthing GPs are particularly annoyed to have received no fees from the Government for flu jabs for the over-65s, despite the Government claiming success for averting a flu crisis.

The situation is not a happy one. At the Shelley road surgery, there is a two-week routine wait to see a GP and a one-week routine wait to see a nurse. Out of 48 GP positions in Worthing, there are four full-time equivalent vacancies. The last three advertised posts attracted zero applications, and the health authority acknowledges the problem. As one GP put it, new GPs consider working in Worthing, but decide to move elsewhere because resources do not flow there proportionately. Although nearly all the surgeries in Worthing have closed their lists, the lists continue to increase because the health authority compulsorily allocates additional patients.

The closure letter sent by the Shelley surgery said:

"We write to inform you that we will be closing our list with immediate effect".

Ten reasons were given:

"1. The increasing complexity of medicine with no increase in GP numbers or resources.

2. Extra NHS funding is not reaching GPs in any useful way.

3. New initiatives in primary care mean more work for individual GPs.

4. The continual shift of work from secondary care.

5. We have 11 times the national average of Nursing Home patients…

6. We have a very high elderly population but no extra resources to deal with them…

7. We have significantly less than our share of District Nursing provision within Worthing (based on capitation alone)…

8. The proliferation of high demand children/adolescent units and community psychiatric units in the local area with no extra provision for primary care.

9. We have for many years provided a specialist clinic for drug addicts which has been totally inadequately resourced.

10. The final straw has been the recent dramatic rise in allocations to this practice."

The letter ends by quoting a local GP:

"Safety is one of the most important issues. It is forcing me to the point of being too quick, with a greater potential for missing problems and making mistakes. I feel that there is an abuse of my integral rights as a human being, consistently overloading me with extra work. My only option is to resign and I will be tendering an undated resignation"—

that is a tragic culmination of a GP's career.

There is a crisis not only in recruitment of new GPs, but in retention of experienced GPs. A recent survey in West Sussex showed the age at which GPs hope to retire: 30 per cent. hope to retire between the ages of 52 and 55, and 60 per cent. before they are 60, whereas only 4 per cent. want to retire aged between 60 and 64, and 6 per cent. want to retire as soon as possible. Experienced GPs are talking about leaving an already demoralised service. They cannot be replaced by going to a shop and buying a new packet of seeds to grow some more.

The health authority knows about the problems, but the glossy, professionally assembled briefing pack full of wonderful brochures with which general election candidates were provided may have led one to think that the health service in West Sussex is flourishing. It was difficult to find much discussion of the problems that I have recounted today. The community health council—long may it remain in Worthing, but if the Government revisit their previous intention, it will not last much longer—flagged up four problems: retaining GPs other than those retiring and recruiting new GPs; appointment times for non-emergency conditions extending in many practices; GP contracts being renegotiated with an adverse effect on morale; and the acute need for more nurses to lighten the load, but severe difficulties in recruiting them.

We hear a great deal from the Government about their plans for NHS hospitals in terms of hospital waiting lists and recruitment of doctors, but GPs account for only 3 per cent. of the entire NHS budget. Small wonder they feel that they get a raw deal. In 1990 there were 27,523 GPs and by 2000 their number had increased to 30,252, which is a 6 per cent. increase in working time equivalent GPs, whereas there were 15,520 consultants in 1990, compared with 23,045 last year, which is a 45 per cent. increase. No wonder GPs feel that theirs is the Cinderella service in the NHS. The statistics on GPs are confused by the full-time working equivalent figures: a truer estimate of the increase in the GP work force is probably no more than 1 per cent.

When international comparisons our made, the figures in this country are woeful. There are 554 doctors per 100,000 patients in Italy, 350 in Germany and 303 in France. In the United Kingdom, there are 164 GPs per 100,000 patients; the next lowest figure in the European Union is Ireland's, where there are 219 GPs per 100,000 patients. In the whole of Europe, only Turkey and Albania have a worse ratio than the UK. The future is worrying. According to the British Medical Association,

"The imminent retirement of large numbers of GPs in the next few years in some of the most deprived areas of the UK is a cause for great concern. One in six GPs currently practising in the NHS qualified in a south-Asian medical school and two-thirds of these are likely to retire by the year 2007."

Apparently, only about 20 per cent. of junior doctors are interested in a career in general practice. The BMA says that a 30 per cent. long-term increase in the GP work force is needed, yet in their NHS plan the Government are promising 2,000 more GPs over the next four years, of whom 1,100 were already planned.

No doubt the Minister will say that the Government are doing their best to retain doctors by offering 10,000 golden handcuffs. It seems amazing that doctors are not interested, but behind the figures is the fact that a GP who retires at the age of 60 in West Sussex has an average life expectancy of 14 years, whereas a GP who retires at the age of 65 has an average life expectancy of only two years. That is a no-brainer—£10,000 in exchange for 12 years of life in retirement is hardly an attractive proposition. The Government need to look beyond that gimmick, because it has not been well received.

We worry, too, about the increase in clinical requirements in the NHS plan, as they will require longer patient consultation times even though doctors' schedules are already tight. An increase of one minute in the average patient consultation time is an increase of just under 10 per cent.; that will require a corresponding increase of more than 3,300 GPs. The BMA notes:

"GPs' morale is at an all-time low, with many doctors feeling that patients are being let down. Inadequate consultation times, burgeoning paperwork, a shortage of doctors, nurses and hospital beds plus under-resourced new directives and targets all lead to patients not getting the care they deserve."

That is the verdict of grass-root GPs. When operations are cancelled or people face long weeks of waiting to see a specialist, the family doctor has to keep the patient going until treatment has been delivered. The Government are not facing reality, and GPs are fed up with warm words. One GP quoted in a national newspaper said:

"We just don't seem able to get ministers to listen. They seem absolutely bent on ignoring everything we say. GPs are fed up and when we talk to them around the country the sole topic of conversation is 'When can I get out?'"

That is the nature of the challenge. That is the drastic problem facing the GP service nationally.

All those factors, and more, are concentrated in and around my constituency, especially in Worthing. The risk is that doctors will leave the NHS en masse, and perhaps leave the country or leave the profession when we can least afford it. Help is needed before something breaks. The current situation is not fair to our doctors or our constituents, nor is it safe.

I ask the Minister to have a close look at the problems in West Sussex and Worthing, which have a high concentration of elderly people and problem patients. Sussex and the coastal strip are not wealthy, cushy areas, but the Minister's colleagues have dismissed them as such. We desperately need help. I implore the Minister urgently to consider the matter in the light of the alarming statistics and case studies that I have presented to her. I hope she will agree to meet GPs in my constituency to see what can be done to help them before things really snap.

I congratulate my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on initiating the debate. I welcome the presence of Conservative Members of Parliament from Sussex. The issue clearly matters to Labour Members as well, and I am glad that they are so well represented—[Laughter.] I would like especially to pay tribute to the Whip for his contribution to our debate.

My hon. Friend's speech was far better than any of the rest of us could have delivered. He brought together the points that matter, and I will not repeat them in any detail. I invite the Minister not just to respond to the debate, but to give a lot of thought to how to respond to the issues that have been spelled out.

In Worthing, West Sussex, Sussex as a whole and in the country, great efforts are being made, and I pay tribute to the efforts of the auxiliary staff, support staff, nurses, doctors, managers and administrators across all the health services. However, it is also true that more could be done but is not being done. Many people's experience of the national health service is that it has become a national waiting service. Some things can be put right. There was a time in Worthing when the wait for a 20-minute hearing test at the hospital on the NHS was a year; once the assessment had been made and the hearing aid had been ordered, it took five months to have it fitted—six weeks for it to arrive and three and a half months to get an appointment to be shown where the on-off switch was. However, that temporary problem has been resolved.

Many other waits have not been resolved. Worthing and Southlands hospitals have reduced some of their waiting times, which is welcome, but they remain far too long. My hon. Friend mentioned the situation in Surrey: one in 10 of those waiting for more than a year in Surrey are waiting for in-patient treatment, and the Sussex figures are not that different. However, it is instructive to contrast those figures with those for Durham health authority area that covers the Prime Minister's constituency: there, the rate is one in 100 or one in 200. There may have been reasons why that disparity arose, but there is no reason for it to persist four years after we were told the NHS was going to be saved.

Hon. Members and their GPs all know people who have died because they have had to wait. The debate is not about hospital services, but I do not want to focus solely on GPs and not mention the efforts being made by people working in hospitals. Some complaints are unjustified, others are justified, but all need investigation and consideration. In GP services, complaints about what doctors do are far fewer, but the concerns about things going wrong have been well spelled out by my hon. Friend the Member for East Worthing and Shoreham. GPs hours are far in excess of those agreed for junior hospital doctors, and at least junior hospital doctors are trying to get experience of new sorts of cases.

GPs working 60, 70 or 80 hours a week is not the same as a Member of Parliament working those hours. Much of our work consists of going to parties or listening to our colleagues speaking: we do not hold people's lives immediately in our hands. Every time a GP examines someone he has to ask serious questions—for example, he might have to determine whether a baby has meningitis, which requires him to be alert to symptoms that are not obvious. I pay tribute to a GP who diagnosed an ectopic pregnancy in someone who matters a lot to me. He dropped his surgery commitments and came round after hearing a couple of sentences on the telephone through his receptionist. That is the kind of skill that GPs exercise all the time.

The underlying point—the challenge for the health authority and the Government—is the special position of Sussex, West Sussex and Worthing in particular. The issues that my hon. Friend the Member for East Worthing and Shoreham spoke about—people with special needs who are in their middle years or younger—do not apply only in inner cities. People with such problems live in many different areas—they include troubled teenagers and people who need to escape addiction to illegal drugs or legal ones, for example, alcohol. However, the real problem locally is the population of over-85s. Thirty years ago, health policy administrators understood the extra loads that the over-75s brought, but the over-75s of that era are the over-85s today.

Three years ago, West Sussex health authority carried out a pilot study to find out how to analyse the needs of the over-85s. The study was not continued, in my view because the cost or resources implications were unsustainable at local level, and because the health authority could not justify using the extra resources that would otherwise help family doctors to meet their patients' needs in a humane way if they could not find the cash.

I shall not say how the resource allocation model penalises places like Sussex. We could start a debate about morbidity and mortality rates, but I am sure that the Minister will become familiar with those and many other figures. Instead, I want to talk about what Worthing is showing the rest of the country. My hon. Friend the Member for East Worthing and Shoreham pointed out that the proportion of over-85s in Worthing is five times higher than in the rest of the country. What is happening now in Worthing will be happening everywhere in 20 years' time. The actuaries can tell us how such things happen.

The spread of the over-85s will come about as did the spread of the over-75s. If we had had this debate 20 years ago, and if I were making the same point about the over-75s, people would have nodded and said that I was right. That is certainly what has happened. It will now happen with the over-85s, but the average person of that age will give doctors almost twice the work load of someone aged over 75, which is many times the load imposed by a person of my age. I am 56 and I see a doctor every two or three years for trivial complaints; I am lucky, but it is a function of my age. However, when I am 75, I am likely to need to see a doctor once a month, and when I am 85 I might have to see a doctor once a week.

That acceleration puts an extra burden on GP services and on their staff and surgeries. The doctors do not mind doing the work—in fact, most of them go into medicine, and most of their nursing contemporaries go into nursing, to help people avoid illness and disease, to help cure those who can be cured and to care for those who cannot be cured. The question is how much of that burden each of them has to shoulder. The fact that 11 per cent. of patients in West Sussex are over 85—the national average is 5 per cent.—has an impact on doctors' surgeries. That should be recognised; an extra doctor, or even an extra half doctor, would make a difference to the work load. It would also allow a bit more room in what I think of as the concertina.

None the less, the problem remains of what happens when a doctor retires, or is sick, or is called away to help run the local primary care trust. This may be the right place, but it is not the right time to rerun the argument on GP fundholding. There are some excellent GP fundholding practices in my constituency, which includes Rustington, but we are now to have primary care trusts. I shall not argue about that today. However, I strongly support what my hon. Friend the Member for East Worthing and Shoreham said in connection with the community health council, and I plead with the Minister to ask her colleagues not to abolish CHCs.

The work of Trevor Richards, chief officer of Worthing and district CHC, and his colleagues has been important and I pay tribute to them. It was their asking whether the Association of Community Health Councils opposed the Government's determination to abolish the councils that began to make the difference, and the timing of the election has made it possible for the Government to think again. I ask them to do so. I ask them not to abolish community health councils. CHCs' work can be expanded into the family doctor field, but the experience that they bring to the job cannot be supplied by reconfiguration, patients' advocates or the other arrangements that the Government have in mind. I do not ask the Minister to say this morning that Government policy will be changed, but I ask her to present our plea to the Secretary of State and the Prime Minister.

I also ask the Minister to request that the Secretary of State and the Prime Minister visit the coastal area of Sussex, together or separately, for a private meeting. I would suggest that the doctors came to No. 10 or to Richmond house in Whitehall, but the travelling time would result in their being unable to see 30 or 40 patients. If the Secretary of State or the Prime Minister could spare the time, they should come to Sussex to meet the doctors, nurses, support staff and local managers and administrators. By all means, let the meeting be private—there is no need for cameras to be present—but it is important that they hear directly from those who can reflect upon today's conditions in Sussex, which will spread around the country over the next 10, 20 or 30 years as the benefits of old age and the consequent burdens on the health service extend.

I pay tribute to the doctors who raised this issue in a responsible manner. The headlines said that no more patients would be accepted south of the railway line in Worthing, but the doctors knew that if a practice kept its list open while others closed theirs, it would get all the new patients. By closing their lists, practices required the health authority to make allocations, but that does not solve the underlying problem of the excessive burden. If the Government could see a way forward through the health authority and implemented a plan to get resources through—rather than relying only on words and charm—doctors would notice the difference, and patients would, too.

I have been a Member of Parliament for quite some time, although not for as long as you, Mr. Winterton. I have had experience of GP services in depressed areas of Victoria, in Stockwell in south London, and in my previous constituency in south-east London. I am now watching GPs in my Worthing constituency. Partly because of conditions there and partly because of the age of the people and the burdens involved, the stress and strain in Worthing are greater than any I have known during 26 years as a Member of Parliament.

I plead with the Minister to ensure that resources can flow and that the approach to the problem can be modified, so that GPs can do their work and meet our constituents' medical need.

I congratulate my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on his excellent speech and my hon. Friend the Member for Worthing, West (Mr. Bottomley) on reiterating the points that it raised. I also congratulate and welcome the Minister. The spirit of today's debate is non-partisan—it is about solving practical problems.

I cannot add to the well researched presentation of my hon. Friend the Member for East Worthing and Shoreham, which dealt with problems along the Sussex coast. If I may, however, I want to discuss an instance involving GPs slightly to the north, in my part of Sussex. I, too, plead for the Minister's help to solve a fairly simple problem—it will involve no cost to the Government—that illustrates some of the problems that GPs elsewhere encounter.

In Pulborough, we have outstanding doctors. Two fundholder practices came together to create a bunch of incredibly hard-working and innovative doctors who serve their community well. For two years, they have been working on plans for a remarkable new centre, which was to have been a model for the country and to have received a beacon award. To get the necessary funding, they used local help to put together a scheme with the Dunhill trust. At the time, they had the support of Horsham district council.

The scheme addresses several problems constructively and collectively. First, the new medical centre would provide nursing care facilities, operation facilities and convalescent facilities—services that a rural community needs. Secondly, by moving into the Horsham and Chanctonbury GP group area, the scheme would gather 140,000 patients who would render the future of St. Richard's hospital much more secure. One of our problems is whether hospitals have enough patients to guarantee their futures; the scheme would indirectly address that and enable consultants to come out and do a lot of operations on the spot. Clearly, the doctors could not finance such a scheme by themselves, so it was a blessing when a charity was brought in to put up the finance and combined the scheme with the provision of a modest retirement village. That would also meet a need, as that part of the world has nowhere of a sheltered nature for elderly people to go, which presents other social problems.

The scheme was worked out over two years. The district council identified the Oddstones site as suitable and suggested that those involved apply for it. Then planning policy guidance note 3 was introduced. At the last minute, the head of planning took the view—wrongly; the note contains certain qualifications— that he could not recommend the site after all because the majority of it was greenfield land. As a result, the planning committee, doing what it thought was its duty, turned the application down. The doctors have spent £100,000 out of their own pockets on planning costs. The district council, trying to be constructive, has made some alternative suggestions but, for a variety of reasons, those will not work.

I was in contact with the Minister's predecessor, the hon. Member for Birmingham, Edgbaston (Ms Stuart), about the scheme, because it would have been a model for the country. West Sussex health authority and the national health service had offered tremendous help, but the rather unhelpful letter that I received—I am sure that it was not written by the former Minister herself—said that the health authority could not be involved in planning issues. That illustrates the precise point that the Chancellor of the Exchequer has endeavoured to address. We have held huge public meetings—attracting 10 times as many people as any political meeting—as the community is genuinely furious that a project that everyone wants is being frustrated.

The community does not want any more housing than it needs, nor does the problem involve choosing one section of the community over another. There is a castiron case for using a bit of greenfield land because that is the only land that would meet the criteria for the site. I have written to the Secretary of State asking for help because there is no point in having a public appeal to finance a planning appeal unless such a planning appeal has a chance of success; otherwise we would be misleading citizens. The doctors cannot be expected to finance that, given what they have already spent to no avail. The issue is bipartisan, involving health and the environment, and the essence of the decision to be made is political: is there a possibility of PPG3 being interpreted in a different way? The question is then whether the health case for the total combined package and the model that it represents are sufficiently deserving to warrant such an interpretation.

I warmly invite the Minister to come and look at what is being planned at the same time as she looks at the more acute problems in coastal West Sussex. It is an example of doctors, on their own initiative, seeking to solve several major problems of the community. They have constructively found the resources to address the problems yet—incredibly frustratingly—they have been blocked by what is perceived locally as narrow-minded pedantry arising from a different issue, that of excessive housebuilding in the area.

We all face the problem of an ageing population. The question in West Sussex is what is the right level of resources for both GPs and hospitals in a community that has both a high average age and an increasing number of people aged over 85. The problems of GPs differ between rural areas and the south-coast urban area. The pressing need in rural areas is for the type of centre that I have described. A lot of beds will be released if there are local convalescent facilities, and a great deal of time and expense will be saved if many minor operations and nursing care can be undertaken in a local centre. For a group of doctors who have come up with the answer to be frustrated in such a way is not only a shame, but a disgrace. I plead for the Minister's help.

Before I call the hon. Member for Romsey (Sandra Gidley) to speak for the Liberal Democrats, I remind the Chamber that the debate is fairly narrow, relating to NHS GPs in Sussex. I shall be generous in showing discretion. and no doubt hon. Members will want to draw comparisons, but I urge them to note the narrowness of the debate.

I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton). I could not disagree with anything he said—he may find that unusual coming from a Liberal Democrat. The hon. Members for Arundel and South Downs (Mr. Flight) and for Worthing, West (Mr. Bottomley) also raised pertinent points. I understand your warning. Mr. Winterton, but the speeches that we have heard not only describe problems in Sussex, but tell of events around the country. From Sussex to Sunderland, from Cumbria to Cornwall, the problems highlighted are present in varying degrees. The hon. Member for East Worthing and Shoreham referred to GPs as normally mild-mannered individuals. I agree. Most people share that perception of their family doctors. However, when I was at the BMA conference last week, I realised that the people in the hall were angry—they had had enough.

Before I turn to more general points, I should talk about the specific problem of an ageing population, which has been identified in Sussex. GPs receive more money for elderly patients, but the way in which contracts have developed has shown a sticking-plaster approach. GPs realise that they have more work to do for elderly patients, they negotiate a little more money, and on the system goes, but as the needs of the elderly become more complex, they require a lot more time, and time is money. There is a balance to be struck. Even if a GP has plenty of work, his patient numbers remain the same, which is a problem. A GP from the north of the country told me that things balance out somehow, but that is clearly not the case. It was said that what is happening in Sussex will happen throughout the United Kingdom in 10 or 20 years. GPs in other parts of the country do not face the problem so acutely, so I thank the hon. Member for East Worthing and Shoreham for making that good point.

GPs want increased time for consultations and are scathing about the 48-hour target that the Government have set for appointments. Some people can wait: those having routine appointments do not need to see a doctor within 48 hours, so it is patently ridiculous to set a target for them, whereas people who require urgent help need to receive it within 24 or 12 hours. We have set a target without thinking about what we need to achieve for the benefit of the patient.

The GP's job has changed. Thirty years ago, GPs referred tonsillitis to specialists, but they would be laughed at if they did so today. There has been a shift from treatment in hospitals: there are no general physicians in our hospitals now; everyone is a specialist. Conditions such as asthma and diabetes are managed in the surgery, which takes an increasing share of the time of doctors and other staff.

It is frustrating for doctors that to an increasing extent they have to manage patients who are on a waiting list. In many areas—I suspect that it is so in Sussex—there is a wait of 18 months for an orthopaedic appointment. In that time the burden of managing the patient's pain and expectations falls on the GP, who probably in the end prescribes antidepressants—after all, it is pretty miserable to wait 18 months for an appointment. More multiagency working is also taking place. Often funding must come from health, education or social services, so more GP time is taken up in meetings. We all know how frustrating and time-wasting those can be.

Computerisation has been mentioned, but no one pointed out that, because most computers are surgery based, GPs who previously took notes home to work on them must arrive at work an hour or two early to update records on the computer.

indicated dissent.

That is not just my view. If the Minister does not agree, perhaps she would like to look at a series of press cuttings compiled under the heading "A time for general practice". There are many quotations from GPs telling how it is.

The stress of being on call has increased. The requirement has grown over the years as many GPs—especially older ones—decide to sacrifice income and pay to have a good night's sleep. GP morale is at an alltime low, and not just in Sussex. Dr. John Chisholm, who chairs the BMA's general practitioners committee, has said:

"First rate family doctors feel their patients get a second rate NHS service—or worse. Many doctors say they are planning to retire early, or leave the profession, rather than go on with the intolerable burdens of paperwork, bureaucracy and the frustration they feel from fighting to get appropriate treatment for their patients."

It is not just politicians, therefore, who are making such points. It is doctors.

There are also problems of recruitment. I have talked to a local GP about this and we have heard about a similar state of affairs in Sussex. Twenty years ago there would be 30 applicants for a job in a certain practice; four years ago there were three applicants for a job in the same practice; another vacancy arose recently and not a single person applied for the job. If our doctors do not want to become GPs, we shall face a crisis. There was a crisis of GP provision in the late 1960s. Reference has been made to the Asian work force. In the 1960s efforts were made to find GPs abroad, but most of those GPs work in the more difficult practices and are approaching retirement age. We desperately need ways to tackle the problem that will probably hit us in about six years.

A recent survey showed that about 80 per cent. of family doctors will consider resigning their NHS contracts next spring if the BMA's GP committee is not able to secure a new and acceptable contract. Negotiations are under way. A public perception survey showed that 72 per cent. of people thought their GP was either fairly overworked or very overworked. If the people whose views were sought heard today's debate, the percentage would probably increase.

We have heard about the rise in the number of consultations per GP, which is contributing to the problem, and about the number of additional GPs announced under the NHS plan—not 2,000 but 900, and it is not even certain that those are to be fulltime equivalents. The BMA has calculated that an extra 10,000 GPs are needed to meet increased patient expectations and to cope with the demands of the national service frameworks. However, the Government appear to have developed an ostrich approach to the problem. A BMA briefing states:

"The Health Departments…did not accept that there was a significant problem with morale and recruitment. They accepted there had been an increase in workload, but maintained that it could be addressed by working smarter as well as harder."

I am sure that Members of Parliament would not like to be told that. The briefing adds that

"they declared that the availability of NHS Direct and skill mix options should reduce work for GPs."

That really is the ostrich approach.

The doctors speak for themselves more eloquently than I can. The final comment that I want to use comes from someone in Cumbria; I apologise for the fact that it is not from Sussex, but the problem is nationwide. The person states:

"We are simply pig sick of the health service. We are having to deliver government promises to patients with no extra funding. This is not a party-political statement as the fault lies equally between the last Conservative Government and the current Labour Government. They have promised and are promising the earth to patients knowing full well that we cannot possibly deliver and it is the patient at the end of the day, who is suffering.

Roughly an extra £10 million has been given to North Cumbria…Very little has filtered down into primary care and yet doctors are being expected to deliver on the new national service frameworks for all sorts of different treatments; asked to carry out appraisals on all staff; reorganise counter services; make improvements in line with national directives; prescribe more expensive treatments; constantly report back to our health authority on a vast number of issues and fill-in a whole host of documentation.

There won't be a GP left in Cumbria"—

any part of the country could be substituted for Cumbria, I think—

"who is not fed-up with this system".

Order. Is the hon. Lady going to mention Sussex?

I am sorry, Mr. Chairman. To keep you happy, I will substitute Sussex for Cumbria.

On a point of order, Mr. Winterton. Who is the Chairman to whom the hon. Lady keeps referring?

I am being very tolerant today. I am not yet an additional Deputy Speaker for sittings in Westminster Hall. The hon. Lady can call me Mr. Chairman or Mr. Winterton. I accept either.

Now, back to Sussex.

If we were on the radio I should press the button to challenge for hesitation.

I have already been accused of deviation for not speaking on Sussex, but I shall carry on and finish the quotation. It continues:

"We've been piggy in the middle for too long working with diddly squat and we've had enough. We've been running so fast for the last ten years just to land up standing still. We're exhausted, fed-up and are now ready to say we've just had enough."

I congratulate my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) on securing this debate and raising important issues. I also congratulate and welcome the new Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), to her important job.

What has been said this morning about West Sussex is to a great extent true of the whole country, although my hon. Friends have raised an important point about the mechanism for allocating funding to health authorities and the system's apparent failure to recognise the severe problems caused in some areas by increases in the elderly population. However, that is a matter for another debate. The Government are examining the allocation mechanisms for health service spending, so no doubt we shall return to the subject.

More than nine out of 10 patient contacts in the national health service are at primary care level, and the majority of those will be with GPs or their staff. The family practitioner service is the jewel in the crown of the NHS. On the whole, it has served the NHS extremely well and provided an efficient, relatively low cost and high quality service. It is apparent to us all that that jewel is under severe threat, and I am amazed that the Government appear to be willing to tolerate that threat to a service that is the core of the NHS, especially in view of the fact that the NHS plan states that development of primary care services is to be the key to the modernisation of the NHS.

I would like to take hon. Members back to before 1997, to fundholding. I shall not argue the merits of fundholding. It had its faults and never covered a sufficient percentage of practices to be evaluated fully. However, from the fundholding experience, I want to draw out a fact that the Government now recognise, which is that entrepreneurial spirit can be unleashed in the delivery of public services. When it is unleashed, it is a powerful force that empowers GPs to develop their practices and find best practice solutions for their patients. The primary interest of the vast majority of GPs is to serve their patients and develop professional services for them, and they can do that enthusiastically using their undoubted skills and imagination. Fundholding certainly stimulated something in the GP population.

Order. Will the hon. Gentleman refer to fund holding in Sussex?

I am grateful to you, Mr. Winterton, for reminding me that fundholding practices in Sussex made an important contribution to the delivery of services in that area. By contrast, GPs in Sussex have found the Government's reforms prescriptive in nature and bureaucratic in structure. The reforms have created significant additional bureaucratic work that has undermined Sussex GPs' ability to use their professional judgment in the interests of their patients. The Government's attacks on the medical profession in Sussex and their sometimes unwise inflation of patient expectation in Sussex and elsewhere have caused morale in general practice to fall to an all time low ebb. No one can doubt that, so I shall not quote from the report of the BMA conference with which we are all familiar.

The Government's agenda is to shift the emphasis of service delivery to the primary care sector and to propose better quality GP services. Most GPs think that that should involve spending a longer time with their patients, but the Government focused on the time before access to a GP is achieved and set a 48-hour target. Additional pressures arise from the Government's programme. I accept that some of the measures are entirely necessary and inevitable, for example, revalidation and continuing professional development, but they must be seen against the demographic background that we have heard described, which will place incredible pressures on the service in future.

My concern is with the Government's response to the problem. In the national plan, they set out several outcome targets including a target for access to GPs. They underpinned those with some input targets that they must know will not deliver the output targets in the plan—the former Minister of State, the right hon. Member for Southampton, Itchen (Mr. Denham), came close to admitting that. The Government have raised public expectations that cannot and will not be met. That places GPs in Sussex and elsewhere under extreme stress and pressure. Day in, day out, they face patients whose expectations have been raised, but the GPs do not have the wherewithal or resources to fulfil those expectations.

The hon. Member for Romsey (Sandra Gidley) spoke about the GP numbers in the national plan. The Government have set a figure of 2,000 additional GPs by 2004, but the BMA says that 900 of them are already in the system, so the figure represents only 1,100 genuinely additional GPs. I do not want to get into an argument about that, but I am concerned that the figure of 2,000—as against the BMA's figure of 10,000—does not represent whole-time equivalent GPs.

I should tell the Under-Secretary of State that there is no doubt about that. I asked the former Minister of State an explicit question and his answer was explicit: it is a head-count figure. That means that if 2,000 full-time GPs retire or leave the service and 4,000 half-time GPs are recruited, the Secretary of State will be able to say correctly, arithmetically speaking, that he has met the target of delivering an additional 2,000 GPs. However, not one additional doctor-hour of patient service will be available.

That problem must be seen against the backdrop of the changing profile of the medical profession and the increasing feminisation of the medical work force. Across the nation, 34 per cent. of GPs are female; that is a fair reflection of the position in Sussex. Last year, the majority of entrants to medical schools—58 per cent.—were female. Our medical work force will, therefore, become increasingly feminised. That is a good thing, but the Government must recognise the fact that female doctors, because of family responsibilities and a greater predilection for part-time working during at least part of their careers, contribute fewer working hours on average over their careers than their male colleagues. That means that, as the medical work force is feminised, it will have to get larger to keep the service at a standstill.

The figures in the NHS plan, which are not whole-time equivalents, take no account of such factors. There is a real probability that the Government will meet the target that they have set themselves in the NHS plan in technical terms, but deliver fewer general practice doctor-hours in total. I challenge the Minister to explain why the Government do not express their targets in whole-time equivalent GPs. That would be a meaningful figure and would underpin, in a way that could be understood across parties and in the community, the Government's laudable strategy to increase the number of part-time workers in the NHS by luring back into the service people who, for various reasons, including family responsibilities, are unable to give a full-time commitment.

There is another problem. The Minister will no doubt tell us about the increased numbers of training places. The Government have committed themselves to creating 450 additional GP training places by 2004, but training GPs is not enough: we must get them to join the service once they have completed their training. However, conversion rates are falling: in 1996–97, 1,029 doctors joined general practice; in 1999–2000, the figure fell to 958. Whether we like it or not, GPs are among the best educated and best trained members of our work force and they are generally endowed with some of the best interpersonal skills. They are therefore much in demand outside medicine. I am sure that other hon. Members know many GPs who have been recruited away from medicine to other careers.

We must recognise those competing demands. The NHS will never be able to compete simply by offering GPs financial incentives, and I do not think that it should. Obviously, money is important, but it is not the whole game and is probably not the most important factor. GPs want the freedom to exercise their professional discretion in the interests of their patients. They want freedom from scapegoating by the Government. Of course there are a few rotten apples in the barrel, as there are in any barrel. Even in so joyous a place as Sussex, we find the odd GP who falls short of the standards that we all expect. However, the vast majority have, as their primary and overriding concern, the ability to deliver, with the benefit of their extraordinary skills and professional training, the best possible services for their patients. To do that, they need not only the resources and the support of Government combined with freedom from scapegoating and the blame culture, but the liberty to exercise their professional judgment locally in the interests of their patients.

The Government must recognise that the primary care group-primary care trust experiment, whatever else it may bring or has brought, has not engaged GPs at the grass roots as was anticipated. It has not provided an alternative mechanism to fundholding for unleashing the entrepreneurial spirit among GPs. The Government must recognise that the practice is the fundamental unit for general practitioners. They need to enthuse and inspire GPs at that level if the services that the public expect and the Government want are to be delivered.

That brings me to my final point about the delivery of first-class general practice services in Sussex. During the general election campaign, the Labour party and the Prime Minister offered the British people world-class public services—not just good or better, but world-class. The ball is now firmly in the Government's court: they have been given a clear mandate to deliver those world-class public services. The Minister must know that the public will be watching. In this Parliament, the Government will be judged by their success or otherwise in delivering world-class public services. They cannot do that in relation to health care unless they win over the GPs in Sussex and elsewhere by inspiring them and empowering them to deliver and develop their professional practice for the benefit of their patients. Unless they have the freedom to do that, we will never restore general practice to what it was and should be—the jewel in the crown of our national health service.

In calling the Minister to reply to the debate, I, too, congratulate her on her appointment.

I congratulate the hon. Member for East Worthing and Shoreham (Tim Loughton) on securing this important debate. I have welcomed the atmosphere and tone in which it has been conducted and have learned a great deal, particularly about the hon. Gentleman's constituency and the specific problems there. I would also like to thank all hon. Members for their kind words of congratulation. I will do my best to address my comments to Sussex and Worthing and to be as direct and focused as I can.

I represent an inner-city constituency that has many problems of deprivation, but that does not mean that I do not recognise that there are sometimes real pockets of hardship, poverty and deprivation in seemingly affluent areas, especially in many of our coastal towns. There are particular problems associated with the structure of the population in such places, and the hon. Gentleman has highlighted the issue of NHS care for the elderly. About 75 per cent. of the NHS centres on care for older people; it is a fundamental part of the service and we need to take it into account.

The hon. Gentleman raised the issue of the combination of services. Older people are not the only ones involved. His area has four hostels for the homeless and a number of institutions looking after vulnerable children. I have been made aware of that combination—he referred to it as a cocktail of ingredients—and I will take it seriously.

Several hon. Members asked if I could arrange for my right hon. Friend the Secretary of State or the Prime Minister to visit the area and talk to GPs and listen to their problems. I cannot promise the Secretary of State, and I certainly cannot promise the Prime Minister, but I can promise myself. I have regional responsibility for the area and I intend to get to know my areas in detail. I want to listen to the GPs and the nurses, the people working at the front end of our services, to find out what it is like on the ground. There is nothing more valuable than hearing people speak in their own voices, rather than reading official documents. Much to the disquiet of some of my officials, I intend to go out during the recess on a tour of the areas for which I am responsible. I shall do my best to visit the areas that are represented by hon. Members who have spoken today.

Let me start my first debate as Minister by paying tribute to all who work in the national health service. They have changed the landscape of the NHS in recent years, and have a key role to play in its future. The hon. Member for Runnymede and Weybridge (Mr. Hammond) referred to public sector entrepreneurs—a phrase that was, I think, first used by my right hon. Friend the Secretary of State. It is good to find that we share a view. In my constituency, a school for social entrepreneurs is developing the imagination, creativity and innovation of people in the public sector. Staff are the key to developing different ways of working.

However, today's debate is about GPs in Sussex. We owe GPs a great debt. I acknowledge the energy that they put in day in, day out, week in, week out. We have heard about their long working hours and their tremendous amount of patient contact. Their commitment is resulting in improved services in all communities. Because the Government recognise the pressures on GPs, we made a commitment in the NHS plan to help to develop primary care services. The hon. Member for Runnymede and Weybridge told us that 90 per cent. of patient contacts in the NHS are at primary care level. That is why the development of primary care is the key to modernising and improving services. One of the things that we have constantly emphasised is our desire to give people in the front line the power, the resources, the money and the decision-making opportunities to change the services that we provide.

Let me run through a few of the things that the Government are doing. I shall not have time to tell hon. Members about everything in the NHS in 10 minutes, but I hope to expand on some issues in future. We are investing £100 million over the next three years to encourage the recruitment and retention of GPs. Some of that will be spent in Sussex. Although new GPs receive £5,000 to enter general practice, I acknowledge that financial incentives are not the be-all and end-all. People work in public service because they believe in it and they want to provide services to their communities. However, financial incentives can help when they are deciding where to practise and what kind of work to take up. It is important that the Government acknowledge the need to attract more people to general practice by providing extra incentives.

We are also trying to provide extra incentives for women returners. The point was well made about the increasing feminisation of the service and the need to ensure that women can continue to practise and that their skills remain up to date while they are at home caring for relatives or on maternity leave. We have introduced a scheme under which women work for four sessions a week in the NHS to maintain their contact and to continue their professional development, so that when they are ready to return, they constitute another pool of workers from which to draw.

We are investing £100 million to support service development. Sussex received £3 million this year—that is about £10,000 per practice, half of which can be spent entirely as the practice wishes. It is important for creative and innovative GPs to be given the resources to change their practices. We recognise the personal strains on GPs, which is why we are setting up the first ever occupational health service for GPs. If we do not look after their health, their ability to care for others may be impaired. In addition, we are trying to reduce the administrative burden on GPs, although there remains a lot more to do. We have saved them from having to sign applications for passports and driving licences, and all the extraneous things that people ask doctors to do. Doctors should be doing what they do best: seeing patients, providing consultations and working out care plans.

We are also modernising the surgeries of 3,000 GPs. It is important that GPs, like Members of Parliament, work in a decent environment, because people's working environment affects the quality of their work.

Order. Is the Minister going to advise us how many surgeries in Sussex have been modernised? It would be helpful if she directed more of her remarks to Sussex.

I am grateful for that comment, Mr. Winterton. I am sure that at least a proportionate amount is being spent on modernising GP practices in Sussex—[Laughter.] When I visit the area, I shall have the opportunity to see for myself the improvements that are being made. I look forward to it.

We are also increasing the number of GPs, although it is a slow process. The target in the NHS plan of 2,000 extra doctors is a floor, not a ceiling. We would like more GPs—indeed, we have asked the BMA to suggest ways in which we might increase the number of doctors. The BMA has not yet responded, but I hope that it will. In fact, the number of GPs in Sussex has increased from 802 in 1997 to 835 in 2001. It is not a huge increase, but it is going in the right direction.

Will the Minister say whether that number is a whole-time equivalent, or whether it is a simple head count that conceals an actual reduction in whole-time equivalents?

I do not have that information with me today, but I shall find out and let the hon. Gentleman know.

We are moving in the right direction. I remind the Opposition that GP numbers began to fall in 1991 and continued to fall for the next five or six years; only now are we beginning to solve the problems caused by the massive reduction in training places that took place under the Conservative Government. I appreciate that we are not here today to make party political points, but we should remember that the GP training places and GP numbers fell dramatically under the Conservative Government.

If the Minister cannot cover the subject in the remaining few minutes—I realise that we do not have much time—would she write to my hon. Friend the Member for East Worthing and Shoreham, sending copies of the letter to the rest of us, saying how she plans to analyse the additional burdens imposed by the over-85s? My hon. Friend and I both spoke about the need to look forward. It may not be possible to answer that question today, but we should be grateful if she would to write to us.

I certainly shall. In the few remaining moments, I shall try to give some pertinent examples of how GPs are being helped to look after elderly people in Worthing.

First, local primary care groups are considering how to use nurse practitioners to provide general medical care in nursing homes. They are already running clinics that deal with coronary heart disease and high blood pressure, which relieves the burden on GPs. Three GP practices in the area now have a dedicated health adviser for the elderly, providing support especially for the over-85s. Under a local scheme, the scoring assessment for those who need cataract operations is now being made when they visit the optician, so that they do not have to return to their GP; that innovation, too, is relieving pressure on general practitioners in the area.

Many general practitioners in Worthing and in Sussex generally are embracing change and innovation. They are looking to the future and are prepared to consider new solutions. We have heard a great deal today about the problems of general practice. The challenge for the Government and for Parliament is to try to come up with long-term, sustainable solutions so that GPs feel really valued and know that they are an important part of the health service. The innovations that we are introducing in Worthing, Sussex and elsewhere help to support GPs in their work.

I must also mention the work of NHS Direct. That service takes thousands of calls a month. It refers people to different kinds of care, gives them advice on how to look after themselves, and refers them to pharmacists, midwives and a range of other services.

If long-term sustainable solutions to the pressures that GPs undoubtedly face are to be found, we politicians must be more creative and more imaginative—we must work smarter and not simply work harder. We need to achieve investment at the front end, so that we can provide patients with appropriate care. It is not always right to visit the general practitioner; patients can often receive care in other ways and in places that are quicker, more appropriate, and that better meet their needs.

We have a responsibility to look creatively at the whole of the health service. We value general practitioners enormously, but we must not forget that the NHS comprises a range of primary care workers, whose contribution I acknowledge. Nurses, advisers and community-based workers are doing a marvellous job in supporting patients and providing services. We rely on them. I want to ensure that they find their working lives enjoyable and satisfying, rather than consisting wholly of pressure and overwork.

I rise from this phalanx of east midlands Members of Parliament to raise a subject that I believe will engender a lively debate. I shall start by setting out the principles on which any modern transport strategy should rest. First, every citizen should be able to fulfil most of his or her daily needs by travelling on foot or by bicycle, which requires, as I shall explain, a change in the way in which we plan our built environment. Secondly, every citizen should have access to quality public transport—by "quality" I mean sufficient to enable people to get to work or to fulfil normal shopping needs. By that criteria the twice-weekly bus service common in some of my villages is inadequate. Thirdly, people need comfortable, affordable access to other parts of the United Kingdom. Delightful though South Derbyshire is, its inhabitants sometimes want to travel to other parts of the country reasonably cheaply and comfortably, without difficulty in accessing the mode of transport that they use from where they live.

Fourthly, companies in our region should have speedy access to their markets and to other parts of their supply chain so that they can build more successful enterprises and reach new markets and new customers. Fifthly, our modes of transport should be integrated. It is not enough to have a bus service if it does not link to the rail network or to the local airport. Such links are sadly too often missing, both in the east midlands and in other parts of the country. Sixthly, information should be made available to people to enable them to make informed transport choices. It should not be difficult to find out where one can catch a bus or a train, or what air services are available in an area. Again, there is a need for improved information and communications technology, in the interests not merely of creating better informed citizens but of creating alternatives to transport.

Seventhly, we need to ensure that alternative transport choices and fiscal measures discourage the most polluting car uses. I represent a rural constituency and recognise that possession of a car—I have one—is virtually essential to carry on any sort of normal life in my area and, although we cannot see too far into the future, probably always will be. However, we want to ensure that we take measures that encourage the most efficient use of a car and not the gas-guzzlers that are still on our roads. Eighthly, we should try to ensure that information and communications technology is fostered in a way that allows people to choose not to travel at all, so that people could, for example, work from home for a substantial part of their working life, thereby minimising transport use.

How can we apply those principles in the east midlands? Our demanding economic goal to turn the east midlands into a top 20 region within Europe by 2010 is made more complex by the fact that the region is substantially rural. People choose to live there because of the smallness of many of the communities, the delightful countryside around them and the quality of the environment that people can enjoy. The last thing that we want is to develop a successful region by polluting its attractiveness and destroying the reasons why many people choose to live and work there. Therefore, transport strategy and the choices that we make are crucial parts of building that successful economy and protecting the things that most of us regard as essential if the east midlands is to continue to be an attractive place to live and work.

Specific measures that must be taken include improving the quality of the rail services in the region. It is crucial that we upgrade the Midland Mainline service between the Derby area, which is the part of the region that I represent, and London. That means increasing the speed and frequency of the service that is available.

Does my hon. Friend share my concern that, in the 10-year transport plan, the west coast main line and the east coast main line are both listed for major investment, but there is no mention whatever of the need to invest in the midland main line? That will have terrible consequences on urban conurbations such as Nottingham, Derby and Leicester.

I entirely share that view. However, a seed of hope—perhaps the Minister will reassure us—in the M1 multimodal study, which I will touch on shortly, is the emphasis on and thorough exploration of upgrading the midland main line as an alternative to some of the more frightening prospects of widening the M1

Corby is the largest town in Europe without a passenger railway station. Midland Mainline has been involved in a feasibility study with a view to reopening the railway station in Corby to make a direct route between London, Corby, Nottingham and the north. A passenger railway service is vital to Corby's regeneration and to attracting new retailers and new building to the shopping centre.

Although I am not nearly as familiar with the needs of Corby as my hon. Friend is, I share his view. A community the size of Corby should have a proper rail service, and the lack of it certainly makes it more difficult to attract inward investment and to regenerate the town further—I recognise that there has already been a great deal of success. The position in my constituency is substantially worse than in many others, as there are no rail services in any part of South Derbyshire, except for the two little villages of Willington and Hatton. Swadlincote, the only town in my constituency, lost its railway service in the Beeching cuts. I shall return to that subject shortly.

In developing a strategy for the east midlands as a whole, we should also explore the need for dedicated rail freight services. That might require support for Central rail. I have an open mind about that: there are some advantages to the Central rail project, but it needs further study. It would be a brave private sector initiative to provide a link from the north-west to London and then into Europe. It would run through our region and provide significant advantages to the areas that it touched. Regardless of that proposal, it would be desirable to increase substantially the freight carried by rail, perhaps moving towards the goal of 10 per cent. of total freight volume by 2010.

We must invest in new local rail services to link the major routes—in this case, the midland main line—to centres of population. That would reduce road use, and I can use myself as an example. When I work at the southern end of my constituency in Swadlincote, I have to use a car, either to reach the rail network or to drive down to London to get to Parliament. The links to the rail network are inadequate, and it takes about half an hour to reach any rail station from Swadlincote.

There is the opportunity to open the existing rail freight line that runs through part of my constituency. It has been called the Ivanhoe line or, increasingly, the National forest line because of its route through the National forest, which is developing successfully throughout that part of our region. The line would provide passenger stations in my constituency on the edge of Swadlincote, as well as linking into Burton and areas of the constituency of my hon. Friend the Member for North-West Leicestershire (David Taylor). I was pleased to see that that option was recognised by the M1 multimodal study as a possible way of dispersing traffic from the M1. I attended the meeting at which that was discussed, and commend the imagination shown. I recommend that approach to the Minister as another reason for supporting the National forest line, together with the opportunities for regeneration and improvement of the environment in South Derbyshire and North-West Leicestershire.

We must invest in railway station improvements, because some stations are unattractive. There has been a welcome programme of improvements in Derby, but other stations in the region do not encourage people to use them. The investment in the new parkway station south of Derby would substantially increase the attractiveness of the Midland Mainline to many people. It would make it easier for people to reach a railway station to join a mainline service, rather than having to choose the unappealing option of heading into a major city.

On the road network, I have already mentioned the M1 multimodal study and I commend its imaginative approach and breadth of vision. I was impressed by the initial consultation document, which set out many alternative strategies to the obvious option of providing more lanes and changing the interchanges for the Ml. That should be the least favoured option, and we should ensure that the study produces action on a range of alternative measures that reduces traffic on the M1 and prevents the need for substantial road widening. I have touched on some initiatives—improving the midland main line is certainly one, as was recognised in the strategy, and the Ivanhoe line is another—and many others are available. I understand that the multimodal study will be published later this year, and many people are looking forward to its contents. I am looking forward optimistically and hope that it will dispense with the arguments for massive road widening along much of the route.

Another multimodal study affects one crucial issue in regional planning, which is linkage between regions. We all represent east midlands constituencies, but we must remember that the region links into other parts of the country as well. The multimodal study on the A38, which touches one side of my constituency, is also crucial, but now I must be rather less positive. The initial information that I received showed that people were starting strongly to favour major widening schemes along the A38. I am not saying that none of that is necessary. The road is heavily used and links Derby, Burton and Birmingham, but I was disappointed at the lack of consideration for other modes of transport, and particularly other interchanges with other modes of transport, that might be fostered.

I shall now deal with air transport. East Midlands airport is a major economic growth point in the region, as everyone examining economic strategy for our region has recognised. We all welcome that. In particular, its success in freight shows the need for a more holistic consideration of strategy. Surely it is crazy for a major freight airport to have no rail link. It is clearly inappropriate that any freight arriving at East Midlands airport has to move to a road-based mode of transport.

I endorse what my hon. Friend said about East Midlands airport being a major engine for economic growth, but will he comment on two related concerns? First, the lack of environmental controls produces extensive night noise. Secondly, the airport is a catalyst for large-scale urban sprawl, particularly around junction 24.

My hon. Friend has snatched the words out of my mouth. Our constituents regularly draw attention to the difficulties of night noise and general noise from the airport. In addition, more than 80 per cent. of the airport's employees travel to it by car, which is not satisfactory. We need better public transport links to the airport to reduce that proportion substantially. The parkway station, which is conveniently located relatively close to the airport, may help to reduce the burden, but more work is required.

Rigorous controls on night flying and noise generation by the airport are needed as the price of its future development and growth. Last year, the Government consulted on noise controls at the airports that are not subject to national noise controls; the east midlands region awaits the outcome. Many people from my area contributed to the consultation, which has taken a year so far. In a recent parliamentary answer, I was told that we could expect a response later in the year. The sooner it arrives, the better.

North West Leicestershire district council has proposed the alternative approach of adding East Midlands airport to the three London airports, obliging it to be subject to national controls. One suspects that the Government may not favour that option, because they consulted on a locally based framework for noise controls, but an early response to the consultations would certainly put many people's minds at rest, assuming that the Government moved in favour of locally set controls.

Lastly, I shall deal with the bus network. All of us who represent more rural parts of the region welcome the substantial additional investment in local transport through bus grants available from county councils, supported by the Government. In my area, there has been an increase of about 50 per cent. in real terms in the amount of money available for that purpose from 1997. That has been well spent on extending evening and weekend services, at least in my constituency. That improves the accessibility of public transport, and people now recognise that it is available all the time, most notably in the community transport system. South Derbyshire community transport in Swadlincote has received a substantial additional amount of money and is now a major bus operator in the area.

I have two criticisms. First, insufficient money is available to introduce substantial numbers of new routes. As I said, many villages in my constituency have minimal or non-existent bus services. Secondly, we have not yet worked out how to integrate community transport and scheduled bus services; people still see them as "either/or" rather than a seamless service in which one could catch a bus from Church Broughton, for example, in the northern part of my constituency, and join a scheduled service in Hilton, which still has a rudimentary bus service. Integration of those services should be more actively explored. It can be done at a local level, but the Government could prompt such initiatives, as a large effort has been put into community transport.

We must have a planning system that supports communities. In my constituency, 200 houses have been built on an old hospital site and 200 more are planned. The estate has no bus service, so possession of a car is essential. Such developments are inappropriate; a planner to whom I spoke about the matter said, "I don't think we'd do that nowadays." We must build into the planning system an obligation to provide public transport, and ensure that there is access to it. Section 102 agreements should be used to fund public transport systems, which are essential in such areas.

Local authorities must more actively engage in the use of information and communications technology in public transport and in providing alternative means of working without needing to use public transport.

People want a growing regional economy without losing the region's beautiful environment and without having to rely on one or two economic sectors which, although they may make organisation of the transport network easier, make our economy more vulnerable. That is why transport diversity and flexibility is crucial. I have emphasised modes of transport and integration between the various parts, and the role of local government in knitting them together. I look forward with keen interest to the Minister's response.

rose—

Order. It appears that as many as eight hon. Members may wish to contribute to the debate, including the Opposition spokesman. There must be adequate time for the Minister to reply, so I ask hon. Members for self-discipline so that everyone who wishes to speak may do so.

I congratulate my hon. Friend and constituency neighbour, the Member for South Derbyshire (Mr. Todd) on securing this important debate. Our east midlands constituencies are the nexus of regional communications, as they contain the East Midlands airport, the M1 motorway, the Midland Mainline railway, the M42-A42 and the Derby southern bypass, and to the south lies the A14-M6 link. Our constituencies are at the heart of the east midlands but, as my hon. Friend said, we need better regional rail services to link with the national network.

Few people remember the third man on the moon, or will remember the third person to drop out of the Conservative party leadership contest, and few will remember that the third commercial railway line to open in this country was the Swannington to Leicester line, much of which is on the National forest route, which my hon. Friend mentioned. The line was opened in 1832, the year of the great Reform Act, and it substantially reformed the lives of businesses and people in our area. Beeching came along 131 years later and, together with thousands of miles of network in the United Kingdom, the line was axed. Many stations—and access to the mainline network on the then Leicester to Burton line, running through North-West Leicestershire, South Derbyshire and other constituencies—were removed.

In the subsequent 20 years the line was used mainly for freight, linking local pits and other employers to the network, but closure continued. The National forest came into being, with a major impact on the environmental and economic regeneration of our area. It brought with it new industries, including the expansion of leisure and recreation, but the people who want to live and work in our area still lack an adequate rail service. That was recognised early on, and the Ivanhoe line project of the 1990s meant the planned opening of 16 new stations on the route from Loughborough via Leicester and Coalville to Burton and Derby.

Twelve sites were identified and work was done to bring track and signalling up to passenger standards. Passing routes were constructed and four trains were to be purchased to run the service. The relatively easy add-on section between Leicester and Loughborough was designed, built and opened in 1994. Along came another Conservative Government to restructure the rail network under the Railways Act 1993. That brought about two changes that had a serious effect on the second stage of the Ivanhoe project—the part that we now call the National forest line. First, capital investment was to be carried out by Railtrack and recouped through track access charges. Secondly, all trains were to be leased rather than purchased. Those two changes had the effect of transferring costs from the capital account, which previously would have been funded by Government grant and borrowing approvals, to a revenue account funded directly by the county council.

The county council baulked at a bid under the rail passenger partnership fund because the outline capital cost was about £15 million. Each train cost about £600,000 to operate, with a third going in lease charges. The forecast revenues meant that the deficit under the restructured rail network was about £2 million a year—a significant sum. At a meeting last year, the county council cabinet of a Conservative-Liberal administration decided not to make a pre-qualification bid to the rail partnership passenger fund.

Many campaigners were extremely disappointed. The argument that the Ivanhoe line did not represent value for money was narrowly financial, born of the cold hearts of accountants in dim and dusty rooms. I speak as an accountant in attributing those qualities to accountants. What of the wider environmental benefits: the reduction in pollution and congestion in cities and towns surrounding the route, the accident savings—despite Hatfield, it is much safer to travel by rail than by car—the regeneration benefits through access to the National forest, and the reduction in social exclusion? My hon. Friend the Member for South Derbyshire mentioned that earlier: we represent similar areas; people living in the rural areas often have poorer access to services and facilities than those in urban areas do.

The county council went cool on the project, but the North-West Leicestershire district, in conjunction with others such as South Derbyshire, did not let it lie there. The project was reviewed to establish whether there was a way ahead. The partnership was and remains more positive about the potential for this line, but even it agreed with the county council that the RPP fund as presently constituted was inappropriate for the scheme. Either the rules on RPP funding must be revised to permit capital grants or another source of grant aid must be used. The failure to address that problem will frustrate Government policy, as laid down in "Transport 2010" and elsewhere.

Some of the options in "Transport 2010", the 10-year plan, suggest that there are ways forward for the scheme. For example, the rail modernisation fund provides investment

"that is necessary to expand the network and increase passenger rail use by 50% and rail freight by 80%. The fund will…encompass a range of funding mechanisms, including capital grant and debt finance".

I should like the Minister to respond to that point, or perhaps write to me.

The partnership that is investigating possible ways ahead has concluded that there are three major aspects to a scheme to restore passenger services on this important regional line. The prime objective must be to open the line to passenger traffic; any expansion of freight or transit excursion traffic should be secondary and should not prejudice a regular passenger service. That is the partnership's key conclusion. The Strategic Rail Authority and train operators must, of course, be involved.

Secondly, my hon. Friend referred to developer interest, which offers some sources of funding. However, in most cases, planning gain for the developments that are seen as necessary in the structure plans up to 2011 and beyond has probably already been taken, so I am not sure whether that option gives us much in the short term.

Finally, the partnership has included the line as a proposed coalfield transport regeneration project, which it has submitted to the Coalfield Communities Campaign. That option offers a great deal, and I am optimistic that it will provide further funding of the sort that we saw in earlier years.

I conclude with three quotes from three campaigners, some of whom have been heavily involved in the issue over the years. County councillor Horace Sankey told me that I should

"support developers who will give money to Burton-Leicester Railway and would make it real"

and tangible. He added that I

"should start pushing for Government to at least part own Railtrack",

and I go along with that.

Mr. Gerald Box, who, together with Keith Payne, has been an active campaigner, said:

"In this district, there is a superb opportunity to set the seal on all the exciting developments that have replaced the rape of the coal industry—the re-establishment of a railway. This would be 1) a visible symbol of national government policy, 2) a practical piece of social, environmental engineering and 3) a chance to use an existing asset to join us to Europe."

Thirdly, to show that it is a cross-age and cross-community issue, I want to quote Matthew Smith, who is 13 and who wrote to me this week. He said:

"The people of this area have recently re-elected you"—

the Labour party—

"back into power…Labour did promise"

that this time would be better and that it would

"do the will of the people. If this is so, make a difference and do your best to improve this area's transport by opening up this rail line and helping people without cars or the elderly to travel more easily."

I look to the Minister to give us that support; it will find an echo in the community and be warmly welcomed by groups and individuals such as those whom I have quoted. I look forward to his comments.

Before I call the next speaker, I should say that I or whoever succeeds me in the Chair will call for winding-up speeches to begin at 12 o'clock.

This is a welcome and timely debate. The regional transport strategy is part of the draft regional planning guidance, the final part of which will be issued this autumn.

There is a great feeling in the east midlands that we need to be in the premier league of top 20 regions in Europe. To achieve that, we need to build our infrastructure. A major aim must be to increase our skills, training and education to enhance the quality of our work force. A secondary and extremely important aim is to invest in the transport infrastructure. I shall briefly discuss three issues that affect the east midlands.

Three major rail routes run out of London: the west coast main line, the east coast main line and the midland main line. In the 10-year plan, there are major investments for the west coast and east coast main lines. The midland main line has always been perceived as the poor relation. It serves major conurbations such as Leicester, Nottingham and Derby, and we must ensure that investment in it continues. The train operator, Midland Mainline, has done well, with its Turbostar service and the parkway station at junction 24. However, major track improvement is needed over the next 10 years. A spur to that will be the redevelopment of the St. Pancras-King's Cross interchange, which will involve the Eurostar coming in to north London. It would be a travesty if the speed of the service on the midland main line were pedestrian compared with that on the line through Kent and the chunnel to France. We need to work hard on that. We also need to work hard on the east coast main line. My hon. Friends who have spoken have mentioned the need for quality services and stations. Further investment is needed in Newark station on the east coast main line.

My hon. Friend the Member for South Derbyshire (Mr. Todd) spoke about the multimodal study on the M1, which is important and must not be delayed. We must think carefully about its consequences. I say to people in Westminster Hall today and to a wider audience that we must tackle the thorny issue of the A453 from junction 24 on the M1 into Nottingham. There has been procrastination on the subject for many years, and the time has come to grip the nettle. Investment will not come into the Nottingham conurbation until hard decisions are taken about widening the route of the A453. Certain routes proposed by some of my colleagues would be environmental disasters. Hard choices must be made following the study, so I hope that the Minister and his colleagues will not renege on them, but will take them and get on with the job.

I want to talk briefly about the need to regenerate coalfields, which my hon. Friends the Members for South Derbyshire and for North-West Leicestershire (David Taylor) mentioned. The Robin Hood railway line has been an enormous success in the east midlands, especially in Nottinghamshire and Derbyshire, whose county councils I commend for pursuing it. We have reopened a derelict line, and the service has been a tremendous success. Unfortunately, its success outreaches the infrastructure available. The trains are crowded, new carriages are needed, and there should be a half-hourly service rather than an hourly one. We must improve quality and reliability. An extension should be made as well, providing a route from Mansfield to Tuxford, taking in Edwinstowe and Ollerton.

We must consider the use of mineral railway lines across the east midlands. The moratorium on their use was recently lifted. If possible, we must reserve the lines for park-and-ride sites, but many of them will not qualify. Many run from urban areas and pit villages into the countryside. As my hon. Friend the Member for South Derbyshire said, we must encourage people out of urban areas into the countryside on their feet and bikes.

One of the problems with Railtrack, aside from simple inaction or the inability to deliver a quality service, is an inability to take decisions about redundant railway lines. If the Government were to examine closely the issue of mineral railway lines, use them positively where possible and, where not, use them for amenity and recreational purposes, that would be a major feather in their cap.

I thank the hon. Gentleman for his succinct and brief remarks.

I am keen to ensure that Lincolnshire plays its full part in making the east midlands a premier region, an aspiration that I share with my colleagues in the east midlands group of Labour MPs. We have worked together to advance that.

Lincolnshire is the largest county in the east midlands, with the greatest length of roads in the region. However, with a population of around 600,000 it has the second lowest population density in the region, and that brings its own challenges. As part of the large network of highways in the county, there are some 2,500 miles of public rights of way, the reopening of which by the county council following the foot and mouth crisis has been desperately slow. Many of my constituents are unhappy about that, as am I, and I urge the county council to get on with the job that they should have got on with already.

Transport is one of the greatest challenges that the present Government have to face. It is one of the greatest messes that we inherited and we face the challenge of putting it right. In my constituency, improved transport links are crucial for attracting, retaining and improving investment and business. They are also essential to enable people to get about safely, conveniently and comfortably, to develop communities and to improve the quality of life.

Lincoln has long suffered from being cut off. The situation will be greatly improved by the dualling of the A46 between Newark and Lincoln, as the Government have now approved the £28 million scheme. However, Lincoln's standing would be greatly improved by better rail services. We have no direct link to London, and the existing routes do not provide the service that many of us would reasonably expect in the 21st century.

As hon. Members will be aware from previous debates and from questions that I have raised in the House, Lincoln also suffers from the unenviable distinction of being the only major city that is cut in two every time a train passes through it. However, we have another challenge before us, as part of the national transport agenda is to remove heavy goods vehicles from the congested road network. The proposal to improve the London to Edinburgh east coast main line includes doubling the present volume of freight over the next 10 years. An integral part of that upgrade would be to divert freight from the east coast main line on to local parallel rail routes. That would mean more freight transport through Lincoln, and would adversely affect the city. As chair of the Lincoln rail working group, I have worked with others to find solutions to the problems that will be created by the new scheme. Although it will bring tremendous benefits to Lincoln and the surrounding area, it must be implemented without detriment to the city.

The Lincoln rail working group is not simply made up of local interested groups and local authorities, but includes representatives of Railtrack, the East Midlands development agency, the Government office for the east midlands and the Strategic Rail Authority. Its composition should give hon. Members an idea of the importance of the issue, in both regional and national terms.

The east coast main line upgrade is a vital scheme that could bring national, regional and local benefits, including the potential for improved rail services, direct services to London and rail freight facilities that would serve local needs. However, it would be completely unacceptable if there were no change in the provision of rail services in Lincoln as that would lead to immense difficulties in the city and the surrounding areas. We are working to address that. Only yesterday, I went on a walkabout in my constituency with members of the Lincoln rail working group and representatives of the Strategic Rail Authority looking at the problems and considering how to overcome them. Our proposals in "Vision @ Lincoln", which were presented to the public some months ago, included an underground and a surface option. I shall be meeting my hon. Friend the Minister for Transport in a few weeks to discuss it.

My firm belief is that we have a one-off opportunity in Lincoln to cure a long-term ill—one that the city has lived with for 150 years. I also believe that it is very much in line with Government thinking that transport solutions should help create new opportunities for regeneration by bringing investment to local areas as well as providing better passenger services and assisting in the movement of freight.

I have no doubt that, without a major development in Lincoln, an artificial cap will be placed on investment and development in the city; again, that would be unacceptable. I must emphasise that it is not a matter only for Lincoln. It is a matter for the region and beyond, which is why I am pleased to have had the opportunity to raise the matter once again in this Chamber.

Transport links are a key matter for the city and surrounding area. An eastern bypass for Lincoln would clearly ease the increasing traffic pressure on the city centre. I am sorry that Lincolnshire county council did not see fit to acquire the land necessary to enable it to be built.

The operation of bus services presents a considerable challenge for companies such as Roadcar, but Paul Hill and his team have worked hard to service Lincoln and beyond. Lincolnshire has received considerable Government funding for rural bus services, and I saw the outstanding results of that investment on the route between Lincoln and Langworth. Use of the Lincoln to Skegness Inter-Connect bus route has increased by 112 per cent. That is not surprising, because it is supported by the new flexible bus services, CallConnect and CallConnect Plus, which are designed to allow those who live in rural areas to reach the main service routes by making a simple telephone call. That must be the way for the future, and I hope that the Minister will continue to endorse such schemes.

As I represent an urban constituency, I have a question for the Minister. What about support for urban bus services? Although it is right and proper to support rural bus services, many needs remain unresolved and unmet. We need continuing support for urban bus services, so that people wanting to travel to Bracebridge Heath or Birchwood and all points between can be sure of travelling when they want in comfort and safety. Transport is the key to lasting prosperity. I ask the Minister to see it in that light and to act accordingly, so that the east midlands region can take its place in the premier league.

I shall give a transport perspective from the northern extremity of the east midlands, and I shall start with the railway. The east coast main line bisects my constituency. I hope that a decision on the franchise will be made in the near future. I hope also that the Government will consider afresh the intricate freight network, which is underused or not used at all, that criss-crosses my constituency to connect current and former coalfields with power stations. As a potential freight network, it is unparalleled. For economic regeneration, it needs to be used not only for the locality and the region but as part of an expanding national freight network. That should be our hope for the future. Little work has been done on that recently, but I hope that the Government will consider it.

The issue of roads is a major one, not least following the Government's announcements on improvements to the A1M, with the removal of six roundabouts between the A1M in Yorkshire and Huntingdonshire. Three of them directly affect my constituency. In local jargon, they are called the "killing fields" because of the number of fatalities that have taken place on and around them. I urge the Government to consider reversing the previous Government's somewhat hidden policy of not allowing short-distance expansion of motorways. The A1M stops at Blyth roundabout, and I should like to see it expanded southwards to at least Newark.

It is absurd that one has to compete with cyclists on the A1, having left the A1M. Hon. Members may not be aware of the cycling heritage in my constituency. On Sunday, I opened a BMX track in Harworth, where the Tommy Simpson memorial museum is based. I hope that the Government will support the proposed new cycleway and racing track that we would like in Harworth as a true memorial to Tommy Simpson. I want to take cyclists off the A1 and put them somewhere safe for them and for motorists. The expansion of the A1M by at least 20 miles southwards would be a major step forward for the region. The number of accidents caused by tractors and others criss-crossing what was the Great North road is absurd. A slight reversal of policy at minimal cost would serve the Government well.

Many hon. Members may want road safety projects in their constituencies. If they want road humps, I have them to spare. In my constituency, Nottinghamshire county council seems to regard road humps in the same way as the mythical bus: we never see one until 100 come along at once. Manton estate has 900 road humps. Some cul-de-sacs have almost as many of them as houses, which shows the absurdity of the decisions. I am all for road humps that secure safety, especially that of young children, but not for those that almost become a BMX track or skateboard park in their own right due to their sheer number. I urge the Government to advise local authorities on road humps, to ensure a balance. Some of the road humps in my area should be removed to more needy parts of the east midlands.

The Chesterfield canal has been a major success for this and the previous Government, and I commend the investment in it. At this time of year, the issue on inland waterways is safety. The Government need to urge British Waterways more strongly, throughout the summer and especially the school holidays, to maintain vigilance and public education to ensure that the fatalities that have occurred over the past two summers on the Chesterfield canal in my constituency are not repeated. Young children dive in and attempt to swim in what can be very dangerous water, especially for them.

The issue of cars brings me to the issue of cable. One way to get cars off the road is to allow people to work from home. In the Bassetlaw constituency, however, it is rather difficult to work from home, because neither NTL nor Telewest has, in its wisdom, chosen to cable the area. I hope that policy on telecommunications and transport can be integrated to put pressure on those companies, which the Government have given lucrative franchises. In that way, we can ensure that my constituency is cabled so that many people—particularly those in rural villages who work from home or wish to do so—can have the benefits of cable, and can minimise the number of journeys that they make. Clearly, that is common sense in this technological age. However, it is also common sense that infrastructure requires investment if local people are to make proper use of it in their homes.

Finally, the east midlands has one airport and the north midlands needs a second airport. Finningley was an air base in Nottinghamshire until someone decided to change the boundaries and stick it in Yorkshire. We can live with that in north Nottinghamshire, but we want aircraft to take off and land at Finningley, as the Vulcan bombers did year on year.

When a new airport or an extension to an airport is proposed anywhere, we seem to see the NIMBYs. In my constituency, however, we have the YIMBYs—which stands for "yes in my backyard". We want an airport at Finningley. We want the runway to be used; we want new developments there; we want to see aeroplanes landing and taking off; and we want the job creation that will result.

I hope that the Government will consider the absurd public inquiry that is taking place. It is wanted not by anyone locally, but by competitors and, in particular, by Manchester airport, which seems to be trying to buy up the regional airport stock of Britain. This Government are a Government of competition, and competition among regional airports is essential. Finningley will increase competition, and I am sure that all hon. Members will agree that competition is good for the economy. I hope that all hon. Members from the east midlands will join together to support the case for a new regional airport to service the north of the east midlands in particular. I hope that we shall have that new airport at Finningley in the near future. That would benefit the east midlands and the country.

Before I call the hon. Member for Carshalton and Wallington (Tom Brake), I make a plea to the Opposition spokesmen. This is a relatively narrow debate and remarks must relate to the east midlands, although I and my successor in the Chair will show some latitude.

I shall try to confine the vast majority of my comments to the east midlands.

I start by congratulating the hon. Member for South Derbyshire (Mr. Todd) on securing this important debate; he touched on many important transport issues. I also congratulate the hon. Member for Bassetlaw (John Mann) on coining the term YIMBYs. I wonder whether everyone who lives around the proposed airport site is quite as keen on the development as he appears to be.

The hon. Member for South Derbyshire touched on the subject of railways and improvements to the midland main line route to London, which Liberal Democrat Members support. However, until changes are made to the way in which Railtrack is run such improvements are likely to take place only in many years' time, not in the immediate future. At the moment, Railtrack seems more interested in pay-offs and pay awards than in building railways.

The hon. Gentleman mentioned the Ivanhoe, or National forest, line. The hon. Member for North-West Leicestershire (David Taylor) pointed out that there was some opposition—or at least lack of support—from the Conservatives and the Liberal Democrats to the scheme. The hon. Gentleman did not say where the funding for the scheme would come from; it would cost something of the order of £2 million a year over 25 years, which is the amount that the council spends on the concessionary fares scheme. Leicester county council would therefore have to make a substantial financial commitment, but it is unclear where the funds would come from. I am sure that there is no objection to the scheme in principle, but Opposition Members need to demonstrate an economically viable way of implementing it.

Two million pounds was the original figure for the scheme, which caused the then Liberal Democrat-Conservative county council to shy away from it, but the present partnership has identified a less costly option, which seems to have considerable potential. I hope that the county council will back it.

I am pleased that a cheaper alternative has been found. I also hope that the council will, as the hon. Gentleman suggested, consider such associated issues as the environmental benefits of the scheme.

The hon. Member for South Derbyshire also mentioned East Midlands airport. I understand that the flight path goes over his constituency and also that it is one of the airports that has unrestricted night flying. We support the development of such regional airports, which can have a positive impact on regional economies. However, we are concerned about the increase in the number of short-haul and domestic flights, at the expense of more environmentally friendly means of travel such as railways. We do not want an unfettered expansion of airports, and we would like the Government to incentivise rail travel, to promote alternatives to damaging short-haul and domestic flights.

There have been no clear guidelines, standards or rules governing the future expansion of airport policy. A national policy is needed, and soon, so that those matters can be considered in the round rather than as individual proposals—whether that of the hon. Member for South Derbyshire or the on-going terminal 5 inquiry. If the hon. Member for Bassetlaw was referring to the Heathrow inquiry when he said that no one locally was in favour of it, I am surprised by that assertion and I disagree with it. That is not the view that I get. I do not know whether the hon. Gentleman wants to intervene.

I hope that we shall not have a discussion on terminal 5 at Heathrow. Will hon. Members stick to the agenda?

Thank you, Mr. O'Brien. Perhaps we shall talk about the issue when the terminal is complete.

The hon. Member for South Derbyshire also mentioned roads, including the M1 corridor multimodal transport study and the A38 multimodal transport study. I understand that at least three other such studies are on-going in the region. That demonstrates the need for the sustainable transport authority for which we are pushing, which would encompass and integrate all modes of transport. Such an organisation might do away with the need for such a proliferation of multimodal studies, which require time and effort to complete. Setting it up may remove the need to put effort into specific multimodal transport studies.

Hon. Members mentioned the Government's 10-year transport plan; the eye-catching headline figure of £180 billion is significant, but dissecting that figure shows that it is only £158 billion at current prices. If what will be spent on new projects, rather than on-going maintenance, is removed it leaves only £103 billion. The £48 billion investment from the private sector is not certain to be forthcoming, given the difficulties that are being experienced in respect of another project that requires massive private sector investment: the London underground. Dissecting the different parts of the £55 billion of committed investment over a 10-year period shows that the annual investment figure is not as great as the £180 billion starting figure suggests.

The hon. Member for South Derbyshire mentioned bus services in the east midlands, and I support his call for more bus services in the east midlands, London or anywhere else. Bus services can deliver improvements in public transport more quickly than any other mode of transport. An initial proposal for the Ivanhoe or National forest line was a complex bus service that would have delivered more frequent and more flexible services than the train alternative.

The hon. Member for South Derbyshire identified some important transport issues in the east midlands, which will not be resolved without fundamental changes to the way in which such matters are governed. That is why my party's alternative Queen's Speech proposed a Bill to establish a sustainable transport authority that would integrate the functions of the Strategic Rail Authority and the rail regulator and oversee buses, coaches and other modes of transport. It would remove from Railtrack its responsibility for operating the railways and put it in the hands of a not-for-profit organisation, which would be much better placed to deliver the transport improvements that the hon. Gentleman wants.

First, Mr. O'Brien, I must tell you that I have an interest in a family business concerned with building and road haulage, which is declared in the Register of Members' Interests.

I congratulate the hon. Member for South Derbyshire (Mr. Todd) on securing the debate and on the reasonable manner in which he presented his case. Listening to what he and other hon. Members said—my party is in listening mode at present—left me in no doubt about the importance of transport in the east midlands. I cannot help reflecting on the major economic changes in the coal and steel industries that have affected the region, which has done extremely well to adjust to those changes. However, integrated transport is the key to attracting jobs and growth in the region. The east midlands is a successful area, but we should not be complacent about it.

In the past four years, the Government have not delivered as much as they promised in respect of transport. A litre of petrol cost 59p in 1997; it is now 80p. The Government have taken about £9 billion from road users, much of which has gone to the Treasury rather than being spent on improving public transport, which many hon. Members consider to be a priority in their constituencies.

The 10-year plan is coming up to its first birthday but we still do not know how the £180 billion—if, indeed, it is £180 billion—will be spent. We need more details and more dates from the Government.

The Confederation of British Industry, the British Road Federation and others in the industry have spoken about the effect of congestion on the economy and on job creation. Transport must be a priority for the nation in the next few years.

Several constituency-specific issues were raised on which it will be more beneficial for the Minister to comment than the Opposition spokesman. However, I shall pick up one or two points. We rightly discussed regional airports, which are most important. Terminal 5 is relevant because the Government's new deal for transport promised a White Paper on regional airports, but they will not produce that document until the inquiry on terminal 5 has reported, which will probably be in the autumn. In the meantime, can the Minister give us some idea—

Order. By discussing terminal 5 at Heathrow, the hon. Gentleman is straying away from the subject of transport in the east midlands. Will hon. Members stick to the subject, please.

Thank you, Mr. O'Brien.

Can the Minister tell us when the White Paper on a new deal for transport and regional airports will be published? It is relevant to the East Midlands airport and to those hon. Members who are interested in what happens in Finningley—there are many more besides the hon. Member for Bassetlaw (John Mann). We all know the impact that the regional airports have on the regions and it is important to have an overall strategy. The impact of competition was mentioned in the context of the Manchester airport company buying the East Midlands and Bournemouth airports and others.

We have heard much about multimodal studies, for which the previous Government will be known; the challenge now is whether they will be implemented and what impact they will have on the M1, the A38 and so on. Some important conclusions can be drawn from the studies, which need the Government's support and taxpayers' money.

I enjoyed hon. Members' contributions, especially that by the hon. Member for Bassetlaw. I have much sympathy with what he said about humps and bumps and what goes on in his constituency, and I look forward to hearing more from him in debates.

The Government have raised from the road user a substantial amount of tax that has not been put back into the infrastructure. We look to the Government to deliver in the next three or four years; they must give transport in the east midlands a high priority.

I join hon. Members in congratulating my hon. Friend the Member for South Derbyshire (Mr. Todd) on securing the debate and for the measured way in which he introduced it. His constituents, and those of other hon. Members with east midlands constituencies, have powerful advocates for transport in the region.

I shall refer to each contribution to the debate and then make some general points. In addition to the speech by my hon. Friend the Member for South Derbyshire, there were good contributions from my hon. Friends the Members for North-West Leicestershire (David Taylor), for Lincoln (Gillian Merron), for Sherwood (Paddy Tipping) and for Bassetlaw (John Mann). The Liberal Democrat spokesman, the hon. Member for Carshalton and Wallington (Tom Brake), flew into the debate from Heathrow. At one time he seemed to be on a non-stopping train through the east midlands; he paused only occasionally. The hon. Member for Poole (Mr. Syms) spoke in his usual measured way. He is a good contributor to these debates but he, too, took the non-stopping train through the east midlands and got on to the subject of Heathrow. Bearing in mind your strictures, Mr. O'Brien, I shall avoid that matter.

My hon. Friend the Member for South Derbyshire made the important point that highways—I shall use that term to consider both the road surface and pavements—are for all users, including pedestrians and cyclists, not just for cars. That point is at the heart of our policies. My hon. Friend also mentioned the need for information for people using public transport. Our proposals on the transport direct service include exciting proposals on the use of new technology to allow passengers to make more reasoned choices.

My hon. Friend also spoke, rightly, about pollution. The Government have made major inroads on that issue by encouraging the use of cleaner fuels by cars and particularly by heavy and diesel vehicles in urban areas. That is important in my hon. Friend's area. We are also encouraging the use of vehicles with smaller engines by reducing vehicle excise duty for vehicles under 1,549 cc from September.

I shall deal with the points raised by my hon. Friend the Member for North-West Leicestershire during the rest of my speech. I hope that I can even embrace some of the points made by his constituent, Matthew Smith, in asking us to do the will of the people.

The east midlands is a diverse region. It is not dissimilar to the areas that I represent in that it has not coalesced into a large urban sprawl. It is a series of habitations contained in a large rural area. Most of the urban areas are relatively self-contained, although the size of their travel-to-work areas continues to increase, partly as a consequence of the improved living standards that they enjoy. I take to heart what my hon. Friend said about our transport policies' informing our regeneration policies and creating new jobs and enterprise. Several hon. Members made that extremely important point.

The main north-south routes—the M1 and A1—are increasingly congested, and in urban areas the rush hour is lengthening. The proximity of settlements to the M1 corridor and the success of economic developments close to it have encouraged the use of private cars and road freight.

Several hon. Members mentioned the regional transport strategy and local transport plan. The integration of transport and land use planning is one key to developing a sustainable transport system. In the east midlands, development of the draft regional planning guidance is well under way, and I expect my right hon. Friend the Secretary of State to issue the final version before the end of the year. The draft regional transport strategy, which forms part of the regional planning guidance, sets out a policy framework for transport in the east midlands, which is reflected in the development plans and local transport plans produced by local authorities.

In recent years, the resources awarded by Government to east midlands local authorities for transport have increased substantially. Since 1999, the level of the settlement has doubled year on year, and under the 10-year plan we expect a further doubling of annual resources by 2010. Notwithstanding the cynicism shown by Opposition Members, people on the ground have seen some of the benefits of those resources. That step-change in investment will enable good progress to be made with the implementation of the region's local transport plans.

Importantly, the funding will enable the east midlands' authorities to address the Government's 10-year plan target of halting the deterioration in local road conditions by 2004 and eliminating the maintenance backlog by 2010. Just before this debate started, I attended a conference in Euston at which we launched a new code of practice for surveyors in local authorities on improving the quality of road maintenance. I believe that the east midlands was represented there.

Several hon. Members mentioned multimodal studies. The content of the regional transport strategy and local transport plans will be informed by the three multimodal studies currently under way in the east midlands. They will identify options for addressing the transport problems of the M1, the A453 and the M42-A42 corridors. The outcomes are likely to amount to a substantial package of new infrastructure and service improvements across all modes of transport.

The Government recognise the urgency of completing the studies as quickly as possible. However, it is important that the studies examine all options in the open, inclusive way that was set out in the transport White Paper. The groups of interested parties that we have established to manage and direct the studies are working effectively, which is a testament to the high degree of partnership working in the east midlands. We expect the M1 and the A453 studies, about which my hon. Friend the Member for Sherwood asked, to report to the regional planning body next spring. The M42-A42 study will report in spring 2003.

The east midlands authorities have an impressive track record of success in bidding for funds under the rural bus challenge, which aims to stimulate innovation in the provision and promotion of rural public transport and improve quality and choice. My hon. Friend the Member for Lincoln spoke about the success in her area. Indeed, Lincolnshire's winning Inter-Connect scheme has been nationally acclaimed as an exemplar for improving rural accessibility, while Leicester and Rutland's Cross County scheme is, at £1.6 million, the largest single award in the history of the competition. I took careful note of what my hon. Friend said about urban transport, especially the integration of buses with other services. Her points were well made and are relevant to other areas.

Building on the success of the rural bus challenge, we have launched an urban bus challenge to improve public transport in deprived urban areas. Some £46 million is being made available during the next three years, and bids have recently been invited. We look forward to receiving bids from the east midlands authorities for innovative and imaginative projects, and some of my hon. Friend's points might be met in that context.

The matter of rural motorists was raised by many hon. Members, including the hon. Member for Poole. In many rural areas, there might be no practical alternative to the motor car for some people. The Government recognise the problems experienced by such motorists, with the price of fuel increasing because of the world price of crude oil. The hon. Gentleman will know that we scrapped the fuel duty escalator, which was introduced by the last Conservative Government; I am sure that the hon. Gentleman welcomes that.

In the previous Budget, the Chancellor also announced a package of measures that will benefit motorists in rural areas. That includes a reduction in duty on low sulphur fuels, a freeze on vehicle excise duty until next year and a raising of the small car threshold for vehicle excise duty on cars. The latter should benefit those in rural areas who have larger cars for travelling longer distances. The hon. Member for Poole should bear in mind the fact that evidence shows that the cost of car use is greater to people who live in an urban area than to those who live in a rural area. People in rural areas who have to travel longer distances, or those using smaller diesel vehicles, might also want to consider converting their vehicles to use liquid petroleum gas. It is considerably cheaper and does not have the pollutants that other fuels do.

There were many mentions of rail investment. In recent years, we have seen substantial levels of investment in the region's rail network. For example, Midland Mainline has doubled the frequency of trains on its routes, and during the next eight years there will be further investment of £230 million in more new trains and facilities, including a parkway station near the M1 at junction 24.

Of course there is much more to be done, as several of my hon. Friends mentioned today. In particular, there is a growing desire among many local communities to be connected to the rail network. My hon. Friend the Member for Corby (Phil Hope), who has now returned to the Chamber, mentioned earlier that Midland Mainline and local authorities are investigating the potential for reconnecting Corby to the passenger rail network. That will be very good news to his constituents, and I am sure that he will continue to press all the relevant authorities on that matter.

Derbyshire county council and its partners are working with the Strategic Rail Authority to examine the potential for reopening the Matlock to Buxton route. No doubt that springs partly from the hugely successful Robin Hood line project, which was mentioned by my hon. Friend the Member for Sherwood. It has made the former Nottinghamshire and Derbyshire coalfield area much more accessible and has brought regeneration and other benefits in its wake. It was to facilitate such schemes that we introduced the rail passenger partnership fund. The proposal to extend the line to Ollerton is interesting and is, I understand, to be the subject of a bid to the rail passenger partnership fund by Nottinghamshire county council.

My hon. Friend the Member for North-West Leicestershire mentioned the Ivanhoe line. Stage 2 of that project is an interesting proposal. His 13-year-old constituent, Matthew Smith, said that we must follow the will of the people. I hope that his constituent will see some progress by the time he takes his A-levels—or even before. I acknowledge the wider benefits that that scheme would bring, but the economic appraisal of the line shows that a prohibitively large operating subsidy would have to be met by Leicestershire county council. I know that my hon. Friend has met previous Ministers to discuss the way forward. Direct capital funding for rail projects is one of the funding options contemplated in the 10-year plan, and the options are being worked up by the Strategic Rail Authority whose strategic rail plan, to be published later this year, will set out the principles of investment support and describe the forms of funding that will be available for rail investment.

The projections of the deficit are linked closely to the county council's estimate of passenger revenue, which is thought by the new partnership to understate the actual position.

I thank my hon. Friend for that comment. Those who are assessing the project will obviously consider that aspect. I am sure that my hon. Friend will be the first to draw attention to it as an advocate on behalf of his constituents.

I shall now discuss problems with the existing rail network in the east midlands. The upgrades of the west coast and east coast main lines have implications. There is an issue about the extended journey time between London and Northampton on the west coast main line following the upgrade, but a working group of local authorities, Railtrack and the Strategic Rail Authority is identifying potential solutions.

My hon. Friend the Member for Lincoln discussed some problems with freight transport through her area. We, too, are aware of the problems that are caused in Lincoln and Spalding by the diversion of freight traffic from the east coast main line during its upgrade. I recognise the seriousness of the issue and its potential implications for retail and other activity in affected towns. The Strategic Rail Authority, with local partners, is already engaged in that issue and will help in working up prospective solutions and advising on the financial role that the Government could play.

In the short time left, I shall mention the East Midlands airport. I acknowledge that public concern is growing about the environmental impact of the airport and the surrounding developments on the local community. I understand that the airport has established a community fund to provide grants of up to £1,000 to soundproof homes affected by aircraft noise.

I have little time left and I know that I have not covered all the issues in detail. If hon. Members draw to my attention any points that they believe have not been covered in enough detail, I will certainly write to them. We have had a useful debate, conducted in a constructive atmosphere. I hope that my comments have been helpful.

My reason for calling the debate is to draw attention to how long people in Norfolk have to wait, often in real pain, to see an orthopaedic specialist—and then even longer for an operation. We all agree that waiting more than a year for a first appointment with a specialist is unacceptable. From first referral to the specialist to having an operation performed can sometimes take a further two to three years. The Government must now respond with additional resources to recruit more specialist staff and enable the Norfolk and Norwich healthcare trust to deal with this waiting-times scandal.

I shall refer to three particular cases. Depressingly, they are not exceptional. The first case is that of Mrs. Green of Trunch, who tells me that she suffers so badly from pain some days that she is unable to walk. She saw her GP in March this year and he wrote to the hospital requesting an appointment with a specialist. Two months later she received a letter from the hospital dated 24 May. It stated:

"The current waiting time for this kind of appointment is approximately 85 weeks. We are very sorry for the long wait and for any inconvenience this may cause."

She regarded that, understandably, as a sick joke. The letter suggested that she might be able to see a consultant in about January 2003. If she subsequently needed an operation, it would probably not happen until early in 2004. Waiting that long simply cannot be justified.

Mr. Oliff of Cromer is another case. He suffers from osteoarthritis and is in considerable pain. He finds it hard to walk, but he is also a carer for his wife, who is a diabetic, has had two strokes and has problems with her balance. Mr. Oliff's GP referred him to a specialist in May last year. When he attended his appointment in January this year, he was told that the wait for an operation would be between a year and 18 months. Let us all try to imagine the problems that he and his wife will suffer while he waits all that time for his operation.

The third case involves a lady who, understandably, wants to remain anonymous. She is 54 and worried about losing her job. She is on long-term sick leave, waiting for an operation. It has been pencilled in for January 2002, but her employers told her that they would retain her job for only six months.

Those are just three examples of people who have come to see me, often in distress, deeply worried about when they will have their operations. Long waiting times have other implications. One consultant explained that a patient's condition often worsens while they are waiting, which can result in more complex, more expensive surgery. Sometimes the patient suffers other medical problems—a stroke or a heart attack—so it is not possible to operate. Patients are likely to remain in pain for the rest of their lives, or simply die before ever being treated. That cannot he what a modern, efficient and responsive health service aspires to.

The hon. Gentleman will not be surprised to hear that in my travels around my adjoining constituency of North-West Norfolk, I have encountered many similar cases. The Queen Elizabeth hospital at King's Lynn has the same problems that he mentioned in respect of Norwich. Does he agree that it is not just a question of the long waiting times given to patients, but the fact that there is a waiting list to go on to the waiting list, which makes the actual waiting times even longer?

I agree with the hon. Gentleman and I intend to allude to that very problem.

I want to deal with the extent of the problem in Norfolk in comparison with the rest of the country. I shall focus first on the out-patient and then on the in-patient waiting times. Regarding the time that patients have to wait between a GP appointment and seeing the specialist, in the first quarter of 1997, just 59 people in Norfolk were waiting more than six months for the first appointment. In the first quarter of 2001, that number had increased dramatically to 461. Interestingly, trusts and hospitals do not even keep statistics on the number waiting more than a year for an appointment, presumably because nobody ever imagined that it would be necessary to compile them. We now know that that is the reality for people in Norfolk.

In-patient waiting times between seeing a specialist and having an operation are similarly worrying. The Norfolk and Norwich trust now has 3,392 people waiting for operations in this specialty. Of those, 445 are waiting more than a year from their specialist appointment. That compares with just 68 people waiting more than a year back in March 1997. The Government should be ashamed of that record.

The Norfolk and Norwich health authority has one of the highest in-patient waiting lists in the country—it is eighth out of 99 health authorities in England, and the proportion of those waiting more than a year is almost double the national average. The Minister may wish to reflect on the enormous variations across the country. In North Yorkshire, only 0.2 per cent. of those on the waiting list wait more than a year, compared to Norfolk's 12 per cent. That demonstrates the postcode lottery in orthopaedic care, which should be taken into account in determining whether it would be fair and equitable to provide additional funds for the worst affected areas.

Why is the position in Norfolk so bad? The problem stems from winter 1996. In the run-up to the 1997 general election, there was a serious problem with emergency admissions. Resources were switched away from specialisms such as orthopaedics to deal with the crisis in emergency admissions and the resulting curtailment of elective activity quickly led to a backlog, which has remained ever since. Depressingly, the year-on-year figures demonstrate that the position has worsened.

I must stress that it is not the problem of an underperforming or inexperienced department. Norfolk's specialists are among the most highly regarded in the country. Among their number is a past president of the British Orthopaedics Association, the president of the British Knee Society and the secretary of the British Hip Society. These are eminent professionals and Norfolk is lucky to have them, but they need extra support and additional resources. Their throughput of patients is one of the best in East Anglia, but because of their reputation, they have specialist work from neighbouring trust areas referred to them. That is part of the problem and part of the reason why they need more resources to cope.

Another cause of the continuing failure to eat into the backlog of patients is that there are not enough beds in Norfolk's main hospital. Shortage of beds means cancelled operations and longer waiting times. Bed numbers have fallen year after year. Although the recent arrival of Philippino nurses has helped, it remains a depressing picture.

Last year, the occupancy rate at the Norfolk and Norwich hospital was 91 per cent., which compares with the nationally accepted standard of 85 per cent. The inevitable result of a hospital operating at such a high occupancy rate is that for much of the time, and not just during the normal winter crises, the hospital is full. That means that operations have to be cancelled, because no beds are available. In the past two years, 500 operations at the Norfolk and Norwich hospital have been cancelled. That is a ludicrous state of affairs, because it leaves expensive highly trained surgeons twiddling their thumbs rather than operating on patients.

What can be done? We have had reassuring words from Norfolk health authority about more funds being invested in this specialty and more people being treated than ever before. I am sure that the Minister will allude to that. I fully recognise that Norfolk has a growing elderly population, but that is an extra justification for more resources to deal with the appalling backlog of patients and to keep pace with demand.

A plan is in place for an eight-month overlap between the opening of the new Colney hospital and the closure of the old Norfolk and Norwich hospital, so that both hospitals operate simultaneously. That could help to reduce the backlog—although it will not remove it—but to achieve that, the hospitals will have to recruit short-term contract surgeons. That has not yet been achieved and will not be easy. Recruitment to permanent posts is hard enough, but recruitment to short-term contracts is even more difficult. I think that it is accepted across the board that the transfer to the new hospital will result in a reduction in activity for a time. It is possible that no operations will take place for two weeks.

Overall, therefore, there is little reason to believe that things will improve in the foreseeable future. Waiting times for orthopaedic appointments and surgery in Norfolk are unacceptably long. It is critical that the Government respond to the debate by providing additional funding to remove the backlog of cases. Further significant investment is needed now, so that the trust can plan its way forward. It must not he left with more uncertainty until the new financial year.

In reality, we have a two-tier health service in this specialty. If people have money, they can opt out of that horror, but if people are on a low wage, unemployed or reliant on the state pension, they simply have to wait and wait and wait. We cannot accept that any longer. The Government must deal with the underinvestment in this specialty and provide the resources that Norfolk needs.

I congratulate the hon. Member for North Norfolk (Norman Lamb) on securing what I believe is his first Adjournment debate and I welcome him to Westminster Hall. Without wishing to sound patronising—I am probably failing—he has done an excellent job on behalf of his constituents. I am aware that there has been considerable local interest in orthopaedic waiting times in Norfolk, and I appreciate his concerns and those of his constituents. I hope that I can reassure him that progress is being made.

As the hon. Gentleman will be aware, the Government have made significant progress in reducing waiting times. As part of the NHS plan, maximum inpatient waiting times will fall on a staged basis from 18 months now to 15, 12, nine and eventually six months by 2005. As a first step towards that, the 15-month maximum waiting time for an in-patient appointment will be achieved by the end of March 2002.

Most out-patients are already seen within six months, which will be an absolute requirement by the end of March 2002. The plan is that by the end of 2005. the maximum waiting time for a routine out-patient appointment will be halved from more than six months to three months. Within those new guaranteed maximum waiting times, patients will be treated according to individual assessment of clinical urgency. The Government's eventual objective is to reduce the maximum wait for any stage of treatment to three months.

We are committed to reducing waiting times for orthopaedic treatment, in line with the national targets set out in the NHS plan. The NHS plan will see year-on-year increases in equipment, facilities and staff. As the extra capacity becomes available, the Government will be able to reduce waiting times. The areas with particular problems will be targeted for special action. On the specific issue of Norfolk, we are committed to increasing resources to the NHS to achieve our aims, and I am pleased to announce that Norfolk has received record increases in funding. I am sure that the honourable Gentleman is aware of the announcement in this year's Budget statement of the largest ever increase in funding for the NHS in England. The total allocation for Norfolk in 2001–02 is £504 million, which represents a total cash increase of £40 million and an increase of 8.6 per cent., or 5.9 per cent. in real terms.

The Government have therefore already to some extent recognised the hon. Gentleman's call for resources and his plan for the future. As he pointed out, we may need to reform and improve the system to ensure that his constituents and people throughout the country receive the treatment that they deserve. The hon. Gentleman is right to be concerned about waiting times for orthopaedic treatment in his area. As he said, waiting times for orthopaedics began to rise in 1995 and increased dramatically in 1997. However, that trend was halted at the end of 1997 and the trust responded with a range of waiting list initiatives and activities to begin dealing with the problem. Those initiatives halted the rise in waiting lists but, as the hon. Gentleman has rightly pointed out, could not address the large number of patients that had been added to the waiting list. I recognise the honourable Gentleman's concern about in-patient and out-patient waiting times. As I have said, the Government are committed to tackling the issue. Action has been and will be taken in Norfolk to address the issue.

Since 1997, an additional £1.5 million has been invested in orthopaedic surgery. That includes the appointment of two additional consultants and supporting orthopaedic investment. There remains the issue of the total number of patients waiting for surgery, which is proportionally higher than the national average. The average waiting time for an orthopaedic operation at the Norfolk and Norwich hospital is 4.9 months, compared with the national average of 4.1 months. That has put a great deal of pressure on the trust, an issue to which I shall return.

Norfolk health authority is reviewing orthopaedic services, under the leadership of Dr. Norman Pinder, Norfolk health authority's director of public health. The review will look at Norfolk as a whole. Importantly, it will identify best practice from independent sources such as the National Institute for Clinical Excellence and the Audit Commission and will relate it to implications for the NHS plan and national service frameworks. It will focus not just on hospital services, but will also give opportunities to examine how current orthopaedic referrals are managed, looking particularly at alternative ways of treating patients. Examples could include the use of surgical podiatry, therapy services for the management of back pain and increasing capacity in rheumatology for the treatment of medical musculoskeletal problems. Those matters are important, because I agree with the hon. Gentleman that the wait for out-patient appointments is too long and that action must be taken.

On one case that the hon. Gentleman raised, it is worth saying that patients who are in considerable pain while waiting for an operation may return to their general practitioner for reassessment of their condition to be re-referred as an urgent case. Notwithstanding that, we must ensure that the system operates properly with appropriate resources.

In addition to the specific orthopaedic services review and to ensure that the Government's targets are met, the national health service plan implementation programme committed the NHS to undertaking local modernisation reviews during the summer. The reviews are intended to aid implementation of the NHS plan by genuinely localising implementation and engaging staff, patients and partners in local government and the private and voluntary sectors. The findings from each review will be used to create robust three to five-year plans, describing specifically how the NHS plan will be implemented in local health communities. There will be a two-stage approach to the local modernisation reviews, the first of which will be completed by the end of this month. The orthopaedic review in Norfolk will inform its local modernisation review by identifying what additional provision must be made and where it should be provided.

Will the review envisage out-of-area treatment? For example in the case of the Queen Elizabeth hospital in King's Lynn, there was a period last summer when there were so many road accidents that orthopaedic operations were continually put back. Will there be an opportunity for people waiting for such delayed operations to be treated outside Norfolk?

I am sure that the balance between emergency and elective care, and the pressures on the system from wherever they come, will be part of that review, and that the hon. Gentleman will be able to feed into the review's conclusions.

As the hon. Member for North Norfolk suggested, the Norfolk and Norwich hospital is recognised as an efficient trust and is opening a new hospital later this year. It will be a brand new, purpose-built hospital for the residents of Norwich and the surrounding area, and will cost £229 million. It will be the largest new single-build hospital to be built in the country under public-private partnership. Although completion was contracted for January 2002, construction has proceeded considerably ahead of schedule, and I am pleased to note that it will open to its first patients this autumn.

The hospital is designed with the latest state-of-the-art facilities and technology, which will provide substantial improvements in accommodation. Perhaps more importantly given today's debate, the new theatre complex will include four orthopaedic theatres that will benefit from an airflow system that will minimise the risk of post-operative infections and allow a greater range of orthopaedic procedures to be performed.

I am pleased to report that the health system has identified an opportunity, as the hon. Member for North Norfolk suggested, to use the vacated space at the old hospital to provide additional surgery, including orthopaedics. That will cover the three-week period during the hospital move when, as the hon. Gentleman pointed out, no elective surgery will be performed. To do that, Norfolk health system has funded an extra £3.9 million to carry out 2,000 additional operations at the old hospital during an eight-month period beginning in the autumn.

Through the proactive work of the local health system, an extra 1,200 patients will be treated during this financial year, at least half of whom will receive joint replacements. The trust aims to reduce the number of long waiters on the waiting list, depending on the suitability of patients to be treated at the old hospital.

The hon. Gentleman rightly raised the issue of staff. The trust is actively recruiting staff at present with a view to commencing the project in October and operating it until July 2002. There will be two additional wards, and two further locum orthopaedic consultants will be appointed. Hon. Members from the area will be interested to know that the programme will offer patients general surgical and urological facilities as well.

I recognise that the trust did not achieve its in-patient targets last year and reported a shortfall of 1,470 against its target for in-patient surgery. I have already referred to the historical difficulties with orthopaedic activity at Norfolk and Norwich hospital. However, recent work by local commissioners has revealed that the department's efficiency compares favourably with departments of similar size and similar large acute hospitals. That has been verified through the use of well-accepted modelling techniques and was highlighted by the hon. Member for North Norfolk.

How is the trust tackling its waiting list targets? It has produced a recovery plan and support has been provided by the regional modernisation action team. In addition, expert advice has been sought on waiting list management to improve the capability to model and forecast waiting list pressures and to work through how different solutions could be used. Despite that efficiency and the additional investment that I outlined, in-patient and out-patient waiting times are still too long, and hon. Members are right to be concerned. However, the GP referral rate is not rising and the number of patients being added to operation lists following out-patient attendance is in equilibrium with the number of operations being carried out.

In addition to the review of orthopaedic services and input into the local modernisation review, the local NHS is clear that early action will need to be taken to reduce waiting times. The trust and health authority are currently developing a proposal to open two additional operating theatres at the new Norfolk and Norwich site, which will considerably alleviate the waiting list problem. The plan will be presented to the regional office in September and, if approved, the new theatres will be operational in July 2002. The local modernisation review will report later this month, and I would be happy to follow up any significant issues if hon. Members would find that helpful.

I recognise that the targets are challenging, but I am reassured that collaborative working with the regional office, health authority and local primary care organisations will allow the targets for 26-week outpatient appointments and 15-month in-patient and daycare waiters to be achieved by the end of the financial year. I can assure the hon. Gentleman that, in addition to the extra investment in the system and the action taken to ensure that that investment is spent in the most effective way, I, and no doubt other hon. Members, will be keeping a close eye on ensuring that his constituents get the health service that the Government are committed to delivering.

I am pleased to have the opportunity to raise this subject in Westminster Hall, and in doing so I welcome my right hon. Friend the Minister for Criminal Justice, Sentencing and Law Reform to his new position. He has already given a speech on this subject in the past three weeks, and he is on the case. I look forward to his reply to the debate.

Hon. Members are aware of the public disquiet that arises when the criminal law seems helpless when faced with catastrophic events, such as the Herald of Free Enterprise disaster, the King's Cross fire and serious rail crashes at Clapham, Southall and Ladbroke Grove. There are also other, less well-publicised tragedies in which people are killed and nothing seems to happen. Today I intend to outline why I believe that holding the companies responsible for such tragedies to account in law is both principled and possible.

I begin by drawing the attention of hon. Members to the problems with the law at present. With regard to the tragedies that I referred to, there might well be prosecutions under the Health and Safety at Work, etc. Act 1974. The Court of Appeal, in a 1999 decision—Howe—said that fines for health and safety offences should be of a level that brings the message home to a company's managers and shareholders. Consequently, First Great Western Trains was fined £1.5 million following the Southall crash. However, can we with all honesty say to the public that such action recognises the degree of culpability that should be attached to a company and its management in such tragedies? If we, as a society, can say that motorists who do not intend to kill someone, but do so through recklessness or irresponsible driving are guilty of involuntary manslaughter, how can we absolve the company that pays little regard to the safety of its staff or its customers? When the inquiry judge in the Herald of Free Enterprise case found that the company was infected from top to bottom with a disease of sloppiness, did that not illustrate the need to make companies as accountable as individuals for their actions? Such sloppiness was not the fault of one individual, but of a culture in which safety was very much a secondary consideration compared with profit.

The recognition that companies are responsible for the ethos and the culture that pervades their action is central to the principle underlying an offence of corporate killing. Safety should not simply be seen as secondary, but as an equal part of the problem. Companies and organisations must recognise their place as stakeholders in society. At the recent conference organised by the British Safety Council at which the Minister gave a speech, Sir Michael Latham, chairman of the construction company Wilmott Dixon, welcomed a law that punishes managers who make no serious attempt to protect people on construction sites. He said:

"Safety is a culture. Those who believe in it and care about it will take it seriously. Those who do not will not voluntarily mend their ways. And if that means they fall foul of the new corporate killing law, I for one will have no sympathy with them at all."

The public disquiet about the lack of an offence of corporate killing reflects the sentiment expressed by Sir Michael—that safety should be a non-negotiable part of business culture.

Having outlined the principle behind an offence of corporate killing, I want to turn to the practice. First, I commend the Government, who have recognised the problem. At the last election the Labour party committed itself to the introduction of an offence of corporate killing. In May last year, the Home Office published a consultation paper based on a 1996 Law Commission report. No implementing measures were mentioned in the Queen's Speech, but I commend the Government for giving a lead on the issue.

I want to discuss the points raised by the Home Office and Law Commission documents. Both show that the ordinary criminal law is inadequate. The Southall rail crash is indicative of the way in which a company's lack of attention to safety led to safety systems on the First Great Western express either being faulty or not being switched on, and inadequate procedures for determining when a train should not be taken out. The Crown Prosecution Service prosecuted the company but the judge halted the trial. The matter was referred to the Court of Appeal, which in February last year upheld the decision of the trial judge on that point.

The result is that, at present, to convict a company of manslaughter by gross negligence it is still necessary to identify the top management of the company as being to blame, rather than to recognise that the company as a whole should be responsible. It is not possible simply to find that the company has a duty of care and has been in breach of it in a grossly negligent way; nor is it possible to aggregate management failures whose cumulative effect is negligence.

When my hon. Friend the Member for Hendon (Mr. Dismore) introduced his Corporate Homicide Bill last year, he rightly pointed out that the so-called identification theory led to the law discriminating against small companies in which it is easier to identify a manager or director who is to blame. Indeed, it is no surprise that the only three successful prosecutions for corporate manslaughter have involved small companies. With larger companies, responsibility is diffuse, so there is often no one person to whom blame can be attached. Even if an individual can be identified, it is highly unlikely that that person will be part of the top management, to accord with the identification theory.

It was to overcome the identification problem that the Law Commission in 1996 proposed a completely new offence of corporate killing. No longer would it be necessary to establish first that an individual was guilty of manslaughter and secondly that he or she was part of the top management. Rather, the prosecution would have to establish that the company's conduct, which caused death, fell far below what could reasonably be expected. Causation would be established by a management failure, such as the management and organisation of activities in a way that failed to ensure the well-being of those affected, whether employees, customers or others. Corporate killing could result from the cumulative acts of several individuals in the company. That approach was rejected by the Court of Appeal in the context of corporate manslaughter.

The offence of corporate killing would not be precluded even if the immediate cause of death was the act or omission of an individual. However, in contrast with corporate manslaughter, individual blameworthiness would not be a prerequisite for corporate killing. The law would then better recognise the reality of business life—that often it is the cumulative effect of many actions within a company's culture that causes poor attention to safety and, sometimes, tragedies. However, as I have said, there might be cases in which, although a charge of corporate killing was available, an individual in the company could also be prosecuted for manslaughter offences. In that way, the offence of corporate killing sidesteps the identification problem. However, that problem would remain outside the context of a death, so that—absent vicarious liability—a company could not be liable in criminal law for wrongdoing unless a directing mind was blameworthy. That causes difficulty with a range of statutory offences that demand mens rea. It is also a problem with the application of statutory defences. I wrote about that problem many years ago. While some judges have indicated a willingness to overcome the difficulty, ultimately we need legislation. However, that is a separate issue.

The Government have accepted the Law Commission recommendation for an offence of corporate killing along with changes in the general law of manslaughter. Those are not my concern today. Indeed, the Government have gone further than the Law Commission and accepted that the offence of corporate killing should be applied not just to companies but to all undertakings such as NHS trusts and partnerships. In their consultation paper they say that some 3.5 million organisations might come within the ambit of the offence. There is no good reason not to extend the law of corporate killing to cover Government bodies as well.

Let us turn to some of the difficulties in implementing an offence of corporate killing. It has been suggested that business is against such a proposal, but that is a red herring; many prominent business leaders, such as Sir Michael Latham, are in favour of the new offence. While there is resistance to a new offence—in some cases, I have to concede, by lawyers—the debate is being won by the proponents of change.

When the consultation document was published last year, the Institute of Directors said that it was happy to support its proposals; in fact it called it a step in the right direction. There were those at the recent British Safety Council conference, like Gwyn Hughes from P&O Princess Cruises, who feared that a law of corporate killing would lead to co-operation and information drying up or being destroyed. However, he said that he could not object to legislation because he had no solution to the social need to allocate blame.

The difficulties that I envisage are to do with the legal ramifications of such an offence. The offence of corporate killing will arise irrespective of individual culpability, although it may be that, as well as citing severe corporate failure, the prosecution in particular circumstances might be able to proceed against an individual—whatever his or her level in the company—for a manslaughter offence. My concern is whether there should be additional, new consequences in the criminal law for people such as directors or managers of companies that are convicted of corporate killing. There can be little argument with the proposal in the consultation document that an individual who contributes to a management failure resulting in death might be disqualified from participation in the management of any future undertaking. That is a principled extension of the company directors disqualification legislation, and would enable the sanction to be tailored to the individual's failure.

More controversially, the consultation document asks for comments on secondary liability for corporate killing for individuals who "substantially contribute" to the undertaking's primary offence. Presumably, the degree of culpability would fall short of conduct otherwise giving rise to a manslaughter prosecution—in the new scheme for that offence, reckless manslaughter, unlawful act manslaughter or manslaughter by gross negligence. However, there are problems of principle and of policy. There must be some causal connection between the individual's conduct and the killing. It should not be enough that he or she happens to be a director or manager of the undertaking—putting the individual in the dock might satisfy a sense of vengeance, but it would be unjust and would provide no incentive for corrective action by undertakings. It would also undermine the principle that the offence of corporate killing should hold to account not individuals but companies as a whole, with the aim of encouraging a business ethos that recognises the duty to stakeholders.

The only way that I can see to take the notion of "substantial contribution" forward is to build on the well-established test for making directors, managers or other similar persons liable under regulatory legislation, such as section 37 of the Health and Safety at Work, etc. Act 1974, which is about whether corporate killing has the consent or connivance of, or is attributable to neglect on the part of, such a person. For individuals to be convicted on that test, it must be shown at least that they have responsibility for making relevant management decisions and have failed, for example, to adopt a sound safety policy based on acceptable risks or to ensure that mechanisms are in place to review and monitor the application of such a policy.

The offence of corporate killing is essential for the sake of public confidence in our system of justice. All too often, companies and organisations have been able to escape the net of the general criminal law for gross errors that would have seen individuals in the dock. The offence of corporate killing will be an important additional string to the bow of making all companies take safety seriously. Most companies recognise not only that they have a moral obligation to those affected by their activities, but that it makes good business sense as well.

In the long run, a good safety record will pay for itself, as shareholders, employees and customers gain confidence in companies. The offence of corporate killing will help all organisations to appreciate that, and help to change corporate culture so that safety is given the same priority as profit.

I congratulate my hon. and learned Friend the Member for Dudley, North (Ross Cranston) on securing the debate, and also on the quality of his speech. It was wide ranging and covered the ground on corporate manslaughter effectively.

As my hon. and learned Friend points out, we are committed to the introduction of an offence of corporate killing that will hold companies to account for serious wrongdoings. Our consultation paper, issued in May last year, set out our thoughts on how to reform the law on involuntary manslaughter as a whole. One of the key proposals was to introduce a new offence of corporate killing to be used instead of the current law of manslaughter. The fact that there have been only three successful prosecutions of a corporation for manslaughter highlights the need for reform. A company may be convicted only if an individual or a group of individuals who embody the company are found guilty. That requirement, known as the identification doctrine, means that it is difficult to secure a conviction, even when a company has been found to be at fault under the Health and Safety at Work, etc. Act 1974.

I shall use an example already cited by my hon. and learned Friend. In the case of the Southall rail crash, which claimed seven lives, the judge ruled that a charge of manslaughter could not proceed because of the difficulty of identifying someone when Great Western Trains was responsible for the negligence. However, it was not in doubt that the company had done wrong. It pleaded guilty to a charge under the 1974 Act and received a fine of £1.5 million. We recognise that convictions under the 1974 Act are serious, but we share the view expressed by my hon. and learned Friend that it is important that a company can be charged specifically with a homicide offence when a death is caused by its wrongdoing.

The proposals put forward for consultation built on the Law Commission report entitled "Legislating the Criminal Code: Involuntary Manslaughter", which was published in 1996. We use the term involuntary manslaughter because our proposals concern the criminal liability of those who kill when they do not intend to cause death or serious injury. There are two ways to consider such people. One way is to argue that society should always punish a person who causes terrible consequences. The other is to argue that a civilised society should not make people liable to punishment for a serious crime simply because of the result of their conduct, but only when they were aware that their conduct could lead to death.

One criticism of the current offence of unintentional manslaughter is its wide scope. At one end of that range is conduct by a person who causes death while engaged in a criminal act that carried with it no more than a risk of causing some slight injury. At the other is death caused in circumstances in which the risk of death was obvious. One of the problems with the wide range of conduct covered by manslaughter is the difficulty that judges have in determining appropriate sentences for particular cases. It also leads to problems for the public, who may not understand why a judge has awarded a particular sentence. It was against that background, as well as because of concerns at the lack of successful prosecutions of corporations for manslaughter, that we made our proposals last year.

The consultation period ended in September 2000. During that time, we received more than 160 responses. Almost all were of high quality and required careful consideration. As my hon. and learned Friend will know, it was not possible to fit a Bill to reform the law in this area into what was to be the final Session of the previous Parliament. Nor was it possible to include such a Bill in last month's Queen's Speech. There has been a benefit, however, in that we have been able to devote more time to giving those responses detailed consideration.

We have yet to make final decisions in the light of the comments put to us. However, the introduction of a new offence of corporate killing is a manifesto commitment. Needless to say, we aim to honour that commitment, but I cannot say exactly when a final decision will be announced. When we make our announcement, we plan to publish a list of those who contributed to the consultation exercise, together with a summary of their responses, except in those cases when contributors asked not to have their comments made public.

Our aim is that the law should be more effective in making private individuals and undertakings accountable for their actions. Unless there are overwhelming reasons against doing so, it is reasonable that large undertakings should be no less liable to prosecution for manslaughter than private individuals or sole traders.

The Government are mindful of the need for businesses to continue to operate successfully. However, corporations must also operate responsibly, and effective sanctions against the kind of negligence or recklessness which kills are an important way to ensure that. To mark the seriousness of the offence, it would be triable on indictment only. We also propose, however, that alternative verdicts under sections 2 or 3 of the 1974 Act would be available to a jury in the event of a defendant being found not guilty of corporate killing.

The proposals set out in the consultation paper focus on the way in which activities are managed or organised by the undertakings. The offence of corporate killing will be committed when a management failure is one of the causes of death. Management failure will be defined as conduct that falls far below what can reasonably be expected of the undertaking in the circumstances. That is an exacting test, but not an unreasonable one; conscientious enterprises that take seriously their responsibility to ensure the health and safety of those affected by their activities should have nothing to fear. Expert witnesses will be available to assist a jury in determining what it was reasonable to expect of a particular defendant in the circumstances.

We also propose that companies should be liable when management failure is a cause of death rather than the cause of death. That is because, in many cases, the death may be more directly connected to the operational negligence of an employee—for example, a train driver may pass through a red signal, or a construction worker may erect scaffolding dangerously. However, the management failure might consist of a failure to take precautions to prevent such negligence, or a failure to introduce appropriate training or supervision.

The Law Commission suggested applying the offence of corporate killing to incorporated organisations only. That would create anomalies, because it would exclude large partnerships yet include some public companies and others that were not run for profit. As my hon. and learned Friend pointed out, we propose going further than that and applying the new offence to all undertakings.

Our proposal would considerably broaden the scope of the offence to about 3.5 million enterprises; for example, it would include NHS trusts and voluntary bodies. That reflects our view that the offence should be as inclusive as possible, and that employees and members of the public should be entitled to the same level of protection, regardless of the status of the undertaking.

Our proposals also recognise that Crown bodies should be held accountable when death occurs as a result of management failure. We have proposed an approach similar to that in the Food Safety Act 1990. That would allow the courts to make a declaration of non-compliance with statutory requirements, which requires immediate action to rectify the shortcomings that have been identified. The proposal provoked considerable debate, and we are carefully considering how Crown bodies should be held to account when a management failure is a cause of death. As my hon. and learned Friend recognised, it is a difficult issue, which raises important constitutional questions about how—not whether—the Government should be held to account.

Our consultation paper also invited views on whether individuals should be liable when they have contributed to a corporate killing. One concern is whether corporate liability alone might fail to provide a sufficient deterrent, particularly within large or group companies. Another consideration is that individuals who are responsible for a fatal incident can be prevented from continuing in similar positions, where the public would be vulnerable to similar conduct. If the causal link between the individual and the death were sufficient, it would be possible to prosecute for one of the individual offences. However, even when the individual cannot be prosecuted for manslaughter in his or her own right, we recognise the force of the argument that the public interest demands that individual directors who have contributed to management failure resulting in death should be subject to specific action against them. As my hon. and learned Friend said, there is already the option of disqualification for up to 15 years under the Company Directors Disqualification Act 1986 in the case of directors who are convicted of an indictable offence in connection with their promotion, formation, management or liquidation of a company.

The consultation paper also invited opinions on whether there should be an additional criminal offence in respect of contributing to the corporate offence and, if so, whether imprisonment should be available as a sanction. Not surprisingly, we received many comments on that proposal. It will come as no surprise that that was probably the most contentious part of the consultation paper. I have noted what my hon. and learned Friend said on the issue, and I agree that the approach taken in section 37 of the 1974 Act is worth considering. We shall have to come to conclusions on the right way forward. In doing so, we will take careful note of the comments that we have received.

Although I cannot say what conclusions we shall reach on that last question or on the other issues of detail, I can set out the broad considerations that we believe we need to bear in mind in reaching them. First, reform is needed. The train accidents that have occurred over recent years, involving the death of passengers, have ensured that the process that the Law Commission started in 1996 with the publication of its recommendation for a new offence of corporate killing remains as relevant as ever.

Secondly, life cannot be made entirely risk-free. We must guard against raising unreasonable public expectations in that respect. The programme of maintenance work that Railtrack put in hand after Hatfield and the disruption to train services raise the issue of the lengths to which an enterprise should go in ensuring safety.

I mention those two points because they underline for us the need to strike the right balance when introducing our proposals on corporate manslaughter in the light of the consultation exercise. My hon. and learned Friend referred to a balance, and safety must be given the same priority as profit. The public and employees have a right to be protected from goods and services that are lethally substandard. On the other hand, we must bear in mind the fact that too strict a test of liability might lead the more conscientious enterprises to question whether to continue supplying goods or services that attract risk. It is important that we consider those issues in detail; we must get it right before we proceed to legislate. We should not let up in our determination to reform the law in this area. I thank my hon. and learned Friend for the opportunity that he has provided for the Government to reiterate those points.

I am pleased to have the opportunity to raise the issue of the Hazel Grove bypass, and I am grateful to the Parliamentary Under-Secretary of State for Transport, Local Government and the Regions, the hon. Member for Plymouth, Devonport (Mr. Jamieson), for being here to listen to my plea. I hope to be even more grateful when he acknowledges that plea and grants my heart's desire.

I have been campaigning for a bypass for Hazel Grove for more than l2 years. During that time, there have been petitions, debates in the House, questions to Ministers and deputations. I am a new hand compared to some residents of Hazel Grove, who tell me that they have been waiting 30 years. Indeed, some people who claim to have met Lloyd George say that they have been waiting 60 years. It is a long-standing and definite need, and from time to time it has been supported by all political parties. Indeed, my Labour opponent in the general election assured residents that he supported that plea.

The argument is not only about another bypass. We are also asking the Government to put their heart and their money into a comprehensive attack on pollution and congestion across a wide swathe of Greater Manchester. On top of the national traffic growth projections, which are horrific enough even on a modest estimate of 20 per cent. by 2010, my constituency has three specific local circumstances that aggravate the traffic and congestion problems.

The first problem is the opening of the final section of the M60 link road that circles Manchester. That has resulted in a great deal of additional traffic being directed into my constituency, filtering through the area and increasing congestion. The second problem is the opening of the second runway at Manchester airport, which has resulted in a rapid and large increase in the number of passengers travelling to and from the airport. The map shows the motorway is on one side of my constituency and the airport on the other—the congestion is in the middle.

As if those two problems were not enough, Greater Manchester is something of an economic hot spot in the north-west; and the south-eastern part of Greater Manchester is particularly so, as a result of the increased prosperity created by the airport. It is estimated that current traffic movements of about 18 million passengers a year will rise to 32 million a year by 2010 and to 42 million by 2015. There will be an additional 70,000 trips per day through my constituency to the airport.

At the heart of that economic hot spot, with the motorway on one side and the airport on the other, the community is in decline. I know that the Minister comes from Plymouth, which is rather a long way from Hazel Grove. Indeed, until this debate, he might not have known where Hazel Grove was. The heart of the issue is the A6 trunk road from Manchester down to Derby, which is straddled by my constituency. In the area that we are talking about, the A6 has two lanes running in each direction through an urban shopping centre. The road takes a great deal of heavy freight traffic to the north-west, particularly transporting minerals from the Peak District. It carries a high load of commuter traffic, as well as traffic seeking access to the M60.

The public transport infrastructure in the area is not good. I have been a persistent critic of First North Western, with its 40-year-old rolling stock, its unreliable services and its overcrowded carriages. The stations have no access ramps, and sometimes no toilets. The alternatives are scarcely in place at the moment.

The road scheme has been a line on the map for many years. It has gone through what I would call engineering overkill. Each time a new group of engineers examined the plans from 10 years earlier they added a couple of lanes each way and a couple of interchanges, so that by 1995 the scheme had reached enormous proportions. It is not altogether surprising that it ran into trouble on cost and other grounds.

The Conservatives took the so-called Stepping Hill link out of the national road programme. They cancelled the Disley and High Lane bypass. In 1997, the new Government dropped the central part of the scheme—the so-called A6M. In the meantime, there has been a steady increase in traffic, congestion, pollution, noise and fatalities. There have been a number of tragic deaths on that length of road. If one examines a map of traffic accidents and incidents in the borough of Stockport, one finds that every junction of the A6 is clustered with accidents and fatalities. Having stood there a few times over the past couple of months, I can say that in wet conditions it is horrific for people standing on the pavements, who are sprayed by the vehicles that race through the town.

The Government established the south-east Manchester multi-modal study—SEMMS—and the transport consultants conducting it are due to report within the next few weeks. That report is eagerly awaited by my colleagues in Stockport, and by the residents of Hazel Grove in particular. We know from the preliminary report that the consultants will put great emphasis on deflection and diversion strategies. Those strategies have my complete support—I am not making a plea for a road at any cost or as the only solution. However, one of the diversion strategies being prayed in aid is the airport authority's intention that a quarter of all journeys to the airport should be made by public transport. That is an excellent aim, which I strongly support. However, even if that aim is achieved, 30 million such journeys will he made by road annually by 2015—double the number made today. When the diversion tactics are in place, road traffic levels will still significantly increase.

I hope that the SEMMS study will state that First North Western should be replaced and that we should have a franchise-holder that can deliver services properly for local commuters. I hope that the report will state that there should be a rail service introduced from Marple to Stockport. I also hope that it will argue that the Metrolink tram should be extended not just to Stockport hut on to Bredbury, where it could join up with heavy rail routes. There are plans for quality bus routes along the A6, part of which is already in place. All those provisions will help to give people alternatives to using their cars.

However, even when all that has been done, road traffic congestion will increase. We still, therefore, need those missing road links. The first and highest priority is a link road round the Hazel Grove shopping centre. Stockport council was so concerned about the decline of that shopping centre that it commissioned shopping consultants to see what might be done to bring it back to life. The consultants, Drivers Jonas, produced a report that said that there were various ways in which the council could try to revive the centre, but that the fundamental problem was the traffic going through the centre. The report stated that until or unless that was got rid of, the centre would continue to die on its feet.

Getting the Stepping Hill link to bypass the shopping centre is a very high priority. We also need to ensure that we have a road that connects the M60 at Bredbury with the Manchester airport eastern link road at Woodford and on to the airport. It used to be called the A6M, but I do not argue that we need the heavily engineered motorway solution that was once on offer. We need a vehicle-only route that safeguards local communities and leaves the citizens of Bredbury, Romiley and Hazel Grove with a reasonable and peaceful environment in which to work.

I want the Minister first to acknowledge the severe problems that local residents and commuters face. Secondly, I want him to show some recognition of the exceptional levels of traffic growth that are starting and which are foreseeable with the expansion of the airport. Thirdly, I want him to put his weight behind the options to be published in the SEMMS report, which we know will be a mixture of public transport and road-based solutions. Their implementation as quickly as possible is essential for the well-being of my area, especially Hazel Grove. Fourthly, I want him to be ready to commit resources for the implementation of those transport solutions.

When I last spoke to the consultants—I am in frequent contact with them, as hon. Members will imagine—they told me that they planned to publish on a time scale that would allow the local authorities to incorporate their ideas in the integrated transport plans that they will propose to the Minister. The timetable is desperately short. Those submissions have to be made in the next six to eight weeks, and the report has still not been published. It is important for the Minister to signal to the local authorities that he will be ready to respond favourably when they include the ideas in their integrated transport plan submission.

In Hazel Grove, we have had plans for decades. Special extra pigeon holes have had to be built for them. Every time someone reconsiders them, they scratch their heads, say that the problem should have been dealt with and call for another plan. The residents of Hazel Grove have reservations and concerns about yet another plan. They do not want just a plan, but an implementation package. I ask the Minister to please accept the plan, provide the resources and give us an implementation package, so that the residents of Hazel Grove do not have to put up with the problem any longer.

I congratulate the hon. Member for Hazel Grove (Mr. Stunell) on securing the debate, on raising a subject that is important to his constituents, and also on his well-considered and thoughtful approach. He has been a tenacious advocate of the bypass on behalf of his constituents.

I am not sure that I will be able to provide something today that will instantly meet the heart's desire of all the hon. Gentleman's constituents. However, I will try to outline the Government's position on bypasses and consider the context in which a decision will be made on the Manchester and Stockport area. I accept his points about pollution and congestion. Although I represent Plymouth, I assure him that the Government represent the United Kingdom. We have a broad brief and understand the issues. Even though I may not be familiar with every piece of gravel at the side of the road in his area, I am exceedingly well informed on the issues by officials.

The hon. Gentleman said that some of his constituents had waited a long time—some thought it 20 years, some 60 years—for the bypass. However, the subject is now being discussed in a different context. The road is no longer part of the major trunk road system, but part of the local road system and will be discussed as part of the local road strategy. There are some differences and, in that context, the Government's role has changed somewhat. He might consider that that is good news, in that the issues will be discussed locally, and local priorities will be brought to bear on the decisions that are made.

The Minister is right about the transfer. I draw his attention to the fact that that will not happen until April next year—so there is plenty of time for him to chip in some money.

I thank the hon. Gentleman for that intervention and for having raised this topic. It is both interesting and useful to hear at first hand about the impact that traffic congestion and pollution have on the economic, social and environmental well-being of Hazel Grove residents, and he has set out the case for transport improvements very clearly.

We recognise that both quality of life and the economy depend upon transport. Motor vehicles have revolutionised the way in which we live, bringing greater flexibility and widening people's horizons. However, the use of our vehicles has a price—for the economy, for our health and for the environment. That is particularly true in urban areas such as Hazel Grove, where the steady increase in traffic over many years has led to increased congestion and the negative effects on communities that the hon. Gentleman has so graphically described.

We made it clear in our White Paper "A New Deal for Transport" that we are committed to improving the environment in towns and cities. We want people to be able to move around easily and in safety. By removing a large proportion of the through traffic from a community, a bypass can certainly bring about an improvement in safety for residents. The severance effect of high traffic flows is reduced and accessibility is increased. Residents face fewer risks when crossing the road and, if the footway is inadequate, when simply walking on the pavement in close proximity to traffic. I am informed that that applies in the area that the hon. Gentleman has mentioned.

A bypass also improves the quality of the built environment. Noise levels are reduced and air quality is improved. The removal of heavy traffic allows communities to develop their opportunities to improve the reliability of public transport and to provide better facilities for cycling or walking. The removal of through traffic can also boost an area's commercial and retail vitality, providing a safer, cleaner and more attractive place in which to shop and to do business. That is also particularly relevant to today's debate.

However, it is also possible to make a harmful impact on the enviroment. People who formerly enjoyed a quiet environment might find themselves near a busy road that has become the bypass for another area. A bypass might adversely affect designated areas. Some of these consequences might be unavoidable, but they should be carefully considered when deciding whether or not to proceed. I am sure that the hon. Gentleman agrees that environmental and other matters should figure in our consideration of bypasses.

As the hon. Member for Hazel Grove said, there are proposals of between 20 and 60 years standing for a bypass of Hazel Grove as part of the larger north-south bypass of Stockport to relieve the A6. Some development work has been undertaken. There are now, as he mentioned, endless pigeonholes with plans in them. As he knows, a public inquiry was held in 1987–88, and orders were made in 1989 and 1990. Supplementary orders were published in 1991 and 1992. However, following a reappraisal of the scheme, the Conservative Administration decided to withdraw those orders.

At the time of this Government's 1997–98 roads review, the Stockport north-south bypass had not been sufficiently developed for us to consider it as a candidate for the targeted programme of trunk road improvements. In addition, the scheme was on a part of the trunk road network that we concluded was not of sufficient strategic national importance to justify its inclusion in the core trunk road network.

The core network will continue to be a direct central Government responsibility, with non-core routes being transferred to local highway authorities in accordance with the policy that was set out in "A New Deal for Transport", which was subsequently the subject of consultation. In all, we propose to de-trunk some 3,000 km—about 2,000 miles—of non-core routes. That will be done in a phased programme with the first tranche of 500 km due to be de-trunked in 2001–02. Non-core trunk roads, which include the A6 and A523 in Greater Manchester, mainly serve local and regional traffic. We concluded that those routes would be more appropriately managed by local highway authorities, to enable decisions about them to be taken locally, and better to integrate them with local transport and land use issues.

Nineteen schemes in the road programme that we inherited from the previous Administration were on non-core routes proposed for de-trunking. They were withdrawn from the national trunk road programme, and the relevant local highway authorities were invited to consider taking them forward as local road schemes within their local transport plans. Among those schemes were the A6 Stockport north-south bypass, the A555-A523 Poynton bypass and the A555 Manchester airport link west.

Rather than put forward immediate bids for the schemes, it was decided to look at the problems that they were designed to address. The south-east Manchester multimodal study is one of several multimodal studies dealing with particularly complex problems that can be tackled only by examining all forms of transport in the relevant area and seeking balanced solutions that will contribute to our integrated transport policy. In recognition of the importance of the problems in southeast Manchester, SEMMS was one of the first multimodalstudies to be commissioned.

It may be helpful to explain the process of the study. A consortium led by Steer Davies Gleave was appointed following competitive tender in December 1999. We are funding the study and the Government office for the north-west is leading, in partnership with key interested parties in the study area. As for all the multimodal studies, we have established a steering group that is responsible for its management and direction. Membership is wide and incorporates all district and county councils that are covered by the study, the Strategic Rail Authority, the Highways Agency and the regional development agency, together with other business interests including Manchester airport and a representative of local environmental and community groups.

The hon. Member for Hazel Grove asked about implementation. Perhaps I can steer things his way a little, even if I cannot give him his heart's desire. The study is going through a well-structured process. Much time has been spent analysing in depth the transport, planning, social and economic issues within the study area. The work has confirmed many of the points raised by the hon. Gentleman about the adverse impact of congestion on parts of the study area, including Hazel Grove and the A6 corridor, and the lack of attractive, sustainable alternatives to the car. Problems have also been identified associated with long-term land use planning decisions and with the adverse impact that stone lorries can have, particularly in his constituency. There are also areas of significant deprivation within the study area, which have their own transport problems and needs.

The study, having produced recognition and understanding of the severity of the problems, is also developing solutions. Working with the steering group, the consultants have identified a range of possible measures to address the problems. Potential solutions being examined include the construction of bypasses; Metrolink extensions beyond those agreed by the Government in March last year; an extension of the Greater Manchester quality bus corridor programme;a significant enhancement of the quality and reliability of rail services, which has been developed in close co-operation with the Strategic Rail Authority's work in Greater Manchester; measures to assist cyclists and pedestrians; the better management of freight movements; and a significant intensification of efforts to promote a change in travel behaviour.

Those measures have been assembled into a number of strategies covering the full range of transport activity. Their potential impact has been appraised in detail to get a broad picture of the potential costs and benefits of the various options. The consultants and the steering group are now engaged—literally as we speak, for they are meeting in Manchester today—in putting together a recommended strategy based on the results of that work. I understand that the recommended strategy is expected to include proposals for bypasses to alleviate traffic for local communities, extensions to the Metrolink and an upgrade in the availability and quality of alternatives to the car.

The hon. Member for Hazel Grove will be aware that consultation is playing a very important part in the study process. Emphasis has been placed from an early stage on giving people, their elected representatives and interested organisations the opportunity to participate in identifying problems, formulating strategy and deriving solutions. There have been regular newsletters, consultation meetings and briefing sessions, and I believe that on three occasions the hon. Gentleman has met with the Government office for the north west and its consultants. There will be a further opportunity for consultation offered shortly, once a recommended strategy has been developed, and officials will be happy to meet the hon. Gentleman should he wish for further briefing.

We expect the final report on SEMMS to be made in August. The regional planning body will then make its recommendations to Ministers in the light of the report. If the case for an A6 by-pass to take traffic out of Hazel Grove is accepted, it will be for Stockport metropolitan borough council to take the lead in working up the scheme and to submit it for consideration for funding as part of the Greater Manchester local transport plan. In the 10-year plan, we have made a clear commitment to fund the outcomes of the multimodal study process. My officials are already discussing how major schemes proposed by SEMMS can be taken forward through the local transport plan system.

I thank the hon. Gentleman for raising those matters. I am sure that, like me, he is looking forward to seeing the results of the study. He can be assured that the issues that he has raised will be considered with great care at all levels. I thank him once again for raising those matters in such a measured way. I am sure that this will not be the last time that we hear from him; perhaps the heart's desires of his constituents will one day be achieved.