I start by welcoming the publication of the national strategy for sexual health and HIV. It is the first such strategy, and the Government are to be commended on their work. The document is not the end of the story: it is out for consultation, and the policy development work continues.

Hon. Members might be aware that my interest is in HIV-AIDS, on which I shall focus in the main. I am sure that other hon. Members will talk about other sexual health matters. My interest in HIV was triggered in the 1980s as a result of my being an Edinburgh Member of Parliament. Hon. Members will be aware that Edinburgh had a huge problem with HIV transmission caused by injecting drugs. In 1985 and earlier, 81 per cent. of HIV diagnoses in Scotland were for infections caught in that way. That has all changed. Injecting drug use accounted for 11 per cent. of diagnoses in the first half of this year, while sex between men is now the largest exposure category.

Many people have been tempted to see HIV as a threat of the past, but that is far from true. It would be helpful to take a quick overview of the HIV epidemic in the UK. There were 3,550 new HIV diagnoses last year—the highest number on record. The majority of cases stem from heterosexual sex, mostly in high-prevalence countries—the number has been rising steeply for several years. However, the majority of transmissions in the UK still arise from sex between men, and there is little evidence that the number of new infections is declining.

The UK's performance in limiting HIV transmission from mother to baby has been poorer than that of several other European countries, but there is evidence that rates have begun to improve. The number of cases that result from intravenous drug usage remains low, but the rate of works sharing is thought to be worsening.

The Government have said that the rise in the total number of HIV diagnoses could be accounted for partly by increased antenatal testing, and I would be grateful if my hon. Friend the Under-Secretary of State for Health, the Member for Salford (Ms Blears), could elaborate a bit further and tell us what proportion of new diagnoses results from antenatal screening.

The final point that I want to make in this overview was mentioned in the Government's strategy document. HIV is not distributed equally through the population. The Terrence Higgins Trust recently published a report showing the association between HIV infection and social exclusion.

The life expectancy of people with HIV has been transformed by combination therapy, and as a result many people with HIV are alive today who would otherwise not be. However, it is equally vital to prevent the spread of HIV. Against the background of the progress made in previous years, it is a matter of great concern and disappointment that high numbers of new infections occur in this country every year. In this day and age, every new HIV infection represents a failure of prevention.

I do not want to exaggerate—it is not all bad news. The HIV epidemic here is not as bad as that in many comparable developed countries, and there has not been the explosion in numbers that many people feared in the 1980s. Prevention work in the early years of the epidemic achieved successes—for instance, needle exchanges, which were controversial at the time, and the high-profile public information campaigns. I am concerned that such prevention work has been allowed to go off the boil in the latter years of the epidemic. In 1998, Peter Piot, the executive director of the joint United Nations programme on HIV-AIDS—UNAIDS—said that, at the very moment when we knew most about preventing HIV infection, there had been a weakening of the global effort to do something about it.

My hon. Friend will be well aware of the National AIDS Trust paper "HIV at the Crossroads" by Professor Peter Aggleton. Professor Aggleton said:

"Almost without exception, governments in the developed world no longer see HIV prevention as a top priority, and there has been a progressive weakening of support for the provision of public information and other prevention initiatives … In Britain, prevention initiatives for the population as a whole are presently conspicuous by their absence, and because there has not been a significant heterosexual HIV epidemic, many health authorities across Britain have sought to 'mainstream' their HIV and AIDS work into other programmes and activities."

Hon. Members may be aware that the Department of Health funding for prevention has not kept up with inflation since the mid-1990s. Funding in Scotland was frozen for several consecutive years, until this year. Good people are doing good work in HIV prevention, but there is a real sense in which prevention work has not kept up with the changing nature of the epidemic.

I draw attention to the words of "John", a gay London man in his 30s, who was diagnosed HIV positive on 10 July. When interviewed by BBC News Online, he said:

"Clearly the message about safe sex is missing the target, if it is being delivered at all. In one internet chatroom used by many gay men in London you can find an area where up to 50 men a night are looking for unsafe 'bareback' sex. I think the reasons behind the rise in unsafe sex are complex. The fear of HIV and AIDS has undoubtedly subsided, making many people complacent. The appeal of taking a risk alongside sexual excitement is another factor. So is the belief among many gay men that sex without a condom is 'better'. Drink and drugs are also part of this potent mix. Lack of self-esteem among many gay men plays its part as well. Two years ago I rarely met people who wanted unsafe sex. In the last six months the numbers grew significantly. If we are really to challenge the spread of HIV and do it in an intelligent and effective way, we need to get to the heart of those issues."

John managed to capture many of the key points. The epidemic—or epidemics—among gay men are complex and changing, and the safe sex message is simply not getting through.

I am aware that these matters are now largely devolved, but I should point out that Scotland might suffer a second wave of HIV infection. This summer, Dr. Jamie Inglis, director of public health at the Health Education Board for Scotland, called for prevention campaigns to be stepped up and warned that if there were a delay in taking new steps to raise awareness about the dangers of unprotected sex, it could be too late to stop a dramatic increase in the spread of HIV.

Derek Bodell, chief executive of the National Aids Trust, said that people becoming sexually active now will not have been influenced by the campaigns of the 1980s. He said:

"I think people are starting to think we don't need to think about this anymore. There is a danger that people don't remember the safer sex messages about wearing a condom which are so important."

Meanwhile, as Professor Roy Anderson of Imperial college London said,

"you get a growing body of evidence that suggests that young people believe the threat of HIV is much less than it was because there's effective treatment. Well that's very far from the truth. This organism, this disease, is in my view the biggest threat human society has seen."

HIV prevention work aims to prevent the suffering and hardship associated with HIV infection. Even with combination therapy, life with HIV is often hard. Resistance to the drugs is growing: around 20 per cent. of newly infected individuals are infected with a resistant virus. HIV is a young person's disease, and while other diseases that rightly attract funding priority tend to affect people in later life, those most vulnerable to HIV have their whole lives ahead of them. It is also fair to make the point, as the Government do in their strategy document, that the monetary value of preventing a single onward transition is estimated at somewhere between £500,000 and £1 million in individual health benefits and treatment costs.

I welcome the Government strategy and the additional money that they have announced. The Minister may be aware that there is some concern, which I share, that very little of the new money attached to the strategy is intended to increase HIV prevention efforts on the ground. I would be grateful to receive assurances on that point.

"Mainstreaming" has been a buzzword in the HIV field for a few years now, and it has several aspects. The mainstreaming of HIV policy is nowhere better illustrated than in the subsuming of the proposed HIV strategy into the current strategy for sexual health and HIV.

I understand the motivation behind the integration of HIV policy with other sexual health policy. Benefits may be secured from an integrated approach. However, there are dangers. We must ensure that the policy framework is not so tightly integrated that the specificity of HIV-related concerns is mainstreamed away, and that the growing skills and knowledge base acquired around HIV is lost.

Funding is also mainstreamed. From 1 April 2002, the HIV-AIDS budget ring fence in England will be scrapped, so the only central mechanism that has required health authorities to spend in this area will be abolished. The worry is that while good work will continue to be done in some areas, HIV work will disappear in others. The most vulnerable spending areas will be the unpopular ones, such as health promotion among gay men and African communities, and voluntary sector grants for social care.

Although the Government's strategy document contains helpful proposals, there are no mechanisms to ensure that they are implemented. I hope that the Government will consider delaying the removal of the ring fence, because it is the main weapon that ensures that the money set aside for the purpose is spent on tackling HIV. There is enough concern about it to justify further consideration and consultation.

As well as the removal of the HIV budget ring fence, the existing health authorities will be scrapped on 1 April 2002 and commissioning responsibility will pass to primary care trusts. That will give rise to two dangers. The first is the risk that we will lose the expertise in HIV-AIDS that some health authorities have developed. A great effort must be made to equip the primary care trusts with the knowledge and resources that they will need. The second is that, in the upheaval of the changes, we may lose sight of the areas for action on HIV that are set out in the strategy.

We can all agree that what is important for HIV prevention is what works, but that is where agreement ends. I read with interest in the strategy document that the Government's view is that the evidence base for HIV prevention is still dispersed and unsystematic. It is regrettable that that is still the case, but it is good that the Government have recognised it and that the Health Development Agency has been commissioned to address the problem.

The Minister knows that I piloted the AIDS (Control) Act 1987 through the House of Commons as a private Member's Bill. I hope that she is also aware that I have set out proposals to bring the Act into the 21st century, so that its provisions for accountability and information are improved, and it allows a better vision of what should happen regionally and nationally. The all-party group on AIDS has also recommended that the Act be updated to include a requirement to report more widely than within the health sector, to provide for greater consultation and to require health authorities to account for discrepancies between spending and local epidemiology. Accountability and communication are as necessary now as they were in 1987. The reports have a valuable role to play in that regard. The strategy promises that the Act will be reviewed, and I look forward to hearing what the Minister has in mind.

The Government announced in December 1997 that they would draw up a strategy on HIV. The membership of the strategy steering group was announced in April 1999. The strategy was published in July 2001 and the Government are now embarking on further consultation to refine it, as is right and proper. However, the situation is urgent, and I hope that the publication of the strategy and its implementation, combined with the work of the Health Development Agency, will prove to be a landmark in the efforts in the UK to reduce the spread of HIV.

Some countries have worse epidemics than we do. However, that is largely thanks to the work that was done in the earlier years of our epidemic. The commendable effort of those years has not been sustained. That complacency might be because combination therapy has allowed many people who would not otherwise be able to do so to lead relatively normal lives. Whatever the reason, complacency is a mistake. Every new HIV infection is a failure. We should take the opportunity that the strategy offers significantly to step up our efforts, especially in higher-risk groups, and to reduce the number of people who become infected with HIV in future.

I congratulate the right hon. Member for Edinburgh, East and Musselburgh (Dr. Strang) on securing this debate. As he rightly said, the health service in Scotland is a devolved matter, so my comments will be relatively brief. Although the matter is devolved, there is the possibility of a second AIDS problem arising in Scotland very quickly. AIDS is a worldwide problem and the virus does not respect borders. Given that we are all travelling more, we should consider the problem more on a pan-European and worldwide basis, not just in terms of the UK or Scotland.

The right hon. Gentleman stated that the highest rate of HIV infection in Scotland was originally among intravenous drug users. However, that has changed over the years. Last year saw the highest levels of HIV infection on record in Scotland, and the number of new cases of HIV diagnosed among heterosexuals was almost the same as among gay men—60 compared with 61. That shows that AIDS has moved out of the groups that were originally hit, and is hitting people throughout the population.

It has been suggested that Scotland's young heterosexual middle classes are becoming the new victims of AIDS. Why is that happening? The right hon. Gentleman hit on it when he said that the message of safe sex has been lost to some extent. Those of us who are now in our 40s remember the almost apocalyptic advertising about the dangers of AIDS that appeared in the 1980s, which had a great effect on young people at that time. That effect has largely disappeared, and many young people have become complacent about the dangers of AIDS. That is shown by the rising number of infections in Scotland and throughout the UK.

There may be other reasons for that increase. I draw the Minister's attention to an investigation carried out by the Sandyford initiative in Glasgow, which found that the recent rise in HIV cases in Scotland may be set to accelerate dramatically. The institute specialises in sexual health matters. It carried out tests on 59 people who were receiving the highly active anti-retroviral therapy HIV treatment. Its study, which was published in The Lancet, showed that 11 of the 43 men and 16 women had become infected with sexually transmitted diseases while they were receiving the treatment, so there is evidence that people infected with HIV are not practising safe sex. The right hon. Gentleman hinted at that.

The Government Minister and Ministers in the Scottish Executive must consider how to retarget the message at young people who are becoming sexually active. Young people are travelling much more than they would have done many years ago, so if there is a problem in other countries, it can be imported into the United Kingdom. Moreover, the message about the importance of practising safe sex should be reinforced for those who are already infected with HIV. The right hon. Gentleman quoted John, a young man in London. That was a frightening intimation of what might happen if the safe sex message were not reinforced. I urge the Minister to meet health officials in England and Wales, members of the Scottish Executive and our European counterparts to consider a strategy to cover the whole area, because the virus knows no borders.

AIDS is not the only sexually transmitted disease with a rising rate of infection: there has been a dramatic rise in instances of chlamydia over the past few years. The figures from my own area of Tayside show that infections have more than doubled during the past three years. The reasons for that worrying trend may be complex, but I suspect that the safe sex message is at the root of it. If the message has been lost in one area, it has probably been lost throughout the population, and that has led to the rises.

Although sexual health is a devolved matter, it concerns everyone in the United Kingdom and Europe. I welcome the Government's strategy. More funds must be made available. Ultimately, the message of safe sex must be put across to our young people. We must be on guard for changes in how the disease appears in Scotland and in the UK as a whole.

I am glad that my right hon. Friend the Member for Edinburgh, East and Musselburgh (Dr. Strang) has secured the debate, as it is important that we consider the strategy on sexual health and HIV. As he said, the strategy is long overdue. It was announced in 1997, and progress appeared to have been made in 1999. I want to concentrate on HIV, for which we initially had a separate strategy that struggled to make any progress until it was merged with the sexual health strategy. That led to the publication of this strategy document earlier this year.

I recognise that the strategy covers many issues other than HIV. There are obviously relationships between actions on the prevention of HIV and those on the prevention of other sexually transmitted infections, such as hepatitis B. Some subjects not mentioned in the strategy may not be directly relevant, such as hepatitis C, which is not sexually transmitted but which remains an important issue and one that the Department of Health needs to tackle.

Anyone who read the strategy would accept that its scope was comprehensive and that it covered a wide range of issues. Someone described it to me as ticking all the right boxes, and it picks up on all the questions that need to be answered. Few would disagree with the key aims in the section on objectives and targets, which are to reduce the number of newly acquired infections, to discourage the practice of unsafe sex, and to raise awareness of services. Nor would many disagree with the methods that it proposes to achieve those aims, such as work in collaboration with health authorities and the voluntary sector, improvements in outreach services, and enhancing the role that HIV treatment and care services play in prevention. We have tended to regard treatment and care as a separate service from prevention, but it can affect prevention so we should ensure that it plays a role.

My right hon. Friend mentioned the building of an evidence base. It makes sense to find out precisely what has worked. When we develop new programmes, especially to prevent HIV and other diseases, we often do not consider what has been effective in the past.

The strategy document for the first time sets specific targets. Paragraph 3.12 sets a target

"to reduce by 25 per cent. the number of newly acquired HIV infections and gonorrhoea infections by the end of 2007".

I am not clear exactly how that target will be achieved, and I shall return to the problem of implementation. How was the figure of 25 per cent. determined? Why was not 20 or 33 per cent. chosen? I suspect that the figure has been plucked out of the air, especially in the light of what has been said about the evidence base, and the uncertainty about what works. We clearly need to monitor progress towards the target.

Few people would fundamentally disagree with much in the strategy. However, the Department of Health will not be directly responsible for implementing most of it. That will be carried out by health authorities, primary care trusts and the voluntary sector, which has a significant contribution to make. It is unclear to me how some of the proposals will be put into practice and what mechanisms will be used to ensure that that happens.

Much of the strategy is about encouraging health planners to do the right things, but it is unclear how some of their actions will be monitored. We know from experience that monitoring is necessary. For example, it became clear from a survey by the National AIDS Trust in 1999 that money from the prevention budget, which has existed for some years, was not necessarily being targeted at the groups most at risk.

My right hon. Friend mentioned the AIDS (Control) Act 1987, and I am far from clear how that will operate within the new NHS structures. At present it requires reports from health authorities. I do not understand how the new structures will relate to the Act—as it is now or as it might be if reformed—if there are changes as to where commissioning takes place, and in responsibility for commissioning.

I am concerned about mainstreaming, which my right hon. Friend mentioned in opening the debate. We know that as from April there will be mainstreaming of all HIV budgets, at least within the health service. Various budgets exist, including the care and treatment allocation, the prevention budget, section 64 grants to voluntary organisations and the AIDS support grant to local authorities. The different allocations are not always planned together terribly well. However, we are told that the money will be mainstreamed. As my right hon. Friend said, that will remove the central mechanism that requires spending by health authorities on particular areas of work.

I understand the argument that ring-fencing does not apply to many other medical conditions, and I know that people ask why HIV should be considered unique. However, one of the achievements of the ring fence was to ensure that the money was spent on HIV. Without that pressure, some health authorities may not have spent it on that. The approach has led to the development of services that may not otherwise have existed. It has been a factor in developing the work of non-governmental organisations, including service delivery, and in developing the interest and involvement of many people in NGOs in what is happening with respect to HIV. Money can be tracked to see where it is being spent.

It is particularly worrying that the change to mainstreaming is happening while health service structures are in a state of flux. Primary care trusts and the new strategic health authorities are moving from the present system towards much more commissioning. Although I have read the strategy, I am still very unclear about how HIV commissioning will fit into the new structure. Most commissioning is expected to go to PCT level, but HIV services such as care and treatment have been regarded as specialisms. Will the new strategic health authorities have a role in commissioning? Will commissioning responsibilities be split in any way? I am not at all clear about the new structure of the health service.

As my right hon. Friend said, if mainstreaming and changes to the structure take place at the same time, there is a danger that we may lose some expertise. Such expertise usually involves a fairly small number of people providing specialist HIV services for a health authority. Some of those people are not clear where their jobs will be in a few months time, or whether they will even exist. Some GPs are well aware of what HIV means, and what type of services and prevention should be provided. However, many are not. If a lot more commissioning is to take place at PCT level, how will we ensure that services are developed and that GPs and PCT boards are aware of what is happening?

My right hon. Friend mentioned the worries that do indeed exist throughout much of the sector. Mainstreaming is an issue that we must think about very carefully. I realise that we cannot argue for ever that HIV should be funded in a unique way, but perhaps we should at least delay removing the ring fence for a year or two, until the new structure has settled down and we are clear about where the money will go and where the responsibilities will lie.

The strategy recognises that HIV is not simply a medical issue. It refers to social care and support for those living with, and affected, by HIV, and to how access to education, employment, leisure, housing and advocacy could be provided. It also refers to the Department's efforts to help deliver social care and support, but it makes little reference to other Government Departments. It discusses developing standards in consultation with the social services inspectorate, local authority commissioners, service users and voluntary organisations, but it says little about the involvement of other Departments.

Earlier this year, the all-party group on AIDS published a report on the United Kingdom, HIV and human rights, which made recommendations about what we should be doing. The report, and all of us involved in its production who talked to those working in the field, made it clear that HIV is much more than a medical issue. We made recommendations about the way in which other Departments should be involved. The Department of Health must clearly take the lead in certain areas, but the Home Office and Departments responsible for employment and for education have a role to play. As we develop the strategy, I would like clear indications of how links between Departments will be built up.

There must also be links with international policy. In his opening remarks, my right hon. Friend mentioned that many people diagnosed in the UK acquired their infections overseas. At the United Nations Special Assembly in June, at which the Department for International Development played an important role, it became clear from the discussions that domestic and international policy must be related, even though strategies may differ. We must make sure that those policies are linked.

Given yesterday's announcement on changes in the asylum system and the setting up of reception centres, perhaps the Home Office could re-examine what health checks could be carried out in those centres to help to deal with the problems affecting asylum seekers with HIV infection, who do not always find it easy to disclose that fact.

Those are the areas that concern me. There is a great deal in the strategy document to be welcomed, and I am glad that it has been published. I think that there is very little in it that people would fundamentally disagree with, but we need to consider how it will be implemented, how to ensure that its targets are met and how we can drive its policies forward within the new structures in the health service.

I should like to thank the right hon. Member for Edinburgh, East and Musselburgh (Dr. Strang) for securing this debate. His long-standing interest in HIV and AIDS is known by all hon. Members. The Edinburgh clinical community has played a leading role, and its paediatric work on identifying the epidemiology of maternal transmission from the intravenous drug-using community was staple education for those of us in medical school at the time. I remember the papers authored by Dr. Jacqueline Mok, who was active in the Edinburgh clinical community.

We have heard useful contributions from the hon. Member for Angus (Mr. Weir), and the chair of the all-party parliamentary group on AIDS, the hon. Member for Walthamstow (Mr. Gerrard). He has been tenacious in' advocating the need to address the issue of HIV-AIDS, as he has been over the issue of refugees, which he mentioned in the last part of his speech. The two issues come together, especially over heterosexually acquired infections that are acquired abroad.

The right hon. Member for Edinburgh, East and Musselburgh made the point that new infections represent a failure of prevention. I want to concentrate my first remarks on why there has been such a failure, as the number of infections increases, and why the Government delayed introducing the strategy. Information was available from an early stage that made clear the extent and the shape of the epidemic. While we have been waiting for the strategy, all the key indicators have shown that the sexual health of the nation has worsened.

Figures covering 1995 and 1996, which showed the worsening situation, were known to Ministers by 1998. Since then, the number of new cases of sexually transmitted diseases has increased dramatically while the Government were delaying the publication and release of their report. Figures from the Public Health Laboratory Service show that between 1998 and 1999 diagnoses of syphilis rose by 58 per cent. in males. It more than doubled in males between the ages of 20 and 44, and rose by 27 per cent. in females. The number of new cases of gonorrhoea in England rose from 12,462 in 1997 to 15,572 in 1999, with the sharpest increases in males aged 20 to 24 and females aged 16 to 19. Genital chlamydial infection has increased by 76 per cent. from 38,997 in 1997 to 51,083 in 1999, with significant increases in both the female and male populations. Asymptomatic HIV infection has risen from just under 1,500 in 1997 to well over 1,600 in 1999, and the position with regard to newly diagnosed HIV infections is worsening and is of serious concern.

Projections made by the PHLS clinical diseases unit suggest that cases of HIV infection are set to increase by 50 per cent. between 1999 and 2003. According to what they describe as conservative forecasts, the total number of people diagnosed with HIV or AIDS may increase from 20,800 in 1999 to 29,000 in 2003. Within that, the figures for heterosexually acquired HIV infection are projected to increase from 6,579 to 11,215. Those figures show a worsening situation. The commentary by the PHLS points out:

"Perhaps the most consistent trend throughout all countries and regions in the UK has been the gradual and sustained increase in STI diagnoses since 1995. Prior to the rising numbers of diagnoses of many STIs in the UK throughout the late 1980s and early 1990s, figures had been declining or were stable, possibly reflecting the changes in sexual behaviour brought about in response to the HIV epidemic. The subsequent rises suggest that recently these behavioural modifications have not been sustained.

The highest rates and increases in STI diagnoses are focussed in those aged 16 to 24, peaking earlier in females than males. Young people are behaviourally vulnerable to STI acquisition as they are more likely to have higher numbers of sexual partners and a higher frequency of partner change than older age groups. Young women may be at particular risk through lack of skills and confidence to negotiate safer sex resulting in inconsistent use of barrier contraception."

Even the Government noticed the urgency of the problem. In July 1999, the public health White Paper, "Saving Lives: Our Healthier Nation", stated:

"Sexually transmitted infections are increasing, particularly chlamydia and gonorrhea".

It then set out the figures, and continues:

"HIV and AIDS remain serious threats to health … we cannot afford to be complacent."

However, there has been significant delay in bringing forward a strategy: not in starting the work—that has been announced and is under way—but in making progress. The public health Green Paper of February 1998 contained only two paragraphs on sexual health and no mention of STDs generally, only of teenage pregnancy and HIV and AIDS. The absence of that information was explained away by the sentence:

"The Government is preparing a separate strategy to combat the spread of HIV infection and to meet the challenge to services which HIV and AIDS present."

Plans for a new strategy—the first promise—were set out in a keynote speech by the then Minister for Public Health, the right hon. Member for Dulwich and West Norwood (Tessa Jowell), at an HIV and AIDS strategy meeting in October 1998. She said:

"The policy development process started today will be overseen by a Steering Group whose membership I will announce shortly. But I hope that it will be possible to issue a draft strategy for wide consultation early next year."

However, no draft strategy was issued during 1998, 1999 or 2000, and the membership of the steering group was not announced until April 1999.

The second promise was also made by the then Minister for Public Health at a conference of the Family Planning Association in March 1999. She said:

"The Social Exclusion Unit's work on teenage pregnancy and parenthood … has highlighted what we already knew—how much we need an integrated health strategy … Over the next 12 months, the Government will be developing a framework that takes the radical approach that provides for the first time, a strategy that covers the whole of sexual and reproductive health … We will publish it next year"—

that was to be 2000—

"but I want to get cracking on it now."

Of course, there was no sign of it. The public health White Paper described the strategy on HIV-AIDS as "forthcoming".

The third major promise, which was announced in a Department of Health press release on 24 April 2000, was of an integrated strategy. The Minister for Public Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), announced the integration of the HIV-AIDS and sexual health strategies into a single programme. She said:

"We need to make rapid progress … This is important public health work and I want to see it progress as rapidly as possible. I take a keen personal interest in this work, and look forward to working closely with Mike Adler and Sheila Adam to ensure an agreed strategy is in place by next spring."

She was referring to spring 2001, which came and went without the strategy being published.

The fourth promise was made in June 2000 by the Minister for Public Health in a written answer. She stated:

"A draft strategy will be issued for consultation in the autumn."—[Official Report, 19 June 2000; Vol. 352, c. 59W.]

Autumn became winter, and still no strategy was issued. On 6 February 2001, in another written answer, she announced:

"We plan to issue the strategy for consultation shortly."—[Official Report, 6 February 2001; Vol. 362, c. 508W.]

Finally, at the end of July, we got the strategy.

I understand from members of the steering group that during the time they were appointed they never saw the draft strategy. One member publicly criticised it after it was produced, which was presumably the first time that he had seen it. Derek Bodell, the chief executive of the National AIDS Trust, is quoted in The Guardian on 27 July 2001 as saying:

"For such an important public health issue this strategy is far too limited in its scope, and fails to look at the broader social impact of HIV such as employment, education in schools and housing. We are disappointed that this strategy is not as far-reaching as we would have wanted."

Although the Government, in their holistic approach, talk about "education, education, education", we appear to have had procrastination, prevarication and yet more procrastination. The signals were not good, because the Health Education Authority was abolished and its replacement, the Health Development Agency, has had a lower profile than its predecessor. Perhaps that was the Government's aim because they were embarrassed by the messages being sent out by the Health Education Authority, but it was a pity that that professional unit was abolished when there was such a challenge in this area, and in many others.

As the hon. Member for Walthamstow said, there is much in the strategy that is unarguable, and can be welcomed and agreed with. It is important to state that—but I want to stress that we have been waiting an awfully long time to make the point—many of the Government's ideas can be welcomed. The Government point out that little clear evidence on prevention has been gathered. It is sad that the Health Development Agency has only now been asked to gather evidence to find out what works. One would have hoped that that had been done from 1997 to 2000.

Despite recognising that little evidence is available, in paragraph 3.5 of the strategy the Government state that various initiatives, including

"the Department for Education and Skills' revised Sex and Relationship Education Guidance are all helping to expand young people's knowledge of and understanding of sexual health and relationships."

I am sure that that was the intention, but I do not believe that there is any evidence that it has worked. Indeed, people working in the field, who were disappointed by the guidance, suggest that it may not be working. We need to ensure that we do not limit ourselves in our examination of what might work. In that respect, the Government have been timid when considering European models that have worked. In paragraph 3.15, the Government state:

"An evaluation of safer sex campaigns in Holland shows attitudes and intentions towards safer sex were affected positively but that the effect was lost when the intervention ended."

We do not have much in the way of a co-ordinated Government health promotion campaign related to safer sex. It is not a question of worrying about behaviour changing when intervention ends; we want intervention actually to start. As the document makes clear, the Government have not set out a health promotion strategy with an advertising campaign or a sustained, co-ordinated programme through schools and youth activities.

Is the Minister convinced that helplines, such as the national AIDS helpline and Sexwise, are coping with demand? Is too much or, as I suspect, too little money being spent on those helplines? As the right hon. Member for Edinburgh, East and Musselburgh said, the Government cut funding in real terms for prevention work in earlier years, and that has made it very difficult for professionals in the field.

Reference has been made to targets, and I want to question the Government further. I have always wondered whether setting targets is sensible because they are targets also for Opposition parties who are more interested in making attacks than examining policy—I do not include myself in that. They are also a distraction to delivery. I have never pressed for rigid targets in this area because they may confound policy. More HIV testing would produce more positive HIV test results, and that would not help to meet a target to reduce the number of detectable newly acquired HIV infections. It is difficult to explain the context of increased HIV infections against a background of decreasing prevalence in anonymous testing, and it will be difficult to get the message across. Setting a target is unhelpful and I would not criticise the Minister for downplaying the target, so long as we agree what the policy should be. The danger is that, ultimately, the target may become the symbol. If professionals believe that their performance will be measured on the outcome, they may decrease their outreach work in the hope of escaping censure.

A fascinating meeting took place last week to examine the national strategy on HIV and sexual health. A number of matters were raised, and I should be grateful if the Government would respond to them. There is potential tension between the PCT's commissioning of sexual health services and specialised HIV treatment and care that is planned at the appropriate strategic level, which may not be PCT level. Split level commissioning following abolition of the health authorities and the need to involve the strategic health authorities will not lead to integration. There is also tension between open access and local funding, because people may congregate on one service and funding may not follow that flow.

The hon. Member for Walthamstow hinted at a significant worry about funding. Money has been announced, but it is only for two years, and if we are to develop new services in this area a commitment to long-term funding and a 10-year funding strategy would be most welcome. The fear is that money is available only for projects and not for the necessary major systemic change. Indeed, primary care organisations have been asking when the money will arrive and when they will know exactly how much they can do. There is also a significant worry that the organisations that currently deliver the service are about to be abolished. The Minister must accept that the effect of continuous change is causing major difficulties.

A spokesman for the Association for Genito-Urinary Medicine has said that general practitioners do not want, or are unable to, become more involved in genitourinary medicine. Diverting funds to GPs who are not motivated to deliver the service would diminish the service in the short term. Education and training of GPs is needed, but genito-urinary specialists are already overloaded, so who will provide the training?

There are many other issues but not enough time to raise them. I shall finish by asking the Minister some specific questions. It is well recognised that the presence of section 28 on the statute book impedes the ability, whether legally or not, of teachers and other professionals in schools to deliver effective sexual health education. During the previous Parliament, the Government were committed to its repeal, so it is reasonable to ask the Minister whether that will happen sooner rather than later and, if sooner, how. When will the health promotion strategy start, and will it take the shape of a national advertising strategy as well as local initiatives that are properly funded? Will she say whether she thinks the prison service is winning or losing the battle on HIV infection, whether it be sexually transmitted through men having sex with men, or through intravenous drug use?

I want to finish on the same point as the hon. Member for Walthamstow. I am no great believer in ring fencing and bids for funds; I would be inconsistent if I were. There should be more flexibility locally to deliver services. It is wrong to worship on the altar of eternal ring fencing. However, there will be significant structural changes when ring-fencing ends, so will the Minister consider retaining ring-fencing for one year so that we can track whether funding is being retained in the services?

I congratulate the right hon. Member for Edinburgh, East and Musselburgh (Dr. Strang) on securing an extremely important debate. Given that it has been 20 years or so since the emergence of HIV-AIDS, it is depressing that in the area of sexual health, which is dominated by HIV-AIDS and other important issues, many of the problems of 20 years ago remain. In that time there has been a move forward, although sadly not far enough, in research, in the development of drugs to alleviate medical problems and in the work done by the voluntary sector, charities, the health service and the Health Department to improve public health.

Unfortunately, three critical areas remain that I think are unacceptable: stigma and prejudice; ignorance and complacency; and delay and procrastination, to which many hon. Members have referred. The first is a matter not only for government; we need to deal with attitudes throughout the country. Any hon. Member who receives constituency mail on the subject is left in no doubt about the prejudice and stigma attached to those suffering from sexual ill-health, particularly, but not solely, from HIV. We all have an important role to play in that area. We must provide a lead to break down the barriers caused by prejudice and to help to educate public opinion. The media also have an important role to play.

While listening to the right hon. Member for Edinburgh, East and Musselburgh, I was reminded that 10 years ago, when the House of Commons was sitting, I was living in London not 20 yd away from where Freddie Mercury died. I was appalled that the paparazzi and tabloid photographers turned up before his death and patrolled the area for six weeks until he died. To be able to remove his body after his sad death, the coffin had to remain in his home for 12 hours until the Sunday evening. The police then emerged to clear the street of the press so that his body could be removed with dignity and without the glare of press photographers. Photographers and the press would not intrude on other people's private grief if it involved any other illness that has resulted in death. That is all part of the picture of prejudice.

I am sure that the hon. Gentleman has seen submissions to the Government on these issues, particularly on prejudice. Most submissions call for the abolition of section 28, and point out that however symbolic it is, it makes it more difficult for those working in this area to deal with prejudice and the prevention of HIV and AIDS. Has the hon. Gentleman taken account of that, and has he given serious consideration to the sexual health consequences of his party maintaining its position on section 28?

I confess that I had expected a question on section 28 if certain hon. Members were in the Chamber. I sincerely believe that a genuine difference of opinion on an issue does not necessarily mean that there is prejudice. That there is ignorance may seem staggering to many of us, given what has happened in the past 20 years, such as the campaign to explain the problems and to show the preventive measures that people can take in their active sexual lives.

The Government's strategy document for sexual health and HIV shows that the extent of the problem is depressingly formidable, even now. The number of visits to departments of genito-urinary medicine has doubled in the past 10 years. According to Public Health Laboratory Service statistics, since 1995 syphilis has increased by 143 per cent.—by 225 per cent. among gay men—chlamydia by more than 106 per cent. and gonorrhoea by 99 per cent. The number of new diagnoses of HIV last year was the highest for more than a decade. The 3,616 people diagnosed last year represented a 20 per cent. increase on the previous year.

Although the United Kingdom can be reassured by the fact that it has one of the lowest rates of HIV in Europe, it is estimated that more than 30,000 people in this country are HIV positive. Every year, about 400 of them die, although, as has been said, it is reassuring that developments in medical science and drug treatments are helping people to live longer and to sustain a better quality of life than was possible a decade ago. That is a step in the right direction, but until a vaccination is possible or a cure is discovered more must be done to try to reduce the death rate.

Sadly, it is estimated that by 2003 HIV prevalence in the UK will be 40 per cent. higher than in 1999. More worrying in some respects is that, as predicted many years ago, the problem has increased in the heterosexual community to a greater degree than in the gay community. In 75 per cent. of cases recently diagnosed the disease had been picked up abroad. Far more must be done to bring it home to people that they are playing Russian roulette with their lives if they do not heed the message of safe sex, or are ignorant of it, and do not know how to minimise the risk of contracting sexually transmitted infections.

The extent of ignorance and complacency is staggering. Recent studies show that between 33 and 50 per cent. of teenagers do not use contraception when having intercourse for the first time. A 1999 survey of gay men showed that 58 per cent. under the age of 20 did not always use a condom, and that of the 44 per cent. who were HIV positive who had sex with a new partner, 40 per cent. reported that they inconsistently, if ever, used a condom. That is partly due to a lack of advertising, particularly on television. In the mid to late 1980s, advertising on television and in newspapers, magazines and specialist communications was considered highly controversial and, as I understand it from reading political biographies and autobiographies, it presented a squeamish problem for some of my former colleagues. However, the fact is that the advertising was effective: it was hard hitting and got the message across. People began to understand that they should consistently practise safe sex.

Sadly, time and the lack of constant reminders has dulled the message, and we have slipped back considerably. It is a dangerous position and the Government must act quickly, so that they do not undermine work being done in other sectors. For example, a survey showed that 90 per cent. of teenagers thought that the pill would protect them from sexually transmitted diseases. That is equally staggering and shows the depth of their ignorance. I urge the Minister to do more to back up other work and her Department's strategies by ensuring that the message is brought home to people across the board that they cannot afford not to indulge in safe sex.

Some people have said that there is too much sex education in our schools. On the basis of what the hon. Gentleman has just said, does he identify himself with those of us who believe that there is too little or the quality is too poor? Does he believe that what we require is not a return to Victorian ignorance, but more information for young people?

As the hon. Gentleman will know, I accept that the question of sex education in our schools is controversial. I believe that it is up to individual parents to decide whether they wish their children to attend sex education lessons in schools. As a parent, I would want my children, at a suitable age, to gain the benefit of impartial sex education from both their parents and schools.

The final strand of my speech concerns delay and procrastination. I have great sympathy with what hon. Members have said about that. The Government announced the idea of a strategy in 1997. Four years later, in August this year, the strategy document was published. It is now out for consultation and has not yet been implemented. We must await the end of the consultation process and the Government's final decisions. On an issue so crucial to the country, that was an unusually long delay and a wasted opportunity.

Steve Jamieson, a key sexual health adviser to the Government, told delegates to a conference earlier this summer:

"The Government sat on the strategy for a long time before finally launching it at the end of July. That was a political decision because Tony Blair and his government were so embarrassed by the level of STIs in this country.

He went on to say:

"While they were sitting on the strategy, there were still people out there who could not access services and who were contracting STIs. I also believe the lack of a government advertising campaign has been a factor in the rising levels of STIs."

He also suggested that the strategy was launched on a Friday in mid-summer in an attempt to ensure minimum media interest. I am quoting not an Opposition spokesman, but one of the Government's key advisers on sexual health. I emphasise that we cannot tolerate such a delay any longer. It is time for the Government to act quickly and put the strategy in place, and to make sure that it is backed up by a proper advertising campaign to start to reverse the trend.

It is crucial that we have a strategy to deal with such a problem. However, given the four-year delay, it is slightly surprising—it shows an odd sense of priorities—that the Government spend time telling people to eat more vegetables rather than producing a coherent strategy to minimise sexually transmitted infections. I accept that the sum of £47.5 million has been described in the strategy as an initial investment, but I echo the comments of other hon. Members that it could be seen—if the Government are not careful—as too little money overall to develop the programme. I urge them to keep an eye on the position, particularly as that investment was described in their in-house NHS magazine as comparatively modest. I am sure that few hon. Members here today would dispute that description.

The hon. Member for Oxford, West and Abingdon (Dr. Harris) referred to targets. The Government seem to need a target for everything. Their target for the waiting list initiative led to gross clinical distortions. It would be a disservice to this area of health care if targets were imposed that caused clinical distortions. I therefore warn the Minister against having targets. Has an assessment been made of the extra work that the strategy will place on GPs? We already know of the pressures that are placed on them, so if the strategy is to be delivered successfully, what consideration has the Department of Health given to their extra work load? How will the Government ensure that GPs are not so burdened and overworked that the whole strategy falls flat on its face because of their inability to deliver?

The Minister will know of the worries that have been expressed by GPs in the past few months. For example, how confident is she that they will be able to provide the sophistication that is required for them to undertake HIV counselling? It is a crucial area, and I hope that the Government have given some thought to it.

Given the publication of the strategy three months ago, it is extremely fortunate that the right hon. Member for Edinburgh, East and Musselburgh has enabled us yet again to discuss this subject and to explain our genuine worries to the Minister. We are united in wanting the problem to be tackled successfully. We want help to be provided to bring down the figures and to relieve the suffering that STIs have caused to far too many members of our population.

I, too, thank my right hon. Friend the Member for Edinburgh, East and Musselburgh (Dr. Strang) for having given us the opportunity to debate this subject. I also thank all hon. Members for supporting and welcoming the strategy in spite of the issues that they have raised today.

My right hon. Friend the Member for Edinburgh, East and Musselburgh has a tremendous record on the issue. Indeed, it was he who brought the AIDS (Control) Act 1987 on to the statute book through his private Member's Bill some 14 years ago; and he has continued to take an active interest in the development of policy on the issue. He wrote to the Department when the strategy was first announced, suggesting that a review of that Act would be timely. We entirely agree. Experts have already started reviewing the Act, and the review will be undertaken as part of the process to implement the strategy. In particular, we need to consider appropriate reporting mechanisms. Tremendous progress has been made in collecting data and analysing the treatment that is available, but changes to the national health service have shifted the balance of power and commissioning has been devolved to primary care trusts, so the reporting elements of the Act will need to be reviewed.

I thank the all-party parliamentary group on AIDS for its comprehensive report, to which reference has been made this morning. It is entitled "The UK, HIV and Human Rights: recommendations for the next five years" and was published almost simultaneously with the strategy, at the end of July. Work on several of its recommendations is being pursued as part of the strategy implementation. The report is extremely helpful and contains several practical recommendations that we shall be extremely keen to pursue.

As hon. Members said, the strategy is the first ever national strategy for England. It recognises the need to take a holistic approach to sexual health. It covers HIV and AIDS as well as the broader issues of contraception and sexually transmitted infections.

Several hon. Members mentioned delay and procrastination and the fact that the strategy has taken some time to emerge. Some delay was perhaps inevitable with the merger of the sexual health strategy and the HIV issue. We also wanted to make absolutely sure that we consulted extensively with voluntary groups, NHS organisations and service users to try to ensure that the strategy was in touch with the experience of people in the field. In spite of the delay, I am pleased that they gave the strategy a broad welcome. The Terrence Higgins Trust welcomed the proposals, and although the National AIDS Trust expressed reservations about the need to join up the proposals throughout government, it has given the strategy broad approval.

Many hon. Members asked what is being done to promote the safer sex message to the groups that are most at risk. A fundamental part of the strategy is to improve health promotion work with those most at risk and those who already have HIV, and to try to reinforce safe sex messages for both those groups. Several contracts are already in place that are designed specifically to target those at risk from HIV and sexually transmitted infections. Health Promotion England undertakes sexual health promotion work aimed specifically at young people aged 16 to 24. The Terrence Higgins Trust undertakes work with community-based groups directed towards those most at risk of HIV and AIDS, including gay and bisexual men in England. The Department of Health has funded health promotion work for African communities, including a pilot African AIDS helpline, a Health Africa radio show, a website and printed information resources. We have used the mass media and funded the National AIDS Trust's work to support World AIDS day. We are funding a National AIDS Trust project to tackle the stigma suffered by people with AIDS, which the hon. Member for West Chelmsford (Mr. Burns) mentioned. It is important for that work to continue.

A great deal of health promotion work is already being done. A key aim of the strategy is to build up an evidence base on effective promotion work, but little is done in the field. It will be important to draw together the evidence on what succeeds, otherwise there is a danger that we will not get maximum value from the proposed new investment. We also lack evidence on which information campaigns work, other than those that concern sexual health. For instance, the same issues apply to drugs. We must discover where messages are best targeted, what media to use and how messages are most likely to be conveyed to those at greatest risk. We are determined to do that.

My right hon. Friend the Member for Edinburgh, East and Musselburgh asked about the effect of antenatal testing on the number of diagnoses. He is correct to say that diagnoses are increasing as a result of the introduction of the test. However, it is right to offer a test to mothers. If it is part of normal health care—not special or singled out but treated as part of general good health—it will reduce stigma, and we should continue it.

Many hon. Members, including my hon. Friend the Member for Walthamstow (Mr. Gerrard), raised worries about the effect on funding of removing the ring-fenced budget and putting the money into mainstream health authority budgets. I assure hon. Members that the Government are determined that when the funding goes into mainstream allocations, it will continue to be monitored through the service assessment frameworks that performance manage all NHS funding. We will closely monitor where and how money is targeted. In the future, health authorities will receive a fair share of the funds. The distribution of HIV infection is uniquely skewed and we want to ensure that allocations take account of that. Money should go to the areas in which there is greatest need and the most people who need treatment. We will ensure that we follow the money through the mainstream budgets.

All hon. Members asked how HIV services will be commissioned, following shifts in the balance of power and the creation of strategic health authorities. Services will be commissioned at primary care trust level, and we will ensure that a number of primary care trusts come together to share their expertise and knowledge. Perhaps one primary care trust in each area could take the lead and develop the expertise that is the key to specialist commissioning. Such an arrangement will apply not only to services for people with HIV and AIDS, but to other specialist services, such as those for burns and haemophilia. The development of specialist commissioning expertise in primary care trusts is crucial if people are to rely on the quality of those services. That will require support, and that is already provided in the system. We must ensure that the experience gained at specialist commissioning level is available to primary care trusts, so that their commissioning process is of a high quality and provides correct services to local people.

The hon. Member for Angus (Mr. Weir) asked whether there is a strategy for Scotland. I am delighted to tell him that the Minister for Health and Community Care has committed the Scottish Executive to producing a strategy for Scotland, and preliminary work on that is under way. Obviously, we keep close contact with colleagues in the devolved Administrations to ensure that expertise and knowledge is available for developing strategies. The hon. Gentleman also asked about chlamydia screening, and the extent of that disease in the community. A phased roll-out of targeted screening will start next year. A couple of pilot projects are under way, and we will learn from those experiences to try to deal with the disease.

My hon. Friend the Member for Walthamstow asked, as did other hon. Members, why we have a target. Clearly, that is a matter of controversy, but it is difficult to persuade an organisation to focus its work without having a target. Targets were drawn up following extensive consultation with voluntary groups and service users, not just plucked out of thin air by the Department of Health. Targets were developed that were intended to be realistic but challenging, so as to have a major impact on public health. We want to maintain focus on those targets, but accept that that must not distort our other policy objectives. We have to get the balance right. Having done that extensive consultation—we did not simply decide on a figure ourselves—we hope that the targets will have broad support within the community.

My hon. Friend the hon. Member for Walthamstow raised the issue of commissioning. I hope that he will be reassured that we intend to make the role of primary care trusts as robust as possible. He also referred to cross-governmental work on education, housing and social care to support people in the community with HIV and AIDS. The strategy has a health focus—we did not want to dilute the health focus message—and mechanisms at official and ministerial level will ensure that we implement the strategy across the board. We are learning from the teenage pregnancy strategy, in which those mechanisms are already in place and which, two years on, is beginning to show some real results.

I can tell the hon. Member for West Chelmsford that our strategy on teenage pregnancy has resulted in a downturn in under-18 conception rates. Under the Conservative Government, teenage pregnancies went up by 25 per cent., but I am delighted to say that our strategy is beginning to work.

I did not mention teenage pregnancies, but it is nice to know that the Minister can blame the Conservative Government even for that. Will she comment on the work load placed on GPs, which is far more important in the context of this debate?

The achievements of the teenage pregnancy strategy are a matter of record.

Training for professionals will be a key part of the Government's HIV strategy not only for GPs but for people involved in supplying the full range of services for people with HIV and AIDS. However, we want to mainstream not just the finance but the general approach to HIV and AIDS. It is a serious health problem but it should be treated like many other health conditions. We should not single it out, but should provide support and training for a whole range of professionals, which they can integrate into their practice. That commitment is part of our strategy.

The hon. Member for Oxford, West and Abingdon (Dr. Harris) raised the issue of repealing section 28. The Government remain committed to that, although we will clearly need to find appropriate parliamentary time for it. He also referred to the Prison Service. It is fair to say that the message we are receiving on the Prison Service's practice of supplying condoms in prisons is that it is pretty variable, and a great deal of work remains to be done to ensure consistency. That will be an important part of our work.

The hon. Gentleman also asked us to delay the ring-fencing issue for a year in order to track the funds. I hope that he will be reassured that our commitment to track the funds through the single assessment process will ensure that funds are targeted where they are needed for best effect.

The strategy is the first ever to cover such matters. It has been improved by the length of time taken to involve all the interest groups, and there will be a further period of consultation until 21 December. Comments from people in the services and the voluntary sector, and from users themselves, will be welcomed as they will inform the development of the implementation plan. We have been encouraged by the work that has been done on our campaigns to target teenage pregnancy, and we want to learn from them. The evidence base for information campaigns is poor, but we are beginning to build that base and we hope that we can continue to make similar progress with this strategy. The consultation period will enable us to learn even more about building evidence of what is effective.

People with HIV who live in the community clearly need the best services that we can provide. I want to make sure that the strategy helps us to make a real difference to essential services in the community, such as care, treatment, support, counselling and screening. We have a real opportunity to make significant step changes in the way in which services are provided. I look forward to working with all hon. Members to implement the strategy and to ensure that we improve services for people with HIV.

Since 1997, the Government have painted a rosy picture of the future of our transport system. Their commitment to public transport meant that road schemes were dropped, and huge figures were bandied about for a 10-year plan to transform our transport infrastructure. Their plan said:

"Our vision is that by 2010 we will have a transport system that provides modern, high quality public transport, both locally and nationally. People will have more choice about how they travel, and more will use public transport."

However, eight and a half years before 2010, in the fifth year under a Labour Government, the problem is that that glorious vision is anything but a near-term reality. The practical experience of the traveller in the south-east is worse than ever, and improvements are nowhere in sight.

Anyone who commutes into London daily by train, as I do, knows how overcrowded virtually every peak-time service is. Anyone who drives to work knows how full our roads are. Anyone who relies on buses knows how vulnerable they are to the vagaries of our traffic, but our roads do not have the capacity to create long bus-only routes without making the motorist's life impossible.

The Conservative Government started—I emphasise the word "started"—to get to grips with the problem. For the first time in 30 years, services were opened, not closed, on the rail network. For the tube, we built the Jubilee line extension, rebuilt the Central line and introduced new trains on the Central, Jubilee and Northern lines. Even the latest, very welcome tube project—the extension of the East London line, which has been confirmed—had its origins under the Conservative Government. We oversaw the introduction of fast modern train services to London's three airports, and started the process of introducing them at Luton. We encouraged the development of light rail in London's docklands, and of the highly successful Croydon Tramlink, London's first street-level tram for decades.

On a smaller scale, stations, such as Haddenham and Thame Parkway in Buckinghamshire were opened, and lines such as that to Bicester town were reopened. There were also major improvements on existing lines, such as the service from London to Southampton.

As regards the roads, we widened the M25 and set out plans to expand the most overcrowded stretches still further. We turned the M20 into a modern link through Kent to the continent. We set out plans and began to buy land to end the bottlenecks on the A40 into London. We turned the A14 into a high-speed route from Essex to the midlands.

Then, in 1997, despite the Deputy Prime Minister's continual statements that he would get motorists off the roads and on to public transport, and despite the high-sounding words about an integrated transport policy, everything seemed to grind to a halt. Since then, words seem to have taken over from action. We have enough multi-modal studies to employ an army of civil servants. We have 10-year plans that are scheduled for review months after they are launched. We have a Government who are keen to pass new regulations for rail companies to adhere to, but who avoid giving them any long-term commitment. Roads were out, but now seem to be slightly acceptable again. New schemes are in the pipeline, but only after five wasted years.

As for the tube, it has taken five years to get where we are with the public-private partnership, which means that modernisation has not started, and discussions and planning are continuing. In the meantime, investment is being squeezed, and not a single new train has been ordered.

What can we expect to be done to solve the problems that so many people face when trying to travel in the south-east? What can we expect to be open for business by the end of this Parliament, almost 10 years after the Government took power? The Under-Secretary of State for Transport, Local Government and the Regions, the hon. Member for Plymouth, Devonport (Mr. Jamieson) kindly gave me some of the answers in a written answer in the summer.

Let us start with the railways. The Government said that without major investment in the network to meet growing demand, levels of service would deteriorate and overcrowding would increase on many lines. By 2006, only two schemes that affect passengers in the south-east are likely to have been implemented: the first phase of the channel tunnel rail link, and the widening of the Chiltern line between Princes Risborough and Bicester, which was singled for no good reason in the bad days of British Rail, and is being restored to its previous state.

Among the passengers still waiting will be the hapless users of the South West Trains routes into Waterloo. The company says that the hiatus in rail financing means that even its less ambitious plans, to lengthen trains from eight coaches to 10, cannot be implemented for at least another five years. Last week, the south central franchise postponed its upgrade to the Brighton line for similar reasons. Other schemes, such as the modernisation of the Uckfield line, seem a country mile away from starting, let alone being completed.

Then there are the bigger projects. Yesterday, I received another answer from the Minister, for which I thank him, about the projects likely to be built under the 10-year plan. He wrote:

"We look to the Strategic Rail Authority's forthcoming Strategic Plan to prioritise investment projects that deliver the greatest value for money for both rail users and the taxpayer."

With the 10-year plan well under way, we are having another strategic review to decide what to do. The Minister's response makes no mention of the schemes that could make a difference to the south-east. What about the next generation of large-scale projects to follow on from the Jubilee line, the docklands light railway and the Croydon Tramlink? Thameslink 2000, perhaps the easiest and most achievable of the bigger ideas for improvement, and part of the original 10-year plan, is nowhere near starting, let alone being completed. Now I fear that it may have disappeared altogether from the Government's planning. According to the Minister, even if they press ahead straight away, it could not happen until late 2007—and that is the optimistic spin. Will it now be dropped? Perhaps the Minister could deal with that question today.

According to Bob Kiley, the transport commissioner for London, crossrail is the project that would make the most difference to London. However, according to the Minister's response last week, that project cannot be completed and open for business for at least a decade, whatever happens. I fully expect the Minister to offer me some history lessons about the structure of the privatised rail industry, so let me anticipate his comments by making three points.

First, when the Government took office they were fiercely critical of seven- year franchises, which they said were a disincentive to invest. If that was true, why have they failed to use section 54 of the Railways Act 1993, which was designed to provide a mechanism to give the operators long-term security to invest? Section 54 has been used only a handful of times—small wonder we have waited so long for new trains. If short franchises are such a bad idea, why is the Department for Transport, Local Government and the Regions now granting franchises of only two years? How will that encourage rapid investment of the kind needed by our commuters?

Secondly, the Government set out in their strategy a clear role at the head of the industry for their new creation, the Strategic Rail Authority. The SRA, they said, would decide what quality and capacity improvements were needed, and would work to directions and guidance from Ministers to provide a bigger and better railway. So why is the head of the SRA leaving his job early, criticising Ministers for not being willing even to talk to him? Last week Sir Alastair Morton told the Transport Sub-Committee that he had placed a memo about the future of the industry on the Secretary of State's desk the day after the election—but to date he has received no response.

Thirdly, if the structure set out for the industry by the previous Conservative Government was so fundamentally flawed, why have the Government not taken advantage of the expiry of the initial franchises and the placing of Railtrack in administration to launch a major restructuring of the industry? If they believed that we should have kept the railways in public ownership, they could simply cease to issue new franchises—or if they believed that we should have had regional companies with control of the tracks and the trains, they could now do that, too. However, they seem not to be choosing to do so.

There is the potential to improve matters with light rail. The 10-year plan states clearly that we will have more light rail systems. After the success of the Croydon Tramlink and its counterparts in Manchester, Birmingham and Sheffield—all started under a Conservative Government—we might have expected a rush to build new schemes. Instead, the only scheme on the way in the south-east is in Hampshire—very welcome for that area, but not likely to provide real solutions for some of the most overcrowded routes in that part of the United Kingdom.

The Mayor of London, to his credit, is exploring one or two possible routes in central London—but only as part of a long-term consultation exercise. For now, once again, we have words and not action. At last the Government seem to be beginning to realise that they cannot drive motorists off the roads if there is nowhere else for them to go. The Minister's response to me suggested that the M25 widening is on the way, but most of the schemes that the Government promote and that the Minister listed are outside the south-east, away from areas where congestion is at its most acute. My list of the schemes initiated by the Government and due for completion by 2006 that involve road improvements in the south-east is extremely thin.

According to the Minister's list, the only scheme due for completion by 2006 in my county, Surrey, is the introduction of a school bus initiative. That is an admirable scheme originated by the Conservatives on the country council to try to reduce congestion by starting an American-style yellow bus service. The Minister will no doubt say that he has recently announced funding for the A3 improvements at Hindhead. That is very welcome, but for much of the rest of the decade, even that will not be open.

What about other parts of the south-east? Hertfordshire and Buckinghamshire each receive a bypass. Berkshire gets nothing, despite all the growth in the Thames corridor. West Sussex is given one scheme, but East Sussex none at all. Only Kent and Essex do better, with five schemes between them. On the fringes of our region, Oxfordshire, Cambridgeshire and Hampshire will have no road improvements at all by 2006, according to the Minister's reply to me.

Do not get me wrong; I am not clamouring for road improvements at the expense of rail, as I too want people to be able to use public transport rather than their cars. I want longer trains into London, light rail schemes and other ways to improve public transport. However, the motor car is a fundamental part of our national and regional life. Supporting public transport does not mean that we should have no road improvements at all, and we are getting precious few of them in this overcrowded part of the country at the moment.

Many authorities consider buses their only short-term option. They set aside road space for more bus lanes or, in the case of London, set aside huge areas of the capital as congestion-charging zones to free up space for buses and reduce traffic. But will shoppers in places such as Guildford choose to carry all their shopping on the bus? Will the delivery vans that clog up central London bring their goods on the bus? Motorists who can afford congestion charges will grumble and pay, but those who cannot will clog up roads in the suburbs and make it even less practical for passengers to travel by bus through the congestion into the centre. We must be careful about what we do in city centres. Every retailer whom I have spoken to in a town or city centre says that in today's world, being anti-car kills town centres. People will ask why they should dodge the bus lanes on the way in to town centres if they can go to Lakeside or Bluewater instead.

The south-east of England is already too congested. It is becoming worse all the time, and its people want solutions. They want not more consultation, studies and reviews, but some alternatives that have a fighting chance of being open for business before we have all retired. The Government need to stop trying to wrap inaction up in seemingly endless consultation exercises. They should take some decisions and begin construction on some projects that can make a difference. They say that they have the money, so it would be nice if we saw some of it used.

In a report this summer, the Institute for Public Policy and Research stated:

"If in five years time, after a sanctioned period of increased funding, customers feel that services are still failing to deliver, there could be a major political backlash."

The funding appears to be stalled, and the projects that could make the difference are not happening. In 2006, Labour will have been in power for nine years. After such a time, people have a right to expect something to have happened. On the current rate of progress, they are likely to be sorely disappointed.

I thank my hon. Friend the Member for Epsom and Ewell (Chris Grayling) for securing the debate. He could not have raised a subject more dear to the heart of my constituents, as thousands of people commute from Orpington to the west end or the City. Their concerns are my concerns. I apologise to my hon. Friend and to the Minister as, unfortunately, I have to go to a funeral, so I might not stay until the end of the debate. In view of that, I shall be brief. Many of my colleagues will be able to stay until the end of the debate, and it is important for them too.

I should like to back up my hon. Friend's comments about what we now call cattle truck commuting—the necessity for people to make their daily journey to and from work in conditions that are worse than those for cattle. They have to stand shoulder to shoulder and back to back, and often have to allow more than one train to pass before they can even get on one going to or from London. A young constituent told me that he had started a new job three months ago in central London, full of the optimism and enthusiasm of the young, but was horrified by the conditions that he endured going to and from work. The worst thing was that after three months he had become inured to it—he accepted the miserable journey, packed like sardines or cattle in old Connex stock, as the daily routine.

What my constituents complain about most is overcrowding. The other enervating factor is that not only is there no prospect of immediate improvement, there is no prospect of medium or even long-term improvement. As a result of their maladministration of transport over the past five years, the Government cannot reasonably hold out any prospect of improvement over the next five years.

What possibilities are there? They do not inspire optimism or enthusiasm in the hearts of my constituents. One is to have fewer seats and more people standing in the trains. Ironically, some of my constituents would welcome that, after all the trouble that they have had in recent years. A second is to put up prices—to price people out of the rush hour scramble. Does that not conflict with what the Deputy Prime Minister has always reckoned is his true test—the number of people he can get off the roads during the lifetime of a 10-year transport plan? Anything that we consider in the short term is confounded by such difficulties. The real solution is to have more and longer coaches. That means longer trains, and therefore longer platforms, and the resiting of signalling between areas such as Orpington and central London. That requires investment, probably of millions of pounds.

As I understand it, in the debates during the summer, Connex—and perhaps others too—was talking to the Strategic Rail Authority and Railtrack about precisely such detailed improvements, and exactly what the planning and investment would be.

Can the Minister tell me—again, I apologise because I might not be here to hear his reply, but I shall read Hansard with close attention—about the talks that were to be held in September between the SRA and a number of railway companies in the south-east of England about an investment plan to cover such improvements as lengthening platforms and resiting signalling to allow for longer trains, and thus less overcrowding? That is what I was expecting to happen this autumn—and what Connex told me that it was expecting.

The decision that has been taken about Railtrack does not redound to the credit of the Government. Whatever their criticisms may have been of what the Conservatives did, they have had five years in which to get Railtrack off the ground, but instead have driven it into the ground. Their comments over the years, and their continual trashing of the company, destroyed the morale of the managers and the workers, contributed enormously to the difficulties that we now face, and delayed investment. As a result, there are now no discussions going on about the matters that I have mentioned, and I read in the papers that discussions with the company that runs the line to Brighton have been put back by at least three months. I do not know what is happening on the Connex South Eastern routes.

Will the Minister tell us the time scale for decisions on the issues of daily concern to my constituents? They come into the centre of wealth-making in the United Kingdom, and must start their ordinary day after putting up with such journeys. When they leave in the evening they face a journey of equal horror in the rush hour. Ironically, the only immediate hope is recession, which might lessen the overcrowding. What a prospect, to have to rely on recession in the City to achieve that. This is an absurd state of affairs, and the Government must tackle it in a time scale that will bring my constituents some hope.

I want to talk about roads and traffic, and the general mayhem in Surrey. The hon. Member for Epsom and Ewell (Chris Grayling) made a wide-ranging speech covering many issues affecting the south-east, but we need to think much harder about what should be done in Surrey.

We have several difficulties. One is that there is a great deal of inward commuting into places such as Guildford, as well as outward commuting. The high cost of living means that we need to bring in the people who can only afford to live in cheaper areas outside. Our problem is the increasing congestion because employees do not live close by. There are constant problems for the Arriva bus company in managing a service. We experience regular reduction in cross-county routes, such as Guildford to Kingston. In Guildford there are not even enough bus drivers, because of housing issues.

In an ideal world, people would live close to their work. The reality is that as people's jobs change and they are required to go all over the country, or to travel internationally, that is not always an option. Although many people hate commuting long distances, they do not have a choice about it, especially if they have children settled in schools or partners in local jobs.

We have heard much about overcrowding on trains and I shall not repeat it, but I support all that has been said on the matter. However, we should appreciate that parts of Surrey would be in easy reach of London if tube routes could be extended. The East London line to Wimbledon could be extended as far as Chessington, through an area of very heavy traffic. It would not even be necessary to build new track for much of the way. Raynes Park would need additional track and an additional platform, but in other areas existing assets could be re-used. We should examine such approaches, in strategic travel plans and multi-modal studies.

With more underground trains serving the Chessington branch, the odd slot to Waterloo could be released. That would be good news for commuters travelling through Surrey. There would be two slots an hour in and out of Waterloo. There could be more frequent services to Hampton Court and Guildford. Perhaps the Chessington line could be taken out to the World of Adventures and the new Epsom housing cluster, through centres of population and traffic movement. It might be possible to move the traffic on to public transport.

I am grateful for the hon. Lady's comments. Can I take it that she and her party will offer their support to my campaign for the extension, with a view to bringing public transport to the Epsom cluster? Although substantial longer-term issues arise about the Chessington line and the possibility of reintegration into a different part of the London network, as opposed to making it a simple branch line on the Waterloo route, none the less the extension of the Chessington line to Epsom would attract significant popular support. The more support that is given, throughout the community, the more chance the plan has of becoming reality.

My understanding is that the proposal would receive support from Liberal Democrats across the county.

I raise the case of Epsom not simply because it is the hon. Gentleman's constituency but also because it is one of those places on the boundary between county transport and commuting transport. There are many people in the area contributing to the congestion, but who would like late-night buses to come out from London to the Epsom area. That also applies to people working late shifts. The cost of coming out to Epsom from central London is about £40.

There is chronic congestion on the A3. Although I welcome the improvements to the bypass at Haslemere, they will increase congestion in Guildford. Anybody who has ever tried to drive through Guildford during the rush hour, especially when it is raining, will recognise that it is not an option—the town is completely gridlocked and one has to crawl through inch by inch. That situation will only get worse when the improvements at Haslemere come on stream. We must consider what can be done to relieve traffic in Guildford.

There are many ways to improve the links between Surrey and London. The underground connection could be further improved by a link between the termini at Wimbledon and Richmond over the Kingston loop and back again towards Epsom, or by carrying out work on the tube line from Morden.

Bus services are important in areas such as Guildford. There is a perception that Guildford people are rich and that all they want to do is to drive their children to and from school in their Range Rovers. In reality, many people do not want to drive their cars around Guildford, either because it is expensive or because they would add to the congestion; however the fact remains that they have many journeys to make. We have a deeply unreliable bus service that continually lurches around.

Several factors are involved, including affordable housing. Bus drivers cannot afford to live in Guildford, and if there is no bus driver there is no bus. Another problem is the amount of overtime that bus drivers need to earn to make it feasible for them to live in the area.

We must consider the whole infrastructure of areas such as Guildford. Why are we destined to get more houses in Surrey? Why might 8,000 more houses be built in Guildford when the infrastructure cannot support them? Nobody disputes the fact that we need additional affordable houses, but large numbers of houses will make a bad situation much worse. Such matters must be considered in the context of transport. We cannot just say that it is a housing problem or a regional development problem—transport is right there in the middle of it.

When people draw up plans to impose housing on the south-east, they must ask how residents will get around. If some of that building is executive housing, it could bring with it two or three more cars per household, which would worsen the problem.

The hon. Lady speaks eloquently of the problems of housing and traffic in Guildford, and having lived there until early this year I concur with much of what she said. However, I have a problem with her party's stance on the matter. Many Liberal councillors who represent boroughs in the Serplan group vote in favour of, not against, the Government's housing targets. Is she out of step with their views?

I reassure the hon. Gentleman that Liberal Democrats have reviewed those views and will not be voting in the same way again.

A U-turn.

Indeed. It might be helpful to add that in the meeting to which the hon. Member for Fareham (Mr. Hoban) refers there were deputies present, and particular circumstances applied to the wording of the motion. Liberal Democrats do not vote in support of extra housing.

Will the hon. Lady give way?

No. I have made the point that we do not support extra housing for the south-east other than affordable housing—not in Surrey, at any rate.

I turn to the problems faced by elderly people who do not wish to drive, cannot drive, cannot afford a vehicle or should not be driving. Although there are transport schemes for such people, they need to know that buses will call regularly—that the bus that takes them to visit family members on a Sunday will always turn up. They do not want to be isolated and unable to go to, say, bingo on Sunday because the bus is not there. There are important issues associated with isolation, and they are getting worse for certain sectors of the community.

During the general election campaign, I was approached by an old lady who wanted to know only one thing: whether the Sunday bus between Guildford and Woking, which was extremely unreliable, would continue to operate. Shopping for her housebound friends was something that she, and they, looked forward to, but the loss of the bus would stop her helping them. Given the poor state of our bus services, a Sunday bus can make a lot of difference to one's quality of life.

As the Minister knows, one of the great problems for bus services in Surrey is that once outside the borders of London the subsidy from the public purse falls off a cliff. London buses with routes from the outer London suburbs across the border into Surrey are to charge a flat rate of £1. As a result, north Surrey buses, which lack the same subsidised support, will be hugely uncompetitive. In terms of bus operators' ability to provide services, there will be a knock-on effect across the county. Because the subsidy stops dead on leaving the borders of London, it is highly probable that in constituencies such as the hon. Lady's bus services will disappear.

I thank the hon. Gentleman for that point.

One of the things that we in Guildford have done is to introduce cross-town buses and shuttle buses from the station. Regrettably, however, Conservative members of the council have voted against our having as many buses as we would like. As a result, the habit of catching the train and taking the bus up to the high street to go shopping will not be so easy to establish. Nevertheless, our cross-town buses are a start. Some of our employers subsidise them heavily and I welcome that.

However, the reality is that since deregulation—introduced by the Conservatives—bus operators are no longer required to operate on the less profitable but more socially desirable routes. As a result, continuity and reliability of service have broken down. Because they are unable to catch a bus home, people cannot go out after 8 o'clock at night, for example, to attend evening classes in an effort to get better qualifications. That tends to affect girls rather than boys, who often have their own transport. Girls in lower-paid jobs need to be able to rely on a bus to get home safely at night.

I ask the Minister to take a good look not only at expensive infrastructure projects such as rail and tube extensions, but at simpler ways to improve matters, such as better support for bus services in the counties, as well as in London. Older people, the less affluent and young students in my constituency need to know that, in future, they will be able to return home safely at night.

May I begin by apologising to you, Mr. Griffiths, and to the Minister for the fact that I must leave at noon because I am leading a delegation to discuss flooding in my constituency with one of the Minister's colleagues at the Department for Environment, Food and Rural Affairs?

I would like to believe that the historical legacy of poor transport links in East Sussex is the result of successive Governments trying to strike the right balance between preserving the environment in a region heavy with areas of outstanding natural beauty and catering for the needs of the travelling public. However, that is not the case. Transport problems are in fact the result of a benign indifference that has turned into real and serious neglect. The whole county of East Sussex has only a few miles of dual carriageway. Train services from Hastings and Bexhill to London are now slower than they were in 1922. In terms of travelling time, Bexhill is further away from London than York.

As a result, the Rother area, especially around Hastings, has some of the worst social exclusion problems in the county. Hastings is a very visible sign of the decline in the county's economy, and its economic and social problems radiate out into my constituency of Bexhill and Battle and the whole Rother area. We all realise that any solutions to the problems of Hastings will necessarily involve my constituency as well.

There was, understandably, huge and bitter disappointment at the Government's decision in the summer not to build the Hastings and Bexhill bypass. After years of dither, the making of such an important decision immediately after a general election, at which the bypass was a crucial issue in a key marginal seat, has been viewed extremely cynically. However, I sincerely welcome, and am grateful for, Lord Falconer's encouragement of the initial responses of the taskforce, led by SEEDA—the South East England Development Agency—which was set up in the wake of that disastrous bypass decision.

Any future plans for Hastings and Bexhill will rightly look for a more holistic solution to the problems of regeneration, and will aim to balance care of the environment with economic development. New plans will put far more emphasis on environmentally sustainable regeneration. Education, a new university, information technology and broadband communications networks for both business and the community will help to deal with the problems of social exclusion.

However, the contrast between the area of Bexhill and Hastings and that of Brighton and Hove is marked: for example, there is a high-speed rail link to London from Brighton, which takes about 45 minutes; improvements have been made to the A23, most of which is now the M23; and there is easy access to Gatwick and the Crawley hub. By contrast, it takes nearly an hour to go from Bexhill to Gatwick, and nearly two hours by road or rail to London. It is not enough to rely on improved education, or improved IT and broadband links. Better transport links remain absolutely vital.

Despite that need, I echo some of the sentiments expressed by the hon. Member for Guildford (Sue Doughty) about threats to local buses. Last week I met some of my constituents from Stone Cross, on the outskirts of Eastbourne, who are extremely concerned by the threat to local bus services. If those buses are withdrawn, thousands of people will be stranded in an area whose incoming population is increasing as more and more houses are built. Unfortunately, the possibility is largely the result of the threat to rural bus grants from the Government, through East Sussex county council. The council has been left in a parlous financial position by the former Lib-Lab coalition that ran down reserves from £24 million to little more than £3 million. Fortunately, after the county council elections in the summer, a new Conservative administration took over, but some difficult financial decisions must now be made.

Will the hon. Gentleman put on record the level to which he expects the new Conservative administration to increase those reserves?

I cannot give the hon. Gentleman a specific figure, but I can assure him that the Conservatives came into office with a steely determination to restore the financial health of the county after the appalling years of Lib-Lab misrule.

We are looking for holistic regeneration in Bexhill, Hastings and across Rother. However, such regeneration must include a fast rail link to London, improvements to the A21 south of Lamberhurst, extending dual carriageways and widening bottlenecks and a new link road from Bexhill to Queensway that avoids the notorious Glynde gap and it must relieve the A259 and Battle's A2100 to end the appalling traffic jams that choke both residents and through traffic.

We must also make safety improvements to the A21. The safety record on the A21 in my constituency is wholly unacceptable. People are dying unnecessarily on that road year in and year out. One of the most difficult visits that I have made as a Member of Parliament was to serving officers at Battle fire station who have been called out time and time again to cut dead youngsters from cars on the A21. The blackspots must be eradicated regardless of the overall plans for the county or the regeneration of the area because they require urgent and immediate attention. Will the Minister tell us what he will be doing with respect to safety on the stretch of the A21 south of Flimwell?

I welcome any partnership with the Government, other parties or stakeholders that will deliver the prospect of regeneration to my constituency. The Government must recognise that regeneration still depends on better roads and better rail. We want to safeguard the terrific natural environment in Bexhill and Battle, and I will be extremely mindful of the environmental impact of any proposals, but we look to the Government to deliver: we want action, not spin.

I add my commendation of my hon. Friend the Member for Epsom and Ewell (Chris Grayling) for obtaining this debate on a subject central to the quality of life for people who live not only in my constituency in west Kent, but in the whole of the south-east.

The subject should not be a matter of party political difference. It is common ground that the level of congestion and the state of public transport in the southeast is absolutely lamentable, and that it has deteriorated in the past four and a half years. It is also a shared view that the south-east has been the engine of the British economy. It incorporates the financial centre of Europe and the highest density of population in the country; indeed, it has one of the highest population densities in Europe. It provides the gateway for foreign investment and tourism into the United Kingdom.

That has all been recognised by the Government in their commitment to a huge amount of new house building in the south-east. Let us remember that the Government, through Serplan, are committed to building 900,000 new houses there. Approximately 50 per cent. of those houses will be occupied by families who have moved out of London or the cities of the midlands and the north to migrate to the south-east. By most estimates, half of those houses will be built on greenfield sites. The new houses will substantially add to the stresses and strains on existing public infrastructure, especially the transport system. Many families who will be relocating from deprived areas in inner London to Surrey, Kent or Sussex will want to commute back to London for work, yet no provision exists in the Government's plans for enhancing and increasing the capacity of the transport system. That is a fantastic example of unjoined-up government.

I was interested to hear the hon. Member for Guildford (Sue Doughty) comment that the Liberal Democrats did not support new house building—apart from affordable house building. That represents a substantial change from their previous position. The Liberal Democrats supported the Government on Serplan and other matters.

In making that statement it would have been more accurate if I had said that we oppose the additional housing numbers announced, not all new building.

I thank the hon. Lady for her clarification—but I do not want to dwell on it, because that is not the main matter for debate. We welcome Liberal Democrat support in opposing, in whatever way, the absurd new plans to force councils in the southeast to build housing where no public infrastructure exists to support it.

I appreciate that house building targets are not the main focus for this debate, but I agree with my hon. Friend the Member for Tunbridge Wells (Mr. Norman) and would like to ask him a question. Does he agree that as district and borough councils begin to anticipate their new local plans and look ahead 10 years, the capacity of transport infrastructure to cope with a large increase in housing should be a key element in the public inquiries that are likely to follow? As the Government continue to thrust such schemes down their throats against their will, local residents should make that important point about the difficulty that transport infrastructure has in coping with new houses.

I agree with my hon. Friend. A great anomaly is that county and borough councils must plan for new houses and communities, but do not have the resources to plan for the infrastructure to support them. That puts them in a highly invidious situation. Despite a commitment to an expansion in population, an increase in the number of houses, and incidental destruction of green fields, the Government have made no consequential commitment to public transport infrastructure.

The Minister may wish to contemplate the fact that one of the first actions taken by the Government when coming to office was to cancel almost all major road schemes in the south-east, including improvements to the A21, under the Weald and Downlands DBFO—design, build, fund and operate—scheme, to which my hon. Friend the Member for Epsom and Ewell referred. Those improvements would have directly met the concerns about safety that he raised, and would have saved many lives. They are now being contemplated again, and if they are implemented they will happen five to 10 years later than when they could have been brought into force.

The cancellation cost the Government some £6 million to compensate contractors—money that could have gone into road improvement. It has been replaced with a plethora of reviews, such as the trunks road review and the access to Hastings study, which produced almost nothing and, as my hon. Friend said, was a tremendous disappointment. Now we are told that a feasibility study into dualling the A21 at. Castle Hill and possible improvements south of Lamberhurst will be carried out.

Recently, I had a meeting with staff at the Highways Agency to discuss the new feasibility study. They were clearly suffering from severe review fatigue. They were the same people who undertook the public inquiry into the A21 in 1991. When I spoke to them, they said that they understood the issues exactly, because they had studied them consistently during the past 20 years and they had not changed at all. They told Ministers about them in 1990 and could produce the same study again in 2001. There is no need for reviews, because the answers are known. Some improvements are blindingly obvious—the A21, is a good example; there are many others in the south-east. Dualling the A21 at Castle Hill between two stretches of dual carriageway should have happened many years ago, and is not contentious. Economically and in terms of social benefit it will pay off many times over. We do not need a feasibility study. We need a private finance initiative, and we need to get on the with the job.

Another aspect is that in cancelling all the major programmes, and in a fit of centralisation, the Government have starved the county councils of funds to undertake minor reviews, with the result that all those environmentally acceptable and sensible minor actions that are required to ease traffic have not taken place either. That has added to congestion and reduced the power and effectiveness of local government to make a difference to transport problems.

Hon. Members have referred to the state of the bus industry. My only comment on that is that the southeast must have brought enormous benefits to the white paint industry, because thousands of miles of bus lanes have been painted on our roads. However, I think I am right in saying—the Minister may want to comment—that the increase in bus passenger traffic in the south-east, excluding London, has been negligible during the past five to 10 years. The result of creating those bus lanes is that car passenger traffic has slowed down, but the response from the bus industry, which operates as a monopoly in many parts of the south-east, has been so poor that there has been no increase in bus passenger traffic. As a public transport initiative it has been a disaster.

Even worse is the state of the rail industry. It is important to say that, following recent developments, almost all the improvements to which Railtrack was committed as part of the network maintenance statement are now at risk. The investment holiday that is likely to result from the period of administration following the demolition of Railtrack means that investment will not be available. The plans for improvement to the infrastructure of the railway lines that we have discussed today—including the London to Hastings line, to which my hon. Friend the Member for Bexhill and Battle (Mr. Barker) referred—are negligible for the next five or 10 years. There is no plan to create a high-speed railway line to Hastings, an area with 10 per cent. unemployment.

Connex South Eastern plans to introduce new trains. The Minister may believe that that is a good thing, as most people do, but those new trains will have no more passenger-carrying capacity than the old trains—with the result that, as my hon. Friend the Member for Epsom and Ewell said, the queues and the number of people standing on those trains will increase. Our commuter capacity will, if anything, diminish. We have no investment for longer platforms. We do not have investment in stations. Access for disabled people is appalling, and would be unacceptable elsewhere in the private sector. Will the Minister tell us specifically whether the Government have any serious commitment to ensuring that commuter train infrastructure improvements will start to take place? Will the period of administration and the extraordinary period of chaos in the rail industry result in a complete holiday for that investment programme, or can any of the schemes now proceed?

It is also worth making the point that all those schemes that have buoyed up the hopes of commuters in the south-east—for example, Thameslink and the Crossrail project—are at risk. Most experts on the rail industry now believe that they will not proceed during the next 10 years. Perhaps the Minister will comment on that. The situation of commuter railways seems desperate.

Where does that leaves us? The lead time for major transport projects means that the legacy of eight or nine years of Labour Government will almost certainly be slower travel in the south-east, with more congestion. The level of congestion will be unprecedented, and among the worst in Europe. We shall have a worse public transport infrastructure. The standard of road maintenance will be the poorest we have ever seen, with reduced expenditure on road maintenance since 1997. We are looking at standstill Britain, and it is vital that the Government get serious about matching their commitment to increase the overcrowding in the southeast with breaking the deadlock on public transport and intitiating some of these projects. They are not contentious, and they are necessary to improve the road system and get the south-east moving again.

I congratulate the hon. Member for Epsom and Ewell (Chris Grayling) on securing the debate. Transport in the south-east is a cause of concern to Liberal Democrat and Conservative Members of Parliament—I do not extend the concern beyond those two parties.

As I waited on the platform at Wallington this morning, I pondered the key issues in this debate. The station board showed that a train had been cancelled, and a notice stated that the 8.10 am train would be late because it was a slam-door stopping train; people therefore take longer to get on and off, or it goes slower—I do not know which. Presumably, the train will be late for as long as it remains in use.

Yesterday, I was at Carshalton Beeches station, just one stop up the line, as a constituent had invited me to look at the large number of missing or broken knots—I do not know what they are called in technical railway terms; they lock the rails on to the sleepers—along the track. Such anecdotal experience of the public transport infrastructure confirms that it is in appalling state of disrepair and disarray. I could dwell briefly on the Tory legacy, but even Conservative Members have confirmed today that they recognise that their party's performance on transport infrastructure was not good. I suppose that if one believes in the great car economy, it is inevitable that public transport infrastructure will suffer.

I mentioned a range of significant schemes introduced by the Conservative Government that made a difference to the transport infrastructure—light rail, rail and so on. I emphasised that they were a start; they stopped abruptly in 1997.

I am well aware of the list. However, my experience, and that of commuters in London in the past 20 or so years, is that despite that list, public transport has been deteriorating for many years and there is no sign of improvement. I shall not dwell on the Tory legacy—

Will the hon. Gentleman give way?

I shall give way shortly.

As the train I was travelling on this morning was at a standstill somewhere between stations, I started to dwell on the Labour Government's responsibility, as they have been in power for four and a half years, and on the impact of the GoVia franchise, which affects large parts of the south-east. I am interested in the fact that the Labour Government have been in power for five years; I do not know what happened in the last six months of Tory Government—not very much, presumably.

I tabled a parliamentary question asking what assessment had been made, before the Government made the Railtrack announcement, of the impact on GoVia's existing and new franchise. The answer was that the Secretary of State's announcement

"was intended to pave the way for those issues to be better addressed."—[Official Report, 24 October 2001; Vol. 373, c. 235W.]

I think that means that the Government did not actually consider the impact on the GoVia franchise before they made the Railtrack announcement. A further Government response to a similar parliamentary question stated:

"The recent Railtrack developments will not impact on the existing or new franchise."—[Official Report, 29 October 2001; Vol. 373, c. 478W.]

The Minister is an honourable man, who will want to take this opportunity to apologise for what is at best an extremely misleading answer to a parliamentary question. It was reported in the newspaper Metro recently that GoVia, the owner of the south central franchise, has already suspended a £330 million upgrade of track and signalling on lines into Victoria. Far from the Railtrack developments having no impact on the existing or the new franchise, we know that the plans have been put on hold. This is an opportunity for the Minister to apologise for that statement, and I hope that he will.

The hon. Gentleman attacked both the Government and the Conservative party for their records on improving public transport. Will he tell hon. Members how much of the tax increase that the Liberal Democrats proposed at the last election would have been spent on improving public transport?

I am sure that the hon. Lady is familiar with our tax plans, which were limited. They focused specifically on education.

Nothing on transport.

Nothing on transport.

Our proposals for Railtrack and the establishment of a not-for-profit trust, and for London Underground, would have addressed the problems that we see on rail and tube today much more significantly and quickly.

The GoVia-Connex handover, which is another area of Government responsibility, demonstrated a lack of joined-up government. The Department for the Environment, Transport and the Regions—as it was then—approved the awarding of the franchise to GoVia. Unfortunately, that was then held up by the Department of Trade and Industry as it considered the details. The impact of the stalled handover was that more drivers left Connex, while there were no recruitment proposals to take on additional drivers. Negotiations took place about terms and conditions for Connex drivers, into which GoVia had no input because of the extended handover. When GoVia eventually took over the franchise, it needed to recruit more drivers just to stand still, because of the enhanced terms and conditions that had been agreed by Connex. There were major failings in areas for which the Labour Government have responsibility.

These are early days for the Crossrail proposal, and the Minister will know that Cross London Rail Links Ltd. had its first meeting yesterday. Have the Government decided whether to proceed with a transport and works order or a hybrid Bill as the means of taking the project forward? Can the Minister guarantee any funding beyond the £154 million that has been agreed for the feasibility work? That work is welcome, but if nothing will be there to take the project further forward once that budget is exhausted, it would be a major disappointment.

The Government's responsibility for the tube is well publicised, and continues to be a source of embarrassment. The public-private partnership has achieved nothing in the past four years, other than the production of enormous and complicated documents at great expense. I understand that the Government have now appointed Ernst and Young as the accountants to examine whether the public-private partnership represents value for money. I welcome the fact that they have not appointed PricewaterhouseCoopers as the arbitrator, because it is so closely involved with the Government. However, will the Minister set out if Ernst and Young is involved with any consortium bidding for a tube franchise? If it has a close connection with any group, there will be concerns that it will find the Government's proposals to be good value for money simply because a partner will derive some financial benefit. Will the Minister confirm that that question has been closely examined?

Other hon. Members have referred to the Hastings bypass. Given that it was difficult to demonstrate overwhelming economic benefits of the project, the Government have probably come to the right decision. However, the multi-modal study identified the need for substantial investment of about £240 million in other local transport improvements. I hope that the Minister will tell us what funds may be forthcoming to deal with that investment.

I understand that we may receive an announcement about terminal 5 tomorrow—if we do not receive one today. After a little less than four years, the inquiry finished in March 1999. A decision is expected imminently on the way forward. Liberal Democrats believe that allowing terminal 5 to proceed would be wrong. We are worried that it is unlikely to help the airlines that the Government presumably want to help—the United Kingdom's regional airlines that want access to Heathrow slots but are not currently gaining them. If terminal 5 goes ahead, our airlines may not benefit, and it will have a significant and detrimental impact on the communities surrounding Heathrow airport.

Is the hon. Gentleman aware that most of our regional airlines are part of foreign-owned airline groups?

Many of our regional airlines are a part of British Airways, which is to be renamed City Express. Clearly, not all UK regional airlines are owned by foreign airlines.

Such issues are of a regional, national or even international nature. I echo the worries of other hon. Members about local transport schemes and Transport 2000. It is often local schemes, such as small road improvements and additional subsidies for bus services, that can make a significant difference at a local level. They can play a major part in reducing congestion in Reading, the Thames valley and a host of small areas in the south-east. Indeed, there is a strong demand for a tram link in Sutton in my area. Will the Minister say what priority can be given to small local projects as opposed to the major regional, national or international projects that have been mentioned?

Mr. Griffiths—no, I mean Mr. Deputy Speaker—[Interruption.] I apologise, I should have called you Mr. McWilliam. It is always helpful to have a name-plate in position so that hon. Members have clear guidance on how Deputy Speakers like to be addressed.

The sign has my name on it on the side facing me, too; I do not know what that says about me.

Thank you for that clarification, Mr. McWilliam.

I should like to think that transport in the south-east will improve, but the evidence of the past 20 years shows that it has deteriorated, and continues to do so. I hope that that will not go on happening. As a daily commuter I, like the hon. Member for Epsom and Ewell, suffer from such transport difficulties, just as others do. Unless the Government start to tackle such fundamental failings in our transport infrastructure, transport will deteriorate in this country to the point when a German diplomat can say in all honesty that the United Kingdom has turned into a third-world country.

It is a pleasure to speak in the debate. I am grateful for the opportunity to do so. I congratulate my hon. Friend the Member for Epsom and Ewell (Chris Grayling) not only on securing the debate but his excellent opening speech. He spelt out many of the transport problems that face the south-east, and referred to the Government's failure to deliver in that area. It is notable that the Government's lack of interest in the south-east's transport problems is shown by the fact that not one Labour Back Bencher has attended the debate.

I am pleased to speak, not only because I am a Transport spokesman, but because my constituency is in a part of the south-east that, as my hon. Friend pointed out in his opening speech, has done worse than many in receiving Government transport improvements. Berkshire does not receive much from the Government for road developments. We got a bus lane on the M4, but I am not sure that many people would call that a road improvement. The Minister looks excited, and I should certainly be grateful if he were to tell us that the Government were willing to support the local project pursued by Reading borough council and Wokingham district council to put another bridge across the River Thames. If he wants to give something to Berkshire, perhaps he could offer that to my constituents.

I remind the Minister why transport is so important: it is not only a key issue about the quality of life for individuals, as was pointed out by my hon. Friends the Members for Tunbridge Wells (Mr. Norman) and for Orpington (Mr. Horam), who mentioned cattle-truck commuting. People face transport problems every day, and that has a real impact on their quality of life. People try to travel to get to and from work, and also for leisure and personal purposes.

Transport also relates to economic development in the south-east. Last week, I attended a meeting with a number of south-east business men and women who bemoaned the south-east's transport problems and the Government's lack of delivery. They emphasised that good transport infrastructure is necessary for the good of the economy, both to retain economic vitality and to develop economic growth. As companies look to expand or locate in the south-east the state of transport links will be a consideration when they make their decisions.

My hon. Friend the Member for Tunbridge Wells and the hon. Member for Guildford (Sue Doughty) mentioned housing development and policy. That is a problem because when the Government consider the number of future houses, they do not examine the infrastructure requirements that the new developments will bring in their wake. Insufficient attention is given to infrastructure with regard to the transport system.

It is interesting to learn from the hon. Member for Guildford that the Liberal Democrats on Serplan who supported the Government's proposed housing figures for development in the south-east until 2016 did not mean to do so, and were deputies who did not know what they were doing. We were all confused by her intervention when she tried to clarify the point by saying that the Liberal Democrats are not in favour of additional houses, but are in favour of new-build houses. If the hon. Lady wants to intervene and explain the position, I will be happy to give way.

We accepted, with reluctance, the original figure of 35,000. We opposed the additional 13,000 for Surrey that was planned above that figure.

Eh?

As the Minister says, that has obviously sorted things out. I also note that as far as the hon. Member for Guildford is concerned, any new housing should only be affordable.

I invite the hon. Lady to reflect that when her party was in power, 60 per cent. of housing was developed on greenfield sites.

rose—

Order. Before the hon. Lady replies, I remind her that this is a transport debate, although I understand the relevance of the points being made.

Thank you, Mr. McWilliam. I return to my original point.

Transport links are essential for housing development and there is no point in the Government trying to build extra homes in the south-east without a transport infrastructure. That will create further problems and further deteriorate people's quality of life.

Several hon. Members referred to the misery of commuters. I emphasise to the Minister that the problem is not only about quality of life; people's jobs will be affected if the Government fail to improve transport infrastructure in the south-east.

In the past four and a half years we received from the Government only vague promises, plans, reviews and reports. It is typical of the Government to talk about something but not to deliver on it. In 1997, they promised to cut congestion and pollution but delivered the highest fuel taxes and the worst traffic jams in Europe. In 1998, the transport White Paper promised to make road maintenance their "first priority", but they have delivered a record backlog of poorly maintained roads and little prospect of constructing the hundreds of bypasses necessary. In 1999, the Deputy Prime Minister promised "Quality, quality, quality" for Britain's rail network, and now the Government have driven Railtrack into the ground. Finally, in July 2000, the Deputy Prime Minister produced his 10-year transport plan. Like a magician pulling a rabbit out of a hat, he expected his latest trick to silence his critics, but I fear that it was merely smoke and mirrors. A year on, there is real doubt about whether the Government will deliver the £180 billion of investment that we were promised as part of that 10-year plan.

After what the Government have done to Railtrack, it is now unlikely that private sector investors will be so eager to produce the necessary £34 billion of private-sector rail investment. If private sector investment is forthcoming, it will be at an extra cost. Indeed, by increasing the political risk to the private sector of being involved in major transport infrastructure projects, the Government may find that they now have to provide the very blank cheque, through guarantees, that they claimed that they could not provide for Railtrack.

The public spending sums promised last year may also be in question and may have to be re-evaluated, not least in the light of economic slowdown. The south-east will lose out if Labour does not deliver.

It is interesting to read Ministers' answers to questions on the future of rail projects in the south-east. For example, when asked about the future of Thameslink 2000, the Minister responded:

"The Government are keen to ensure that the Thameslink 2000 project should not be put at risk by Railtrack being taken into administration."—[Official Report, 24 October 2001; Vol. 373, c. 222W.]

That suggests that the Government paid no attention to the future of such projects when they put Railtrack into administration. They have no idea about the future of many rail infrastructure projects, as that answer shows.

It is evident in much of transport policy that Labour is still pursuing short-term political needs rather than making the long-term decisions necessary to get the country moving. An example from the railways is the decision made in July in awarding some of the new rail franchises. Instead of making the sensible long-term decision to grant 20-year deals to allow companies to plan future investment—when the Secretary of State could have demanded strict service improvements so that passengers would gain from the decisions—the Secretary of State opted for two-year contract extensions. He is kicking the problem into the long grass, and that means no improvement in services. The problems will not go away.

I hope that the Minister will confirm that that decision is not part of a wider agenda for train operating companies. In 1997, the Deputy Prime Minister said:

"If rail franchises come to an end, I will keep open the option of the public sector running the railway".

After what has happened to Railtrack, will the Minister assure us that that is not his plan: that the Government have no intention of taking any of the train operating companies into the public sector or of imposing the same structure on them as is being imposed on Railtrack, and that they will shortly take the long-term view and grant longer franchises for train operating companies?

Nor are the Government failing only on railways: my hon. Friend the Member for Bexhill and Battle (Mr. Barker) gave a concrete example of how they are failing on rural bus services. London Underground is subject to strikes and strike threats, and is paralysed by disputes over funding. We have no aviation policy, in spite of having been promised one in 1998. The south-east has a huge congestion problem in aviation that the Government have done nothing to tackle.

We have had four and a half years of delay, dither and wasted opportunities. I hope that the Minister will give concrete examples of how the Government will deliver, with firm timetables, on getting the south-east moving. To give him some help, I have several questions.

When can we expect an announcement on the timetable for road building in the south-east? When will the Minister make an announcement on the long-term future of rail franchises in the region? Will he assure us that the Government's intervention in Railtrack will not set back the timetable for any planned rail or station improvements in the south-east, such as the Brighton upgrade, the Shortlands flyover in Kent and proposals to expand track capacity at Reading station? Will he set out the timetable for those improvements, and suggest where the funding will come from and whether it is assured? Many fear that the move to special-purpose vehicles will simply cause delay in such infrastructure projects, or even lead to some being cancelled. When can we expect an announcement on Heathrow's terminal 5?

My constituents and others in the south-east will listen carefully to the Minister's answers, not only because the problem affects their quality of life, but because it affects many of their jobs. The economic vitality of the south-east depends on the Government's answers to the transport problems. Plans are no good unless the Government are willing to deliver. People in the south-east have waited for four and a half years. Their quality of life is being affected day by day, so it is time for Ministers to stop talking and start delivering.

I congratulate the hon. Member for Epsom and Ewell (Chris Grayling) on securing the debate, and on raising matters of considerable importance to his constituents and others living in the south-east. Some of the bright young things from the Conservative Back Benches sat with him at one stage, and I read yesterday that the shadow Leader of the House had organised a group of them to create a nuisance for the Government. That will be a considerable relief, after the extinguished volcanoes who usually occupy the Conservative Front Benches—of course, I make an exception for the hon. Member for Maidenhead (Mrs. May), for whom I have enormous respect and regard.

One reason for increased congestion in the south-east, and many other conurbations in the country, is that the economy is doing so well, and so many more people are travelling to work. The hon. Gentleman did not have time to mention the fact that in his constituency the number of unemployed people has fallen from 1,032 to 363 since 1997. Throughout constituencies in the southeast, far more people are in work and travelling—a reason why there has been further pressure on the system. As the hon. Member for Tunbridge Wells (Mr. Norman) suggested, economic activity, certainly in the south-east, is at record levels. We are pleased about that, but it puts pressure on the road and rail system that we inherited from his party, which was in government before 1997.

Several hon. Members spoke about the funds available for local road schemes and transport plans. Listeners to the debate would think that nothing had happened at all. The hon. Member for Epsom and Ewell said that improvements were nowhere in sight—but he needs to get out a little more, and speak to people in his local authority. His highways authority in Surrey has had a 91 per cent. increase in funding for local transport plans. In Kent, the increase is 76 per cent. In Berkshire it is 67 per cent., and in Windsor and Maidenhead 72 per cent. Funds for local schemes are available.

rose—

I shall not give way to the hon. Gentleman. He spoke for long enough, and I have only a few minutes.

An interesting feature of the debate was the rapier-like intervention of the hon. Member for Maidenhead on the hon. Member for Carshalton and Wallington (Tom Brake). As usual, he gave us 15 minutes of platitudes and huge wish lists of schemes. I lost count of the number of schemes and questions that he raised—but when it came to the question of where the money for the Liberal Democrats' schemes would come from, it turned out that their extra penny would go into education and there was nothing extra for transport. Members will have noted that carefully, and I thank the hon. Lady for teasing the information out. We hear much talk from the Liberal Democrats, but they never back it with action or appropriate funds.

I should briefly put some of the subjects for debate into context. The south-east has one of the United Kingdom's busiest and most important transport networks. Most of the country's international traffic passes through the region, via either the airports or the major ports, and about a quarter of the national motorway network is in the south-east.

Excluding London, the south-east accounts for more than 15 per cent. of the United Kingdom's GDP. Good strategic road and rail links have aided the considerable prosperity of the region, but they have also brought severe congestion. Significant improvements are urgently needed to the road and rail infrastructure to enable this prosperity to continue.

Quality of life is equally important. As well as areas of economic success, there are areas of significant deprivation. In many cases, strategic and local transport improvements would contribute to their regeneration. However, such developments must not be at the expense of the environment. We should not forget that the south-east includes many areas of great natural beauty and environmental importance—6,500 sq km of the region are in designated "areas of outstanding national beauty".

I cannot agree with those who criticise the Government for not taking action. We are taking vigorous steps to tackle the transport problems that have been mentioned, and I would like to remind hon. Members of the measures that we are taking at national, regional, sub-regional and local levels.

The integrated transport White Paper, published in 1998, was the first White Paper on transport for more than 20 years; there had not been such a thing under the Conservatives. It set the broad policy framework for integrated transport policies. We followed this with the 10-year plan for transport, which announced national investment of £180 billion for new transport measures. Just as importantly, it made clear our objectives for transport. For example, by 2010 we want to reduce congestion below current levels on the inter-urban trunk road networks and in large urban areas. We shall achieve that by promoting integrated transport solutions and investing in public transport and the road network. We should also like to achieve a 50 per cent. increase in passenger rail use in Great Britain, improved punctuality and reliability, and the doubling of rapid transit use—that is, light rail and trams.

In the south-east, contrary to the impression that was given earlier, 11 major trunk road schemes are progressing as part of the Highways Agency's targeted programme of improvements. They will bring safety and environmental benefits. A further 15 improvements affecting congestion and safety will be made across the region by March 2002, and there is scope for much more. The 10-year transport plan will deliver substantial rail improvements to the region; the completion of the channel tunnel rail link to St Pancras will open up fast travel from London and Kent to Paris, and overcrowding on rail commuter services into London is to be targeted. Other improvements are under active consideration.

I shall answer some of the individual points that have been raised, but I fear that I shall not get through them all. If hon. Members wish, they can write me a note later, and I shall try to respond. The light rail scheme was mentioned. A number of such schemes are being considered by local authorities in the south-east—for example in Oxford, Milton Keynes and Reading, and on the Isle of Wight. Some of their bids are expected in the near future. It was always intended that the 10-year plan be reviewed, and it is proper that that should happen. It is nonsense to suggest that revising it is a panic measure.

What a grim picture the hon. Member for Epsom and Ewell painted of his area. I wonder whether people reading his speech in Hansard would be attracted to invest there. Sometimes we should reflect on our words, and the influence that they might have. His description was nowhere near reality as most people understand it. The hon. Gentleman almost told us that we should have renationalised the railway system when we first came into government in 1997. That was an interesting U-turn from the Conservative Back Benches. Perhaps we shall hear more about it at some other time.

I have very little time to respond to all the points in this debate, but it is clear that we cannot deliver any of our transport solutions without effective partnership. That is what we will have with agencies such as the Strategic Rail Authority and the Highways Agency. Most importantly, the local transport plans, which have been given so much extra funding—

Order. Time is up.

I am pleased to have secured this debate at such an appropriate time, as there is somewhat less than a week to go until 5 November and bonfire night. It is particularly appropriate to debate such a topic in this place. I enjoy firework displays. I have always taken my kids to see them and they have enjoyed them. It is right that we commemorate a momentous occasion in British history. However, some serious issues must be tackled.

The sale of fireworks through retail outlets should be prohibited. I would like the Minister to comment on that. I hold that view for three key reasons. The first is the level of injury to individuals, in particular young people. In the most extreme cases, fireworks cause fatalities—two were recorded last year. My second key reason is the incidence of criminal damage. For example, I have had conversations in the past couple of years with British Telecom, which recorded 5,000 incidents of firework-related vandalism involving public payphones last year. The criminal damage costs so far this year are running at about £1.2 million and the burden of those costs is ultimately born by the taxpayer and the consumer.

My third reason for seeking a prohibition on the retail sale of fireworks is that they make people afraid. Fear is a less tangible phenomenon than the other two that I have listed, but it is none the less profound. Fear, anxiety and distress particularly affect some of the more vulnerable members of our society. I receive letters every year from elderly people and their relatives, telling me that those people are very nervous about going out of doors when darkness falls. Some of them are frightened to go out at all at this time of year. I also receive similar letters from other groups, but I use elderly people as an example.

Like the hon. Lady, I have received many letters on the subject, including a petition bearing many names. If the sale of fireworks from retail premises is not banned, would she agree that perhaps there should be some control over the time of year during which fireworks are used? Nowadays, it seems as though they are used throughout the year.

I agree. When I was thinking about this debate, I considered saying that firework accidents and attacks are now considered an inevitable, seasonal event, but in fact that is no longer the case. Fireworks are let off at new year and for other festivals, so it is not feasible to rely on the provision in the voluntary code for a three-week sales period before bonfire night. There are other festivals at other times of the year, so relying on that provision would not be fair and would not tackle the problem of the level of injuries and criminal damage. That is why I want a ban.

I have outlined three key reasons why a ban should be imposed. With respect to fear, many hon. Members, including myself, receive letters from people concerned about the distress and fear caused to their pets and animals by the—generally illegal—letting off of fireworks in the street.

My hon. Friend is right to focus on the number of accidents and on the distress that animals can be caused. Is she aware of the increase in the use of fireworks as weapons? In two incidents in my constituency at the weekend, a cat and a dog were severely injured by gangs of thugs who were using fireworks as weapons, firing them at the animals.

My hon. Friend makes his point well. It adds further weight to my argument that we should consider the prohibition of sales through retail outlets, rather than regulation. That way forward has not proved effective.

The misuse and abuse of fireworks and the injuries caused by them continue, despite the well-intentioned Fireworks (Safety) Regulations 1997. Those most notably banned the sale to, and use by, the general public of aerial shells and similar devices. The statistics unfortunately and overwhelmingly demonstrate the impotence of the regulations in securing greater public safety throughout the firework season. The number of injuries from fireworks was higher in 1999 and 2000 than in 1998, which illustrates that the 8 per cent. reduction in casualties from 1997 to 1998 was merely arbitrary and owed nothing to the implementation of the regulations. The present legislation makes it extremely difficult for trading standards officers and the police to deal effectively with the sale and misuse of fireworks. Statistics demonstrate that tightening laws and increasing penalties for those guilty of the criminal use of fireworks will not be enough to curtail firework injuries.

For the past five years, the illegal use of fireworks has consistently been the second largest cause of firework-related injuries, but the primary cause has been family and private parties. Deliberate misuse is therefore not the only culprit; we must also consider the genuine use of fireworks as instruments of celebration. The evidence demonstrates that merely trying to eradicate the misuse of fireworks will not combat the high rate of firework-related injuries. It is therefore necessary to conclude that the thorough prohibition of the sale of fireworks to the general public is the only means by which firework-related injuries, accidents and damage can satisfactorily be tackled.

Those with vested interests, such as commercial manufacturers whose profits and employees would be affected, would obviously object to such a measure. Their economic gains are economic losses for others, such as the health service and ultimately, therefore, the taxpayer who must pick up the tab for firework-related injuries. Others who might face losses include individuals and private sector companies whose property incurs severe criminal damage.

My hon. Friend will be aware that there was a serious incident in my constituency last week—a fire in premises where fireworks were being stored for the retail trade. Does she agree that attention needs to be paid to not only the immediate point of sale, but the whole chain of sale? Does she agree that such incidents require the Government and industry to reconsider their approach to the voluntary code of practice to prevent incidents at any point in the sale chain?

I agree with my hon. Friend. As I said, and my hon. Friend confirmed, regulation simply has not proved effective.

There is a fundamental assumption in any social democracy that commercial viability cannot go unchecked, but must be balanced against the wider principles of public welfare and safety. Although commercial vested interests would argue against prohibition, the weight of the argument is in favour of it and of protecting the public.

In response to a parliamentary question about firework-related injuries from my hon. Friend the Member for Plymouth, Sutton (Linda Gilroy) in July, the Secretary of State for Trade and Industry stated:

"We will further target this age group as part of the 2001 firework safety campaign."—[Official Report, 20 July 2001: Vol. 371, c. 606W.]

Indeed, that was so, and we should give credit for that campaign. It has been appropriately targeted, with a higher profile than any campaign that I have been aware of for many years. However, therein lies our problem. Legislation requires that consumers of fireworks be aged 18. Statistics show, however, that the greatest percentage of fireworks injuries—despite the 1997 regulations, which raised from 16 to 18 the age at which one could buy fireworks—are to those aged 15 and under. Those account for 40 to 50 per cent. of all fireworks injuries in the past five years.

The evidence clearly shows the effectiveness of the legislation. The Secretary of State's answer in July and the targeting of the safety campaign in the media are explicit acknowledgement that the under-15 group is at high risk of fireworks injuries. Simultaneously there is an implicit acknowledgement that current statute, namely the increase in the 1997 regulations of the age for purchasing fireworks from 16 to 18, does not prevent access to fireworks for people under the age limit.

Even aside from the problem that all age certification entails—that of unscrupulous retailers who sell merchandise to those who are under age—firework safety cannot be guaranteed by ensuring that statutes are more vigorously enforced. Age alone does not qualify someone in the responsible and competent handing of what are, essentially, explosives. We could use the analogy of driving licences. Someone who reaches the age at which it is possible legally to hold a driving licence cannot then just get in a car and drive down the road. They must take lessons and pass a test. However, on reaching 18 someone can buy fireworks whether competent to handle them or not. We should bear in mind that fireworks are explosives.

I have a 78-year-old constituent who was constantly bombarded, until she was forced to ask the council to move her. Youths as young as 12 have been involved. Should not such cases persuade us that the voluntary code is not working and that fireworks are available to anyone who wants to purchase them?

I agree with my hon. Friend. I am sure that most hon. Members could give instances of their constituents being subjected to intolerable fear and persecution as a result of the illegal use of fireworks by youngsters.

The problem is getting worse. I shall tonight present to the House a petition with about 28,000 names, from an organisation that is concerned about, for example, the impact on pets. I have tapes from individuals who need guide dogs. Fireworks can send the animals into complete panic, which restricts the ability of the people concerned to get out and about and lead normal lives at this time. The difficulty is not even restricted to this period of the year; it happens at other times, such as the millennium and Christmas, and at private parties. I believe that it is getting worse.

I am sure that some people would respond to a call for prohibition by claiming that there was a civil liberties issue to be considered. However, balance is necessary. One person's freedom is, after all, another person's prison. Human rights legislation also states that people have the right to quiet enjoyment of their property. Many people feel that that right has not been afforded to them. It is an issue of safety and balance, and safety must be paramount.

Legislation, despite its theoretical accuracy, is only as good as its implementation. Some would argue that legislation already exists that makes the misuse of fireworks an offence, which is correct. In reality, however, fireworks cause distress, anxiety and injury to an intolerable number of people as well as considerable criminal damage during every firework season and, more than ever before, throughout the year. We must emphasise that injury is not caused simply through the misuse of fireworks. Both the legal and illegal use of fireworks cause major problems, and that is why a prohibition is necessary.

I quote two examples that have already been quoted in the House and which show how legal and illegal use can cause loss of life. Dale Mitchell, a 10-year-old, died in 1996 after a lit firework was pushed through the letterbox of his family home. That is an example of the illegal use of fireworks. In the case of David Hattersley, however, fireworks were being used with the best of intentions. He was headmaster of Hazlemere primary school, and lost his life in November 1996, when he stumbled forward as he supervised the school's annual firework display.

Last year, 972 people were admitted to hospital as a result of firework injuries, but the actual number of injuries may have been significantly higher. Numerous statistics show the need for reform of the firework legislation. I hope that I, and my hon. Friends who have intervened, have made a case for it. The Government believe that it is required because in 1997 they supported a private Member's Bill introduced by my hon. Friend the Member for Plymouth, Sutton, which was unfortunately talked out in 1998. They supported key measures in that Bill to deal with the licensing, training and qualification of those organising public and private firework displays. That is the way forward, along with a prohibition on the sale of fireworks. With those measures, we may all enjoy fireworks safely.

The British Retail Consortium will put to the Home Office later today its ideas for a national scheme to allow retailers to identify genuine proof-of-age cards. That may not solve the problem, but it might be a step in the right direction if we cannot achieve a complete prohibition.

I congratulate my hon. Friend the Member for Enfield, North (Joan Ryan) on securing this debate, which is clearly topical. I am delighted to say a few words on the issue, as I know from my postbag that many people have concerns about it, which my hon. Friend and other hon. Members have raised effectively.

The sale of fireworks, although it is important, forms only a part of the overall firework scene. I stress the fact that fireworks are well regulated in many regards in the United Kingdom. The Firework (Safety) Regulations 1997 were made under the Consumer Protection Act 1987 and played a significant role in reducing the number of firework injuries treated in accident and emergency departments around the firework season of 5 November. Through regulations, we have restricted the general retail of certain types of potentially dangerous fireworks to those who are qualified professionals. We have the regulatory powers to deal with the antisocial practice of letting off fireworks in the street, and other such practices—but that is a question not only of regulation but of enforcement.

Millions of fireworks are sold and millions used safely each year in people's back gardens, providing a popular form of family entertainment. Many others enjoy public displays, and I hope that people will continue to enjoy fireworks in such ways. The vast majority of accidents involving fireworks are caused by misuse—partly by people not following the fireworks code and partly by the action of irresponsible individuals and hooligans. My hon. Friend referred to the British Retail Consortium's possible proof-of-age cards. The statistics show that a large number of those injured are quite young and many are under the legal age for being able to acquire fireworks.

My hon. Friend made several important points about the sale of fireworks through retail outlets. Under the 1997 regulations and the other legislation that impinges on the retailing of fireworks, all fireworks have to comply with British standard 7114, which governs their construction, labelling, testing and so on. Any products on sale that do not comply with that standard can be removed by trading standards officers. No fireworks may be sold to anyone under 18 years of age. That rule is also enforced by the trading standards department. Those who break the rules are subject to prosecution. We must examine how effectively that enforcement is being carried out and in what ways people aged under 18 are acquiring fireworks, as many are.

The legislation that controls the storage of fireworks is the responsibility of the Health and Safety Executive, but the Act requires shops that keep fireworks to be registered with the local authority, thereby informing it of the premises where fireworks are kept and enabling them to undertake inspections to ensure compliance with the law. Considerable effort has been made under the present regulations to protect consumers from unsafe products and to ensure that the storage and handling of potentially dangerous products is controlled.

My hon. Friend asked about the period during which fireworks are available for sale. I know from my postbag that many people are worried that they are becoming more prevalent throughout the year as consumers choose to celebrate occasions such as parties, weddings and 4 July with fireworks. The Government recognise that. Our regulation-making powers allow us to deal with the intrinsic safety of goods under the Consumer Protection Act 1987, including fireworks, but do not enable the regulation of periods when they can be sold or let off. Wider powers to allow for that could be made available only through further legislation. A voluntary code of practice works for a three-week period around 5 November and for a similar period around the new year. That is beneficial in that it contains the period during which many retailers—especially those on the high street such as local newsagents and post offices—sell fireworks. The voluntary agreement is not perfect, but it has generally worked well. Those in the industry and in trading standards have been reinforcing the agreement during this fireworks season by sending out reminders and circulars about retailer's responsibilities.

Several hon. Members have urged that we should not allow the retail sale of fireworks to the public. Every year my Department receives a number of requests for a total ban on fireworks for private use. I do not believe that that is the way forward. Millions of people still enjoy fireworks. In 1996, the Department reviewed and considered a total ban. There were several reasons for rejecting it, including the fear that it would lead to the development of an illegal market for fireworks and to more illegal imports, which would involve quality control problems. Nevertheless, the Government were prompt in trying to restrict the type and sale of fireworks through the 1997 regulations, which prohibit the sale to the public of dangerous fireworks such as bangers, mini rockets, those of erratic flight and some of the larger and more powerful fireworks, and bans all category 4 and some category 3 fireworks.

My hon. Friend discussed injuries, which we all take very seriously, and the thrust of the effectiveness of this year's campaign in getting the messages out. I recognise that she would like more to be done overall, but messages about firework safety are being sent out. Over the years, the number of people requiring treatment in hospital casualty departments has been cut by about a third from 1,530 in 1995 to 972 in 2000. We hope that that trend will continue. My hon. Friend quoted some figures that showed a rise between 1997–98 and 1999. We suspect that that was due to the millennium period, which caused more fireworks to be used.

Statistics show reductions in certain categories of injury. Gains are being achieved because of steps that we have taken that have played a valuable role in keeping the number of accidents down. The annual firework statistics enable us to design the focus for the following year's campaign. This year, we have targeted people under 16 years old because they were particularly subject to injury during the 2000 firework period.

On the letting off of fireworks in the street, which we have all experienced, points have been raised about controls. To put it simply, it is illegal to let off a firework in the street: it is an offence under section 80 of the Explosives Act 1875. The police enforce that section and anyone found guilty is liable for a fine of up to £5,000. I recognise that enforcement is tricky, but legislation deals with the issue effectively.

Legislation also deals with distress to any domestic or captive animal, under the Protection of Animals Act 1911. Prosecution can be undertaken by the police or by trading standards authorities, and in some cases the Royal Society for the Prevention of Cruelty to Animals can instigate prosecution. Again, the fine is £5000, up to six months' imprisonment or both. There is a legal underpinning for effective action where such problems arise and, on noise nuisance, we encourage all those who use fireworks to consider neighbours and inform them—particularly old people—of what is planned.

We recognise the concerns raised by my hon. Friend, other hon. Members and the public, but we have introduced a comprehensive package of legislation in the UK to cover the supply of safe fireworks. The effective enforcement of various regulations is crucial. It must not be an idle threat. Prosecutions must take place and I am sure that that will happen more often in future. I appreciate that resources are extremely pressed in some areas, but the police and local authorities will follow up complaints about the sale or misuse of fireworks.

I assure my hon. Friend that her arguments and those of other hon. Members have been well made in this worthwhile debate. I have listened carefully to what they have said about arising difficulties. We will continue to keep firework safety and usage under review, particularly in light of this year's experience.

I am grateful for the opportunity to hold an Adjournment debate on the future of Kent and Canterbury hospital and on wider acute services in east Kent. I welcome the Minister to her place.

Immediately after the 1997 election, the East Kent health authority brought forward plans to run down Kent and Canterbury hospital so that it would become a nurse-led minor injuries unit, supplemented by a few beds for slow-stream recovery geriatric wards. EKHA, as the authority is normally abbreviated, argued that there was insufficient critical mass for doctor training on the three major sites in its area. It had submitted similar plans under the previous Conservative Government, with children's services as the first area to be considered. The plans were firmly rejected by the then Secretary of State, who insisted that critical mass training requirements for doctors should be met in a different way by a new concept of rotating training across all three sites.

In 1998, after a long and gruelling consultation process, the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), ruled on a compromise. It was unsatisfactory, because the most accessible accident and emergency unit in east Kent was lost. Canterbury is the hub of the bus and rail systems of east Kent where 37 per cent. of the population live in villages. To give one small example, the last regular bus service from Whitstable, a town in my constituency, to Margate is about to cease.

The compromise at least guaranteed the future of East Kent's joint cancer centre at the Kent and Canterbury hospital and of a limited cardiac service there, as well as 230 beds. The then Secretary of State wrote to me in December 1998 and September 1999. He asked EKHA to guarantee that on-site consultant anaesthetic, surgical and medical cover would be provided at the Kent and Canterbury hospital during the day, with full on-call cover out of hours, and that consultant medical cover would include cover for the coronary care unit. He announced expenditure of millions of pounds on a new linear accelerator to replace an old one at the cancer centre. That facility is now being installed at the Kent and Canterbury hospital and is a major part of the joint cancer centre shared with Maidstone hospital. That joint centre obtained the country's first cancer charter mark in 1998.

EKHA has continued to argue that, to meet requirements for critical mass, it needs to reconfigure services in Kent. The requirements for reconfiguration were denied in writing from the very beginning by the secretary of the Royal College of Physicians. None the less, the only available route, then and now, has been a private finance initiative programme. That would mean that our local health service would have to bear a heavy and perpetual financial penalty. Due to the sheer scale of the costs involved in the reorganisation, that must affect its ability to deliver capacity. Therefore EKHA logically recognised that a lower bed and nursing capacity would have to be accepted to achieve the reconfiguration of which it dreamed. Since then, for a number of reasons, the position has changed radically and it has become obvious, even to the health authority, that east Kent is suffering from a severe shortage of capacity.

Our local hospitals gained two stars out of three in the recent awards, and I congratulate the hard-working and over-worked clinical and nursing staff who helped to achieve that. None the less, as my postbag continually testifies, waiting times are getting worse despite changes made in the method of recording.

We have just come through summer, which is traditionally less busy than winter, but combined queues in the three accident and emergency units have sometimes totalled as many as 100 people. Behind the appalling statistics are the individual people waiting on trolleys, inevitably, without proper supervision. I could refer to several horrifying individual cases, but time allows me to mention only two.

Earlier this year, Mrs. Connie Jones, a woman of 97, waited two whole nights in casualty before she could be admitted to a proper ward. Much more recently, we had another terrible case. A Whitstable man, Ray Gilson, aged 81, was left in the accident and emergency department while he underwent tests for swelling and pain in his legs. He spent three whole days in the accident and emergency unit, being wheeled backwards and forwards between tests. He was refused a bath, presumably because no one was available to supervise him. His family had to come in and change his pyjamas when they became stained. Sadly, it became clear that he was in the last stages of terminal cancer, but the indignity of his last few days on this earth was so desperate that the family of that seafood shop owner from Whitstable—a much respected figure—scraped together the money to get him out of the Kent and Canterbury and into the private Chaucer hospital where he was able to spend his last few days with some dignity in a proper bed in a proper ward.

Although EKHA, and now the hospital trust, continue to talk the obsessive language of reconfiguration, half the consultants—81 in total—from across the three East Kent acute sites have attended a meeting. They passed a unanimous motion saying that shortage of capacity now threatened clinical standards. Even more amazingly, junior doctors—they have their whole careers ahead of them, so one would not expect them to go public—have almost all signed a letter saying the same thing. In doing so, they have put their careers on the line. In both cases, the concern relates to the shortage of capacity; they were not a call for a reconfiguration.

EKHA's response has been a new public consultation document, suggesting five options. Time precludes me from evaluating each singly, so I will just say that they range from option one, keeping the status quo—which EKHA effectively rubbished in its initial announcement—through to the Secretary of State's plan, which is now called option two. Option five, at the other extreme, is a reversion to the original 1997 plans to close the whole hospital apart from a nurse-led minor injuries unit, out-patient services and a few recuperation beds.

The halfway house on which the previous Secretary of State decided would have been very expensive, costing more than £100 million even by EKHA's estimates—and it seriously underestimated the cost of its last big private finance initiative. One can only imagine the colossal cost of the reorganisation proposed under option five. Yet that appears to be EKHA's favoured choice. It would mean not only the loss of the accident and emergency unit, which proved so vital during the flooding when roads in both directions were blocked, but the loss of the beds and the coronary unit promised us by the Secretary of State. Perhaps most seriously, it would result in abandoning the necessary support for the cancer centre. Some cancer services would, of course, be able to continue, but services for the most dangerous cancers—those requiring more complex chemotherapy and radiotherapy—would be lost to East Kent completely if option five went through.

I believe that all east Kent MPs strongly oppose that option. The hon. Member for South Thanet (Dr. Ladyman) has suggested that the loss of those services from east Kent would be unacceptable to him and I know that my hon. Friend the Member for Faversham and Mid-Kent (Hugh Robertson) will say something on the subject in a moment. Yet, incredibly, although at least one of the proposed options involves abandoning those services and would result in our walking away from the new linear accelerator that is just being completed, the options have been framed without any mention of cancer at all. Apparently, that is to be dealt with in a separate plan.

I want to give the Minister plenty of time to respond, so I will end by asking three simple questions. First, were the former Secretary of State's pledges to the people of east Kent worth anything to my constituents? Secondly, does the Minister accept that, even if substantial extra sums were made available, the addition of a gigantic financial burden to our current health budget—a PFI on such a scale must result in that—will lead to a lower capacity than could otherwise be afforded? Thirdly, does she accept that any move away from the status quo must mean a loss of access for people in Canterbury, Whitstable and Faversham and for those in villages who make up more than a third of the population of east Kent?

I urge the Minister to tell EKHA that it should reconsider it proposals. It should examine how it can increase the capacity of our already overstretched system, and not get involved in empire building through expensive reconfigurations.

I should like to add some brief comments to the excellent speech made by my hon. Friend the Member for Canterbury (Mr. Brazier).

My concern about the Kent and Canterbury hospital stems from three factors: I was born there; my parents, now retired, live in Canterbury; and the hospital has been the dominant issue in my postbag in the four months since my election. The matter affects approximately 20,000 of my constituents, so the extent of local anger should not be underestimated. There is anger that the hospital is being downgraded at a time when the public perceive that more money is going into the national health service. There is also massive local anger about the decision to row back from the commitments given by a previous Secretary of State. My hon. Friend has also alluded to the capacity concerns that many of us share.

Canterbury is a cathedral city. It has a large and growing student population and it is also an extremely popular retirement venue. In anybody's figures, the population in Canterbury and its surrounding areas can only rise over the next 10 to 15 years. In short, it is the dominant population centre in east Kent, and it needs its own hospital in the current configuration. I therefore support totally my hon. Friend's efforts.

I congratulate the hon. Member for Canterbury (Mr. Brazier) on securing a debate on a matter of great concern to him, to other Members of Parliament and, crucially, to his constituents. For many years, the hon. Gentleman has been a fervent supporter of his local hospitals. He, like the people of Canterbury, is eager to secure the best quality health services that any community expects. At the outset, I assure him that the Government share common ground with him. We are committed to providing a high-quality NHS for everyone, wherever they may live.

As the hon. Gentleman said, the provision of hospital services in east Kent has been the subject of much debate in the House and the local community. I am pleased that this debate gives me an opportunity to outline some of the changes that have taken place since the issue was last debated. I shall also try to outline some future plans for the development of services both specifically at the Kent and Canterbury hospital and generally in east Kent.

As the hon. Gentleman said, the former Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), originally made the decision on changes to the area's hospital services in December 1998. He also set out the conditions on which the changes should be based. The reasons why he made that decision have previously been debated by the hon. Gentleman, and I do not propose to go into them now. The chosen option for reconfiguring acute services, which was endorsed by my right hon. Friend, was right at the time that it was taken. However, we are three years on and we have seen the introduction of a whole agenda for clinical governance. We must therefore reconsider whether that configuration would still be able to meet present-day needs. I shall speak about the detailed options later.

As well as the need to meet the clinical governance agenda, I am well aware that the hon. Gentleman and other hon. Members have raised concerns about the increasing pressure placed on the capacity of the local health economy as the demands for hospital services grow in that area. I should like to outline the progress that has been made since the original decision was taken. There has been significant extra investment at the Kent and Canterbury hospital. We have expanded renal inpatient beds at the hospital and the surgical ward block, and we have refurbished a day-surgery area. A purpose-built unit for the health care of older people has also been completed. It includes two rehabilitation wards, a stroke unit, a therapy centre and a day hospital. Elderly care services have been transferred from Nunnery Field hospital to a new elderly care facility, and a new daycare recovery unit has been opened. There also plans to open a new cataract centre at Canterbury in the next few months. Despite all that investment, I acknowledge that the local health economy is still under pressure and that local people are concerned about the future of their hospital.

A key plank in the development of services is the major capital investment—the hon. Gentleman referred to this—in the Queen Elizabeth Queen Mother hospital, the William Harvey hospital and the Kent and Canterbury hospital. To achieve that aim, the East Kent Hospitals NHS trust submitted a strategic outline case for investment, which was approved in February. However, in the next stage of developing that business case, it became clear that were other ways in which to try to achieve the overall objective of providing first-class health services for the people of Kent and that those options should be reassessed. A rigorous reappraisal of the original endorsed option has taken into account the standards for current clinical work and the requirements for developing new hospital facilities.

However, I should like to take this opportunity to tell local people that there is no question mark over the future of Kent and Canterbury hospital. There are no proposals to abolish it or to prevent it from functioning; instead, we are reappraising the balance and mix of services that ought to be provided throughout the health community in trying to ensure that people have access to high-quality care. None the less, I acknowledge that physical and geographical access is an issue. It is always very difficult to decide on such matters, and to balance local people's need for access with the need for quality, accreditation and sufficient throughput of work to maintain clinical standards.

In reappraising the options, we have tried to ensure the involvement of front-line staff. Indeed, clinicians' support for some of the options has been an issue for many years. As the hon. Gentleman said, there are four options, all of which are based on the principle that there will be two main centres at Margate and Ashford, but a mix of services at Canterbury. Option one is the former Secretary of State's endorsed option; option two is to have an elective service at Canterbury; option three is to develop Canterbury as a community hospital; option four—perhaps the most substantial of those currently proposed—is for Canterbury to have an acute medical unit, a critical care unit, elective orthopaedics and a day surgery.

Have the Government and the East Kent health authority abandoned the status quo—which was option one—in the past few days? As I understand it, such an option is a legal requirement in any private finance initiative submission.

As far as I am aware, the options that are being developed are those that I have outlined. Of course, we have yet to begin a formal consultation process. If a further option emerges, I shall inform the hon. Gentleman. However, according to my information, the four options to which I referred are being developed.

I want to make it clear that none of the proposed options means that the Kent and Canterbury hospital will lose its ability to deal with emergency cases—an issue that I know has been of great local concern. There will be a full accident and emergency service on the Kent and Canterbury site until the William Harvey hospital and the Queen Elizabeth Queen Mother hospital are able fully to accommodate patients from Canterbury. Under each of the four options that I outlined, a unit would remain on the Kent and Canterbury site. I understand that it will continue to treat between 70 and 80 per cent. of the patients that it sees. The impression has been given that a minor injuries unit will see only a minority of the cases that must currently be dealt with, but the reverse is true: it will deal with the majority of such cases.

As I understand it, there will be a three-month period of public consultation, so I cannot comment further on any of the options. However, I am sure that they will be the subject of intense debate in the local community.

The hon. Gentleman raised the issue of how the proposals will interact with cancer services. That is an extremely important point, and I can reassure him that proposals for public consultation on the options for the future of services in Canterbury will not be published until it is clear how they will relate to cancer services. I agree with him that we do not want consultation on one set of services to proceed in isolation. In developing services, we must fully take into account their clinical implications for the cancer services that are available at the Kent and Canterbury hospital. We have responsibilities in accordance with the national cancer plan to ensure that people in Canterbury have access to good, high-quality cancer services, but we must ensure that the proposals are not seen in isolation, and do not have a detrimental effect on developing cancer services for local people.

That does not quite answer my question. Will there be consultation on the implications for cancer services, or will they simply be listed? At least one of the options, certainly the minimum option, means losing the cancer centre in Canterbury and probably in east Kent. It would be extraordinary if the Government consulted on that issue at the same time as the rest of the package.

The proposals for the consultation will not be published until it is clear how they relate to cancer services. I cannot confirm that there will be a joint consultation on the services, but I take the hon. Gentleman's point about the minimum option. I make it clear to people in east Kent that I will urge the health authority to ensure that, if the proposals have implications for cancer services, it will not simply be a matter of including them and ticking a box. No decisions will be taken that could have a knock-on effect on cancer services from which it would be impossible to recover. We need to get the balance right.

The hon. Gentleman mentioned capacity, which is an underlying issue in the area. In April 1999, there were 1,627 acute beds in east Kent, and the number has increased slightly to 1,633 in 2000 and to 1,642 at present. I accept that the increase in the number of acute beds is slow, but it is going up. I acknowledge that services are under pressure, so it is crucial that the beds inquiry continues to monitor the number of beds available in the east Kent area. I am pleased that a new service, the east Kent bed bureau, is monitoring bed occupancy in the area, and that will result in a more efficient and effective use of the existing capacity. I do not say that it is an entire solution but, in many cases, bed usage is not maximised because people do not have up-to-date, online information on the beds that are available in each hospital at a particular time. We are gradually developing more sophisticated systems to monitor bed occupancy in the NHS to ensure that the maximum use is made of the beds in the system.

Every hospital now has a medical acute assessment unit, and community assessment and rehabilitation teams, day hospitals and crisis outreach teams help to reduce the pressure on accident and emergency departments by supporting people, especially elderly people, in their own homes, thus avoiding emergency admissions when possible. A key plank of our strategy for hospitals is to support people at home and another is to tackle the important matter of delayed discharges, which is essential if we are to maximise hospitals' capacity.

I am pleased that the announcement of extra money to deal with delayed discharges will affect capacity in east Kent, not just this winter and for the next 12 months but for the next few years. We will put in £100 million this year and £200 million in the following two years and that money will have a real impact. Kent county council has been allocated an extra £2.1 million from the extra funds to try to ensure that people do not linger in hospital when they no longer need to be there. If people stay in hospital when they do not need to, other people cannot be treated, and it is bad for their health. Once people no longer need acute medical care, they should be either in intermediate care or supported by domiciliary care packages in their own homes so that they can maintain their independence. Putting all the measures in place will be essential in ensuring, as far as possible, that we relieve the pressure on the health economy in east Kent.

I acknowledge that staff in all the area's hospitals work incredibly hard and do their best to ensure that patients get the highest quality care and that we do not see repeats of the terrible incidents of the past. I am pleased to say that the trust has not reported any cancelled urgent operations in the past three months, and that is a tribute to its management and working systems. As the hon. Member for Canterbury said, the trust was awarded two stars, and it is delivering on its targets on many of the indicators that we monitor. It is important to say that, because I do not want to create the impression that there is an on-going crisis in the hospitals. They are doing a fine job in providing a high standard of care to local people.

I am concerned about the length of time that it has taken to reach a resolution on many issues in east Kent. Uncertainty for staff and the public can affect morale and recruitment, and does not ensure that people perceive their health services to be prospering and growing in the local community. Whichever option is decided on after consultation, the overriding concern must be that patients are treated in a safe environment and in facilities that are fit for the 21st century.

Given that the decision may mean the abandonment of the former Secretary of State's pledges, is the Minister willing to commit the Government, rather than EKHA, to making it? Will she assure me that, if EKHA were to choose an option that involved abandoning even the minimal pledges made by the then Secretary of State three years ago, EKHA alone would not be allowed to make the decision and that it would require the new Secretary of State's approval?

As I have said to the hon. Gentleman, the decision made then was the right one at the right time for the circumstances. Time has moved on and we have a new clinical Government agenda. It is right that further options are considered. He will know that there is a process through which every option must go, and that involves it being drawn up, public consultation involving the whole of the local community and, if there is not agreement, submission to Ministers for consideration. That is why it would be inappropriate for me to comment further on those options. If there is no local resolution, a central decision will be taken.

The modernisation of services in the area will go ahead. I acknowledge that there have been some problems and that they are a sign of the need to invest in new, modernised services for local people. That is exactly what we intend to do. I accept that there have been problems in the transition, but we have not simply stood still and not made progress. I have set out today the investments that have been made in Kent and Canterbury hospital for new surgery units and rehabilitation facilities. People in Canterbury and all east Kent have a right to expect to be able to rely on the best national health service facilities for themselves and their community. Consultation on the options will undoubtedly take place in the next few months, and hon. Members will have the opportunity to make further representations. I know that they will do their utmost to represent the views of local people and to ensure that we are thoroughly informed when we come to deciding on the crucial issue of the future of health care in the area.

I am delighted to have the opportunity to debate transport to school.

The debate about home-to-school transport has been controversial, and many issues have been considered: the age and condition of contract buses, the provision of seat belts, the qualifications and competence of drivers, as well as three-for-two seating arrangements. During my time as the Member of Parliament for Monmouth, I have made representations to Ministers about school transport. One of my former constituents, Mrs. Pat Harris, formed the organisation "Belt Up School Kids"—BUSK—which has campaigned vigorously and with much success for the compulsory use of seat belts on contract buses and those used on school visits.

The safety of pupils on scheduled bus services and the problem of overcrowding in particular have caused me to request this debate on the transportation of pupils to Monmouthshire comprehensive school from the village of Llandogo in the Wye valley, the beautiful area of outstanding natural beauty in my constituency. People believe that it must be one of the most beautiful and tranquil routes to school that pupils could have. It is a journey of about six miles and meanders along the valley against a backdrop of fields and forests. The bus passes under a beautiful canopy of trees and crosses from the Welsh side of the Wye into the English side and back into Wales over the historic Wye bridge in Monmouth.

However, the 69 route from Llandogo to Monmouth on weekday mornings in term time has been described as "the nightmare journey". It has caused considerable anxiety to pupils and parents alike. In recent years, the village of Llandogo has grown and, on average, 60 to 70 pupils aged from 11 to 18 attend Monmouth comprehensive school. In rural areas, most pupils living in excess of three miles from Monmouth comprehensive school and other comprehensive schools are transported to school in designated school transport buses. In Monmouthshire, there is an extensive network of coaches, contracted to take pupils to school from communities where public transport is limited or non-existent. They are run generally by private, local bus operators.

In recent years, the regulations affecting the buses have changed to require them to have seats that are fitted with seat belts. Only one pupil is permitted to occupy a seat and no pupils are allowed to stand. Hence, no bus that is contracted for conveying pupils from home to school can legally accommodate more passengers than the number of seats on the vehicle. Llandogo lies on the scheduled bus route from Chepstow to Monmouth, which is operated by Stagecoach plc. Pupils are therefore expected to catch the scheduled service, and the costs are covered by the county council, which negotiates season tickets with Stagecoach. That arrangement makes sense in most cases, except for Llandogo. It avoids unnecessary bus journeys, it is good for the environment, it avoids a duplication of services and it keeps costs down.

The situation is different in Llandogo. The arrangement has caused parents and pupils several worries, which were aired at a public meeting in the spring convened by local parents, Avril Seabury and Gail Reynolds. The main concern was overcrowding. The morning and evening buses are full to capacity, with some children sitting three to a double seat. Several pupils are required to stand for the entire half-hour journey, which has resulted in injury when they have been thrown around. Buses are often late arriving at Llandogo and, generally, pupils have been late for school. Recently, the bus was an hour late. As for reliability, the buses have broken down occasionally, a problem that has caused parents concern when it has happened in fairly remote country areas between Llandogo and Monmouth.

A few weeks ago I decided to experience the situation myself. I travelled on the bus with the pupils from Llandogo. It was a wet Wednesday morning. The No. 69 arrived about 10 minutes late. It was a 53-seater bus and, by the time it left the village, it was overcrowded with pupils. Some were sitting three to a seat. About 10 pupils were standing with me. Other passengers on the route boarded the bus although it was clearly overcrowded. Throughout the journey, the bus was carrying between 60 and 65 passengers. The bus was driven competently and within the speed limit, although some of the standing passengers lost, their balance on several occasions as the bus drove through the Wye valley or stopped in traffic in Monmouth. When we arrived at Monmouth comprehensive school, the pupils said, "This is a good day. We're only five minutes late."

I wrote to Stagecoach and Monmouthshire county council about the problem, and suggested that the pupils from Llandogo should have the use of a designated school transport bus. That seems an obvious solution. It would get the pupils to school on time in more comfort and safety, and in a mode that is similar to that used by most pupils who travel to school from the villages of Monmouthshire. It would also ensure that other passengers were not faced with a service that is overwhelmed by school pupils. The pupils of Llandogo are an exceptional case and should be provided with a designated contract bus as part of the school transport network.

A second solution to the problem is for Stagecoach to provide a duplicate bus to deal with excess passengers. Surely it feels a duty to provide an adequate service for not only the pupils, but other fare-paying passengers? Stagecoach has apparently refused to do that unless Monmouthshire county council funds it.

Both solutions have been resisted. At a recent meeting, which I requested, Stagecoach, the Gwent passenger transport unit and Monmouthshire county council decided that both of the solutions are unacceptable because they are too expensive and require breaching, or re-tendering, of the existing contracts.

The season ticket contract between Stagecoach and Monmouthshire county council for the Llandogo pupils is worth £22,000 per annum. If Stagecoach loses that revenue, the company cannot give assurances that the No. 69 service will be viable and it may be withdrawn. The contract for the No. 69 route also covers a further nine routes in Monmouthshire and applies for a further three to four years. Therefore, all of those routes may be in jeopardy. The pupils of Llandogo hold the key to the entire bus network in Monmouthshire. Stagecoach has driven a hard bargain and is abusing its monopoly. Not for the first time, it is holding the county council to ransom.

The proposed solution is to provide a larger bus—a double decker. However, double-decker buses cannot run in the Wye valley because of the overhanging trees, which are one of the route's attractive features. The quest is now on to cut the overhanging trees and to solve the problem of the overcrowded bus. Monmouthshire county council has admitted that the solution sounds complicated, but once it is achieved pruning from time to time would be relatively simple. However, it must cooperate with all the people who own land containing the affected trees and it must liase with Gloucestershire county council, which is the authority that controls the English part of the route.

Parents consider the solution to be laughable. Decisions to run larger buses were previously proposed and were not always adhered to. If the double-decker solution was so good, why was it not introduced before? Parents have little confidence that the use of double-decker buses will be an adequate solution. It appears that the safety of pupils from Llandogo who attend school in Monmouth will be dependent on a gang of tree surgeons—perhaps a company called "The Tree Fellas" could be employed to carry out the task.

Two main issues arise from the Llandogo case. The first is the abuse of Stagecoach's monopoly and the second is the legalised overcrowding of which it, and other scheduled bus service providers, may take advantage. In Monmouthshire, Stagecoach has used its monopoly by giving notice to withdraw virtually its entire bus network to lay claim to the increased public funding for rural bus services, which was introduced by the present Government. In effect, it has held the local authority to ransom. In the case of the No. 69 route between Chepstow and Monmouth, Stagecoach receives a public subsidy between £10,000 and £20,000 under the local transport services grant, which is given by the National Assembly for Wales and ring-fenced for procuring and enhancing existing services. Stagecoach also receives a guaranteed income of £22,000 from season ticket sales on the No. 69 route. In effect, it receives a double subsidy. However, it is not prepared to provide an additional bus to resolve overcrowding unless the county council funds it. To concede would mean that Stagecoach would receive a triple subsidy on the route. Surely that cannot be in the public interest or in accordance with best value practice.

Private bus operators on scheduled services can take advantage of legalised overcrowding. The issue raises serious public safety questions. Under the Education Act 1944, it is permissible for three pupils under the age of 14 to occupy two seats. However, new seat belt regulations have altered that ruling for contract buses such that if a safety belt is fitted there may be only one pupil per seat. However, that rule does not apply to scheduled bus services, which are exempt from the regulations governing the fitting of safety belts. Hence, bus operators can take advantage of that rule, which relates to legislation passed 65 years ago. Provided that the passengers are under 14, it is possible to seat 50 per cent. more passengers than the number of seats on the vehicle. What may have been acceptable in 1944 is clearly not acceptable in the 21st century, as the size of children has increased and other school pupils are likely to be carrying bags and other items for school, including musical instruments.

A further worry is the permitted number of standing passengers. On the 53-seater bus on the No. 69 route—Chepstow to Monmouth—it is permissible to have 12 passengers standing. Theoretically, if every passenger were under the age of 14 and sitting three to a seat, it would be possible for such a bus to carry 90 passengers. On a 48-seater bus, it is possible and permissible to have 20 passengers standing. Therefore, again, if all the pupils were under 14, there could be 72 pupils in seats and 20 standing, and it would be within the law to carry 92 passengers.

Concern would be widespread if it were generally known that in 2001 it is possible under the law for a 48-seater bus to carry 92 children and young people, none of whom is required to wear seat belts on journeys to and from school. That reminds me of the case involving a school in the constituency of my hon. Friend the Member for Vale of Clwyd (Chris Ruane), in which a contract double-decker bus was involved in an accident in which several children were injured. If there is another serious incident, will parents not ask why such overcrowding is lawful?

Why has the law relating to transport on school buses and scheduled bus services not been amended in 65 years? What assessment has the Health and Safety Executive made of the issue? I understand that the Northern Ireland Assembly is considering abolishing the three-for-two rule. If that can be done in Northern Ireland without primary legislation, why can it not be done in Wales? The law needs to be reviewed and amended. I propose that my hon. Friend the Minister should examine the matter with colleagues in the Departments for Transport, Local Government and the Regions, and for Education and Skills, and the National Assembly for Wales.

In recent years, the Government have introduced and supported some welcome initiatives on home-to-school safety. The safe to school initiative is welcome, although I understand that it is confined to walking and cycling and does not apply to school transport routes. The piloting in this country of American-style yellow buses is also welcome. Such buses are used only for the provision of school transport, and important safety regulations apply to such buses that do not generally apply in this country. The RAC should be commended for its work with local authorities and other agencies to improve home-to-school transport.

The pupils of Monmouth comprehensive who live in the village of Llandogo will this morning have travelled on the overcrowded No. 69 bus and will face similar overcrowding on their return home this afternoon. Their experience raises serious questions about the operation of the law in respect of bus safety and the monopoly position of private bus operators such as Stagecoach.

I ask my hon. Friend to liaise with the National Assembly for Wales and the Department for Transport, Local Government and the Regions to examine the impact of the monopoly position of private operators and to consider both the recommendations of the Select Committee on the Environment, Transport and Regional Affairs, which examined the tendering of bus services in 1999, and the law relating to the Transport Act 1985 which was chiefly responsible for the deregulation of the bus network.

I also propose that the Government use the forthcoming education Bill to amend the Education Act 1944 in relation to overcrowding and to abolish the three-for-two rule that applies to children and young people on scheduled bus services. Such a change would be inexpensive, achieve greater parity with the situation for contract buses and make a significant contribution to public safety.

I hope that the experience and discomfort of the pupils of Llandogo will lead to improvements in transport to school and will benefit all pupils.

I congratulate my hon. Friend the Member for Monmouth (Mr. Edwards) on securing the debate. I have seen the news coverage of his campaign for many months and I commend him for his efforts on behalf of his constituents who, he feels, are at risk, given the way in which the service operates. As a Member of Parliament, I am acutely aware of the problems of home-to-school transport, and there are also difficulties in my borough and constituency.

Monmouthshire county council serves my hon. Friend's constituency. It is the local education authority and has a statutory duty to decide how best to meet its obligations in the matter of home-to-school transport. LEAs are obliged to provide free transport to the nearest school for pupils under eight years old who live more than two miles from the school, and for pupils above the age of eight who live more than three miles from the school.

As I learned during my time as a county councillor, LEAs can be more generous with that provision, and Monmouthshire county council already operates a 'more generous home-to-school transport policy. The relevant distances in Monmouthshire are one and a half miles for pupils under eight years of age and two miles for pupils aged eight years and over.

The LEA also operates a concessionary seat scheme under which pupils who would not normally qualify for free school transport may be allowed, for a charge, to occupy spare seats on buses. Obviously, that does not apply in the case of the bus that comes from Llandogo. The LEA also provides free school transport for pupils aged 16 to 19, whereas LEAs are statutorily obliged to provide free school transport only for children of compulsory school age up to the age of 16.

It is therefore reasonable for us to expect the LEA to ensure that pupils travel to and from school in safety and in reasonable comfort. The courts have stated that LEAs are obliged to provide non-stressful transport so that a child can travel to and from school without undue stress, strain or difficulty that would prevent him or her from benefiting from the education that the school has to offer. The transport provided should be appropriate to ensure that pupils travel in safety and comfort. It is therefore reasonable to expect LEAs, in their contracts with bus drivers, to ensure that transport that is provided for children is of a standard that would encourage them to use it and to use it safely.

Of course, the bus service to which my hon. Friend referred is not a dedicated bus service but a scheduled bus service. As the LEA is using that scheduled service as the provider of school transport for children from Llandogo to Monmouth comprehensive school, the same requirements apply.

I thank my hon. Friend for clarifying the legal position. Does he agree that everyone who is making decisions in that matter—at Stagecoach and at Monmouthshire county council—should experience what I have experienced? They should go on that bus and assess whether it is stressful and causes the pupils strain or difficulty.

I take my hon. Friend's point. He might care to invite the chair of education in Monmouthshire to travel on the bus with him and to see what he thinks of the difficulties of coming from Llandogo to Monmouth. On public service vehicles such as the one used on that route, the Public Service Vehicle (Carrying Capacity) (Amendment) Regulations 1994 permit three seated children under the age of 14 to count as two passengers. My hon. Friend made that point powerfully. That is a concession, and if bus operators such as Stagecoach wish to take advantage of it, they must ensure that it is possible to seat children in the manner prescribed by the regulations.

The concession applies only to children under 14, but my hon. Friend says that pupils attending Monmouth comprehensive school are aged between 11 and 18 years. I cannot see how the county council and the bus operator can ensure that the concession is not abused. To comply, they would need to check the age of every child and ensure that, where three pupils occupy two seats, they are under the age of 14. My hon. Friend may like to take the issue up with the county council and the bus operator, Stagecoach.

From 1 October, schools may be offered rear-facing seats with seat belts in new minibuses and coaches that comply with the European directive, but children must continue to be provided with forward-facing seats with seat belts in older vehicles that are used exclusively to provide home-to-school transport. Until recently, legislation required that seatbelts be fitted only in coaches and minibuses that carry children to and from school and on organised trips.

The regulations signal the beginning of the end of the concession that allows three children under the age of 14 to travel in two seats. My hon. Friend has painted a serious picture of what could happen if a bus of the capacity that he mentions has an accident. The county council and the bus operator must take account of that possibility. From what I have heard today, it seems that the arrangements for transporting pupils from Llandogo to Monmouth comprehensive school may be unsatisfactory. The county council and the bus operator may be failing in their responsibilities.

I cannot tell my hon. Friend that the Government will provide measures in the forthcoming education Bill that would answer his queries on the Education Act 1944, but we have made secondary legislation to implement new safety standards for seat belts. Additionally, Sue Essex, the Welsh Minister for the Environment, who has responsibility for transport, issued a consultation paper in September called "Safe Roads, Safe Communities." She would welcome suggestions on road safety, including any that my hon. Friend or his constituents might make on school transport. The consultation period ends on 30 November, so there is ample time to make a contribution.

I am so concerned about what I have read in the newspapers, and more so by what my hon. Friend has said on the subject of the bus route, that I intend to ask the Welsh Minister for Education and Lifelong Learning, Jane Davidson, to contact Monmouthshire county council as soon as possible, to see how the problem can be overcome. It is unsatisfactory for the situation to continue as my hon. Friend describes it and I will do all that I can to assist him and my colleague the Welsh Minister to bring that to a satisfactory conclusion.